KALTENBORN MANUAL

MOBILIZATION
 KALTENBORN – EVJENTH
ORTHOPEDIC MANIPULATIVE
THERAPY (OMT)
• Kaltenborn Techniques

 Kaltenborn’s techniques use a combination of traction and

Sreeraj S R
mobilization to reduce pain and mobilize hypomobile
joints

 According to Kaltenborn, all joint mobilizations, when

performed correctly should be made parallel, or at right
angles to this plane of motion

• Maitland's grades of joint mobilization differ from

Kaltenborn's because they are oscillations while Kaltenborn's
are sustained.

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TWO TYPES OF BONE MOVEMENTS ARE
IMPORTANT IN OMT SYSTEM:

Sreeraj S R
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• A common goal in OMT is to restore the gliding
component of roll-gliding to normalize
movement mechanics.

Sreeraj S R
• Joint rolling movements in the absence of gliding
can produce a damaging concentration of forces in
a joint.

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 THE KALTENBORN
TREATMENT PLANE

• passes through the

joint and lies at a right

Sreeraj S R
angle to a line running
from the axis of
rotation in the convex
bony partner, to the
deepest aspect of the
articulating concave
surface.
Kaltenborn FM. The Extremities Volume 1. 6th Edition. Norli, Norway; 2006.Chapter 2: Translatoric joint play: p. 32

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 THE KALTENBORN
TREATMENT PLANE

• remains with the

concave joint surface

Sreeraj S R
whether the moving
joint partner is concave
or convex.

• Always test joint play or

mobilize a joint by moving
the bone parallel to, or at
a right angle to, the
Kaltenbom Treatment
Plane.
Kaltenborn FM. The Extremities Volume 1. 6th Edition. Norli, Norway; 2006.Chapter 2: Translatoric joint play: p. 32

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 TRANSLATORIC JOINT PLAY
MOVEMENTS
• The translatoric joint play movements used in
the OMT Kaltenbom-Evjenth System are

Sreeraj S R
• Traction,
• Compression, and
• Gliding.

Kaltenborn FM. The Extremities Volume 1. 6th Edition. Norli, Norway; 2006.Chapter 2: Translatoric joint play: p. 33

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 Tractio
n

Sreeraj S R
Compressio Glidin
n g

Kaltenborn FM. The Extremities Volume 1. 6th Edition. Norli, Norway; 2006.Chapter 2: Translatoric joint play: p. 33-34

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 DETERMINING THE DIRECTION OF
RESTRICTED GLIDING

• There are two methods of determining the

direction of restricted joint gliding:

Sreeraj S R
1. The glide test, and
2. The Kaltenborn convex concave rule .

Kaltenborn FM. The Extremities Volume 1. 6th Edition. Norli, Norway; 2006.Chapter 2: Translatoric joint play: p. 34

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 GLIDE
TEST
• It is the direct method
• Apply passive translatoric gliding movements in all

Sreeraj S R
possible directions and determine in which
directions joint gliding is restricted.
• The glide test is the preferred method because it
gives the most accurate information about the
degree and nature of a gliding restriction,
including its end-feel.

Kaltenborn FM. The Extremities Volume 1. 6th Edition. Norli, Norway; 2006.Chapter 2: Translatoric joint play: p. 34

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 KALTENBORN CONVEX-
CONCAVE RULE

• the indirect
method

Sreeraj S R
Kaltenborn FM. The Extremities Volume 1. 6th Edition. Norli, Norway; 2006.Chapter 2: Translatoric joint play: p. 35

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 GRADES OF TRANSLATORIC
MOVEMENT
• The translatoric movements of traction and
gliding are divided into three grades.
• These grades are determined by the amount of

Sreeraj S R
joint slack (looseness and resistance) in the joint
• The slack is taken up when testing and treating
joints with gliding or traction.
• When gliding is performed, the slack is taken up
in the direction of joint gliding;
• when traction is performed, the slack is taken up
in the direction of traction.
Kaltenborn FM. The Extremities Volume 1. 6th Edition. Norli, Norway; 2006.Chapter 2: Translatoric joint play: p. 36

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 NORMAL GRADES OF TRANSLATORIC
MOVEMENT

• In the Grade I and II SZ

range the therapist
senses little or no

Sreeraj S R
resistance.
• In the Grade II TZ range
the therapist senses
gradually increasing
resistance.
• At the First Stop, the
therapist senses
marked resistance as
the slack is taken up
and all tissues become
taut.
• Kaltenborn
Stretching occurs
FM. The Extremities Volume 1. 6th Edition. Norli, Norway; 2006.Chapter 2: Translatoric joint play: p. 37-38

beyond this point. 13

PATHOLOGICAL GRADES OF
TRANSLATORIC MOVEMENT

Sreeraj S R
Kaltenborn FM. The Extremities Volume 1. 6th Edition. Norli, Norway; 2006.Chapter 2: Translatoric joint play: p. 39

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 USING TRANSLATORIC
GRADES
• Grade I (loosen): relief pain
• Grade II (tighten): initial treatment, maintain

Sreeraj S R
joint play
• Grade III (stretch): stretch joint and increase
joint play

1. Kaltenborn FM. The Extremities Volume 1. 6th Edition. Norli, Norway; 2006.Chapter 2: Translatoric joint play: p. 40
2. http://sunrise.hk.edu.tw/~stpt/languagetherapy/therapeutic/teacher/Introduction%20of%20manual%20therapy.pdf

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 TESTS OF
FUNCTION
• Tests of function are a key element within the
OMT evaluation;

Sreeraj S R
• Assessing quantity of movement
• Assessing quality of movement

Kaltenborn FM. The Extremities Volume 1. 6th Edition. Norli, Norway; 2006. Chapter 3: Tests of Function: p. 42-46

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 QUANTITY OF
MOVEMENT

Sreeraj S R
Kaltenborn FM. The Extremities Volume 1. 6th Edition. Norli, Norway; 2006. Chapter 3: Tests of Function: p. 42

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 QUALITY OF
MOVEMENT

Sreeraj S R
1. Kaltenborn FM. The Extremities Volume 1. 6th Edition. Norli, Norway; 2006. Chapter 3: Tests of Function: p. 45
2. Petersen CM, Hayes KW. Construct Validity of Cyriax's Selective Tension Examination: Association of End-feels With Pain at the Knee and
Shoulder. Journal of Orthopaedic & Sports Physical Therapy 2OOO;3O (9) :5 12-527
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 QUALITY OF
MOVEMENT
Normal End Feel

• Soft: characteristic of soft tissue approximation. Feels

Sreeraj S R
like squeezing two balloons together. e.g., knee flexion.

• Firm: indicates that the joint capsular or ligamentous

stretching limiting the ROM. Feels like stretching a
leather belt. A normal ligamentous end-feel > capsular
end-feel.

• Hard: indicates that bone touching bone is limiting the

ROM. Feels like pushing two wooden surfaces together.
e.g., elbow extension.
1. Kaltenborn FM. The Extremities Volume 1. 6th Edition. Norli, Norway; 2006. Chapter 3: Tests of Function: p. 45
2. http://www.scranton.edu/faculty/kosmahl/courses/gonio/intro/end-feel.shtml

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 QUALITY OF
MOVEMENT

Pathological end-feel
• Boggy: intra-articular swelling produces a

Sreeraj S R
soft resistance
• Springy: For example, a displaced meniscus
• Empty: Pain
• Firmer, less elastic: scar tissue, shortened
connective tissue
• More elastic and less soft end-feel: muscle spasm

Kaltenborn FM. The Extremities Volume 1. 6th Edition. Norli, Norway; 2006. Chapter 3: Tests of Function: p. 46

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 ELEMENTS OF FUNCTION
TESTING
• Standard (anatomical) movements
• Combined (functional) movements

Sreeraj S R
• Painful arc
• Capsular pattern
• Differentiating Contractile lesions
from Non contractile lesions
• Differentiating muscle shortening
from muscle spasm

Kaltenborn FM. The Extremities Volume 1. 6th Edition. Norli, Norway; 2006. Chapter 3: Tests of Function: p. 46-51

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DIFFERENTIATING CONTRACTILE LESIONS
FROM NON CONTRACTILE
LESIONS

Contractile Non contractile

Sreeraj S R
Muscle with its tendons and attachments Bones, joint capsules, ligaments,
bursae, Fasciae, nerve roots

Active and passive movements Active and passive movements

are restricted in opposite are restricted in the same
directions. direction.
Passive joint play movements are Passive joint play movements produce
normal and symptom free. or increase symptoms and are
restricted.
Resisted movements produce or Resisted movements are symptom free.
increase symptoms.

Kaltenborn FM. The Extremities Volume 1. 6th Edition. Norli, Norway; 2006. Chapter 3: Tests of Function: p. 50

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DIFFERENTIATING MUSCLE SHORTENING
FROM MUSCLE SPASM
• Based on end-feel testing.
• A shortened, tight muscle imparts a firmer,

Sreeraj S R
less elastic end-feel
• Muscle spasm produces a more elastic and less
soft end-feel.

Kaltenborn FM. The Extremities Volume 1. 6th Edition. Norli, Norway; 2006. Chapter 3: Tests of Function: p. 51

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 TRANSLATORIC JOINT
PLAY TESTS
• Testing the quantity and quality of joint
play, including end feel, using

Sreeraj S R
• Traction,
• Compression, and
• Gliding
• In all of the translatoric directions in which a joint
is capable of moving.

Kaltenborn FM. The Extremities Volume 1. 6th Edition. Norli, Norway; 2006. Chapter 3: Tests of Function: p. 51-52

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 TRACTION AND
COMPRESSION TESTS

Traction Compression
Relieves joint pain Aggravates joint pain

Sreeraj S R
If traction tests is positive in the normal If compression tests are negative, the
resting position, find a position of tests should also be performed in
greater comfort and reevaluate the various three-dimensional positions.
patient's response to traction.

Kaltenborn FM. The Extremities Volume 1. 6th Edition. Norli, Norway; 2006. Chapter 3: Tests of Function: p. 52

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 GLIDING
TESTS
• Translatoric gliding primarily tests those
structures belonging to the anatomical joint.

Sreeraj S R
• Also important for determining the
specific directions of joint movement
restrictions.

• Evaluates gliding movement both in the

joint's resting and non resting positions.
Kaltenborn FM. The Extremities Volume 1. 6th Edition. Norli, Norway; 2006. Chapter 3: Tests of Function: p. 52

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 RESISTED
MOVEMENTS

 Ifcompression tests provoke pain, resisted tests are of

limited Value.

Sreeraj S R
 Resisted tests evaluate
 neuromuscular integrity,
 contractile elements and
 status of associated joints, nerves, and vascular supplies.
 Cyriax interprets resisted tests in the following ways:
 Painless and :
Painful and strong minor lesion of a muscle or tendon
strong

: Norli,
major
Norway;lesion of3:aTests
muscle or tendon
Painful and weak
Kaltenborn FM. The Extremities Volume 1. 6th Edition. 2006. Chapter of Function: p. 52

: neurological lesion or complete rupture of 27

Painless and
a muscle or tendon
weak
: normal
 DIFFERENTIAL DIAGNOSIS FOR PAIN IN
A MUSCLE SYNERGY
• To identify a specific muscle responsible for a
patient's pain, the examiner selectively elicits or
prevents contraction of a specific muscle or group

Sreeraj S R
of muscles. There are three methods described
below.
1. Testing a muscle's secondary function in
the same joint.
2. Testing a muscle's secondary function at
an adjacent joint
3. Testing using reciprocal inhibition
Kaltenborn FM. The Extremities Volume 1. 6th Edition. Norli, Norway; 2006. Chapter 3: Tests of Function: p. 53-54

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TESTING A MUSCLE'S SECONDARY FUNCTION
IN THE SAME JOINT
• If one muscle in a joint movement synergy has a
secondary function not shared by the other
muscles in the synergy, it can be selectively tested.

Sreeraj S R
For example,
• if resisted knee flexion is painful, further
examination of resisted lateral and medial leg
rotation may identify the specific muscle causing
the pain. If lateral rotation is painful and medial
rotation is not, then it is likely that the biceps
femoris is injured and not the other knee flexors
which medially rotate the leg.
Kaltenborn FM. The Extremities Volume 1. 6th Edition. Norli, Norway; 2006. Chapter 3: Tests of Function: p. 54

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TESTING A MUSCLE'S SECONDARY FUNCTION
AT AN ADJACENT JOINT
• A muscle or tendon can be selectively stressed if it
is the only muscle in a synergy which functions at
another joint.

Sreeraj S R
For example,
• pain with resisted shoulder flexion can be due to a
lesion in one of several muscles in a synergy
producing this movement. If resisted elbow flexion
produces the same pain, then the biceps is
implicated as it is the only muscle which can
produce both shoulder and elbow flexion.

Kaltenborn FM. The Extremities Volume 1. 6th Edition. Norli, Norway; 2006. Chapter 3: Tests of Function: p. 54

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 TESTING USING RECIPROCAL
INHIBITION
• This technique uses to prevent a muscle from
contracting in synergy with other muscles during a
movement by resisting the antagonist of the

Sreeraj S R
muscle.

For example,
• To eliminate the wrist extensors and test the finger
extensors, the examiner resists palmar flexion at
the wrist and finger extension simultaneously; the
resisted wrist palmar flexion will inhibit contraction
of the wrist extensors.
Kaltenborn FM. The Extremities Volume 1. 6th Edition. Norli, Norway; 2006. Chapter 3: Tests of Function: p. 54

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 INDICATI
ONS
• Restricted joint play
(hypomobility)

Sreeraj S R
• An abnormal end-feel

Kaltenborn FM. The Extremities Volume 1. 6th Edition. Norli, Norway; 2006. Chapter 3: Tests of Function: p. 59

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 ABSOLUTE
CONTRAINDICATIONS
• Malignancy in area of treatment
• Infectious Arthritis

Sreeraj S R
• Metabolic Bone Disease
• Neoplastic Disease
• Fusion or Ankylosis
• Osteomyelitis
• Fracture or Ligament Rupture
• excessive joint play (hypermobility) for grade
III mobilization

http://www.physio-pedia.com/images/c/c0/Principles_of_Joint_Mobilization.pdf

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 RELATIVE
CONTRAINDICATIONS
• Excessive pain or swelling
• Arthroplasty

Sreeraj S R
• Pregnancy
• Hypermobility
• Spondylolisthesis
• Rheumatoid arthritis
• Vertebrobasilar insufficiency

http://www.physio-pedia.com/images/c/c0/Principles_of_Joint_Mobilization.pdf

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 Sreeraj S R
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THANK
YOU