Manual Therapy – Spinal Mobilisations & Peripheral Mobilisations Course

Day 1 – Peripheral Mobilisation / Manual Therapy Techniques for Shoulder, Elbo, Wrist, Hand, Hip, Knee, Ankle and foot.

Day 2 – Spinal Mobilisations, Manual Therapy for the Cervical, Thoracic, Lumbar and Sacro-Iliac areas will be taught.

Examination and Assessment Protocols

Before applying a mobilisation technique we have to have clinical reasoning for each technique’s application and hopeful outcome. David will show Musculoskeletal Examination and Assessment techniques for all the joints covered in the course.

Mobilisations, Manual Therapy and  Manual Therapy Belt Techniques.

Course Pen Drive with videos of all the techniques and SSMT belt will be supplied for each candidate.

Techniques

David will discuss the following as they arise during the course and again at the end of the course,-

• Which techniques should be used following the results of the examination and assessment.
• What is the expected physiological response to each technique and what should the outcome be after application.
• Which techniques can be applied pre, post and during sporting events or how to include these techniques into your current practice.

This course as others we run is very practical in nature and you should be physically fit enough to practice these techniques and have them applied during the course. We run this with a maximum of 8 candidates and we are happy to take a deposit to hold your candidate place.

Please note if you book a course with us and cancel within a week of the course start date, we cannot guarantee a refund unless another candidate is found to fill your slot. In certain circumstances, we are happy to transfer you to another date or offer attendance on another to the same value of your course. We do understand things happen at short notice so we will always try and accommodate when this happens.

Techniques

Repositioning of one articular surface on its partner with a movement or function.

We always now, when teaching our MWM techniques begin with the When MWMS is applied as an assessment they will tell you immediately they are indicated as a treatment when they have a

P…..Pain-free:
There will be no pain felt by the patient with the sustained mobilisation (repositioning) and there will be no pain with the movement taking place.
I….Immediate result:
There will be an immediate improvement in the function being undertaken.
L….Long
L….Lasting: The improvement gained must be long lasting.
If you do not get the PILL effect, MWMs are not indicated. There is no exception to this rule. However having said that, the good result obtained at the time of delivery may not be retained due to the patient not complying with activity advice given. Because MWMS are never used as a treatment when you do not get the PILL effect one could never be criticised for teaching them and because they are pain free they are safe. This is important in countries where litigation is a thriving industry.
To correctly reposition joint surfaces you need excellent handling skills and knowledge. It is helpful here to remember the

C…Contraindications:

MWMS are a form of manual therapy and thus the contraindications that apply to manual therapy.
R…Repetitions:

If on applying an MWM it has the desired PILL effect then you would repeat the technique several times. With extremity joints you can apply up to three sets of ten (use common sense).
With spinal joints it is often prudent to just do three repetitions on day one as sometimes after any form of manual therapy the patient can get a latent reaction.
O…Overpressure:
To get the maximum benefit from an MWM you need to apply overpressure. This of course is passive and may be applied by the therapist, patient or a third party.
C…Communication with patient:
The patient must know what you are doing and why you are doing it. You need their cooperation to ensure success. They must for instance tell you immediately if they feel any discomfort. I would not treat a patient that I could not communicate with. You might need an interpreter.
S… Sense:
You must be able to sense the movement you are undertaking. This means you need good handling skills. Another sense is common sense and when handling patients

S…Sustain:
When you reposition joint surfaces, maintain that correction throughout the movement. Start to finish. (Refluxing!)

PRINCIPLES OF  TREATMENT

1. During the assessment the therapist will identify one or more objective signs may be;; a loss of joint movement, pain associated with movement, or pain associated with specific functional activities.
2. A passive accessory joint mobilisation is applied following the principles of Kaltenborn (i.e. parallel or perpendicular to the joint plane).
3. ensure no pain is recreated. Utilising his/her knowledge of joint arthrology, a well-developed sense of tissue tension and clinical reasoning, the therapist investigates various combinations of glides to find the correct treatment plane and grade of mobilisation.
4. While sustaining the accessory glide, the patient is requested to perform the objective sign, which should now be significantly improved.
5. The application of overpressure at the end of the available range is necessary for lasting improvement.
6. The patient typically undertakes 3 sets of 10 pain-free repetitions of the previously provocative movement to promote lasting improvement.
7. Failure to improve the objective sign would indicate that the therapist has not found the correct treatment plane, grade or direction of mobilisation, spinal segment or that the technique is not indicated.

Joint Mobilisation Grading Scale

• Grading based on the amplitude of movement & where within available ROM the force is applied.
• Grade I
  • Small amplitude rhythmic oscillating movement at the beginning of the range of movement
  • Manage pain and spasm
• Grade II
  • Large amplitude rhythmic oscillating movement within the midrange of movement
  • Manage pain and spasm
• Grades I & II –often used before & after treatment with grades III & IV
  GradeIII
  • Large amplitude rhythmic oscillating movement up to point of limitation (PL) in range of movement
  • Used to gain motion within the joint
  • Stretches capsule & CT structures
• GradeIV–  Small amplitude rhythmic oscillating movement at the very end range of movement