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MovementDiagrams

MovementDiagrams

Movementdiagramsareatoolusedtoaidteachingandcommunication,i.e.anobjectivemeansof
quantifyingtherelationshipbetweenmovementandpaindeterminedduringapassiveexamination
technique.
DuringmyMastersdegreeIwascontinuallyaskedtoexplainwheretheonsetofpainwas,theonsetof
resistance,therelationshipbetweenthetwo,andthelimitingfactortomovement.Compilingthisinformation
intheformofamovementdiagramenabledmetounderstandtheprimarycauseofthemovement
abnormalityandallowmetocarefullyselectandapplytreatmenttechniquestotheproblem.
Movementdiagramsareaconceptthathavebeentaughtandwillcontinuetobetaughtatbothan
undergraduateandpostgraduatelevel.MypersonalexperienceduringundergradwasthatIpaidno
attentiontotheconcept,howeverfollowingmyMastersIusethemwitheverypatient.
BelowisasummaryandguidelinetoMaitland'steachingsontheuseofmovementdiagrams.Theaimisto
expandonyourcurrentunderstandingoftheuseofthistool,andperhapsencourageyoutoapplyitmore
frequentlytoclinicalpractice.
Whydoweusemovementdiagrams?
Themostimportantreasonistoknowwhatwearefeeling.Movementdiagramsareessentialtoseparate
thedifferentcomponentsofwhatisfeltwhenexaminingmovementandtoallowyoutoanalysetheeffect
thattreatmentishavingonsignsandsymptoms.
"Movementdiagramsareessentialfortounderstandtherelationshipthatthevariousgradesof
movementhavetothepatient'sabnormaljointsigns"(Maitland.,2005.p.446).

Howtoconstructamovementdiagram?
Thecomponentsconsideredinamovementdiagrampain,spasmfreeresistance(stiffness),musclespasm
(wherespasmisreferringtoprotectivemusclespasmsecondarytojointdisorder,notspasticitycausedby
upperneuronediseaseandnotvoluntarycontractionofmuscles).
1.Startoffbydrawingabox.
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2.MarkthehorizontallineAB=whichrepresentstherangeofmovement,whereAtoBisthelimitof
normalpassivemovement.(ROMisdeterminedtobenormalifanoverpressurecanbeappliedatthe
endofrangewithoutpain,andisdenotedbyadoubletickinclinicalnotes)
3.MarktheverticallineAC=whichrepresentsthequality,nature,orintensityofthevariablesbeing
plotted.
1.MarkP1=thefirstpointofpainalongtheABLine
2.MarkR1=thefirstpointofresistancealongtheABline.
4.Determinethelimitingfactor(Painorresistance)andatwhichpointthroughrangethelimitoccurs.At
thispointdrawaverticallineandlabelLwithadescriptionofthelimitingfactori.e.determinewhatL
represents.
5.DeterminethebehaviourofP1P2andR1R2andplotthemintheboxtocreatelinearlinesorcurved
lines.

Todeterminepain:
Askthepatienttoreportwhenthefirstdiscomfortbegins.
IfpainisthelimitingfactorthenL=P2
YoushouldtrytodescribeP2e.g.P2(leftsidedsuprascapularpain)
ThelinethatconnectsP1toP2caneitherbelinearorcurvilineartorepresentthatrateofchangein
pain.
TodetermineResistance:
Resistancemaybeduetoadaptiveshorteningofmusclesorcapsules,scartissue,arthriticjointchanges
andmore..
Anormaljointthatisrelaxedisfrictionfree.
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IfpainisthelimitingfactorthenR`isthenotationusedtorepresentatwhatpointinresistancethelimit
hasbeenreached.
IfL=R2thenR1R2behaviourneedstobedefinedandexpressedonthemovementdiagram.

Usingamovementdiagramtodeterminechoiceoftreatment.
Beforeyoucanusethemovementdiagramtodeterminewhatgradeoftreatment,firstletsrefreshhow
Maitlanddefinesthesegrades.
Grade1=asmallamplitudemovementnearthestartingpointofR1butnotintoresistance
Grade2=alargeamplitudemovementnearthestartingpointofresistancewhichisfreeofstiffnessor
spasm
Grade3=alargeamplitudemovementthatmovesintostiffnessorspasm
Grade4=asmallamplitudemovementthatmovesintostiffnessorspasm.
ThesefourgradescanthenbemodifiedasGrIII,GrIII,GrIII,GRIII+,andGRIII++.
Thishasbeenpresentedinthediagrambelowforfurtherclarification.

Sotocomebacktothepreviouspointusingamovementdiagramtodeterminechoiceoftreatment,these
arethestepsyoucanusetodeterminethegradeoftreatment.
1.PerformthePAIVM(Passiveaccessoryintervertebralmovement)orPPIVM(Passivephysiological
intervertebralmovement),applyingoverpressureattheendofrangeasappropriate.
2.DecidewhereP1andR1are,whatthelimitingfactoris,andwhereinrangethelimitexists.
3.Aimnottomobilisewithmorethan2025%ofpainasaroughguideline.Thisobviouslydependson
severityandirritabilitybutisasafeplacetostart.

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Thebelowimagesareexamplesgiventomeduringmymasterscoursewhenstudyingtheconceptof
movementdiagrams.Thecommentsontheimagesaremyindividualthoughts.

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Closingthoughtsaboutmovementdiagrams
Movementdiagramsareusefulto:

Explaintopatientsandtherapistswhatyouarefeelingduringyourassessment.
Helptojustifytreatmenttechniques.
Monitorpatientprogress.
And,ifusedwell,patientswillreallyunderstandthebenefitthetreatmenthasontheirmovement
dysfunction,helpingtobuildrapportandtrustwiththem.
Sian:)

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References:
Maitland,G.D.,&Hengeveld,E.(2005).Maitland'svertebralmanipulation.Edinburg:ElsevierButterworth
Heinemann.

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