NIMS COLLEGE OF

PHYSIOTHERAPY

KALTENBOR
N MANUAL
MOBLIZATIO
N
 concept
• The Kaltenborn Concept, often referred to as the
Orthopedic Manual Physical Therapy (OMT)
Kaltenborn-Evjenth Concept, is a highly respected and
widely practiced system of manual therapy. It's a
comprehensive approach to diagnosing and treating
musculoskeletal dysfunctions, particularly those affecting
joints.
 Origin
• The Kaltenborn Concept was developed by Freddy
Kaltenborn, a Norwegian physical therapist, in
collaboration with Olaf Evjenth over several years,
beginning in the 1950s. Kaltenborn integrated
knowledge from various disciplines, including
orthopedic, medicine, osteopathy, and chiropractic,
to create a systematic approach to joint examination
and treatment.).
INTRODUCTION
 Principles

• The Kaltenborn Concept is grounded in several biomechanical

and physiological principles:
1 Arthrokinematics: This concept emphasizes the importance
of accessory movements (joint play), which are small,
involuntary movements that occur between joint surfaces during
normal physiological motion.
• These movements, such as distraction, sliding (gliding),
compression, rolling, and spinning, are crucial for pain-free
and full range of motion.
• The Kaltenborn method focuses on restoring these specific
joint play movements.
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2 Translatoric Joint Play: Kaltenborn specifically
emphasizes translatoric (linear) joint play
movements in relation to a treatment plane.
Translatoric joint play movements
(traction, compression, and gliding)
are used in both assessment and treatment
to address joint dysfunction.
These movements are applied within the
Kaltenborn Treatment Plane
Translatoric Joint Play Movements:

• Traction:
• This involves separating the joint surfaces by pulling them apart
along the treatment plane.
• Compression:
• This involves pushing the joint surfaces together along the treatment
plane.
• Gliding:
• This involves sliding one joint surface on the other within the
treatment plane.
 Kaltenborn Treatment Plane
The treatment plane is a plane perpendicular to a line extending from
the axis of rotation in the convex bony partner to the deepest part of
the concave joint surface.
The keltenborn treatment plane remains with the concave
Joint surface whether the moving joint partner is concave or convex
Treatment plane
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3 Convex-Concave Rule: This fundamental rule helps determine the
direction of the accessory glide movement during mobilization:
• When a convex joint surface moves on a stable concave surface, the
roll and glide occur in opposite directions. To increase motion, the
therapist mobilizes the convex bone in the direction opposite to the
restricted physiological movement.
• When a concave joint surface moves on a stable convex surface, the
roll and glide occur in the same direction. To increase motion, the
therapist mobilizes the concave bone in the direction same as the
restricted physiological movement.
 Example:
• For a restricted shoulder external rotation where the
humerus (convex) is moving on the glenoid (concave),
according to the convex-concave rule, the glide of the
humeral head will be in the opposite direction to the
external rotation (i.e., anterior). Therefore, to increase
external rotation, the therapist would perform a posterior
glide of the humeral head.
 4 Grades of Movement
• (Used non thrust sustained stretching)
• Kaltenborn developed a grading system for mobilization based on the amplitude and
location of the movement within the joint's range of motion:
• Grade I (Loosening): Small amplitude movement, typically performed in the
beginning of the range, used for pain relief or to relieve joint compression.
• Grade I TRACTION nullifies the normal compressive forces acting on the joint and
reduces friction between the joint surfaces during gliding movements
• Grade II (Tightening):enough distraction or glide is aaplied to tighten the tissue)
• Movement first takes up the slack in the joint capsule and moves into the tissue
resistance.(Used to assess joint sensitivity and maintain joint play movement.
• .
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• Grade III (Stretching): Large amplitude movement,
performed to the anatomical limit of the joint to stretch
tight structures and increase range of motion
 Objectives

• The primary objectives of the Kaltenborn Concept are to:

• Reduce Pain: By restoring normal joint mechanics and reducing stress on pain-
sensitive structures.
• Increase Joint Mobility/Range of Motion (ROM): By addressing restrictions in
accessory movements and stretching tight joint capsules and ligaments.
• Restore Normal Joint Function: By optimizing arthrokinematics, which in turn
facilitates normal osteokinematic (physiological) movements.
• Prevent Further Dysfunction: By educating patients on proper movement
patterns and self-treatment techniques.
• Accurately Diagnose Musculoskeletal Dysfunctions: Through a systematic and
biomechanical evaluation.
 Treatment Methods

• The Kaltenborn Concept employs various manual therapy

techniques, primarily joint mobilization and traction,
along with complementary soft tissue techniques and
therapeutic exercises. The treatment is highly
individualized and based on a thorough assessment.
 Examination and Assessment:

• History Taking: Detailed information about the patient's symptoms, mechanism of injury,
and functional limitations.
• Observation: Assessing posture, gait, and overall movement patterns.
• Active and Passive Physiological Movement Testing: Evaluating the range, quality, and
presence of pain during active (patient-initiated) and passive (therapist-initiated) movements.
• Joint Play Testing: This is a hallmark of Kaltenborn. The therapist passively assesses the
accessory movements (distraction and glides) to identify hypomobility (restricted movement)
or hypermobility. This helps pinpoint the specific joint structure causing the dysfunction.
• End-feel Assessment: Evaluating the quality of resistance felt at the end of passive range of
motion.
• Palpation: Feeling for tenderness, muscle spasm, and joint position.
 Treatment Techniques:

• Traction (Distraction): Applying a force perpendicular to the treatment

plane to separate the joint surfaces. This can:
• Decrease joint compression.
• Reduce pain by relieving pressure on pain-sensitive structures.
• Increase mobility by stretching the joint capsule and ligaments.
• Often used as an initial technique before glides.
• Gliding (Sliding): Applying a force parallel to the treatment plane to slide
one joint surface over another. This is used to:
• Increase specific ranges of motion by stretching restricted parts of the joint capsule.
• Follows the convex-concave rule to determine the direction of the glide.
 Mobilization Grades Application:

•Grade I & II: Primarily used for pain relief and to reduce muscle guarding. Performed within the pain-
free range.
•Grade III: Used to increase joint mobility and stretch tight connective tissues. Applied into resistance,
often at the end of the available range.
•Pre-positioning: Positioning the joint in its "resting position" (a position of maximum joint play) or a
specific "treatment position" to optimize the effectiveness of the mobilization.
•Stabilization: The therapist ensures that adjacent joints are stabilized to isolate the movement to the
target joint.
•Self-Treatment and Ergonomics: Patients are often taught self-mobilization techniques and
provided with ergonomic advice to maintain the gains made in therapy and prevent recurrence.
•Thank you