Basic Concepts of Extremity Joint

Mobilization

Ref: Peripheral Manipulation. 4ed.

GD Maitland

Chapter I

Using the Maitland Concept Toward             Patient Treatment

I. The patient -centered approach to dealing     with movement disorders:

Therapist needs to develop a level concentration: • a.See each piece of info given by the patient.• b. Ask relevant questions.

Follow up questions Good exam-revisit patient’s sensory,cognitive and emotional world. With regards to both subj/obj exam.Non-judgmentalTherapist’s needs to developed understanding of verbal and non verbal communication skills as it relates to patient-encourage patient confidence.

Using the Maitland Concept Toward             Patient Treatment

II. The Brick Wall Approach & Primacy of Clinical      Evidence

Applies to all manual PT models of treatment

Maitland defines the brick wall as permeable

dividing two compartments.

Special mode of thinking

Theoretical Clinical

Central Theme

The central theme of Maitland’s concept thinking, the symbolic permeable brick wall and the primacy of clinical evidence.

There are five requirements to assist with the brick wall approach.

Requirement One

Think in two distinctly separate compartments- (are separate yet interdependent)

• Theoretical Clinical

Pathology

Biomedical engineering

Diagnosis

Neurophysiology

Anatomy

History

Symptoms

Signs

Requirement 2

Need to know the history, signs and symptoms while making use of the theoretical compartment to formulate an diagnosis

What does the brick wall mode of thinking caters to?

• Recognizable syndromes( IT band)

• Recognizable pathology ( MM in the knee)

• Clinical disorders of movement (antalgic gait with hip pain)

Requirement 2

According to Maitland the clinical compartment has priority over the theoretical compartment.

What does this mean?

Example: DX of chronic tennis elbow

Avoid just focusing on elbow rule out other factors that could be relevant to the problem:

shoulder,

cervical and T spine

neural tissue

Requirement 3

Good choice of wording Example: “shoulder pain “may better serve the concept of separation of theory and clinical by the stating “pain in the shoulder area” thus not indicating thought that the shoulder was the specific cause of pain without ruling out other structures.

Requirement 4The therapist should choose a treatment technique in relation to the patient’s sign & symptoms.

Avoid having the theoretical compartment influence the vigor and choice of techniques

Example: DX. Acute hip bursitis limiting hip flexion

The technique of choice might be accessory passive movement in posterior glide in a gentle manner grade 1 (small amplitudes) due to server pain.

Requirement 5

The therapist be able to apply the brick wall concept to contemporary models clinical decision making

Summary

The two compartmental mode of thinking allows for discussion on speculation, hypotheses and research for the cause of the patient’s condition.

This concept allows for the theoretical mode, the widest thinking while knowing that, if that is correct, it must match with clinical information.

How Can We Interrelate the                  Two Modes?

ExaminationSubjective

Objective• Accessory movements /compression test

• Combined movements/ special test/ Rom and pain response/over pressure/MMT

Techniques

Assessment