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[Purpose] This study evaluated joint mobilization and therapeutic exercise applied to the cervical spine and upper thoracic spine for functional. Purpose: To explore the range of forces used across a sample of MSc physiotherapist students applying a central posterior-to-anterior vertebral mobilisation. Learn more about performing joint mobilizations via the Maitland approach.

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When refering to evidence in academic writing, you should always try to reference the primary original source. That is usually the journal article where the information was first stated. In most cases Physiopedia mobilisatoon are a secondary source and so should not be used as references.

Physiopedia articles are best used to find the original sources of information see the references list at the bottom of the article.

If you believe that this Physiopedia article is the primary source for the information you are refering to, you can use the button below to maitlanr a related citation statement.

Maitland’s Mobilisations – Physiopedia

Original Editors – Scott Buxton. There is a wide range of disciplines which use manual therapeutic methods to treat and manage pathology and dysfunction as a primary treatment method or in conjunction with other treatments. Physiotherapists mpbilisation sometimes considered specialists in manual therapy but other professions such as Osteopaths, Chiropractors and Nurses employ manual therapy in treatment.

Manual therapy works through a multitude of different mechanisms to be effective and understanding the physiological, neurological and psychophysiological mechanisms is critical to utilising manual therapy clinically in a competent and safe manner [1]. From a Physiotherapy perspective manual therapy is an essential and commonly used treatment method for the management of tissue, joint and movement dysfunction.

There are several different main stream approaches to manual therapy; arguably the most common form simplistic form manual therapy used by physiotherapists are mobilisations from the Maitland school of thought [2]. The application of the Maitland concept can be on the peripheral or spinal joints, both require technical explanation and differ in technical terms and effects, however the main theroetical approach is similar to both [4]. The Maitland concept is a fantastic tool for approaching an initial assessment as it can be used to form a logical and deduced hypothesis about the nature of the origins of the movement disorder or pain.

As with any treatment decision a competent and effective assessment is crucial to any patient interaction.

Brief Review of Maitland Joint Mobilization Grades – Physical Therapy – CyberPT

The Subjective Assessment is necessary for determining whether or not mobilisations are suitable for this patient or if they are contraindicated by looking maiitland red flags such as cancer, recent fracture, open wound or active bleeding, infective arthritis, joint fusion and more [6]. The Objective Assessment is an area which the versatile nature of mobilisations becomes clear.


Additionally to being a treatment method they are available to the therapist to assess a patients joints and tissues by analysing their extensibility, pain reproduction, bony blocks or abnormal end feels. To make sure you settle on appropriate mobilisations it is important to get the type of glide, the direction and speed correct. Each joint has a different movement arc in a different directon to other joints and therefore care needs to be taken when choosing which direction to manipulate; this is where the Concave Convex Rule comes into use, but for now consider the number of possible glides a clinician may use:.

Due to anatomical position and other physical limitations not all peripheral or spinal joints can be subjected to all of the types of glide.

Here are examples of mobilisations of joints of the jaitland. Choosing the direction of the mobilisation is integral to ensuring you are having the desired clinical outcome. To improve shoulder flexion you would perform an A-P mobilisation due to the way the convex humerus articulates with the concave glenoid fossa. An easier way to visualise this is to try and show this rule with your hands. Grade Maitlajd — small amplitude movement at the beginning of the available range of movement Grade II — large amplitude movement at within the available range of movement.

Grade III — large amplitude movement that reaches the end range of movement Grade IV — small amplitude movement at the very end range of movement.

The grading scale has been separated into two due to their clinical indications: The rate of mobilisation should be thought of as an oscillation in a rhythmical fashion at [11]: There are a number of complex systems which interact to produce the pain-relieving effects of mobilisations, subsequnelty there is not a single theory into its mechanism.

Therefore this article will outline the basics and evidence for the claims and further links will be added for additional more in-depth information.

The pain gate theory PGT was first proposed in by Melzack and Movilisation [12]and is a commonly used explanation of pain transmission. Thinking of pain theory in this way is very simplified and may not be suitable in some contexts, however when discussing pain with patients this description can be very useful.

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In order to understand the PGTthe sensory nerves need to be explained. At its most simple explanation there are 3 types of sensory nerves involved of transmission of stimuli [13] [14]:. The size of the fibres is an important consideration as the bigger a nerve is the quicker the conduction, additionally conduction speed is also increased by mobioisation presence of a myelin sheath, subsequently large myelinated nerves are very efficient at conduction.


All of these nerves synapse onto projection cells which travel up the spinothalamic tract of the CNS to the brain where they go via the thalamus to the somatosensory cortex, maittland limbic system and other areas [16].

In the spinal cord there are also inhibitory interneurons which act as the ‘ gate keeper’. When there is no sensation from the nerves the inhibitory interneurons stop signals travelling up the spinal cord as there is no important information needing to reach the brain so the gate is ‘ closed’ [12]. When the smaller fibres are stimulated the inhibitory interneurons do not act, so the gate is ‘ open’ and pain is sensed.

For an alternate explanation: The sensation of pain is subject not only to modulation during its ascending transmission from the periphery to the cortex but also to segmental modulation and descending control from higher centres [17].

It needs to be thought of as not just a linear process, instead a complex interaction of a multitude of different biochemical and physical factors which must be thoroughly understood to understand the process and this is why this topic has a page dedicated to it Descending Inhibition.

Hypertension is one of the biggest causes of stoke but also can be used as a warning sign for the risk a patient has of having a stoke.

Therefore it should be used to ensure there is not risk to a patient by performing cervical manual therapy. This is a concern due to the numbers of people suffering from hypertension, obesity and other known risk factors for hypertension and stroke surely it should be important for any patient population. International Maitland teachers Association. Find out more about a Physiopedia membership. The content on or accessible through Physiopedia is for informational purposes only. Physiopedia is not a substitute for professional advice or expert medical services from a qualified healthcare provider.

Toggle navigation p Physiopedia. Contents Editors Categories Share Cite. Failed to load RSS feed from http: There was a problem during the HTTP request: Retrieved from ” https: Would you like to earn certification to prove your knowledge on this topic? All you need to do is pass the quiz relating to this page in the Physiopedia member area. Maitland’s Mobilizations Quiz Find out more about a Physiopedia membership.