Front Matter

Chapter 6 Manual Therapy 133

precursor to joint mobilization. Exercise is the
most effective means of warming the tissues;
however, modalities may be used if the patient
cannot tolerate exercise. Once joint mobiliza­
tion is performed and improved PROM is
noted, it is important that the patient actively

uses the newly achieved ROM when possible.

This can be accomplished with an exercise pre­

scription that uses the new ROM. For example,

in the case above where the treatment goal

was to increase stifle flexion, the patient may

perform sit‐to‐stand exercises or walk over

high cavaletti poles in order to use the newly

acquired ROM.

Figure 6.13 Caudal glide of the proximal humerus with
scapular stabilization at the caudal aspect of the acromion.

Table 6.8 Technique for caudal mobilization of femo-
rotibial joint

Goal To increase stifle flexion, decrease pain

Patient Lateral recumbency; stifle in resting position

Therapist Stabilizing hand: web space at caudal

distal femur

Mobilizing hand: web space on tibial

tuberosity

Figure 6.14 Caudal glide of the tibia with femoral

stabilization.

Case Study 6.2 Manual therapy for postoperative TPLO

Signalment: 4 y.o. F/S Labrador.

Presenting complaint: 8 weeks post‐op R TPLO with

decreased ROM and weakness; radiographs reveal

good bone healing.

Evaluation reveals: Physical exam WNL except:

Function: standing PWB R pelvic limb (approxi-

mately 40%).

Sitting R hip abducted/externally rotated; decreased

stifle and tarsal flexion.

Gait: walk—PWB (approximately 65%) 100% of

time; minimally+ shortened stride length and

stance time.

Palpation: mild swelling at ventromedial and ventro-

lateral stifle joint.

PROM:

Stifle extension L 165 R 150

Stifle flexion L 40 R 50

Tarsal flexion L 40 R 55

Flexibility: moderately tight R hamstrings, iliopsoas,

sartorius.

Joint play: caudal tarsal glide—grade 2 hypomobility.

Atrophy: moderate at R gluteals and quadriceps,

moderate at R hamstrings.

Strength:

● 3‐leg standing test: good (3+/5)

● Diagonal leg standing test: fair (3/5)

(Continued)