Mulligan Home Exercise :: Lumbar Self SNAG with Belt :: Ext

[RuudG1988]

the patient flexes the elbow ... 0:41 AND PROTRACTS CERVICAL REGION .

Notice the guy gets younger respectivly to the number of repetitions she does whith the self SNAG. haha :p

[RuudG1988]

the patient flexes the elbow ... AND PROTRACTS CERVICAL REGION .

Notice the guy gets younger respectivly to the number of repetitions she does whith the self SNAG. haha :p

[kevinharriet12]

Why not just go to a chiropractor?

[ProPTRehab]

Because, many, not all, of them manipulate everyone who walks through their door when that is just one of many other options. Manipulation is a 'last resort' not a first resort. U notice this person is able to move on their own as part of their home program. The medical professional many have applied manual mobs with movement prior to showing them this technique. Look at my video where I too use this as an adjunct after we've cleared lumbar extension. This is an excellent self mob technique.

[rhodesdarcy]

@ProPTRehab "Manipulation is a 'last resort' not a first resort." - I can think of many occasions when this isnt the case. Manipulation often is the safest way of facilitating inhibited movements. Once the correct proprioceptive afferents have been re established the body is able to segmentally stabilise far easier. Mobilisation can often work the wrong type of mechanoreceptor leading to short term instability (although symptom relief) and then a return of the same protective segmental tension.

[WingThaiJ]

@rhodesdarcy if you are causing cavitation and the joint becomes lax, the tendons act in a guarded fashion to restablize the area. Cineradiographs note this occurs. When you apply a manipulation to a supposed fixated joint, where do you think the force pressure goes? To the region of least resistance. Go to the Mulligan site, many research studies are validating Mulligan approach. As far as being easier to stabilize, this is pure speculation; a hypothesis, nothing more.

[WingThaiJ]

Excuse me, Cinetradiographs note the laxity...

[rhodesdarcy]

@WingThaiJ and with that failure of muscular stabilisation we normally see an historically hypermobile joint - this is where the average fool continues to manipulate - these areas often only need a small amount of movement to become unstable again. They are often secondary. This is what scares people of manipulation - the fact that many times the practitioner should not be doing it because they are not skilled enough to diagnose what should and shouldnt be manipulated.....

[WingThaiJ]

Despite having had about a dozen pts in 20 yrs in my facility who have suffered from post chiropractic manip herniated discs, in general, I agree in most cases,risk of causing harm is not an issue. I take issue w/using terms which r non-anatomical (adjustment), etc.., or palpating spinous processes which may be naturally asymmetrically developed & assuming they're rotated to 1 side or the other, etc.. I am ok with techniques to work on curves & the ability of jts to move as they are designed

[WingThaiJ]

I'm also ok with using manips if they help; I'm not dogmatic about premanip testing, it's just that there are ways to achieve the desired results w/out manips. Regardless of which theory is right about what happens with manips, there seems to be enough data to suggest doing this to the T/S with cervical patients; so I'm fine with this, even if we might not agree on what's happening physiologically.

[rhodesdarcy]

@WingThaiJ ....so for those individuals who have the "manip as a last resort" it shows they obviously see a risk with it - this shows they would be taking a risk - which really shows a lack of certianty through just not being an expert in the area. Thats fine! - just like when a chiropractor of phyio chooses not to do his own surgery - they are not experts in surgery..... In skilled hands manipulation carries very little risk, in bad hands - run for the hills! Just like with surgery...

[WingThaiJ]

@rhodesdarcy I see you are unfamiliar with pre-manipulative testing! The progression from self applied techniques to self and manually applied overpressures comprise pre-manipulative testing. When you achieve what you want during the step-by-step process, you will most often find you DON'T need to manipulate and of course you don't need to do this with postural syndromes. If the force direction has proven beneficial, but doesn't quite get the job done than you manipulate. (To continue)

[WingThaiJ]

Cineradiographs have shown separation of joints with manips & of course the manip force takes the path of least resistance; hence, when U try to manip a fixated joint the force moves to the path of least resistance, the ALREADY hypermobile jt which doesn't need manips, but will still cause Type III mechanoreceptor stimulation to modulate pain.Note, the manip did not 'correct a misalignment' it just causes artificial looseness. Point behind Mulligan is to help the joint to what it's suppose to do

[rhodesdarcy]

@ProPTRehab Having said that - many manual therapists and chiropractors over use manipulation. Just like many surgeons use the scapel too easily! I personally think Mulligan has a lot of great ideas and I do use them when gentle safe manipulation isnt possible due to contracture and adhesions or for homework such as this one!

[WingThaiJ]

@rhodesdarcy actually manipulation is probably most appropriate with 'certain' adhesions. I'm also familiar with studies which support use of manipulation to the thoracic spine to while treating the cervical spine. No matter what we do, in the end, postural / gravitational influences rule. I'm also not opposed to using manips when one believes it can be useful, just not on a regular basis.

[rhodesdarcy]

@WingThaiJ Of course manipulations are useful with certain adhesions - not sure why you choose the word "actually" - sounds pretentious as if you are infering I suggest differently. I was talking of times when you should not manipulate - eg a 90 year olds neck with severe adhesions and contracture. I think we all can appreciate risk vs benefit. Lastly I never said anything against the Mulligan approach. I just think you have an unfounded view of the risk of manipulation.

[WingThaiJ]

@rhodesdarcy -- OK after all of this typing, I see you think I have a problem w/manips as a risk for causing damage. I don't think I conveyed that; but if I did I'll make a correction. The point behind the Mulligan procedure is to allow for normal movements of spinal joints w/out causing or potentially causing increased laxity. As you said, if it is shown that ligs don't become lax w/the technique you described, than fine; go for it.

[rhodesdarcy]

@WingThaiJ For what its worth: In mobilisations yes the force goes to the most mobile area (normally not helpful in long term) in HVLA manips the inertia of the segmental motion unit is taken advantage of due to the high velocity of the thrust - this is why it can sometimes be a safer form of returning motion than a mobilisation. With the low amplitudes no ligaments become lax, if by tendon you ment ligament. Finally passive stability is a terrible form of stabilisation - muscles move joints....

[WingThaiJ]

@rhodesdarcy I'm with you on this if you don't cause an artificial loosening of the joint and increase the joint capsule volume.

[WingThaiJ]

Oh, and on occasion if such a procedure which causes laxity does the job and the patient feels better, I'm ok with this too; just not if it is repeated over and over again, especially when someone has no pain. I don't think there is a need to cause a cycle of the feeling that one needs to be manip'd all the time.

[ProPTRehab]

@rhodesdarcy Sounds good to me.

[WingThaiJ]

@kevinharriet12 because they are not needed..

[rhodesdarcy]

@WingThaiJ muscles move joints not chiropractors of physios, nerves move muscles, and nerves are only as good as the information they receive - proprioceptive feedback. Proprioceptive feedback largely comes from mechanoreceptors, golgi tendon organs, muscle spinds etc...these cant work or fire without movement. Restoration of normal movement is imperitive if dynamic stabilisation is to occur. Passive stabilistation is a sure fire sign of the bodies failure to stabilise with muscles.....

[WingThaiJ]

@rhodesdarcy I use the ATM2 to theoretically allow for normal neurologic input to spinal cores. Note how I use the term Theoretical, something missing from the vocabulary of most and should be used all of the time.

[keto6789]

shes hot!!

[eriiiiiiiiiii]

she must play softball.

[jewlzorjay]

Thanks, i got the Brian Mulligan book and found it a tad confusing what a SNAGs were untill this. Is it him or Maitland who prefers passive movement away from pain as apose to into pain?

[brattybaby]

thank you for sharing!