Mobilization With Movement (MWM) is a new manual therapy technique that uses the benefit of passive mobilization and adds active movement. The technique is painfree and can return comfortable mobility in just a few visits. Immediate pain relief and increases in your range of motion can be expected when this technique is indicated.
Brian Mulligan FNZSP, Diploma MT, is the Physical Therapist from New Zealand who developed the Mobilization With Movement concept. Mr. Mulligan has been practicing Physical Therapy for over 40 years, and through his experience and ingenuity "MWM" was born. In an attempt to educate the world on his concept, Mr. Mulligan developed the Mulligan Concept Teachers Association (MCTA).
There are currently only 40 Physical Therapists in the world certified to teach the MWM Concept, and our owner Frank Gargano is one of those certified teachers. Dr. Gargano travels around the United States educating other Therapists, Doctors, Chiropractors, and Athletic Trainers in the MWM concept.
MWM can be beneficial for any orthopedic condition that is painful and has limited range of motion. The following list is only an example of the types of conditions that can be helped by this treatment
- Shoulder Pain/Impingement
Principles of Treatment
In the application of manual therapy techniques, Physiotherapists acknowledge that contraindications to treatment exist and should be respected at all times. Although always guided by the basic rule of never causing pain, therapist choosing to make use of Sustained Natural Apophyseal Glides (SNAG's) in the spine and MWMs in the extremities must still know and abide by the basic rules of application of manual therapy techniques.
Specific to the application of MWM and SNAGS in clinical practice, the following basic principles have been developed
During 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 (i.e., lateral elbow pain with resisted wrist extension, adverse neural tension).
A passive accessory joint mobilization is applied following the principles of Kaltenborn (i.e., parallel or perpendicular to the joint plane). This accessory glide must itself be pain free. The therapist must continuously monitor the patient's reaction to ensure no pain is recreated. Utilizing his/her knowledge of joint arthrology, a well-developed sense of tissue tension and clinical reasoning, the therapist investigates various combinations of parallel or perpendicular glides to find the correct treatment plane and grade of movement.
While sustaining the accessory glide, the patient is requested to perform the comparable sign. The comparable sign should now be significantly improved (i.e., increased range of motion, and a significantly decreased or better yet, absence of the original pain).
Failure to improve the comparable sign would indicate that the therapist has not found the correct contact point, treatment plane, grade or direction 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. Further gains are expected with repetition during a treatment session typically involving three sets of ten repetitions.
Further gains may be realized through the application of passive overpressure at the end of available range. It is expected that this overpressure is again, pain-free.
Self-treatment is often possible using MWM principles with adhesive tape and/or the patient providing the glide component of the MWM and the patient's own efforts to produce the active movement. Pain is always the guide. Successful MWM and SNAG's techniques should render the comparable sign painless while significantly improving function during the application of the technique. Sustained improvements are necessary to justify ongoing intervention.
For more information on this treatment concept visit the Mulligan Website or contact Frank Gargano, PT, DPT, OCS, MCTA.
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For purchase the DVD "The Cervical and Upper Cervical Spine MWM's" by Frank Gargano and Brian Mulligan go to Northeast Seminars.
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