Concepts of joint mobilization musculoskeletal key. The calcaneocuboid joint however, has a saddleshaped joint surface. Manual mobilization of the lumbar and thoracic spine. This change in joint shape allows for more rotation and torsional movement above rib 7 and more planar gliding movement below that level. Manual therapy and corrective exercise for common extremity. The authors used two different styles of diagnostic reasoning. Made up of articular cartilage, articular capsule, synovial cavity, synovial fluid, bursae and tendon sheath, meniscus, a nerve supply, and blood supply. Jan 11, 20 arthrokinematics refers to the movement of joint surfaces. Jul 25, 2020 the concaveconvex rule by kaltenborn tells us which part of the joint capsule is stressed when we move an adjacent joint partner. This logic is consistent with a combined anterior slide and posterior roll during external rotation of the humeral head.
Kaltenborn evjenth orthopedic manipulative therapy omt. The convexconcave rule is considered an important theory during treatment decisionmaking kirby et al. Concave convex rule movement gained by a specific manual technique performed in isolation will be lost within how many hours if the motions gained are not reinforced. Comparison of manual therapy and exercise therapy in osteoarthritis of the hip. This concept is transferred into manual therapy to define the concave convex rule. The convexconcave rule is the basis for determining the direction of the mobilizing force when joint mobilization gliding techniques are used to increase a certain. Analysis of kneeling by medical imaging shows the femur moves.
Concave convex rule convex moves on concave, roll and glide in opposite directions concave moves on convex, roll and glide in same direction convex concave rule it doesnt always work johnson aj, godgesjj, zimmerman gj, et al. Research and rehabilitation plantar fasciitis, lateral epicondylitis. Anatomically, all articular surfaces are either convex or concave, 4, 21 although the surfaces of some joints are not. As such, the findings have major therapeutic implications for manual therapy. The convex concave rule is the basis for determining the direction of the mobilizing force when joint mobilization gliding techniques are used to increase a certain. My rebuttal to this argument is that the convexconcave rule was never intended to establish the. When a concave joint surface is moving, the roll and the glide occur in the same direction. During my entry level pt program, i was taught that movements occurring at various joints in the human body such as l5s1 zygapophyseal joints can be classified into having normal mobility, hypermobility or.
Define the arthrokinematic rules with convex and concave relationships to determine the appropriate traction and glide directions for improving motion at the thumb, wrist, elbow, and shoulder. The kaltenborn convex concave rule is a familiar concept in manual therapy joint techniques and arthrokinematics. One of the staples of physical therapy and kinesiology foundations includes the convexconcave rules of joint motion. The convexconcave rules of arthrokinematics the manual.
Jan 01, 2006 the motion of the radial head on the ulnar surface consists of an anterior spinning with anterior gliding which contrasts with the concaveconvex rule as used in manual therapy i. Manual therapy manual accumulated learning from osu. In this edition i revisit the concept to clarify its use and misuse. Analysis of kneeling by medical imaging shows the femur. My rebuttal to this argument is that the convex concave rule was never intended to establish the. Manual therapy in the management of upper extremity musculoskeletal. It states that when a convex surface moves on a concave surface, the convex surface rolls one way and glides the opposite direction.
Its all about which bone contains the axis of rotation. Information from the convex concave rule can also be applied when performing manual glides. According to capte who can perform joint mobilization manual therapy techniques. Concaveconvex rule for the accompanying article with. With mathematical calculations they deduced intraarticular kinematics which were not according to the convexconcave principle. When a convex joint surface is moving, the roll and glide occur in the opposite direction. During my entry level pt program, i was taught that movements occurring at various joints in the human body such as l5s1 zygapophyseal joints can be. Free physical therapy dictionary concaveconvex rule. The authors suggested that the standard rationale for manual therapy interventions, known as the concave convex rule of mobilization, is erroneous. Manual therapy techniques are skilled hand movements intended to improve tissue extensibility, increase range of motion rom, induce relaxation, mobilize or manipulate soft tissue and joints, modulate pain, and reduce soft tissue swelling, inflammation, or restriction. Manual therapy manual accumulated learning from osu sports.
Convex concave rule when examiner mobilizes the bone with the concave surface, move in the same directionas the restriction when the examiner moves the bone with the convex surface, move in the opposite directionas the restriction joint mobilization grades of movement for oscillations grade i. How to get range of motion when other methods fail. The concaveconvex rule by kaltenborn tells us which part of the joint capsule is stressed when we move an adjacent joint partner. Kaltenborns convex concave rule is a familiar concept in joint treatment techniques and arthrokinematics. The convex concave rule suggests that the preferred direction of a manual glide to improve external rotation is anterior. You can watch a video in the top right corner in which we cover the concept in more detail. This is because the direction which an articular surface should naturally glide, is the same direction you will use for a mobilisation. Pt, proposed concave convex rules which mt evaluation and treatments are to be based on kaltenfborn 1975. The effect of anterior versus posterior glide joint mobilization on external rotation range. Figure 1 from the convexconcave rule and the lever law. Proper positing of the patient as well as the therapist proper hand placement.
Feb 01, 2012 the convexconcave rule suggests that the preferred direction of a manual glide to improve external rotation is anterior. The rule is based on the relationship between normal bone rotations and the gliding component of the corresponding joint movements. They utilized a variety of clinical reasoning cr strategies to explain their findings within this case study. The concaveconvex rule by freddy kalternborn is taught in many physio. The convexconcave rule and the lever law researchgate. For kaltenborn literature overview, please click here. The convexconcave rule of arthrokinematics has been widely accepted and practiced in manual therapy. Kaltenborns concaveconvex rule flawed or just misinterpreted. Distal concave segment base of p1 moves on proximal convex segment mc head roll and slide are in same direction posterior glides to increase extension anterior glides to increase flexion small joints of the hand. As such, the findings have major therapeutic implicat. Biomechanics of manual therapy uofspt wikia fandom.
Anatomically, all articular surfaces are either convex or concave,4,21 although the surfaces of some joints are not. In yesterdays post we showed that posteriorly directed mobilizations of the gh joint improved external rotation more than ap mobilizations, which. Kaltenborn f, evjenth o, kaltenborn t, morgan d, vollowitz e. Deep flexion requires femoral posterior translation and external rotation. Exam 2 musculoskeletal assessment flashcards quizlet. Manual therapy the convexconcave rule is considered an important theory during treatment decisionmaking kirby et al. This online physical therapy glossary can be helpful in learning physical therapy definitions. Combination of both mac conaill 1969 used mechanical models in describing roll, spin and glide in gh joint kaltenborn 1980 used macconaills work in. The kaltenborn convexconcave rule is a familiar concept in manual therapy joint techniques and arthrokinematics. Patient response approach movements and treatments based on pts reports of symptoms provocation and resolution 3. The convex concave rule is a didactic simplification of determining the direction of.
One of the staples of physical therapy and kinesiology foundations includes the convex concave rules of joint motion. The convex concave rule i introduced over four decades ago, has been widely misunderstood. Joint mobilization an overview sciencedirect topics. This is based upon which articular surface distal vs. This joint is formed by the trapezium bone of the wrist and the first metacarpal bone of the thumb. The concave surface on the inferiorposterior surface of the talus articulates with the convex surface of the superior calcaneus. The idea that the morphology of articular surfaces is strongly related to kinematics can be.
In the upper thorax, there is a concave convex articulation between the convex costal surface and concave tp surface. Hand and upper extremity manual therapy certificate program. In a convex bone humeral head it rotates around the axis which is. The costotransverse joints gradually flatten and are more planar in the lower thorax. Free physical therapy dictionary offers a free online physical therapy dictionary that allows users to search physical therapy terms based on first letter or by phrase. Because of its relative instability, this joint is a frequent site for osteoarthritis. The specific kaltenborn mobilization of posterioranterior gliding with distraction in grade 3 of the cmc joint. The concave convex rule by freddy kalternborn is taught in many physio. The convex concave rule of arthrokinematics has been widely accepted and practiced in manual therapy. If a concave surface moves on a convex surface, the concave surface rolls and glides in the same direction. Trapeziometacarpal osteoarthritis, also known as osteoarthritis at the base of the thumb or as rhizarthrosis, is a reparitive joint disease affecting the first carpometacarpal joint cmc1.
In vivo 3d arthrokinematics of the proximal and distal. One way to predict arthrokinematic roll and slide combinations is through the convex concave rule. The concave surface on the cuboid guides movements for flexion and extension. Convex concave rule it doesnt always work johnson aj, godgesjj, zimmerman gj, et al. The convexconcave rule suggests that the preferred direction of a manual glide to improve external rotation is anterior. The motion of the radial head on the ulnar surface consists of an anterior spinning with anterior gliding which contrasts with the concaveconvex rule as used in manual therapy i. Mar 16, 2015 the convex concave rule specifically states, when the concave surface is stationary and the convex surface is moving, the gliding movement in the joint occurs in a direction opposite to the bone movement.
Originally developed by contributors such as kaltenborn and evjenth from norway kaltenborn et al 2002, orthopaedic manual therapy omt utilizes a clinical reasoning paradigm based on the manual therapists perception of joint restriction as revealed by passive movement examination and the application of the concave convex rule. The 8th edition has been updated with an introduction to manipulative thrust techniques, both in theory and practice, in addition to conventional nonthrust mobilization techniques. Describe the clinical presentation of a patient with disputed neurogenic thoracic outlet and apply treatment techniques to address this condition. Indication and contraindication points to be remembered manual therapy has a long history effective treatment differentiate physical therapists from gps. In brief, kaltenborn described these mechanics in terms of the convex concave rule. Scarvell concluded that deep flexion requires femoral posterior translation and external rotation. Applying the theory to manual therapy results in parameters of techniques such as. Jun 02, 20 the kaltenborn convex concave rule is indirect, and is used to deduce the direction of restricted joint gliding only in cases where the clinician cannot palpate movement restrictions directly, for example, in cases of severe pain or spasm, or in joints with very small range of movement e. Research commentarychris showalter pt, dpt, ocs, faaomptprogram director, maps orthopedic manual therapy fellowship backgroundthe concave convex rule is widely considered to be an important concept utilized by approaches in orthopedic manual therapy that rely heavily upon utilizing biomechanical principles in the management of joint dysfunction. In yesterdays post we showed that posteriorly directed mobilizations of the gh joint improved.
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