Maitland Grades

• Accessory Movement - Accessory or joint play movements are joint movements which cannot be performed by the individual. These movements include roll, spin and slide which accompany physiological movements of a joint. The accessory movements are examined passively to assess range and symptom response in the open pack position of a joint. Understanding this idea of accessory movements and their dysfunction is essential to applying the Maitland concept clinically

• Physiological Movement - The movements which can be achieved and performed actively by a person and can be analysed for quality and symptom response.

• Mobilisation  (Grade I---IV)

A passive movements performed in such a manner and speed that at all times they are within they are within the control of the patient so that the movement can be prevented if the patient so chooses.

• Manipulation  ( Grade V )

A passive movement consisting of a high velocity, small amplitude thrust within the joints anatomical limit performed in such a way that the patient is powerless to prevent.

• Lower grades (I + II) are used to reduce pain and irritability (use VAS + SIN scores).

• Higher grades (III + IV) are used to stretch the joint capsule and passive tissues which support and stabilise the joint so increase range of movement.

Grade I – small amplitude movement at the beginning of the available range of movement, when pain limits movement.

Grade II – large amplitude movement at within the available range of movement, as above for pain dominant states.

Grade III – large amplitude movement that moves into stiffness or muscle spasm, for stiffness > pain dominate states

Grade IV – small amplitude movement stretching into stiffness and resistance, as above.