Joint MobilizationIntermediate

Kaltenborn–Evjenth Mobilization

Mobilization that uses joint shape (the convex-concave rule) to pick the glide direction, and traction grades to loosen, take up slack, or stretch.

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What it is, in plain words

Mobilization that uses joint shape (the convex-concave rule) to pick the glide direction, and traction grades to loosen, take up slack, or stretch.

The Kaltenborn-Evjenth approach explains which way a joint surface should glide so that a restricted movement can improve. You apply sustained or gentle traction and gliding in the joint's own 'treatment plane', using three stages that range from simply relieving pressure to stretching tight tissue.

Think of it like this: A key only turns if you push it in the direction the lock expects. Joint surfaces are curved; if you know their shape, you know which way the bone must slide for the movement to open up.

1. The three ideas behind it

1Convex-concave rule: when a convex surface moves on a concave one, the bone glides opposite to the direction the bone's shaft moves. When a concave surface moves on a convex one, the glide goes the same way as the shaft.
2Three stages of traction: Stage I loosens (relieves pressure, no stretch), Stage II takes up the slack, Stage III stretches tissue.
3Compare to the other side and feel the end-feel (the quality of the stop) to judge whether the joint is stiff, loose or normal.

2. Words you need (no dictionary required)

Convex / concave: Convex is rounded outward like a ball; concave is curved inward like a cup.
Treatment plane: An imaginary flat plane across the concave joint surface. Gliding runs parallel to it and traction runs at right angles to it.
Slack: The free play in tissues before they begin to tighten.
End-feel: What the stop at the end of a movement feels like: firm, hard, springy or empty.
Hypomobile: A joint that moves less than expected.

3. When to use it, and when not to

Good fit

A joint that moves less than the other side with a firm, capsular-type end-feel.
When you need to decide glide direction logically, for example for shoulder elevation or knee extension.
Pain-dominant joints (Stage I) and stiff joints (Stage III) in the same framework.

Do not use, or get advice first

Unstable joints, acute fractures, active infection or inflammation, and suspected tumour.
Hypermobile joints, where you stabilize instead of stretching.
Any worsening neurological symptoms during the technique.

4. How to do it, step by step

Step 1 · Find the joint and its shape
Example: the shoulder. The humeral head is convex and the socket is concave.
Step 2 · Work out the glide direction
For shoulder elevation, the convex head must glide downward (inferior), opposite to the arm rising. For knee extension, the concave tibia glides forward on the convex femur.
Step 3 · Compare sides and feel the end-feel
Test the same glide on both joints. Note which is stiffer, and whether it is painful.
Step 4 · Stage I
Apply a small traction that just relieves joint pressure. Use this to calm pain and test sensitivity.
Step 5 · Stage II then III
Take up the slack, then add a sustained stretch into the resistance if the joint is not irritable.
Step 6 · Release slowly and retest
Let go gradually and re-check the original movement.

5. How much is enough?

Typical teaching range: a gentle Stage I traction held about 10 seconds for pain; for stiffness, a Stage III stretch held roughly 6-10 seconds and released, repeated several times. Adjust to the response.

6. A real-life example, start to finish

Fictional teaching case. Real patients always need individual assessment.

The patient: Meena, 58, cannot lift her right arm above the shoulder after six weeks in a sling.
What you find: Elevation is 100 degrees on the right and 160 on the left, stopping with a firm end-feel. Pain is mild and settles quickly.
What you do: Using the convex-concave rule you apply an inferior glide of the humeral head with the arm supported, after a short Stage I traction to settle the joint, then a Stage III stretch.
What changed: Elevation reaches 120 degrees. You follow with active lifting practice with a stick, then repeat within a few days.

7. Mistakes that spoil it

Applying the glide in the wrong direction because the rule was memorized, not understood.
Stretching (Stage III) an irritable, painful joint.
Forgetting to retest the movement.

8. Check yourself

Concave tibia moves on a convex femur in knee extension. Which way does the tibia glide?

Forward, in the same direction as the shaft moves.

What is Stage I traction for?

To relieve pressure and settle pain, with no stretch.

Remember this one line

Know the joint shape, choose the glide direction, escalate the stage only if the joint is calm.

What the research does and does not support

The convex-concave rule is a useful teaching model, but real joints do not always glide exactly as predicted. Evidence for outcomes is similar to other mobilization: helpful short-term for selected patients, best with exercise.

Educational content. Hands-on skills require supervised practice, screening and informed consent.

Optional · Short patient story to help rememberA joint can feel restricted. Which direction deserves your attention?

PNA · Inside the clinic

Joint surfaces never studied the convex–concave rule.

A fictional teaching scenario to make the clinical reasoning memorable. The real patient, of course, always gets an individual assessment.

01 · The patient walks in

Here is the problem. What would you notice?

An overhead reach stops halfway. The patient looks at the arm as if it betrayed them. You observe the shoulder hike, then check the painful direction before considering the treatment plane.

02 · The decision

Now the hands—and the thinking—come in.

Stabilize comfortably and introduce a measured traction or translatoric glide chosen from anatomy and examination. A diagram suggests a direction; the patient's response decides whether to keep it.

Freeze-frame · Picture it happening

Imagine the arm fully supported while one hand stabilizes and the other introduces a measured glide. Nothing jerks; nothing needs to pop. The therapist asks about the familiar reach and watches the patient test it rather than admiring the neatness of the glide.

03 · The moment of truth

After the hands leave, what is different?

Repeat the reach without your hands. The real goal is easier function—not proving that a convex–concave rule is always the whole story.

The treatment plane is the map. Reassessment is the destination.

Ready for the actual technique? Continue to the practical guide

Practical Application

How the technique is actually applied

Patient setup, therapist position, hand placement, force direction, what to expect, when to stop, and common mistakes.

A closer look

Patient Position

The treatment begins before the first contact. Comfort, support and a relaxed starting position shape everything that follows.

Support the joint in its resting or treatment position so surrounding muscles are relaxed. Use belts, towels or the table when appropriate to reduce the amount of muscular effort needed from the therapist and patient.

A closer look

Therapist Position

Now consider the person delivering the technique. Control should come from thoughtful body mechanics, not unnecessary force.

Stand in the line of the treatment plane and keep your body close to the patient. Use a stable base of support so you can maintain a sustained force without shaking or changing direction.

A closer look

Exact Hand Placement

The details of contact change the quality of the whole technique. This is where precision matters.

Stabilize one bone firmly but comfortably. Contact the moving bone close to the joint line using a broad surface of the hand or a treatment belt when appropriate.

Keep pressure away from superficial nerves and painful bony points.

A closer look

Direction & Type of Force

Every input needs a purpose. Watch how direction, pace and pressure shape the patient's response.

Traction is applied perpendicular to the treatment plane. Gliding is applied parallel to the treatment plane.

Grade I is a very small distraction that reduces compressive contact; Grade II takes up slack; Grade III stretches restricted periarticular tissue. Convex-concave rules can guide the first choice of glide, but the patient's response confirms whether the direction is useful.

The clinical sequence

Complete Applying Method — Step by Step

01
Measure active movement, passive movement, end feel and joint play.
02
Place the joint in a comfortable treatment position.
03
Stabilize the proximal segment and gently remove slack.
04
Apply Grade I or II first when pain is dominant; use Grade III only when stiffness is dominant and the joint is safe.
05
Hold the translatoric force steadily without bouncing.
06
Release slowly, allow a short rest, then reassess range and symptoms.
07
Repeat only if the response is positive and then reinforce the improvement with active movement.

A closer look

What Would Count as Progress?

When you release the contact, look for a meaningful change—not simply a dramatic sensation.

Reduced compression pain, improved joint play, easier osteokinematic movement, or a more comfortable end range.

Clinical safety

Stop / Modify Immediately If…

Safety is never the final footnote. These responses call for immediate reassessment.

Sharp joint pain, apprehension, neurological symptoms, increasing guarding, or worsening movement after each attempt.

Clinical safety

Where Good Intentions Go Wrong

Even a familiar technique can lose its value when these mistakes enter the room.

Confusing osteokinematic motion with translatoric glide. Applying traction in the wrong direction relative to the treatment plane.

Using Grade III in an acutely irritable joint. Holding the distal limb without adequately stabilizing the proximal bone.

Another worked clinical example · Open when you want more practice

Inside the clinic

See It Through a Patient's Eyes

Picture this as a hypothetical clinical moment. The real lesson is what happens to the patient's movement afterward.

Example: limited ankle dorsiflexion after a healed sprain may respond to a sustained talocrural glide. Recheck the weight-bearing lunge immediately, then train calf strength and squat/step mechanics.

Illustrative teaching scenario, not a patient testimonial.

Clinical curveball · Your turn

The technique is over. But did it work?

The glide follows the textbook perfectly but the functional reach worsens. Is the treatment still correct?

Think first, then reveal the reasoning

No meaningful positive response has been demonstrated. Stop or modify, assess symptom irritability, and use the patient's response rather than treating a model as a verdict.

An educational scenario, not a replacement for individual clinical assessment.

The non-negotiables

Useful, safe and worth repeating?

Indications, dosage, precautions and contraindications — kept clear and easy to find.

A closer look

How Much Is Enough?

A measured dose makes it easier to understand whether the technique is helping.

Grade I traction: neutralizes joint compression. Grade II: takes up slack.

Grade III: applies a sustained stretch to restricted tissues. Hold times are individualized; sustained bouts are commonly repeated with rest and reassessment.

A closer look

Indications

Consider this approach when the assessment supports the following clinical situations.

Joint pain related to compression, Capsular or periarticular stiffness, and Restricted joint play.

Clinical safety

Precautions

These factors invite a more careful decision, a modified approach or additional screening.

Osteoporosis, Postoperative restrictions, Hypermobility, and Inflammatory flare.

Clinical safety

Contraindications

Some presentations mean this technique should not be used. Screen before attempting it.

Acute unstable injury, Fracture, Dislocation, Active infection, and Unexplained severe pain or neurological deterioration.

A closer look

Small Details That Change Everything

Sometimes one small clinical decision changes the value of the entire approach.

Know the treatment plane, but let the patient's response decide whether the technique is clinically useful.

Mechanism & Physiology

Why might this technique work — and what is still uncertain?

Kaltenborn mobilization uses sustained traction or translatoric gliding. The force can temporarily reduce joint compression, load the capsule in a controlled direction and provide strong sensory input. The likely result is a combination of pain modulation, reduced guarding and improved tolerance to movement rather than a permanent change in bone position.

Science without the snooze button

A joint is not two billiard balls rolling in an empty room: capsule, cartilage, muscles and neural responses all matter. The selected translatoric force is a controlled input, not visual proof of a particular hidden joint-surface correction.

Mechanism in one line

Sustained traction/glide → reduced compression + mechanoreceptor input + tissue loading → pain modulation + increased movement tolerance → active use

Want the full science? Open mechanisms, physiology and limits of the evidence

A closer look

The Response: What Could Be Happening

1. Traction or glide changes the mechanical load across the joint. 2. Capsule, ligament, muscle and skin receptors respond to the sustained force.

3. Low-grade traction may decrease compressive stress and make the joint feel more comfortable. 4. Higher-grade sustained loading can increase short-term extensibility and stretch tolerance of periarticular tissues.

5. Sensory input can change spinal and supraspinal pain processing. 6. Reduced pain/guarding allows more active range and better movement confidence.

7. Exercise consolidates the gained range and makes it functionally useful.

A closer look

Under the Surface: The Science

The science is most useful when it helps explain what we can observe—and what remains uncertain.

Joint distraction may transiently reduce articular compression and nociceptive input in compression-sensitive presentations. Sustained tissue loading produces viscoelastic deformation and changes in stretch tolerance, although these changes are often temporary.

Mechanoreceptor input from joint and periarticular tissues can alter nociceptive processing. Muscle tone may change through altered sensory input and reduced protective response.

There is no strong evidence that a single sustained glide permanently changes joint alignment.

A closer look

Bring the Science Back to the Patient

Grade I is mainly a comfort/compression-reduction strategy. Grade II takes up slack and is commonly used to assess/treat pain without aggressive stretch.

Grade III provides greater capsular loading when stiffness is the main problem.

Clinical safety

What the Evidence Does Not Let Us Promise

Convex-concave rules are a useful starting model, not proof that one glide must work. Traction does not 'open the joint permanently'.

More force does not automatically produce more mobility.

Evidence note

The mechanical model is useful clinically, but contemporary evidence suggests the response is multifactorial and includes neurophysiological as well as mechanical effects.

Across manual therapy as a whole, current evidence supports interacting peripheral, spinal, supraspinal, neurovascular, neuromuscular and contextual responses rather than one universal mechanism.

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