Joint Loose-Packed Close-Packed Capsular Pattern Temporomandibular Mouth slightly open Teeth clenched Limited mouth opening Cervical spine Midway between Maximal extension Limitation in all motion, except
flexion and extension flexion
Continued
Continued
Joint Loose-Packed Close-Packed Capsular Pattern
Sternoclavicular Arm resting by side Maximal shoulder Limited full elevation; pain at
elevation end ranges
Acromioclavicular Arm resting by side Arm abducted 90° Limited full elevation; pain at end ranges
Glenohumeral 55° shoulder Maximal Loss in external rotation > loss abduction, 30° abduction and in abduction > loss in internal horizontal adduction external rotation rotation
Humeroulnar 70° flexion, Full extension and Loss of flexion > loss in 10° supination supination extension
Humeroradial Extension and 90° flexion, 5° Loss of flexion > loss in
supination supination extension
Radioulnar: proximal 70° flexion, 35° 5° supination, Limited pronation = limited supination full extension supination
Radioulnar: distal 10° supination 5° supination Limited pronation = limited supination
Radiocarpal Neutral, slight ulnar Full extension, Limited flexion = limited deviation radial deviation extension
Midcarpal Neutral, slight flexion Full extension Equal limitation in all
and ulnar deviation directions
Trapeziometacarpal Neutral Full opposition Limited abduction > extension Carpometacarpal Neutral Full opposition Equal limitation in all
directions Metacarpophalangeal Slight flexion, ulnar Full flexion
deviation
Interphalangeal Slight flexion Full extension Limited flexion > extension Thoracic spine Midway between Maximal extension Side-bending and rotation
flexion and extension > extension > flexion Lumbar spine Midway between Maximal extension Equal limitation of side-
flexion and extension bending and rotation; extension
> flexion
Hip 30° flexion, 30° Full extension, Flexion and internal rotation abduction, slight abduction, > abduction > adduction external rotation internal rotation > external rotation Tibiofemoral 25° flexion Full extension and Limited flexion > extension
external rotation
Talocrural 10° plantar flexion, Full dorsiflexion Plantar flexion > dorsiflexion neutral inversion/
eversion
Subtarsal 10° plantar flexion, Full inversion Limitation in varus neutral inversion/
eversion
Midtarsal 10° plantar flexion, Full supination Supination > pronation neutral inversion/
eversion
Bibliography
Abbott JH, Patla CE, Jensen RH: The initial effects of an elbow mobilization with movement technique on grip strength in subjects with lateral epicondylalgia,Manual Ther6:163-169, 2001.
Bang MD, Deyle GD: Comparison of supervised exercise with and without manual physical therapy for patients with shoulder impingement syndrome,J Orthop Sports Phys Ther30:126-137, 2000.
Bergman GJ et al: Manipulative therapy in addition to usual medical care for patients with shoulder dysfunction and pain: a randomized, controlled trial,Ann Intern Med141:432-439, 2004.
Bronfort G et al: Efficacy of spinal manipulation for chronic headache: a systematic review,J Manipulative Physiol Ther24:457-466, 2001.
Bronfort G et al: Efficacy of spinal manipulation and mobilization for low back pain and neck pain: a systematic review and best evidence synthesis,Spine4:335-356, 2004.
Browder DA, Erhard RE, Piva SR: Intermittent cervical traction and thoracic manipulation for management of mild cervical compressive myelopathy attributed to cervical herniated disc: a case series,J Orthop Sports Phys Ther34:701-712, 2004.
Cagnie B et al: How common are side effects of spinal manipulation and can these side effects be predicted?, Manual Ther9:151-156, 2004.
Childs JD: A clinical prediction rule to identify patients with low back pain most likely to benefit from spinal manipulation: a validation study,Ann Intern Med141:920-928, 2004.
Cleland JA et al: Immediate effects of thoracic manipulation in patients with neck pain: a randomized clinical trial,Man Ther10:127-135, 2005.
Deyle GD et al: Effectiveness of manual physical therapy and exercise in osteoarthritis of the knee: a randomized, controlled trial,Ann Intern Med132:173-181, 2000.
Flynn T et al: A clinical prediction rule for classifying patients with low back pain who demonstrate short-term improvement with spinal manipulation,Spine 27:2835-2843, 2002.
Flynn T et al: The audible pop is not necessary for successful spinal high-velocity thrust manipulation in individuals with low back pain,Arch Phys Med Rehabil84:1057-1060, 2003.
Hoeksma HL et al: Comparison of manual therapy and exercise therapy in osteoarthritis of the hip: a randomized clinical trial,Arthr Rheum51:722-729, 2004.
Jull G et al: A randomized controlled trial of exercise and manipulative therapy for cervicogenic headache, Spine27:1835-1843, 2002.
Ross JK, Bereznick DE, McGill SM: Determining cavitation location during lumbar and thoracic spinal manipulation: is spinal manipulation accurate and specific?,Spine29:1452-1457, 2004.
UK BEAM Trial Team: United Kingdom back pain exercise and manipulation (UK BEAM) randomised trial:
effectiveness of physical treatments for back pain in primary care,BMJ329:1377, 2004.
Vernon H, McDermaid CS, Hagino C: Systematic review of randomized clinical trials of complementary/
alternative therapies in the treatment of tension-type and cervicogenic headache,Complement Ther Med 7:142-155, 1999.
Weiss HR, Dieckmann J, Gerner HJ: Effect of intensive rehabilitation on pain in patients with Scheuermann’s disease,Studies Health Technol Informatics88:254-257, 2002.
Continued
Joint Loose-Packed Close-Packed Capsular Pattern Tarsometatarsal Neutral supination Full supination
and pronation
Metatarsophalangeal Neutral Full extension Extension > flexion Interphalangeal Slight flexion Full extension Limited extension