Wednesday, September 23, 2009

Mulligan’s positional fault corrections cause pain relief & mecanical corrections for long lasting effect!!!


According to Vicenzino et al (2007) there are an increasing number of reports espousing the clinically beneficial effects of Mulligan's mobilization-with-movement (MWM) treatment techniques. The most frequent reported effect is that of an immediate and substantial pain reduction accompanied by improved function.

Manual therapy effects on pain have been explained by many authors. The mechanism involved is thought to be an effect of mechanoreceptor response that affects the pain gait. Few others claim pain relief may be due to supra-spinal mechanisms based on opiate-like substance releases. However recent findings refer the supra-spinal mechanisms may not be involved especially spinal manual therapy-induced hypoalgesia.

Naloxone antagonism and tolerance studies employ widely accepted tests for the identification of endogenous opioid-mediated pain control mechanisms. Paungmali et al (2004) reported that rapid initial hypoalgesia caused by Mulligan MWM was not antagonized by naloxone, suggesting a nonopioid mechanism of action in tennis elbow i.e. existence of similar non-opiate pain control mechanism seen after spinal manual therapy. Vicenzino et al described this effect as unique & characteristic hypoalgesia of Mulligan’s techniques. The selective and specific effect of this treatment technique warrants further investigations in physical modulation of musculoskeletal pain.

Ankle positional fault corrections!!!

Study that indicates Mulligan’s ankle technique first corrects mechanical errors:

Talocrural dorsiflexion is a major impairment following ankle sprain. Lack of posterior talar glide and weight-bearing ankle dorsiflexion are common physical impairments in individuals with recurrent ankle sprains. MWM of the ankle joint involves the application of a combined posterior talar glide mobilization and active dorsiflexion movement. Collins et al reported this MWM treatment for ankle dorsiflexion has a mechanical rather than hypoalgesic effect in subacute ankle sprains. Vicenzino et al reported both the weight-bearing and non-weight-bearing Mulligan’s MWM treatment techniques improve posterior talar glide by 55% and 50% in recurrent ankle sprain cases. Treatment of existing positional faults leads to increased chances of not getting back the ankle sprain may the plausible mechanism. However these authors indicated future research to explore the mechanism by which this occurs to better understand the role of manipulative therapy.

References:

1. J Manipulative Physiol Ther. 2004 Mar-Apr;27(3):180-5.
2. Vicenzino B et al; Man Ther. 2001 Nov;6(4):205-12.
3. Man Ther. 2007 May;12(2):98-108. Epub 2006 Sep 7.
4. Collins N et al; Man Ther. 2004 May;9(2):77-82.
5. Vicenzino B et al; J Orthop Sports Phys Ther. 2006 Jul;36(7):464-71.

Manual therapy class (theory) : Mulligan's technique-MWM effects on peripheral joints


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