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Kaltenborn Wedge: Design, Applications & Technique in Manual Therapy

The Kaltenborn wedge is a triangular, firm foam or wood block used in orthopedic manual therapy (OMT) to facilitate joint mobilization, soft tissue tensioning, and patient positioning. Developed by Freddy Kaltenborn, PT, it embodies the principle of localizing force to a specific segment.

Design & Sizing

  • Right triangular cross-section; hypotenuse provides graded height.
  • Common sizes: 2", 3", 4", 6" (5–15 cm) rise; 12–18" length.
  • Material: High-density foam (durable, hygienic) or hardwood.

Primary Applications

  1. Segmental Isolation (Traction/Glide): Place wedge under a body segment to create a fulcrum. Example: Under thoracic spine for PA glides; under cervical spine for distraction; under pelvis for lumbar gapping.
  2. Soft Tissue Pre-tensioning: Wedge under scapula to tension pectorals/latissimus before mobilization; under heel to tension plantar fascia/Achilles.
  3. Patient Positioning: Prone wedge under abdomen/pelvis to reduce lumbar lordosis during thoracic work; side-lying wedge under waist to open contralateral rib cage.
  4. Self-Mobilization Home Program: Patient uses wedge for sustained thoracic extension, first rib depression, or neural glides.

Technique Principles

  • Direction: Force applied parallel to treatment plane (Kaltenborn's concave-convex rule).
  • Grade: I–IV oscillations or sustained stretch (Grade V = manipulation).
  • Therapist stance: Body weight drives force; wedge stabilizes fulcrum.
  • Feedback: Monitor tissue resistance, patient pain (VAS), end-feel.

Clinical Examples

  • Cervical retraction/extension with wedge under occiput/C7.
  • Thoracic rotation mobilization with wedge under contralateral transverse process.
  • Talus anterior glide with wedge under calcaneus (ankle dorsiflexion restriction).
  • Scapular upward rotation assist with wedge under inferior angle.

Precautions

  • Avoid over wedges on recent fractures, severe osteoporosis, malignancy, infection, ligamentous instability.
  • Screen for vascular compromise (vertebral artery test for cervical).
  • Patient must communicate discomfort clearly.

The wedge is a force-multiplying tool—precision in placement and grading distinguishes skilled OMT from generic mobilization.

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