Maitland's Mobilization Grades
Beyond joint restriction
Grade V
Determines which direction a joint is mobilized
Concave-Convex Principle
Retraction, depression, and downward rotation
Scapula - D1 Extension
Used for developing strength at certain points of ROM
Slow Reversal Hold
Commonly called "Removing the Sword"
D2 Flexion Upper Extremity
Grade IV
joint restriction
If concave fixed -- convex is mobilized, which direction do you move
opposite of desired motion
Flexion, external rotation, adduction
Shoulder - D1 Flexion
Used for muscle tightness causing limited ROM
Contract relax
Wrist - D2 Extension
Ulnar flexion
Midrange
Grade II
Joint mobilizations are best completed in what kind of position
loose-packed position
Hip - D1 extension
extension, abduction, and internal rotation
What would be the agonist in the Hold-Relax pattern
Quadriceps
Manual resistance points for D2 Extension - Upper Extremity
Volar surface of hand and cubital elbow
Grade III
midrange to joint restriction
Direction of desired motion
convex fixed--concave mobilized
Manual resistance points for D1 Flexion - Lower Extremity
dorsomedial foot and anteromedial knee
Slow Reversal uses
used for AROM and normal timing of agonist/antagonist
These can be extended or flexed depending on D2 pattern for the lower extremity
Toes, Knee & Hip
Joint play
Grade I
Common exceptions to the concave-convex principle are found in what joints
spinal facets
scapulothoracic joint
proximal tibiofibular joint
Fingers - D1 Flexion
flexion and adduction
1) Isotonic agonist contraction (quadriceps) into agonist pattern
2) Isometric antagonist contraction (hamstrings)
3) Antagonist (hamstring) relaxes and agonist contracts (quadriceps) moving towards agonist pattern
Slow-Reversal Hold Relax
Tibia - D2 Flexion
External Rotation