The Mulligan Concept of Manual Therapy

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The Mulligan Concept of Manual Therapy

Mulligan Concept
Concurrent application of sustained accessory mobilization applied by a therapist and an active
physiological movement to end range applied by the patient
How it is Applied
● NAGS- Natural Apophyseal Glides
● SNAGS – Sustained Natural Apophyseal Glides
● MWMS- Mobilization with Movements
Mobilization with movement (MWM) is the concurrent application of sustained accessory
mobilization applied by a therapist and an active physiological movement to end range applied
by the patient. Passive end-of-range overpressure, or stretching, is then conveyed without pain as
a barrier
Benefits
Pain reduction. Joint mobility. Increase in function
Patient Population
Patients with restricted motion caused by an orthopedic or joint issue, including arthritis,
post-spinal surgery pain, headaches and dizziness
Principles of Treatment
A passive accessory joint mobilization is applied following the principles of Kaltenborn.
Kaltenborn established the Convex-Concave Rule to allow ease in identifying the
direction of limitation and subsequently the direction that treatment is to be applied.
When a convex joint surface is moving, the roll and glide transpire in the opposite
direction
During the assessment the therapist will identify one or more comparable signs as
described by Maitland. These signs may be; a loss of joint movement, pain associated
with movement, or pain associated with specific functional activities
The therapist must continuously monitor the patients reaction to ensure no pain is
reproduced. The therapist assesses various combinations of parallel or perpendicular
glides to find the correct treatment plane and grade of accessory movement
While sustaining the accessory glide, the patient is instructed to perform the comparable
sign. Something that can be reproduced/retested that often reflects the primary complaint.

Failure to improve the comparable sign would indicate that the therapist has not found the
correct treatment plane, grade of mobilization, spinal segment or that the technique is not
indicated
The previously restricted and/or painful motion or activity is repeated by the patient
while the therapist continues to maintain the appropriate accessory glide
Maitland vs Mulligan technique
Mulligan mobilization allows the patients to perform the offending movements in a functional
position. Maitland mobilization aims to reestablish the spinning, gliding and rolling motions of
two joints
Concept of ‘Positional Fault’
Mulligan proposed that injuries or sprains might result in a minor “positional fault” to a
joint causing restrictions in physiological movement
Development in techniques used to overcome joint `tracking’ problems or `positional
faults’ i.e. joints with subtle biomechanical changes

References:
Mulligan, BR: Manual Therapy “NAGS,” “SNAGS,” “MWM’S: Etc., ed 4. Plane View
Press, Wellington, 1999
Exelby, Linda. “Peripheral mobilizations with movement.” Manual Therapy 1.3 (1996):
118-126
Kisner, Carolyn, and Lynn Allen Colby. Therapeutic exercise: foundations and
techniques. FA Davis, 2012
Manual therapy NAGS,SNAGS,MWMS,etc by Brian R.Mulligan, 5th edition, 2004.

The Power of Physical Therapy in Treating Plantar Fasciitis

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Plantar fasciitis is a common foot condition that affects millions of people worldwide. It is characterized by inflammation and pain in the plantar fascia, a thick band of tissue that runs along the bottom of the foot, connecting the heel bone to the toes. This condition can be extremely debilitating, making it difficult to perform daily activities and adversely affecting quality of life. While there are several treatment options available, physical therapy has emerged as a highly effective and non-invasive approach for managing and overcoming plantar fasciitis. In this blog, we will explore the various benefits of physical therapy in treating this condition.

  1. Accurate Diagnosis: One of the primary advantages of seeking physical therapy for plantar fasciitis is the opportunity for an accurate diagnosis. Physical therapists are experts in musculoskeletal conditions and can perform a thorough evaluation to assess the underlying causes of your plantar fasciitis. They will consider factors such as foot mechanics, gait analysis, muscle imbalances, and flexibility issues to develop a personalized treatment plan tailored to your specific needs.
  2. Pain Relief: Physical therapy offers various techniques and modalities to alleviate pain associated with plantar fasciitis. Therapeutic exercises, such as stretching and strengthening exercises, are crucial in reducing inflammation, improving blood flow, and promoting healing. Physical therapists may employ manual therapy techniques, such as massage, joint mobilization, and myofascial release, to target tight muscles and trigger points, further alleviating pain and discomfort.
  3. Improved Flexibility and Range of Motion: Plantar fasciitis can lead to reduced flexibility and restricted range of motion in the foot and ankle. Physical therapy includes specific stretching exercises to improve flexibility in the plantar fascia and the surrounding muscles, tendons, and ligaments. By gradually restoring range of motion, physical therapy helps to relieve tension, increase mobility, and prevent future injury.
  4. Strengthening and Stability: Weak muscles and poor biomechanics can contribute to the development and persistence of plantar fasciitis. Physical therapists devise individualized strengthening programs to address these issues. They focus on strengthening the muscles of the foot, ankle, and lower leg, aiming to improve overall stability and support the plantar fascia. Strengthening exercises not only aid in the recovery process but also help prevent future occurrences of plantar fasciitis.
  5. Correcting Biomechanical Issues: Abnormal foot mechanics and faulty gait patterns can put undue stress on the plantar fascia, exacerbating the condition. Physical therapy can identify and address these biomechanical issues through gait analysis and foot posture assessment. By implementing corrective techniques, such as orthotics, taping, and shoe recommendations, physical therapists can provide long-term relief and prevent recurrent plantar fasciitis.
  6. Education and Self-Management: Physical therapy empowers individuals with the knowledge and tools to actively participate in their own recovery. Physical therapists educate patients on proper footwear choices, activity modification, and home exercise programs. They also provide guidance on self-management strategies, such as ice and heat therapy, use of night splints, and pain management techniques. By understanding how to manage their condition effectively, patients can continue their progress even after completing their physical therapy sessions.

Plantar fasciitis can be a persistent and debilitating condition, but physical therapy offers a comprehensive and effective approach to its treatment. From accurate diagnosis and pain relief to improved flexibility, strengthening, and correcting biomechanical issues, physical therapy provides a holistic solution that targets the root causes of plantar fasciitis. If you are struggling with this condition, consider consulting a physical therapist to help you regain your foot health, reduce pain, and improve your overall quality of life. Remember, taking early action can lead to a quicker recovery and a faster return to an active lifestyle.

Pre-hab

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Prehabilitation or (pre-hab) is defined as “a process of improving the functional capability of a patient prior to a surgical procedure so the patient can withstand any postoperative inactivity and associated decline.” In terms of outcomes, studies have shown that patients who are to undergo knee and hip replacements and perform 6-weeks of land and water-based PT decreased their odds of needing in-patient rehab by up to 73%. This basically demonstrates the stronger and more flexible you go into the procedure, the better and quicker outcomes you’ll have afterwards. Some exercises that will be beneficial prior to a knee or hip replacement would be lower extremity stretching, glute and quad strengthening, as well as cycling for continuous non weight bearing motion. Ask your physical therapist for prescribed therapeutic exercises to create a mobility and strengthening program to perform prior  to your upcoming procedure.

Sources:

 www.arthritis.org

Arthritis Foundation | Symptoms Treatments | Prevention Tips | Pain Relief Advice

Ways to Give. Every gift to the Arthritis Foundation will help people with arthritis across the U.S. live their best life. Whether it is supporting cutting-edge research, 24/7 access to one-on-one support, resources and tools for daily living, and more, your gift will be life-changing.

www.arthritis.org

 

Understanding and Treating Vertigo and BPPV

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Disturbances in the inner ear can cause Vertigo which is a type of dizziness. A common symptom is the feeling of spinning in your head or the world around you is spinning or moving. It can last several seconds or minutes.

Benign Paroxysmal Positional Vertigo is a specific type of vertigo and usually presents as a feeling of spinning with head motions such as turning over in bed, looking up or looking down, sitting up, turning your head to look at your surroundings. It consists of brief episodes of mild to severe symptoms and can include nausea. It can result to gait and balance problems.

Crystals in your ear being in the wrong place in the inner canals can cause BPPV. These crystals in your ear can be dislodged from their normal position as you change your head position. If you experience dizziness due to BPPV, consulting a physical therapist can help treat BPPV and dizziness by restoring the normal function of the inner ear through positional treatments and exercises. A physical therapist can also help if you have gait and balance problems associated with BPPV.

One of the common treatments for vertigo caused by BPPV is Epley maneuver. It consists of turning the head towards the affected ear followed by a series of head and body movements to help move the ear crystals from the semi circular canals to reduce or eliminate vertigo.

Here are some tips to manage Dizziness caused by BPPV

  1. Avoid tilting or moving your head quickly
  2. Sit for a few minutes at the side of your bed before getting up
  3. Try some deep breathing exercises to help you relax
  4. Focus your eyes on a stationary object while waiting for the dizziness to subside
  5. Elevate your head while lying on your back by using several pillows

What is Dry Needling and How Can It Help My Pain?

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What is Dry Needling?

Dry needling is a manual treatment method that healthcare providers use for management of pain and issues with movement quality that stem from musculoskeletal conditions. With this method, the provider inserts a thin needle into or near the area of pain, trigger points, or related symptoms. A common method of dry needling is called Trigger Point Dry Needling that focuses on targeting myofascial trigger points in the muscles. Trigger points occur when the muscle is overused which can cause an energy crisis resulting in muscle fibers not receiving adequate blood supply. When this happens, the muscles aren’t getting the oxygen and nutrients that it needs to return to a resting state causing pain and increased sensitivity. Trigger Point Dry Needling stimulates these areas to help bring back normal blood supply to clear built up acidity and release tension. With this method, people will often feel muscles contract or twitch as the muscle relaxes and resets. Another method of dry needling is called Neurologic Dry Needling which evolved from Trigger Point Dry Needling with greater focus on needling the system versus the points in order to treat all types of neuromusculoskeletal conditions. This method is based on peripheral and central neurologic principles and works to deliver treatment locally, segmentally, and systemically. The goal is to improve inflammatory responses, improve blood flow, and reduce muscle guarding. Ultimately, both dry needling techniques help to  relieve pain, increase blood flow, and improve mobility for most people.

 

What Type of Pain Does Dry Needling Treat?

Dry needling can be used to treat a multitude of musculoskeletal conditions to address pain and mobility restrictions that can occur from scar tissue, myofascial tension, trigger points, and other connective tissue issues. Some conditions include:

  • Lower back pain
  • Neck pain
  • Headaches/Migraines
  • Shoulder Pain
  • Muscle Strains
  • Osteoarthritis
  • Overuse Injuries
  • Post-Surgical Recovery
  • Generalized Muscle Tension
  • Range of Motion Restrictions
  • Joint Issues
  • Tendinitis
  • TMJ Pain/Dysfunction
  • Pelvic Pain

What to Expect During and After Dry Needling Treatment?

Each time you receive dry needling, your licensed physical therapist will assess each treatment area via palpation (use of hands to feel the muscle tissue). Following the assessment, your provider will use a sterilized needle to work on the treatment area. The needles are always single-use and disposed of immediately in a sharps container. The needle is surrounded by a plastic tube that helps to guide with placement of the needle in the appropriate treatment. Some people fear that the needles will be extremely painful, but because of how thin the needles are along with technique, needles are able to penetrate the skin with little to no sensation. Once the needle is in place, your tissue can response with reduction in tension or an involuntary muscle contraction when a trigger point is released, which can feel uncomfortable, but this sensation is short-lived and people often times feel immediate changes.

It is common to experience soreness in the area following dry needling for 24-48 hours, but it will resolve on its own. It is a similar feeling to the soreness that one would feel after strength training or a hard workout. Soreness can be managed with ice, heat, and gentle stretching. Other recommendations to further assist the healing process include:

  • Drinking Plenty of Water: Hydration can help to avoid or reduce sore muscles by helping to flush out toxins, transport nutrients into cells, and regulate body temperature and pH balance.
  • Exercising: As long as your pain doesn’t return, it is helpful to stretch, work your muscles, and continue your daily activities. Movement helps to improve mobility and blood flow.
  • Massaging Your Muscles: Massaging helps to further relax muscles and stimulate tissues to improve blood flow and encourage reduction in tension and soreness.

Who Can Perform Dry Needling?

Dry needling is regulated differently from state to state on which healthcare professionals can perform dry needling. Healthcare providers that can generally perform dry needling consist of physical therapist, chiropractors, and athletic trainers. Regulations and requirements vary from state to state. In the state of Maryland, athletic trainers are not permitted to use dry needling as a course of practice. Maryland law requires that licensed physical therapist undergo 80 hours of training prior to eligibility to practice dry needling, therefore are highly trained compared to other requirements in other practicing states.

Acupuncture vs. Dry Needling

Although acupuncture and dry needling both use the same type of myofilament needles for treatment, the two methodology and theories are very different. Acupuncture is a treatment developed with theories centered in Eastern Medicine beliefs with the idea that illness and pain occurs when the body’s vital energy doesn’t flow freely. Acupuncture is guided by needle placement along meridians that can help to restore physical, mental, and emotional equilibrium. Dry needling on the other hand was a development of Western Medicine beliefs are targets the source of pain from a musculoskeletal or neuromusculoskeletal approach. Although clients may see the similarities on the surface, the function of the two professional approaches are very different.

 

Dry needling is a very helpful technique in the rehabilitation process, but it is simply another tool in the toolbox for physical therapy treatment. Dry needling is best when paired with other treatment approaches to help relieve pain and improve function. The best way to know what will work for you to relieve your pain and improve your function and quality of life is to schedule an appointment with a physical therapist to diagnosis your pain, create an individualized plan of care, and help you get back to feeling better. Here at Red Canyon, we are ready and excited to be able to help you! Schedule today!

Can Physical Therapy Help My Headaches and Migraines?

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If you suffer from headaches or migraines, you may have tried many methods for relief. Common techniques that can often be successful include medications, caffeine, supplements or rest and sleep.

Some forms of migraines and headaches however can be very chronic in nature and not respond to some of these go to home approaches, or the headache can come back very quickly and repetitively if not addressing other contributing factors. Oftentimes we find ourselves discussing these conditions and symptoms with primary care physicians or neurologists, who can be very helpful in the diagnosis and treatment of headaches and migraines. Often overlooked when it comes to the clinical treatment of headaches is Physical Therapy. Read more

Blood Flow Restriction Therapy (BFRT)

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What it is/background:

BFRT was first invented by Dr. Yoshiakia Sato from Japan in 1966. BFRT has become popular with weightlifters, professional sport athletes, and medical professionals over the recent years. BFRT is a strengthening technique that uses a device similar to a blood pressure cuff, which safely restricts blood flow to a muscle. Read more

Osteoarthritis

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Osteoarthritis affects over 3 million people in the US every year. More common in men under the age of 45, and becomes more common in women after this age. It can be caused by weight, genetics, aging, history of injury or surgery, overuse of repetitive movements of the joint, and joints that do not form correctly. Read more

What is the McKenzie Method

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The McKenzie method is a physical therapy treatment classification that was first introduced to the physical therapy world in the 1950’s by Robin McKenzie. Robin McKenzie had a clinic in New Zealand and that is where he first observed the phenomena of centralization, and it was by accident. McKenzie had a patient he was treating with lower back pain that radiated to his left buttock and down his leg. The patient was not responding to conventional treatment and one day the patient happened to lie on a treatment table on his stomach that was elevated on one side. The patient was lying there for 10 minutes waiting for McKenzie to return to the room. Once McKenzie returned to the room the patient noticed his leg and buttock pain was gone. McKenzie realized that extension was the factor that reduced the pain in the patient’s back and that was the start of the McKenzie Method. Read more

Practices to Prevent Burnout

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As we all know, these past three years have been more than crazy. Stress is on the rise throughout the world, due to the everlasting pandemic. But how much stress is too much stress? And how should we healthily deal with it?

According to Herbert Freudenburg, burnout describes a severe stress condition that leads to severe physical, mental, and emotional exhaustion. Burnout is more than ordinary fatigue; it makes it challenging for people to cope with stress and more difficult for them to handle day-to-day responsibilities. We have all heard of many people, including medical staff, leaving their career field due to the overwhelming load that they have on their shoulders during this time. Katie Gerten found that from December “a whopping 76% of Americans are experiencing burnout” from the current state of the pandemic. Read more