Maitland's Peripheral Manipulation

Front cover
Half title page
Dedication
Maitland's Peripheral Manipulation
Copyright page
Table of Contents
Contributors
Biography
	Geoffrey Douglas Maitland MBE AUA FCSP FACP (Monograph), FACP (Specialist Manipulative Physiotherapist) MAppSc (Physiotherapy)
Preface
Acknowledgements
In Memoriam: Kevin Banks (1959–2012)
Glossary
	Chapter 1 The Maitland Concept as a clinical practice framework for neuromusculoskeletal disorders
	Chapter 2 The Maitland Concept: evidence-based practice and the movement sciences
	Chapter 3 Management of craniomandibular disorders
	Chapter 4 Management of shoulder and shoulder girdle disorders
	Chapter 5 Management of elbow disorders
	Chapter 6 Management of wrist and hand disorders
	Classification of neuro-musculo-skeletal disorders
	Chapter 7 Management of hip disorders
	Chapter 8 Management of knee disorders
	Chapter 9 Management of foot and ankle disorders
	References
1 The Maitland Concept as a clinical practice framework for neuromusculoskeletal disorders
	Chapter contents
	Setting the scene – the Maitland Concept as a clinical practice framework
		Adapt, adopt and improve
		The five pillars of clinical practice
			Patient-centred practice
			Clinical reasoning
			Examination
			Interventions
			Assessment
		Professional and clinical competencies supporting physiotherapists as  autonomous practitioners
		The bio-psychosocial paradigm
			Evidence-informed practice, research and the Maitland Concept
		The Maitland Concept as a clinical practice framework
	The five pillars of  clinical practice
	Patient-centred practice
		The patient and healthy living
		Analyzing the patient experience
		Patient inclusion and participation in decision making
		Patient-centred communication
		Understanding the body’s capacity to inform and adapt
		The role of collaborative reasoning
	Clinical reasoning
		Clinical reasoning and the brick wall concept
		Patient-centred clinical reasoning
			Clinical reasoning and treatment selection and progression
			Clinical reasoning and the  expert clinician
		Clinical reasoning, specific care pathways and best practice
		Clinical reasoning and the clinical practice framework of the Maitland Concept
	Examination
		Communication during the subjective examination
			The subjective  examination-interview strategies
		Manual testing
		Reassessment during examination
		The order and structure  of examination
		Reasoning strategies during examination
		Planning and performing the physical examination
	Interventions
		An overview of mobilization and manipulation and their effects
		An understanding of how techniques are selected, progressed and related to  self-management strategies
	Assessment
		Assessment and outcome measures
		Analytical assessment
		Forms of assessment
			First assessment
			The first session
			Reassessment before and after treatment
				Indicators of change
				The ‘art’ of reassessment
			Assessment while performing  a treatment procedure
			Retrospective assessment
				When improvement has stopped
			Final analytical assessment
		Prognosis
	Competencies framework and autonomous practice
		OMT and IFOMPT
		Autonomous practice
	The bio-psychosocial model of health care
		The International Classification of Functioning, Disability and Health (WHO 2001)
		The movement continuum theory  of physiotherapy
		The movement continuum theory and the International Classification of Functioning, Disability and Health (ICF)
		From a medical to  a bio-psychosocial paradigm
		The role of the biomedical model in manipulative physiotherapy
		International classifications of disease (ICD) and functioning, disability and health (ICF) and the brick wall concept
		The bio-psychosocial paradigm and healthy living
	Research and  the Maitland Concept
		Passive movement
		Irritability
		Grades of mobilization and manipulation
		Dosage parameters of mobilization and manipulation
		Movement diagrams
		Reassessment
		The oxymoron that is the  Maitland Concept
	References
2 The Maitland Concept:
	Chapter contents
	Introduction
		Physiotherapy diagnosis and ICF
			International Classification of Functioning, Disability and Health (ICF)
	Evidence-based practice
		Dilemmas and challenges of evidence-based practice
		Evidence-based practice and clinical reasoning
	Movement sciences and paradigms to movement
		Paradigms to movement
		Physiotherapy diagnosis
		From biomedical models to  bio-psychosocial models
			The role of the biomedical model
			The role of the bio-psychosocial model
				Phenomenological perspective
		Neurophysiological models
			Neurophysiological pain mechanisms
				End-organ dysfunction and altered nervous system processing – complex clinical reasoning processes
			Dynamics of a pain experience
				Integrative, dynamic models of pain
			Definitions of pain with regard to inclusion criteria in research
		Cognitive–behavioural models
			Phases of change
			The physiotherapist as an educator
			Compliance enhancement
			Research
		Biomechanical models
	Conclusion
	References
3 Management of craniomandibular disorders
	Chapter contents
	Introduction
	Theory – functional anatomy
	Causes and contributing factors for craniomandibular dysfunction
	Subjective examination
		Kind of disorder
		Areas of symptoms (body chart)
		Behaviour of symptoms  (over a 24-hour period)
		History of symptoms (present  and past)
			Trauma
			Events
			Spontaneous onset
			Gradual onset
			Contributing factors
			Medical screening questions
	Physical examination
		Present pain?
		Observation
			In standing
			In sitting
			En face
			In profile (Fig. 3.10)
		Functional demonstration
		Brief appraisal
			In sitting
			Active movements
			Mouth opening (depression) (Figs. 3.14  and 3.15)
			Mouth closing (elevation) (Fig. 3.21)
			Protraction
			Retraction
	Isometric tests
		In supine lying
		Active tests of the cervical spine
	Precautions
		Neurological examination
		Neurodynamic tests
			Cervical slump and occipital nerve major test (Maitland et al. 2005)
			Mandibular nerve, right side
			Facial nerve, right side
	Extraoral palpation
		Palpation of the TMJ
		Extra- and intraoral palpation of stomatognathic muscles
		Intraoral observation and palpation
	Accessory movements
		Extraorally applied accessory movements
			Transverse movement medially  (Fig. 3.35)
				Localization of forces (position of  therapist’s hands)
				Application of forces by therapist (method)
				Interpretation of findings
				Uses
		Intraorally applied accessory movements (Figs 3.36 and 3.37)
			Longitudinal movement caudad
				Localization of forces (position of  therapist’s hands)
				Application of forces by therapist (method)
				Interpretation of findings
				Uses
			Posteroanterior and anteroposterior movement
				Localization of forces (position of  therapist’s hands)
				Application of forces by therapist (method)
				Alternative in case intraoral application is not possible
				Localization of forces (position of  therapist’s hands)
					For posteroanterior
					For anteroposterior
				Application of forces by therapist (method)
				Variations in the application of forces
				Interpretation of findings
				Uses
			Transverse movement medially  and laterally
				Localization of forces (position of  therapist’s hands)
				Application of forces by therapist (method)
				Interpretation of findings and uses
			Longitudinal movement cephalad  and posterocephalad
				Localization of forces (position of  therapist’s hands)
				Application of forces by therapist (method)
				Interpretation of findings
				Uses
		Conclusion
			Other structures in plan
		Hyoid and larynx (Fig. 3.39)
			Transverse and rotary movement of the laryngeal and hyoid joints
				Localization of forces (position of  therapist’s hands)
					Movement of the thyroid cartilage
					Movement of the hyoid bone
				Application of forces by therapist (method)
				Uses
		Occlusal–cervical–pelvic relationships
		Cranium
			Occiput-C1 longitudinal cephalad  (Fig. 3.40)
				Localization of forces (position of  therapist’s hands)
				Application of forces by therapist (method)
		Temporal bone
			Bilateral medial – lateral (Fig. 3.41)
				Localization of forces (position of  therapist’s hands)
				Application of forces by therapist (method)
			Bilateral circumferential (Fig. 3.42)
				Localization of forces (position of  therapist’s hands)
				Application of forces by therapist (method)
			Bilateral caudolateral (Fig. 3.43)
				Localization of forces (position of  therapist’s hands)
				Application of forces by therapist (method)
		TMJ: bilateral longitudinal (compression – decompression)
			Bilateral longitudinal cephalad  (phase 1,compression) (Fig. 3.44)
				Localization of forces (position of  therapist’s hands)
				Application of forces by therapist (method)
				Traditional rationale
			Bilateral longitudinal caudad (phase 2, decompression) (Fig. 3.45)
				Localization of forces (position of  therapist’s hands)
				Application of forces by therapist (method)
				Rationale
		Mandibula
			Bilateral longitudinal caudad (distraction) (Fig. 3.38)
				Localization of forces (position of  therapist’s hands)
				Application of forces by therapist (method)
				Rationale
		Maxilla (Fig. 3.46)
			Lateral, anterocephalad
				Localization of forces (position of  therapist’s hands)
				Application of forces by therapist (method)
		Sphenoid bone (Fig. 3.47)
			Anteroposterior (compression) and posteroanterior (decompression)
				Localization of forces (position of  therapist’s hands)
				Application of forces by therapist (method)
				Management
	Definitive occlusal restoration/therapy after successful/stable symptomatic therapy
	References
4 Management of shoulder and shoulder girdle disorders
	Chapter contents
	Introduction
	A brief introduction to  the role of the extended  scope physiotherapist
	Diagnostic considerations – a perspective from the medical profession, an ESP role  and the traditional physiotherapy role
		Physiotherapy diagnosis
		Diagnosis and the ESP in the neuromusculoskeletal specialty
	The diagnosis and diagnostic titles of shoulder conditions
		Diagnosis and  the Maitland Concept
		The biomedical perspective
			Diagnostic labels and  shoulder conditions
			Physical examination related to the differential medical diagnosis of shoulder conditions
				Diagnostic accuracy – a brief review
				Diagnostic accuracy of physical tests
				Rotator cuff integrity and diagnosis based on physical examination tests
				Impingement and diagnosis based on physical examination tests
				Glenoid labrum pathology and diagnosis based on physical examination tests
				Shoulder instability and diagnosis based  on physical examination tests
				Acromioclavicular joint conditions  and diagnosis based on physical examination tests
				Frozen shoulder diagnosis based on physical examination tests
				Diagnosis of shoulder conditions based on physical examination tests – an appraisal
				Medical diagnosis of shoulder conditions based on physical examination tests –  a summary
		Imaging and the diagnosis of  shoulder conditions
			The use of imaging in the diagnosis of shoulder conditions
			Rotator cuff integrity and imaging
			Subacromial impingement and imaging
			Glenoid labrum and imaging
			Other shoulder structures and imaging
			The limitations of imaging – an appraisal and some considerations
		Surgical findings – some considerations with regard to specific diagnosis
		The impact of changing knowledge on the diagnosis of shoulder conditions – a clinical example relating to rotator  cuff tendinopathy
	Shoulder conditions – a perspective from an ESP role
		ESP role practice and the diagnostic task
		The importance of screening for red flags
		Screening for conditions which require early medical attention
		Screening for extrinsic sources – analytical assessment and differentiation
			Cervical spine disorders – an example of an extrinsic source
		Establishing the medical diagnosis of the shoulder disorder
			A diagnostic dilemma
			Considerations relating to medical shoulder diagnosis in primary care
			Considerations relating to patients  with persistent symptoms
				Psychosocial considerations
				Conservative management considerations
				Surgical considerations
			Summaries of the most common shoulder disorders – a biomedical perspective with implications for ESP and traditional physiotherapy practice
	Shoulder conditions – a physiotherapy perspective
		An overview
		Physiotherapy diagnosis and shoulder conditions
			Physiotherapy diagnosis and the ICF
		Physiotherapy diagnosis and shoulder conditions – the  American Physical Therapy Association perspective
		Other developments and considerations in the physiotherapeutic management  of shoulder conditions
			Physiotherapy diagnosis and the concept of non-specific shoulder pain and subgrouping classification
			Physiotherapy diagnosis and the concept of clinical prediction rules
		Integration of the Maitland  Concept into contemporary physiotherapy practice relating to shoulder conditions
			The symbolic permeable brick wall
				Integrating evidence from Tables 4.8–4.15 into clinical physiotherapy practice using the brick wall model
				Orthopaedic special tests – a reinterpretation and redefinition  with respect to the Maitland Concept  and the brick wall model
			Physiotherapy examination, assessment and treatments of shoulder disorders
			Demonstration through case studies
	References
5 Management of elbow disorders
	Chapter contents
	Introduction
		Anatomical and biomechanical considerations
	Subjective examination
		Body chart
		Behaviour of symptoms
		History (present episode and its progression since onset and past episodes and their natural histories)
		Special questions
	Evidence-based practice with reference to manual therapy
	Physical examination:  elbow region
		In standing
		In sitting
		In supine
		In side lying
		In prone lying
		Precautions and planning
	Physical examination:  the elbow complex
		Observation
		Functional demonstration/injuring movements/active functional movements and differentiation of these movements (to P1 or limit)
		If necessary tests
		Upper limb dynamic control
		Muscle isometric and length testing
		Palpation
		Upper limb neurodynamic  tests, nerve palpation and neurological examination
		Passive movements (joints)
		Mobilization with movement (MWM)
		Differentiation tests
	Examination and treatment techniques: elbow complex
		Neurological examination
		Nerve palpation
			Median nerve (Fig. 5.28)
			Radial nerve (Fig. 5.29)
			Ulnar nerve (Fig. 5.30)
		Passive movements
			Extension/adduction (Fig. 5.31)
				Localization of forces (position of  therapist’s hands)
				Application of forces by therapist (method)
				Uses
			Extension/abduction (Fig. 5.32)
				Localization of forces (position of  therapist’s hands)
				Application of forces by therapist (method)
				Uses
			Flexion/adduction (Fig. 5.33)
				Localization of forces  (position of therapist’s hands)
				Application of forces by therapist (method)
				Uses
			Flexion/abduction (Fig. 5.34)
				Localization of forces (position of  therapist’s hands)
				Application of forces by therapist (method)
				Uses
			Extension (Fig. 5.35)
				Grade II
				Localization of forces (position of  therapist’s hands)
				Application of forces by therapist (method)
				Uses
				Grade III (IV)
				Localization of forces (position of  therapist’s hands)
				Application of forces by therapist (method)
				Variations in the application of forces: grade III (IV)
				Localization of forces (position of  therapist’s hands)
				Application of forces by therapist (method)
				Uses grade III (IV)
			Flexion (Fig. 5.36)
				Grade II
				Localization of forces (position of  therapist’s hands)
				Application of forces by therapist (method)
				Grade III and IV (almost full range)
				Localization of forces (position of  therapist’s hands)
				Application of forces by therapist (method)
				Flexion with longitudinal movement  caudad (Fig. 5.37)
				Localization of forces (position of  therapist’s hands)
				Application of forces by therapist (method)
				Uses (all flexion techniques)
			Longitudinal movement caudad (elbow in 90° flexion) (Fig. 5.38)
				Localization of forces (position of  therapist’s hands)
				Application of forces by therapist (method)
				Uses
			Supination (Figs 5.40 and 5.41)
			Grades III and IV
				Localization of forces (position of therapist’s hands)
				Application of forces by therapist (method)
					Grades III and IV
					Grade IV−
				Localization of forces (position of  therapist’s hands)
				Application of forces by therapist (method)
				Uses
			Pronation (Figs 5.42 and 5.43)
			Grades II, III and IV
				Localization of forces (position of  therapist’s hands)
			Grade IV−
				Localization of forces (position of  therapist’s hands)
				Application of forces by therapist (method)
				Uses
			Anteroposterior movement of the head of the radius (Fig. 5.44)
			In supination
				Localization of forces (position of  therapist’s hands)
				Application of forces by therapist (method)
			In pronation
				Localization of forces (position of  therapist’s hands)
				Application of forces by therapist (method)
				Uses
			Posteroanterior movement of the head of the radius (Fig. 5.45)
			In supination
				Localization of forces (position of  therapist’s hands)
				Application of forces by therapist (method)
			In pronation
				Uses
			Longitudinal movement caudad (radioulnar) (Fig. 5.46)
				Localization of forces (position of  therapist’s hands)
				Application of forces by therapist (method)
				Variations in the application of forces
				Uses
		Mobilization with movement
			Elbow extension with lateral glide MWM – assessment (Fig. 5.47)
				Localization of forces (position of  therapist’s hands)
				Application of forces by therapist (method)
				Uses
			Elbow extension with lateral glide MWM – belt (Fig. 5.48)
				Localization of forces (position of therapist’s hand and manual therapy belt)
				Application of forces by therapist (method)
				Uses
			Elbow extension with medial glide MWM – assessment (Fig. 5.49)
				Localization of forces (position of  therapist’s hands)
				Application of forces by therapist (method)
				Uses
			Elbow extension with medial glide MWM – belt (Fig. 5.50)
				Localization of forces (position of therapist’s hands and belt)
				Application of forces by therapist (method)
				Uses
			Elbow flexion with lateral glide MWM – assessment (Fig. 5.51)
				Localization of forces (position of  therapist’s hands)
				Application of forces by therapist (method)
				Uses
			Elbow flexion with lateral glide MWM – belt (Fig. 5.52)
				Localization of forces (position of therapist’s hand and manual therapy belt)
				Application of forces by therapist (method)
				Uses
			Elbow flexion with medial glide MWM – assessment (Fig. 5.53)
				Localization of forces (position of  therapist’s hands)
				Uses
			Elbow flexion with medial glide MWM – belt (Fig. 5.54)
				Localization of forces (position of therapist’s hands and belt)
				Application of forces by therapist (method)
				Uses
			Elbow extension with ulnar lateral tilt MWM (Fig. 5.55)
				Localization of forces (position of  therapist’s hands)
				Application of forces by therapist (method)
				Uses
			Elbow extension with ulnar medial tilt MWM (Fig. 5.56)
			Elbow flexion with longitudinal caudad glide MWM (Fig. 5.57)
				Localization of forces (position of  therapist’s hands)
				Application of forces by therapist (method)
				Uses
			Elbow pronation or supination with  or  radius MWM (Fig. 5.58)
				Localization of forces (position of  therapist’s hands)
				Application of forces by therapist (method)
				Uses
		Techniques for lateral epicondylalgia
			Gripping with lateral glide MWM  (Fig. 5.59)
				Localization of forces (position of  therapist’s hands)
				Application of forces by therapist (method)
				Uses
			Gripping with  radius MWM (Fig. 5.62)
				Localization of forces (position of  therapist’s hands)
				Application of forces by therapist (method)
				Uses
		Neurodynamic techniques
			Cervical lateral glide technique  (Fig. 5.64)
				Localization of forces (position of  therapist’s hands)
				Application of forces by therapist (method)
				Uses
			Scaphoid IV and V (Fig. 5.65)
				Localization of forces (position of  therapist’s hands)
				Application of forces by therapist (method)
				Variations in the application of forces
				Uses
	Elbow disorders and their clinical profiles
		Introduction
		Lateral epicondylalgia
		Joint stiffness
		Chronic minor joint pain
		Proving the elbow unaffected
		Composite elbow
	References
6 Management of wrist and hand disorders
	Chapter contents
	Introduction
		Origin of the symptoms
		Finding consistency  in functional demonstrations
		Defining the dominant  pain mechanism
			Input
			Output
			Processing
		Deciding the normal range or ideal range for wrist and hand movement (Fig. 6.1)
	Subjective examination (C/O)
		Kind of disorder: establishing the patient’s main problem(s)
		Areas of symptoms
		Behaviour of symptoms
		History (present and past)
		Medical screening questions
	Planning the physical examination (P/E)
		Physical examination (P/E)  (Boxes 6.1-6.9)
			Observation
			Functional demonstration
			Active movements of whole hand
		If necessary tests
			Isometric tests (grip strength test)
			Neurological examination
			Neurodynamic tests
			In supine lying
				Inspection and palpation
			Differentiation of movements reproducing pain
			Passive movements wrist and hand – examination and treatment techniques
				Whole hand movements,  differentiating rows:
			Differentiation of radial  and ulnar deviation
			Differentiation of horizontal flexion  and extension
			Supination (Figs 6.16 and 6.17)
				Method
			Pronation (Figs 6.18 and 6.19)
				Method
			Inferior radioulnar joint posteroanterior and anteroposterior movements  (Fig. 6.20)
				Application of forces by therapist (method)
				Variations in the application of forces
				Uses
			Inferior radioulnar compression  (Fig. 6.21)
				Localization of forces (position of  therapist’s hands)
				Application of forces by therapist (method)
				Variations in the application of forces
				Uses
			Inferior radioulnar joint longitudinal movement caudad/cephalad
				Method
				Variations in the application of forces
					Longitudinal movement cephalad
					Longitudinal movement caudad
				Uses
			Wrist flexion (general) (Fig. 6.23)
				Localization of forces (position of  therapist’s hands)
				Application of forces by therapist (method)
				Uses
			Radiocarpal flexion (Fig. 6.24)
				Localization of forces (position of  therapist’s hands)
				Application of forces by therapist (method)
				Variations in the application of forces
				Uses
			Midcarpal flexion (Fig. 6.25)
				Localization of forces (position of  therapist’s hands)
				Application of forces by therapist (method)
				Summary
				Uses
			Wrist extension (general) (Fig. 6.26)
				Localization of forces (position of  therapist’s hands)
				Application of forces by therapist (method)
				Uses
			Radiocarpal extension (Fig. 6.27)
				Localization of forces (position of  therapist’s hands)
				Application of forces by therapist (method)
				Variations in the application of forces
				Uses
			Midcarpal extension (Fig. 6.28)
				Localization of forces (position of  therapist’s hands)
				Summary
				Application of forces by therapist (method)
				Uses
			Wrist ulnar deviation (general and localized) (Figs 6.29 and 6.30)
				Localization of forces (position of  therapist’s hands)
				Application of forces by therapist (method)
				Variations in the application of forces  (for the purpose of differentiating the source of wrist pain)
					Localization to the radiocarpal joint
					Localization to the midcarpal and carpometacarpal joints
				Uses
			Wrist radial deviation (general and localized) (Figs 6.31 and 6.32)
				Localization of forces (position of  therapist’s hands)
				Application of forces by therapist (method)
				Variations in the application of forces
				Uses
			Radiocarpal posteroanterior movement (Fig. 6.33)
				Localization of forces (position of  therapist’s hands)
				Application of forces by therapist (method)
				Variations in the application of forces
				Uses
			Radiocarpal anteroposterior movement (Fig. 6.34)
				Localization of forces (position of  therapist’s hands)
				Application of forces by therapist (method)
				Variations in the application of forces
				Uses
			Radiocarpal supination (lateral rotation) (Fig. 6.35)
				Localization of forces (position of  therapist’s hands)
				Application of forces by therapist (method)
				Variations in the application of forces
				Uses
			Radiocarpal pronation (medial rotation) (Fig. 6.36)
				Localization of forces (position of  therapist’s hands)
				Application of forces by therapist (method)
				Variations in the application of forces
				Uses
			Radiocarpal lateral transverse movement
				Localization of forces (position of  therapist’s hands)
				Application of forces by therapist (method)
				Variations in the application of forces
				Uses
			Radiocarpal medial  transverse movement
				Localization of forces (position of  therapist’s hands)
				Application of forces by therapist (method)
				Variations in the application of forces
				Uses
			Intercarpal horizontal extension  (Fig. 6.37)
				Localization of forces (position of  therapist’s hands)
				Application of forces by therapist (method)
				Variations in the application of forces
				Uses
			Intercarpal horizontal flexion (Fig. 6.38)
				Localization of forces (position of  therapist’s hands)
				Application of forces by therapist (method)
				Variations in the application of forces
				Uses
			Posteroanterior and anteroposterior intercarpal movements (Figs 6.39  and 6.40)
				Localization of forces (position of  therapist’s hands)
					Posteroanterior
					Anteroposterior
				Application of forces by therapist (method)
				Variations in the application of forces
				Uses
			Wrist and hand intercarpal longitudinal movement caudad and cephalad  (Figs 6.41 and 6.42)
				Localization of forces (position of  therapist’s hands)
				Application of forces by therapist (method)
				Variations in the application of forces
				Uses
			Pisiform movements (Fig. 6.43)
				Localization of forces (position of  therapist’s hands)
				Application of forces by therapist (method)
				Variations in the application of forces
				Uses
			Carpometacarpal extension and flexion (Figs 6.44 and 6.45)
				Localization of forces (position of  therapist’s hands)
					For extension (lateral CMC joints)
					For extension (CMC of the little finger)
					For flexion
					For flexion (for the second CMC joint)
				Application of forces by therapist (method)
					For extension
					For flexion
				Variations in the application of forces
				Uses
			Intermetacarpal movements (Fig. 6.46)
				Localization of forces (position of  therapist’s hands)
					General horizontal flexion (the whole row of metacarpals)
					Localized horizontal flexion
					General horizontal extension
					Localized horizontal extension
					Posteroanterior or anteroposterior
					Compression (transverse)
				Application of forces by therapist (method)
					General horizontal flexion
					Localized horizontal flexion
					General horizontal extension
					Localized horizontal extension
					Posteroanterior or  anteroposterior movements
					Compression (transverse)
				Uses
			Metacarpophalangeal and interphalangeal joint flexion and extension (described for MCP joints) (Figs 6.47 and 6.48)
				Localization of forces (position of therapist’s hands) (for the index finger)
				Application of forces by therapist (method)
					Flexion
					Extension
					Variations in the application of forces
				Uses
			Metacarpophalangeal and interphalangeal joint abduction and adduction (described for MCP joint)  (Figs 6.49 and 6.50)
				Localization of forces (position of therapist’s hands) (for the index finger)
					Abduction
					Adduction
				Application of forces by therapist (method)
					Abduction
				Variations in the application of forces
				Uses
			Metacarpophalangeal and interphalangeal joint medial and lateral rotation (described for MCP joints)  (Figs 6.51 and 6.52)
				Localization of forces (position of therapist’s hands) (for the index finger)
					Medial rotation
					Lateral rotation
				Application of forces by therapist (method)
					Medial rotation
					Lateral rotation
				Variations in the application of forces
				Uses
			Metacarpophalangeal and interphalangeal joint longitudinal movement caudad (distraction) and cephalad (compression) – described for the MCP joint (Figs 6.53 and 6.54)
				Localization of forces (position of therapist’s hands) (for the index finger)
					Longitudinal caudad
				Application of forces by therapist (method)
					Longitudinal caudad
					Longitudinal cephalad
				Variations in the application of forces
				Uses
			Metacarpophalangeal and interphalangeal joint posteroanterior and anteroposterior movement (described for the MCP joint) (Figs 6.55 and 6.56)
				Localization of forces (position of therapist’s hands) (for the index finger)
				Application of forces by therapist (method)
				Variations in the application of forces
				Uses
			Metacarpophalangeal and interphalangeal joint general flexion, extension and circumduction
				Localization of forces (position of  therapist’s hands)
				Application of forces by therapist (method)
				Uses
			Thumb movements (first carpometacarpal joint) (Figs 6.57-6.59)
				Localization of forces (position of  therapist’s hands)
					Flexion
					Adduction, abduction, opposition
					Longitudinal cephalad (compression)
					Posteroanterior movement (including anteroposterior, and transverse medial  and lateral)
				Application of forces by therapist (method)
				Variations in the application of forces
				Uses
		Screening tests
		Treatment of wrist and hand conditions – an overview
			Management
	References
7 Management of hip disorders
	Chapter contents
	Introduction
		Components of hip disorders
			Structural sources
			Functional causes (contributing factors)
			Pathobiological disorders
	Applied theory
		Integration of structural and functional disorders
		Muscle classification and associated muscle imbalance
			Muscle classification
			Muscle imbalance and  associated dysfunction
		Motor control
		Treatment principles
	Evidence supporting practice
	Subjective examination
		Main problem (‘Question 1’)
		Areas of symptoms (body chart)
		Behaviour of symptoms
		History
		Special questions and medical screening questions
	Physical examination
		Observation
		Functional demonstration tests
		Active movements
			Gait analysis
		Active testing in standing
			Weight bearing (Fig. 7.7)
			Technique
			Swing movement
			Trunk movements: assessment of relative flexibility of the movement chain
			Step-down test (Fig. 7.8)
			Getting up and down steps
			Descending steps
			Squatting
			Progression of the examination
		Active testing in sitting
		Active testing in supine and prone positions, including overpressure
			In supine
			In prone
			In four-point kneeling
			In sitting
			Active hip flexion in supine (Fig. 7.9)
				Deviations
				Additional manoeuvre
			Flexion in four-point kneeling
				Comparison of hip flexion test in supine and four-point kneeling
			Medial and lateral rotation in 90° flexion (Fig. 7.10)
			Lateral rotation
			Medial and lateral rotation in sitting
			Lateral rotation in supine (relative flexibility test) (Fig. 7.11)
			Abduction in supine (Fig. 7.12)
			Adduction in supine (Fig. 7.13)
			Extension in prone (Fig. 7.14)
			Medial and lateral rotation in prone  (Fig. 7.15)
		Muscle tests
			Isometric tests
			Muscle length tests
			Global stabilizers
			Iliacus (Fig. 7.16)
			Deep gluteus maximus (Wagner et al. 2010) (Fig. 7.17)
			Posterior gluteus medius (Fig. 7.18)
			Anterior gluteus medius and minimus (Fig. 7.19)
			Hip adductors: pectineus, adductor brevis, longus and magnus and quadratus femoris (Fig. 7.20)
			Global mobilizers
			Hamstrings (Fig. 7.21)
			Superior gluteus maximus/iliotibial tracts (see Wagner et al. 2010) (Fig. 7.22)
			Tensor fascia lata in standing (Fig. 7.23)
			Modified Thomas’ test (Sahrmann 2002) (Fig. 7.24)
			Modified ober test: tensor fascia lata (see Ferber et al. 2010, Milner et al. 2010) (Fig. 7.25)
			Rectus femoris (Sahrmann 2002)  (Fig. 7.26)
			M. piriformis (Tonley et al. 2010)  (Fig. 7.27)
			Adductors (Fig. 7.28)
		Screening of other structures  in ‘plan’
		Palpation
		Passive test procedures
			Flexion/adduction
				Localization of forces (position of  therapist’s hands)
				Application of forces by therapist (method)
				Variations of F/Ad as  an examination technique
					Progression of examination
					Differentiation tests
			Uses of flexion/adduction  and its variations
		Accessory movements
			Specific tests for restricted  gliding movements
			Restricted posterior gliding (Fig. 7.38)
			Test in flexion/adduction: right hip (Addison 2004)
			Restricted anterior gliding
			Stability tests
			Excessive anterior gliding dysfunction (Sahrmann 2002) (Fig. 7.39)
			Excessive posterior gliding dysfunction (Fig. 7.41)
			Excessive lateral gliding dysfunction
	Treatment
		Passive mobilizing techniques: accessory movements
			Lateral movement (Figs 7.42, 7.43)
				Localization of forces (position of  therapist’s hands)
					In side lying
					In supine
				Application of forces by therapist (method)
					In side lying
					In supine
				Variations in the application of forces
				Uses
			Longitudinal movement caudad  (Figs 7.44-7.47)
				Localization of forces (position of  therapist’s hands)
					In supine
					In side lying
					In flexion
				Application of forces by therapist (method)
					In supine
					In side lying
					In flexion
				Variations in the application of forces
				Uses
			Posteroanterior and anteroposterior movements (Figs 7.48, 7.49)
				Localization of forces (position of  therapist’s hands)
					Posteroanterior
					Anteroposterior
				Application of forces by therapist (method): PA and AP
				Variations in the application of forces
				Uses
			Along the femoral line (longitudinal movement cephalad) (Fig. 7.50)
				Localization of forces (position of  therapist’s hands)
				Application of forces by therapist (method)
				Variations in the application of forces
				Uses
			Compression medially (with transverse medial movements) (Fig. 7.51)
				Localization of forces (position of  therapist’s hands)
				Application of forces by therapist (method)
				Uses
		F/Ad as a treatment technique
			Grade IV
				Uses
			Grades II and III (Figs 7.53, 7.54)
				Localization of forces (position of therapist’s hands)
					Grade II
					Grade III
				Application of forces by therapist (method)
					Grade II
					Grade III
				Uses
		Other passive treatment techniques
			Medial rotation (Figs 7.55-7.60)
				Localization of forces (position of  therapist’s hands)
					In supine
					In side lying
					In extension supine
					In extension prone
					In flexion
				Application of forces by therapist (method)
					In supine (grades I and II)
					In side lying (grades I and II)
					In extension supine (grades III and IV)
					In extension prone (grades III and IV)
					In flexion (grades III and IV)
				Variations in the application of forces
					In extension prone
				Uses
			Lateral rotation (Figs 7.61, 7.62)
				Localization of forces (position of  therapist’s hands)
					In flexion supine
					In extension prone
				Application of forces by therapist (method)
					In flexion supine (grades III and IV)
					In extension prone
				Variations in the application of forces
				Uses
			Abduction (Fig. 7.63)
				Localization of forces (position of  therapist’s hands)
					In flexion
					In extension (Fig. 7.63)
				Application of forces by therapist (method)
					In flexion
					In extension
				Variations in the application of forces
				Uses
			Extension
				Localization of forces (position of  therapist’s hands)
				Application of forces by therapist (method)
				Variations in the application of forces
				Uses
			Extension/abduction
				Localization of forces (position of  therapist’s hands)
				Application of forces by therapist (method)
				Uses
	Active techniques
		Active correction of posture and movement patterns
		The segmental stabilizers (adapted from Comerford & Mottram 2001, Gibbons 2001)
			Psoas (Fig. 7.64)
			Gemelli and obturatorii (Fig. 7.65)
		The global stabilizers
		The global mobilizers
			Hamstrings
			Gluteus maximus (superficial fibres)
			Tensor fascia lata
			Rectus femoris
			Piriformis
			The long adductors
	References
8 Management of knee disorders
	Chapter contents
	Introduction
	Applied theory and evidence supporting practice
		Anatomy
		Stability and mobility
		Movement patterns, motor  control patterns
		Range of motion
		Nerve supply
		Pathobiological processes
			Osteoarthritis of the knee
			OA-related research
			‘Anterior knee pain’
			Total knee replacement
	Clinical reasoning
	Subjective examination
		Main problem (‘Question 1’)
			Locking
			Catching
			Instability – ‘giving way’
			Swelling
		Areas of symptoms (body chart)
		Behaviour of symptoms – activity limitations
		History
		Medical and health screening questions
	Physical examination
		Present Pain
		Observation
			Alignment
		Functional demonstration tests
		Brief appraisal
		Active movements
			Weight bearing
			Active tests of the knee  (in non-weight bearing)
				Extension (supine)
				Flexion (Fig. 8.2)
					In 90° of flexion: medial rotation, lateral rotation
			If necessary tests
		Muscle tests
			Isometric tests – as symptom reproduction
			Recruitment patterns, patellar alignment and symptom reproduction
			Muscle function and strength tests
				Muscle length tests
		Screening of other structures  ‘in plan’
		Palpation
			Temperature
			Effusion
			Swelling
			Tenderness
		Passive tests
			Movement diagram
			Stability, integrity and meniscus testing
			Passive test movements of the various knee components
				Tibiofemoral joint
				Patellofemoral joint
				Superior tibiofibular joint
	Treatment
		Selection
		Group 1 – pain
			Accessory movements in a part of the range that is totally free of any pain or discomfort
			Physiological movements
		Group 2 – stiffness
		Group 3 – pain with stiffness
		Group 4 – momentary pain
			Tibiofemoral joint
			Patellofemoral joint
			Superior tibiofibular joint
	Description of techniques
		Physiological movements of the tibiofemoral joint: examination and treatment techniques
			Extension (Fig. 8.31)
				Localization of forces (position of  therapist’s hands)
				Application of forces by therapist (method)
				Variations in the application of forces
				Uses
			Extension/abduction, extension/adduction (extension) (see Fig. 8.18)
				An example of this concept’s approach
				Localization of forces (position of  therapist’s hands)
					Grades III and IV – E/Ab
					Grades III and IV – E/Ad
					Grades IV and IV+ – E/Ab (see Figs 8.1, 8.4)
					Grades IV and IV+ – E/Ad (see Figs 8.1, 8.4)
				Application of forces by therapist (method)
					Grades III and IV – E/Ab
					Grades III and IV – E/Ad
					Grades IV and IV+ – E/Ab
					Grades IV and IV+ – E/Ad
				Variations in the application of forces: extension (E)
				Uses
			Flexion/abduction, flexion/adduction  (see Fig. 8.5)
				Localization of forces (position of  therapist’s hands)
					For F/Ab
					For F/Ad
				Application of forces by therapist (method)
				Uses
			Medial rotation, lateral rotation  (Fig. 8.32, see also Fig. 8.3)
				Localization of forces (position of  therapist’s hands)
					In flexion supine
					In flexion prone
				Application of forces by therapist (method)
					In flexion supine
					In flexion prone
				Uses
		Accessory movements of the tibiofemoral joint: examination and treatment techniques
			Abduction and adduction (see Fig. 8.18)
				Application of forces by therapist (method)
				Uses
			Longitudinal movement caudad and cephalad (see Fig. 8.33)
				Localization of forces (position of  therapist’s hands)
				Application of forces by therapist (method)
				Variations in the application of forces
				Longitudinal movement cephalad
				Uses
			Posteroanterior movement (see Fig. 8.34)
				Localization of forces (position of  therapist’s hands)
					For grades I and II
					For grades III and IV
				Application of forces by therapist (method)
					For grades I and II
					For grades III and IV
				Uses
					Grades I and II
					Grades III and IV
			Anteroposterior movement  (see Fig. 8.35)
				Localization of forces (position of  therapist’s hands)
					For grades I and II
					For grades III and IV
				Application of forces by therapist (method)
					For grades I and II
					For grades III and IV
				Uses
					Grades I and II
					Grades III and IV
			Lateral movement and medial movement (Fig. 8.36)
				Localization of forces (position of  therapist’s hands)
					Lateral movement (Fig. 8.36A)
					Medial movement (Fig. 8.36B)
				Application of forces by therapist (method)
				Uses
			Tibiofemoral treatment techniques  under compression
		Accessory movements of the patellofemoral joint: examination and treatment techniques
			Compression (see Fig. 8.21)
				Localization of forces (position of  therapist’s hands)
				Application of forces by therapist (method)
				Variations in the application of forces
				Uses
			Distraction (see Fig. 8.20)
				Localization of forces (position of therapist’s hands) (see Fig. 8.20A)
				Application of forces by therapist (method)
				Variations in the application of forces
				Uses
			Transverse movement medially and laterally (Fig. 8.39)
				Localization of forces (position of  therapist’s hands)
				Application of forces by therapist (method)
				Variations in the application of forces
				Uses
			Longitudinal movement caudad and cephalad (Fig. 8.40)
				Localization of forces (position of  therapist’s hands)
				Application of forces by therapist (method)
				Variations in the application of forces
				Uses
				Special testing
				Two rotary movements
			Patellofemoral movements in knee flexion (examples of treatment)  (Fig. 8.41)
				Localization of forces (position of  therapist’s hands)
				Application of forces by therapist (method)
				Uses
		Accessory movements of the superior tibiofibular joint: examination and treatment techniques
			Anteroposterior movement  (see Fig. 8.23)
				Localization of forces (position of  therapist’s hands)
				Application of forces by therapist (method)
				Variations in the application of forces
				Uses
			Posteroanterior movement  (see Fig. 8.24)
				Localization of forces (position of  therapist’s hands)
				Application of forces by therapist (method)
				Variations in the application of forces
				Uses
			Longitudinal movement caudad and cephalad (see Fig. 8.25)
				Localization of forces (position of  therapist’s hands)
				Application of forces by therapist (method)
				Variations in the application of forces
				Uses
	References
9 Management of foot and ankle disorders
	Chapter contents
	Introduction
		Anatomy and regions of the foot and ankle
		Movements of the foot and ankle
		Axes and planes of movements
		Movements of the single joints
			Distal tibiofibular joint (syndesmosis)
			Talocrural joint
			Subtalar joint
			Midtarsal joint
			Rays
			The first metatarsophalangeal joint
	Musculoskeletal foot and ankle disorders
		Typical medical diagnoses of the foot and ankle
			Plantar fasciitis
				Diagnosing plantar heel pain
			Chronic ankle instability
				Chronic ankle instability and mobility  of the ankle
				Chronic ankle instability and pain
		Cognitive processes and injury
		Chronic musculoskeletal foot  and ankle disorders
	Psychosocial factors of pain and disability
		Psychosocial factors and neurophysiological pain mechanisms
		Psychosocial factors and musculoskeletal foot and ankle disorders
	Lifestyle factors and musculoskeletal foot and ankle disorders
	Work-related factors and musculoskeletal foot and ankle disorders
	Subjective examination
		Kind of disorder
		Symptom area(s)
		Behaviour of the symptom(s)
		Behaviour of the patient according to the disorder
		History of the symptoms
		History of the patient’s behaviour according to the disorder
		Medical screening questions
	Planning the physical examination
		Reflection on the subjective examination
		Expressing hypotheses categories
			Nature of the disorder
			Source of the symptoms
			Neurophysiological pain mechanisms
			Direction of the impairment
			Contributing factors
			Intervention
			Precautions and contraindications
			Prognosis
		Planning physical  examination procedures
	Physical examination
		Observation in non-weight bearing
		Observation in weight bearing
		Functional tests
		Observation of gait
		Active movements
		Passive movements
		Provocation tests
	Treatment techniques
		Passive physiological movements of the foot and ankle
			Plantar flexion (Fig. 9.5)
				Localization of forces (position of  therapist’s hands)
				Application of forces by therapist (method)
			Dorsiflexion (Fig. 9.6)
				Localization of forces (position of  therapist’s hands)
				Application of forces by therapist (method)
			Supination (Fig. 9.7)
				Localization of forces (position of  therapist’s hands)
				Application of forces by therapist (method)
			Pronation (Fig. 9.8)
				Localization of forces (position of  therapist’s hands)
				Application of forces by therapist (method)
		Passive physiological movements of the hindfoot
			Plantar flexion of the hindfoot (Fig. 9.9)
				Localization of forces (position of  therapist’s hands)
				Application of forces by therapist (method)
			Dorsiflexion of the hindfoot (Fig. 9.10)
				Localization of forces (position of  therapist’s hands)
				Application of forces by therapist (method)
			Supination of the hindfoot (Fig. 9.11)
				Localization of forces (position of  therapist’s hands)
				Application of forces by therapist (method)
			Pronation of the hindfoot (Fig. 9.12)
				Localization of forces (position of  therapist’s hands)
				Application of forces by therapist (method)
		Passive physiological movements of the forefoot
			Plantar flexion of the forefoot (Fig. 9.13)
				Localization of forces (position of  therapist’s hands)
				Application of forces by therapist (method)
			Dorsiflexion of the forefoot (Fig. 9.14)
				Localization of forces (position of  therapist’s hands)
				Application of forces by therapist (method)
			Supination of the forefoot (Fig. 9.15)
				Localization of forces (position of  therapist’s hands)
				Application of forces by therapist (method)
			Pronation of the forefoot (Fig. 9.16)
				Localization of forces (position of  therapist’s hands)
				Application of forces by therapist (method)
		Passive physiological rotation and inversion/eversion movements of the hindfoot
			Medial rotation and lateral rotation  (Fig. 9.17)
				Localization of forces (position of  therapist’s hands)
				Application of forces by therapist (method)
			Inversion and eversion (Fig. 9.18)
				Localization of forces (position of  therapist’s hands)
				Application of forces by therapist (method)
		Passive accessory movements of the hindfoot
			Distal tibiofibular joint
			Posteroanterior movement (Fig. 9.19)
				Localization of forces (position of  therapist’s hands)
				Application of forces by therapist (method)
			Anteroposterior movement (Fig. 9.20)
				Localization of forces (position of  therapist’s hands)
				Application of forces by therapist (method)
			Compression (Fig. 9.21)
				Localization of forces (position of  therapist’s hands)
				Application of forces by therapist (method)
			Talocrural joint
			Posteroanterior movement (Fig. 9.22)
				Localization of forces (position of  therapist’s hands)
				Application of forces by therapist (method)
			Anteroposterior movement (Fig. 9.23)
				Localization of forces (position of  therapist’s hands)
				Application of forces by therapist (method)
			Distraction (Fig. 9.24)
				Localization of forces (position of  therapist’s hands)
				Application of forces by therapist (method)
			Compression (Fig. 9.25)
				Localization of forces (position of  therapist’s hands)
				Application of forces by therapist (method)
				Movements under compression
				Subtalar joint
			Posteroanterior movement (Fig. 9.26)
				Localization of forces (position of  therapist’s hands)
				Application of forces by therapist (method)
			Anteroposterior movement (Fig. 9.27)
				Localization of forces (position of  therapist’s hands)
				Application of forces by therapist (method)
			Distraction (Fig. 9.28)
				Localization of forces (position of  therapist’s hands)
				Application of forces by therapist (method)
			Transverse movement medially  (Fig. 9.29)
				Localization of forces (position of therapist’s hands)
				Application of forces by therapist (method)
			Transverse movement laterally  (Fig. 9.30)
				Localization of forces (position of  therapist’s hands)
				Application of forces by therapist (method)
		Passive accessory movements of the forefoot
			Anteroposterior movement of the MTJ (Fig. 9.31)
				Localization of forces (position of  therapist’s hands)
				Application of forces by therapist (method)
			Transverse movement medially of the MTJ (Fig. 9.32)
				Localization of forces (position of  therapist’s hands)
				Application of forces by therapist (method)
			Anteroposterior movement of the medial cuneiform (Fig. 9.33)
				Localization of forces (position of  therapist’s hands)
				Application of forces by therapist (method)
			Anteroposterior movement of the IV-ray (Fig. 9.34)
				Localization of forces (position of  therapist’s hands)
				Application of forces by therapist (method)
		Combined movement techniques
			Dorsiflexion and posteroanterior movement of the STJ (Fig. 9.35)
				Localization of forces (position of  therapist’s hands)
				Application of forces by therapist (method)
			Dorsiflexion and anteroposterior movement of the TCJ (Fig. 9.36)
				Localization of forces (position of  therapist’s hands)
				Application of forces by therapist (method)
			Dorsiflexion and compression of the hindfoot (Fig. 9.37)
				Localization of forces (position of  therapist’s hands)
				Application of forces by therapist (method)
			Dorsiflexion and lateral rotation of the hindfoot (Fig. 9.38)
				Localization of forces (position of  therapist’s hands)
				Application of forces by therapist (method)
			Dorsiflexion and anteroposterior movement of the talocrural joint and distraction (Fig. 9.39)
				Localization of forces (position of  therapist’s hands)
				Application of forces by therapist (method)
			Plantar flexion and anteroposterior movement of the subtalar joint  (Fig. 9.40)
				Localization of forces (position of  therapist’s hands)
				Application of forces by therapist (method)
			Plantar flexion and inversion (Fig. 9.41)
				Localization of forces (position of  therapist’s hands)
				Application of forces by therapist (method)
		Therapeutic exercises of the foot and ankle
		Mobility exercises
			Mobilization of the ankle into dorsiflexion (Fig. 9.42)
			Mobilization of the ankle in different directions with a balance board  (Fig. 9.43)
		Motor control: exercises in a  sitting position
			Activation of the forefoot (Fig. 9.44)
			Dissociative hindfoot supination  (Fig. 9.45)
			Dissociative hindfoot pronation  (Fig. 9.46)
			Integrative hindfoot plantar flexion  (Fig. 9.47)
		Motor control: exercises in a standing position
			Squatting (emphasis on foot and ankle control) (Fig. 9.48)
	References
1 The Maitland Concept as a clinical practice framework for neuromusculoskeletal disorders
2 The Maitland Concept:
3 Management of  craniomandibular disorders
4 Management of shoulder and shoulder girdle disorders
5 Management of elbow disorders
6 Management of wrist  and hand disorders
7 Management of hip disorders
8 Management of knee disorders
9 Management of foot  and ankle disorders
Vertebral manipulation
Appendix 1 Self-management strategies: Compliance and behavioural change
	Chapter contents
	Compliance
		Barriers to compliance
	Cognitive–behavioural approach
	Habits don’t change overnight – phases of change
		Motivational phase
		Short-term compliance
		Long-term compliance
	Compliance enhancement strategies
		Selection of coping strategies  to control pain and wellbeing
			Example
		Integration of the exercises into daily life situations
	Conclusion
	References
Appendix 2 Recording
	Chapter contents
	Introduction
		SOAP notes
	Asterisks
	Conditions
	Some remarks with regards  to recording
	Recording of subjective examination findings
		Body chart
		Clinical tip
		Behaviour of symptoms  and activities
		History
	Recording of physical examination findings
	Active movements
	Passive movements
	Recording of treatment interventions
		Examples:
		Other forms of treatment:
	Information, instructions, exercises, warning at the end of a session
		Example
	Recording of follow-up sessions
	Retrospective assessment
	Written records by the patient
	Conclusion
	References
Index
	A
	B
	C
	D
	E
	F
	G
	H
	I
	J
	K
	L
	M
	N
	O
	P
	Q
	R
	S
	T
	U
	V
	W
	Y