Grade V Mobilization

Physical therapists widely use joint mobilization techniques consisting of controlled skilled passive movements to the joint structures with appropriate velocity and amplitudes aimed at increasing joint range of motion ROM, decreasing pain and improve functional activities.

Maitland joint mobilization techniques was developed by an Australian physiotherapist named

Geoffrey Douglas Maitland. Maitland technique has five basic grades of joint mobilization depends upon the rate and rhythm of movement used by physical therapist along the direction of movement within available ROM. According to Dutton 2012, appropriate selection of the grade is based on the end feel of the joint movement and the stage of the condition. Amplitude

referred

Inferior glide- glenohumeral joint

MAITLAND JOINT MOBILIZATION 6

Grade V Mobilization. The Grade V mobilization or manipulation uses a short-duration, small amplitude and high velocity thrust applied at the physiologic limit of the joint ROM, (Dutton

2012). Grade V mobilization needs more skilled and experienced hands in order to ensure safety and effectiveness of treatment. Speed, force, and correct application of a high velocity thrust are very critical to the success of the treatment, Dutton 2012. High velocity thrust helps in improving the ROM by breaking the adhesion formation within the joint capsule, and also helps in promoting normal alignment of collagen fibers. Dutton (2012) explained that high velocity thrust technique is safer than other grades if applied safely and helps minimizing the creep and fatigue failure in normal collagen tissues.

Example: Patient presented with terminal range limitation of hip joint extension without any signs of acute inflammation and pain. The clinician decided to apply Grade V mobilization technique to break adhesions and improve the terminal ROM. Patient is position in

After assessing the end-feel of the hip extension range, the clinician applied a sudden, short duration, small amplitude and high velocity thrust intended to go past the barrier , in the range of 20-30 degree of extension. 10-15 repetitions with 2 times a week for 3 weeks will be sufficient to regain the maximum range of motions. The clinician must be able to identify the nature of restriction before deciding to choose the Grade V mobilization. As Dutton (2012) pointed out, if the reason for restriction is chronic capsular fibrosis, then it is advisable to avoid end range mobilization