Questions
3 questions per theory paper
Difficulty
Medium
Importance
High yield for clinical viva and practical exams
Overview
Joint mobilization and goniometry are foundational manual therapy and assessment skills in physiotherapy. Mastering these is crucial for clinical assessment and rehabilitative intervention, as they form the bridge between diagnostic range measurement and therapeutic manual technique.
Maitland Mobilization Grades
Maitland's classification describes the oscillation techniques used to manage pain and stiffness by moving joints within their physiological or accessory range. Examiners look for precise knowledge of the mechanical intent behind each grade.
- Grade I: Small amplitude at the beginning of range for pain modulation.
- Grade II: Large amplitude within the range, not reaching tissue resistance.
- Grade III: Large amplitude reaching into tissue resistance for stiffness.
- Grade IV: Small amplitude at the end of range for mechanical remodeling.
- Grade V: High velocity thrust technique (Manipulation) beyond resistance.
Goniometry Principles
Goniometry is the systematic measurement of joint angles to quantify active and passive range of motion. Success in exams depends on identifying proper axis placement, stationary arm alignment, and moving arm movement.
- Fulcrum: Placed over the axis of rotation of the joint.
- Stationary arm: Aligned with the proximal long axis of the segment.
- Moving arm: Aligned with the distal long axis of the segment.
- Documentation: Record as ROM (e.g., 0-140 degrees) to denote start/end points.
- Universal goniometer is the gold standard for clinical measurement.
Range of Motion (ROM) Assessment
ROM assessment distinguishes between physiological barriers and pathological limitations in joint function. Understanding the 'end-feel' is critical for differentiating between bony, capsular, and muscular restrictions.
- Hard end-feel: Bone-to-bone contact.
- Soft end-feel: Soft tissue approximation.
- Firm end-feel: Capsular or ligamentous stretch.
- Empty end-feel: Pain prevents reaching true resistance.
- Passive ROM usually exceeds active ROM due to slack in muscle tissue.
Exam Tip
Always link the mobilization grade directly to the patient's primary symptom: Grades I/II for pain (hypo-mobile), Grades III/IV for stiffness (hyper-mobile).
Common Mistakes
- Confusing Grade II and Grade III mobilization parameters regarding tissue resistance.
- Incorrect placement of the goniometer fulcrum leading to inconsistent angle readings.
- Failing to stabilize the proximal segment during goniometric measurement, leading to compensatory movements.
More Revision Notes
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