look inside the book! - Capri Institute of Manual Therapy

R
SINCE 1992
STEP BY STEP GUIDE TO DELIVER MANUAL THERAPY
BASED ON MULLIGAN CONCEPT
More than 1500 illustrations
(including common mistakes done by therapists)
This book has been written for physiotherapists who practice manual therapy, and for those clinicians who are keen on
getting an insight into the Mulligan Concept. From its introduction and especially in the recent past, Mulligan Concept
has gained a lot of popularity because of its instantaneous and effective results.
The Mulligan Concept is one of the preferred concepts in the field of manual therapy. It is often the first choice of
treatment among clinicians because this concept allows the patients to perform the offending movements in a
functional position, that too in a pain-free way, hence, making the outcome very rewarding.
The thought process behind this book has been to elaborate the Mulligan Concept in a step by step manner to ensure
easy understanding and comprehension of all the techniques used in the concept. Its systematic approach to teaching
the principles behind the concept makes it particularly valuable to the physical therapist practicing Mulligan Concept.
This book features descriptions of all the techniques in the Mulligan Concept with a detailed set of illustrations in a
sequential manner. Emphasis has been laid on the patient's position, therapist's position, hand and belt placement
including method of delivery of treatment with proper communication and reasoning throughout this book. The
accurate application of the techniques is necessary to obtain optimal results; and the book emphasizes on this through
demonstration of precautions to be taken. In this book, a free-flow of language is used to ensure that the user is able to
actually feel the practical essence and easily understands the details.
Most of the Illustrations are provided with the following signs and symbols to enhance the reading experience and for
better understanding of the Concept.
Blue line- denotes
TREATMENT PLANE
Green Arrow- denotes
DIRECTION OF THE GLIDE
Red Arrow- denotes
DIRECTION OF STABILIZATION
Thumb up - denotes
CORRECT HAND PLACEMENT/
THERAPIST POSITION
White line- denotes
MOVEMENT PLANE
Red Dot- denotes
STABILIZATION
Pointed finger - denotes
ATTENTION TO BE GIVEN
Thumb down - denotes
WRONG HAND PLACEMENT/
THERAPIST POSITION
This book contains 288 pages covering the following topics
CHAPTER 1: CERVICAL SPINE
1.1. Natural Apophyseal Glides (NAGs)
1.2. Reverse NAGs
1.3. Sustained Natural Apophyseal Glides
(SNAGs)
1.4. Functional SNAGs/Cervical MWMs
1.5. Fist Traction
1.6. Segmental Traction for Cervical Spine
1.7. Forearm Traction for Cervical Spine
1.8. Assessment of Cervicogenic Headache
1.9. Headache SNAGs with Headache
1.10. Reverse Headache SNAGs with
Headache
1.11. Headache SNAGs without
Headache
1.12. Vertigo SNAGs
1.13. Self-SNAGs
CHAPTER 2: THORACIC SPINE
2.1. Segmental Traction for Thoracic Spine
2.2. Sustained Natural Apophyseal Glides
(SNAGs)
2.3. Self-SNAGs for Thoracic and Lumbar
Spine
2.4. MWMs for Intercostal Joints/Space
2.5. MWMs for Costochondral /
Costovertebral Joints
2.6. MWM for 1st Rib
CHAPTER 3: LUMBAR SPINE
3.1. Segmental Traction for Lumbar Spine
3.2. Sustained Natural Apophyseal Glides
(SNAGs)
3.3. Bent Leg Raise (BLR) Technique
3.4. Two Leg Rotation Technique/Gate
Technique
CHAPTER 4: SACRO-ILIAC JOINT
4.1. Anterior Innominate Dysfunction
(Postero-Medial MWM)
4.2. Posterior Innominate Dysfunction
(Antero-Lateral MWM)
4.3. MWMs for Up-Slip/Down-Slip
Dysfunction
4.4. MWMs for Anterior Tilt Dysfunction
4.5. MWMs for Posterior Tilt Dysfunction
4.6. MWMs for Nutation/Counter-Nutation
Dysfunction
CHAPTER 5: HIP JOINT
5.1. MWM for Hip Flexion (Non-Weight
Bearing)
5.2. MWM for Hip Internal/External
Rotation (Non-Weight Bearing)
5.3. MWM for Hip Extension (Non-Weight
Bearing)
5.4. MWM for Positive Faber Test
5.5. MWM for Hip Abduction (Weight
Bearing)
5.6
MWM for Hip Extension (Weight
Bearing)
5.7. MWM for Hip Flexion (Weight Bearing)
5.8. MWM for Hip Internal/ External
Rotation (Weight Bearing)
5.9. MWM for Hip Abduction (Tight
Adductors)
5.10. MWM for Hip Extension (Tight
Quadriceps)
5.11. Traction SLR
5.12. Compression SLR
CHAPTER 6: KNEE JOINT
6.1. Medial MWM for Knee Extension
6.2. Medial MWM for Knee Extension
with Belt
6.3. Medial MWM for Knee Flexion
6.4. Medial MWM for Knee Flexion with
Belt
6.5. Lateral MWM for Knee Extension
6.6. Lateral MWM for Knee Extension
with Belt
6.7. Lateral MWM for Knee Flexion
6.8. Lateral MWM for Knee Flexion with
Belt
6.9. Rotational MWM (Medial)
6.10. Rotational MWM (Lateral)
6.11. Squeeze Technique
6.12. MWM for Terminal Knee Flexion
6.13. MWM for Superior Tibio-Fibular Joint
CHAPTER 7: ANKLE AND FOOT COMPLEX
7.1. Ankle Rocking
7.2. MWM for Tarso-Metatarsal
7.3. MWM for Metatarsal
7.4. MWM for Foot (Toes)
7.5. MWM for Ankle Sprain
7.6. MWM for Plantar Flexion
7.7. MWM for Dorsiflexion
7.8. MWM for Ankle Dorsiflexion in
Weight Bearing (with Hand)
7.9. MWM for Ankle Dorsiflexion in
Weight Bearing with Belt
CHAPTER 8: SHOULDER JOINT
8.1. MWM for Shoulder Distraction
8.2. MWM for Shoulder Internal/ External
Rotation (Belt)
8.3. MWM for Shoulder Flexion (Belt)
8.4. MWM with Traction
8.5. MWM for Terminal Internal Rotation
8.6. Postero-Lateral MWM for Shoulder
Pain
o
8.7. Postero-Lateral MWM for Flexion (30
o
to 120 ) with Belt
8.8. Acromio-clavicular Joint Assessment
8.9. MWM for Acromio-clavicular Joint
8.10. MWM for Sterno-clavicular Joint
8.11. Postero-Lateral MWM forFlexion
(beyond 120o) with Belt
8.12. MWM for Internal/External Rotation
(Gross Restriction)
8.13. Shoulder Girdle MWM (4-point
Correction in Sitting)
8.14. Shoulder Girdle MWM (Lion Position)
CHAPTER 9: ELBOW AND FOREARM
9.1. Medial and Lateral MWM for
Extension
9.2. Medial and Lateral MWM for Flexion
9.3. Lateral MWM for Elbow
Flexion/Extension (with Belt)
9.4. Medial MWM for Elbow
Flexion/Extension (with Belt)
9.5. Self-MWM (Elbow)
9.6. MWM for Tennis Elbow (Lateral Glide)
9.7. MWM for Tennis Elbow (with Belt)
9.8. Self-MWM for Tennis Elbow
9.9. MWM for Distal Radio-ulnar Joint
9.10. MWM for Proximal Radio-ulnar Joint
CHAPTER 10: WRIST AND HAND
10.1. MWM for PIP, DIP and MCP Joints
10.2. MWM for Metacarpals
10.3. MWM for Intercarpal Joints
10.4. MWM for Wrist Joint
(Lateral/Medial/Rotation)
10.5. MWM for Wrist Joint
(Anterior/Posterior)
10.6. MWM for Wrist Joint (Weight Bearing)
CHAPTER 11: TAPING
11.1. Scapula
11.2. Lumbar Spine
11.3. Wrist Joint
11.4. PIP/DIP Joint
11.5. Tennis Elbow
11.6. Knee Joint (Osteoarthritis)
11.7. Sacro-Iliac Joint
11.8. Shoulder Joint
11.9. Ankle Sprain
11.10. Retrocalcaneal Bursitis/Tendo-Achilles
Strain
11.11. Plantar Fasciitis
11.12. Tarso-Metatarsal Joint
11.13. Miscellaneous Taping Techniques
CHAPTER 12: PAIN RELEASING
PHENOMENON (PRPs)
12.1. Hip Joint
12.2. Shoulder Joint
12.3. De Quervain's Tenosynovitis
12.4. Small Joints (Inter tarsals, Inter carpals
and finger joints)
12.5. Golfer's Elbow
12.6. Tennis Elbow
12.7. Sesamoid Bone and Great Toe
CHAPTER 13: NEURODYNAMICS
13.1. Spinal Mobilization with Arm
Movement (SMWAM)
13.2. Neural Tissue Mobilization
(Neurodynamic Test Position)
13.3. SMWAM (Radial Nerve)
13.4. SMWAM (Median Nerve)
13.5. SMWAM (Ulnar Nerve)
13.6. Neurodynamic SNAGs (Radial Nerve)
13.7. Neurodynamic SNAGs (Median Nerve)
13.8. Neurodynamic SNAGs (Ulnar Nerve)
13.9. Spinal Mobilization with Leg
Movement (SMWLM)
13.10. SMWLM (Femoral Nerve) 2 Therapists'
Technique
13.11. SMWLM 3 Therapists' Technique
13.12. SMWLM (Sciatic Nerve) Single
Therapist Technique
13.13. SMWLM (Femoral Nerve) Single
Therapist Technique
13.14. Neurodynamic SNAGs (Sciatic Nerve)
13.15. Neurodynamic SNAGs (Femoral Nerve)
13.16. Neurodynamic SNAGs (Saphenous
Nerve)
SUGGESTED READINGS
GLOSSARY
INDEX
1
CERVICAL SPINE
1.1 Natural Apophyseal Glides (NAGs)
Illus. 1.1.1 : Cervical Spine
Illus. 1.1.2 : Cervical Spine and its Treatment Plane
NAGs
•
•
•
These are small gentle glides and should
always be pain-free for the patients. If these
are painful in spite of applying correctly, then
all other means would be painful.
NAGs are small amplitude, multiple, rhythmic,
mid to end range gentle oscillatory glides
which can be applied to the cervical spine
from C2 to C7.
Indications
These are the mildest form of manual therapy.
•
Gross restriction in cervical range of motion.
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MANUAL OF MULLIGAN CONCEPT
Illus. 1.1.3 : Position of the Therapist and the Patient for Central NAGs
•
These can be used in the case of elderly
patients having severe spondylitic changes.
•
To relieve post-manipulative soreness.
•
To check irritability of the cervical spine.
Patient Position
Therapist Position
•
Walk stance- standing antero- lateral to the
patient with weight evenly distributed on
both the feet (Illus.1.1.3).
•
Therapist's groin is in contact with the anterolateral surface of the patient's shoulder.
Therapist cradles the patient's head from his
hand, forearm and antero- lateral side of the
torso.
•
Sitting upright at the edge of a chair without
armrest (Illus.1.1.3)
•
•
Head of the patient should be held in neutral
position (neck may be kept in slightly flexed
position in order to have better palpation, if
pain-free).
Hand Placement
•
Therapist grasps the patient's base of the head
Illus. 1.1.4 : Hand Placement of Therapist on Spine for Central and Unilateral NAGs
5
6
CHAPTER 1 \ CERVICAL SPINE
•
•
and all vertebrae above the level of
mobilization with his index, middle and ring
fingers of one hand (except little finger which
is to be used for mobilization).
•
Unilateral NAGs for cervical facet joints are
given antero- cranially towards the opposite
eyeball (Illus.1.1.4).
•
2-3 oscillations are performed per second.
Middle phalanx of little finger of the same
hand is placed under the spinous process, i.e.,
hooking the spinous process to the desired
level (vertebra to be mobilized).
•
Glides are performed rhythmically through
mid to end range after taking up the slack.
Small gap should be maintained between little
and ring finger (Illus.1.1.4).
Variations
•
Traction to the cervical segments can also be
provided using the above technique.
Illus.1.1.5 : Position of the Therapist and the Patient for Central NAGs with Mild Traction
•
Lateral border of thenar eminence of the other
hand is placed obliquely under the little finger
in order to push it towards the eye ball of the
patient (as per treatment plane).
•
Mobilizing hand should be in mid-prone
position with the wrist in slight ulnar
deviation.
•
The therapist applies traction to the cervical
spine by gaining his height and shifting the
weight from his front foot to the back foot
and then the glide can be performed at the
desired level (Illus.1.1.5).
•
In the case of patients with an exaggerated
cervical lordosis, the therapist can perform
the above glide after the patient is instructed
to do chin retraction.
•
For unilateral NAGs, little finger is placed on
the facet joint of the affected side by moving it
little laterally from the spinous process
(Illus.1.1.6).
Mobilization
•
The glide is given by pushing the middle
phalanx of little finger of stabilizing hand with
the thenar eminence of mobilizing hand
antero-cranially (towards the eyeball of
patient) along the treatment plane
(Illus.1.1.2, 1.1.4, 1.1.6).
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MANUAL OF MULLIGAN CONCEPT
Illus. 1.1.6 : Hand Placement of Therapist for Central and Unilateral NAGs
Illus. 1.1.7 : Common Mistakes done by the Therapist during NAGs
Precautions To Be Taken
•
Do not block airway of the patient.
•
Any rotation, side-flexion of the neck should
be avoided (Illus.1.1.7).
•
Female therapist is advised to use a pillow or a
thick towel between the patient's head and
her breast. Patient's trunk should be properly
stabilized (Illus.1.1.8).
•
•
It might correct the positional fault between
affected facets.
•
It might release an entrapped meniscoid
between facet joints, if any.
•
It might stimulate mechanoreceptors and
proprioceptors in and around the joints.
•
It helps to release muscles around the joints.
Therapist should use brachioradialis for giving
the glide and not the pronators of the
mobilizing forearm (Illus.1.1.5).
Reasoning
•
Inferior facet of the superior vertebra glides
cranially on the superior facet of the inferior
vertebra (to treat C4-5 segment, facet joint /
spinous process of C4 is mobilized).
•
Mobilization induced movement helps to
provide nutrition to the facet joints and disc.
Illus. 1.1.8 : Use of Pillow/Towel during NAGs
7
STEP BY STEP GUIDE TO DELIVER MANUAL THERAPY
BASED ON MULLIGAN CONCEPT
Dr. Deepak Kumar, MSPT, FIAP,
CMP, PhD, MCTA
Dr. Deepak Kumar graduated from National Institute (1993) &
completed his PG in Sports Physiotherapy (2000) and Doctorate in Mulligan
Concept (2012). He has also been to Curtin University, Australia, to get his
super specialization in Manipulative Physiotherapy (2002). He was
awarded with distinguished service award by Indian Association of
Physiotherapists in 2006 and the prestigious fellowship award from Indian
Association of Physiotherapists in 2010. He is a clinical teacher and
examiner to various Universities in India.
He is one of the certified Mulligan Concept Teachers. He is also a
certified McConnell Concept Teacher for Asia region. Trained more than
10,000 students during the last 11 years from various reputed institutes of
Asia. Made 12 inventions in manual therapy, electrotherapy & exercise
therapy. Guided 53 research projects and still growing. Presented 34
research papers in various state/ national & international conferences like
IFOMT and WCPT, bagged 9 best papers and six 1st runner up awards.
Published 4 papers in reputed journals. The new techniques on Mulligan
Concept have been acknowledged by Brian Mulligan and mentioned in his
5th & 6th edn. book.
Dr. Deepak Kumar has an excellent background in teaching,
research, & clinical management skills to run Manual Therapy courses.
Treated more than 80,000 patients during the last 20 years (together with
the team). Administrating more than 60 professionals & support staff as
Director of Capri Institute of Manual Therapy. Organized more than
hundreds of CME / workshops / conferences including International
Conference on Manual Therapy in 2005, 2006, 2013 & 2014.
R
SINCE 1992
Capri Institute of Manual Therapy
New Delhi, INDIA
www.capri4physio.com
ISBN 13: 978-81-930073-9-6

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