Mulligan Flashcards
(29 cards)
Mulligan pioneered the idea of _ with _ and _ _ to address musculoskeletal disorders with pain free manual joint repositioning techniques for restoration of _ and abolition of _.
Idea of MOBILIZATIONS WITH MOVEMENT AND MANUAL THERAPY to address musculoskeletal disorders with pain free joint repositioning techniques for restoration of FUNCTION AND ABOLITION OF PAIN
_ or _ _ _, can be applied from _ to _ (the functional cervical spine). These techniques are _ to _ _ mobilizations
NAGS or NATURAL APOPHYSEAL GLIDES can be applied from C2-T3 (the functional cervical spine. Techniques are MID- TO END RANGE mobilizations
NAGS may cause _ _ but they should never cause _
May cause MILD DISCOMFORT but they should never cause PAIN
What is the patient position for NAG’s?
Always performed in sitting
A _ _ may also be added to the NAG technique.
TRACTION FORCE
NAGS are indicated where _ (_) techniques may be too aggressive or _. Are indicated in patients with _ _ _ or with _ associated with _ _ _.
NAGS are indicated where PAIVM (PA) techniques may be too aggressive or INEFFECTIVE. Are indicated in patients with CERVICAL MOVEMENT IMPAIRMENTS or with PAIN associated with CERVICAL MOVEMENT IMPAIRMENTS
With NAG techniques the _ facets glides _ upon the _ joint partner. Facet plane is at a _ _ _.
The SUPERIOR facet glides ANTERIOR-CEPHALADLY upon the INFERIOR joint partner
Facet plane is at a 45 DEGREE ANGLE
_ _ are indicated for the upper thoracic spine (_ or _ impairment) or on the extremely rare occasion where the _ made the patient worse. Is _ the _ of a NAG
REVERSE NAGS are indicated for the upper thoracic spine (STIFFNESS OF MOVEMENT impairment) or on the extremely rare occasion where the NAG made the patient worse.
Is BIOMECHANICALLY OPPOSITE of the NAG
With reverse NAGS the _ facet glides anterio-cephaladly _ the _ joint partner. With a _ _ _ such as cervical rotation, focus the reverse NAG on the _ side.
The INFERIOR facet glides anterio-cephaladly UNDER THE SUPERIOR joint partner. With a UNILATERAL MOVEMENT IMPAIRMENT, such as cervical rotation focus the reverse NAG on the RESTRICTED SIDE.
A _ or _ _ _ _ the technique is essentially mobilization with movement. They are indicated in the _ of movement impairments of the _ _. Technique must be __ _.
A SNAG or SUSTAINED NATURAL APOPHYSEAL the technique is mobilization with movement
Are indicated in the RESTORATION of movement impairments of the ENTIRE SPINE
Technique must be PAIN FREE
SNAGS are unique to other mobilization techniques in regards to: _ _, active movements followed by _ -, follow _ _ rule, the mobilization component is sustained at the _ _ (maintain _ _ until the cervical spine has returned to the _ _).
Unique in regards to:
- WEIGHT BEARING
- active movements followed by PASSIVE OVER-PRESSURE (OP)
- follow the TREATMENT PLANE RULE
- the mobilization component is sustained at the END RANGE (maintain STATIC OVERPRESSURE until the cervical spine has returned to the RESTING POSITION)
SNAGS are unique to other mobilization techniques in regards to: _, immediate _, occur in the range where the patient _ _ _(either _ or _), is easily _ and extremely _.
Unique in regards to:
- PAINLESS
- immediate REASSESSMENT
- occur in the range where the patient EXPERIENCES THEIR SYPTOMS (either STIFFNESS OR PAIN)
- is easily MASTERED and extremely EFFECTIVE
Though the cervical facet is 40-45 degrees to the horizontal in neutral, at _ _ _ the facet plane is near or at _. PT must _ the _ of the mobilization force throughout the _.
At END RANGE EXTENSION the facet plane is near or at VERTICAL
PT must ADJUST THE DIRECTION of the mobilization force throughout the PROCEDURE
If the patients impairments are not _, than mobilize the _ _ or _ and _. If still no improvement?
If patients impairments are not REDUCED, than mobilize the JOINT ABOVE OR BELOW and REASSESS
If still not improvement discard the technique
With this technique be sure _ _ _ _ on day one.
Be sure NOT TO OVER TREAT on day one
With cervical rotation application of the SNAG should be applied with a _ _ in the treatment plane. Treatment should be held for _ _ and repeated _ _.
Applied with CEPHALAD FORCE in the treatment plane.
Treatment/ force should be held for 6 SECONDS and repeated 6 TIMES
For self-rotation SNAGS (ex. At C2/ C3 Right sided pain Ipsilateral technique) towel should fixate _ _ with _ force and _ hand, and mobilize _ _ with force directed at _ _ and with the _ hand.
Towel should fixate RIGHT C3 with DOWNWARD force and OPPOSITE hand, and mobilize LEFT C2 with a force directed at 45 DEGREES and with the OPPOSITE hand.
With pain with Ipsilateral rotation you should block the _ _ the facet you want to affect, and with pain with contralateral rotation you should block the _ _ the facet you want to affect.
Ipsilateral you should BLOCK THE JOINT BELOW
Contralateral you should BLOCK THE JOINT ABOVE
How does self-rotation SNAG with towel change when you are trying to affect the C1/ C2 facet joint?
Upper hand is no longer at a 45 degree angle, it changes to horizontal to align with the angle of the treatment plane.
If you want to apply a _ _ in addition to the NAG you should have the patient sitting with forehead facing PT’s / and your hand grasping the _ _ of the patients _. Then use your _ _ to stabilize the superior joint partner and with the _ _ of the opposite hand apply an _ _ force.
If you want to apply a TRACTION FORCE in addition . . .
Have patient sitting with forehead in PT’S ELBOW/ BICEPS and your hand grasping the POSTERIOR ASPECT of the patients head.
Then use your 5TH RAY to stabilize the superior joint partner and with the THENAR EMINENCE of the opposite hand apply an ANTERO- CEPHALAD.
With NAG plus traction technique the oscillation force is applied at a rate of -/ _, for - _. Repeat _ or _ times and then _.
Oscillation force is applied at a rate of 1-3/ SECOND for 10-30 SECONDS. Repeat 6 OR LESS times and then REASSESS
If you want to perform a _ _ with traction you use the same set up as a regular NAG with the exception of the inferior hand, instead of using thenar eminence you make a _ with the _ of your _ and the _ _ _ of your _ _
If you want to perform a REVERSE NAG with traction, use the same set-up …
With inferior hand make V WITH THE PAD OF YOUR THUMB and the PROXIMAL PHALANGEAL JOINT of your FIRST RAY
To apply traction force using your forearm: place forearm _ patients _, with patient in _. Using the _ _ of your forearm start in a _ _ position and _ _. Other hand is on patients _ for stability.
Place forearm UNDER patients HEAD, with patient in SUPINE
Using the DISTAL 1/3 of your forearm start in a FULLY SUPINATED POSITION and SLOWLY PRONATE.
Other hand is on the patients FOREHEAD for stability.
To apply a “headache SNAG”: have the patient in _ position, with their face in PT’s _ stabilizing the _ of the patients head with your _ using the _ _ of your _ _, place the _ _ of the opposite hand on top and apply an _ _ pressure.
Have the patient in a SITTING POSITION, with their face in PT’s BICEP using the MIDDLE PHALANX of your 5TH DIGIT, place the THENAR EMINENCE of the opposite hand on top and apply an ANTERIORLY DIRECTED pressure.
