Mulligan Manual Therapy Concept: Part A: The Upper Quadrant: Peripheral Joints, Cervical and Thoracic Spines

Part A: The Upper Quadrant: Peripheral Joints, Cervical and Thoracic Spines

Saturday 12th – Sunday 13th September 2020

Venue: Thurrock Community Hospital, Long Lane, Grays, Essex RM16 2PX

Lecturer: Thomas GC Mitchell, BSc (Hons) MSc MCTA

Ref. 2844

A two-day course presenting the Mulligan approach to manual therapy for the Cervical and Thoracic spine as well as for the upper extremity.

Course Outline:

Aimed at the frontline practitioner, the Mulligan Concept is a series of instantaneous and pain-free manual therapy techniques to allow assessment and treatment of musculoskeletal disorders to provide symptom and functional modification. Mulligan Concept courses provide clinically-directed education in:

• hands-on techniques
• self-treatment and self-management strategies
• taping and home taping techniques

These interventions shall be underpinned by sound clinical reasoning in the application of Mobilisation with Movement on patients. Current rationalisation of the evidence base for the use of the Mulligan Concept and manual therapy will be considered to facilitate participants a thorough and in-depth coverage of the Mobilisation with Movement approach.

Course objectives:

On completion of this course participants will be able to:

• Describe the underpinning theory of NAG's, SNAG's and Mobilisations with Movement (MWM's).
• Demonstrate and justify the use of spinal NAG's and SNAG's in the cervical, thoracic and lumbar spine.
• Demonstrate and justify the use of peripheral MWM's for the shoulder, elbow, wrist and hand, hip, knee and foot and ankle with reference to common musculoskeletal disorders.

Course materials:

The candidate shall receive the following to allow immediate application of the Mulligan Concept in their clinical environment:

• A copy of ‘NAGS, SNAGS, MWM’s etc’ by Brian Mulligan
• A Mulligan treatment belt
• An extensive printed course Handbook
• Sponge foam for improved comfort with handling

Who is this course suitable for?

This course is suitable for all musculoskeletal practitioners. It will be particularly useful to Newly Qualified, Junior or Senior Physiotherapists within musculoskeletal practice or aspiring ESP clinicians within First Contact Roles of MSK/Orthopaedic triage.

14 hour CPD certificate handed at end of course signed by tutor

Fee:£300 (Refreshments included)

SPECIAL OFFER: £300 per part; £575 for Part A and B, £825 for all three parts and £350 for the exam (Part D)

Limited funded places may be available for AHPs working for the NHS within the East Midlands.

01332 254679 | uhdb.ncore@nhs.net | www.ncore.org.uk

Course Programme

8:30

Registration

08:45

Commencement of course

10:30

Break

12:30 – 13:15

Lunch

15:15

Break

17:00

Close

Day 1

• Introduction of concept- 70 minutes
• About Brian Mulligan
  • History of development: Kaltenborn, McKensie, Maitland
  • The process of innovation- ‘opportunity favours the prepared mind’
• The concept of the positional fault
  • Evidence for the positional fault
• Alternative mechanisms of the effect of Manual therapy
  • Non-specific effects of Manual Therapy
    • Bialowsy, Zussman, Gifford
  • Neurophysiology
    • Mosely, Gifford, O’Sullivan
• Delivery of treatment- the golden rules:
  • CROCKS
    • Note therapists expected to know their red flags and efficacious examination techniques prior to coming onto course
  • PILL
    • Relate to Zussman etc

• Principles of MWM- 20 minutes
  • Concave/convex rule- Kaltenborn
  • Appling glide at 90 degrees to motion plane
  • Medial glide/lateral glide/rotation
  • Long bone Vs Short bone theory
  • Overpressure
  • Taping

1. Fingers/hand wrist
   1. Finger IP Flexion/Ext MWM:
      1. Side Glide
      2. Rotation
      3. Taping for rotation
   2. Fifth Inter‐metacarpal Fist MWM
      1. Taping for glide
   3. Thumb Extension MCP MWM Rotation
      1. Taping
   4. Saddle joint compression MWM in WB
   5. Wrist Extension MWM:
      1. Scaphoid
         1. NWB
         2. Scaphoid in closed kinetic chain in WB
         3. Taping
      2. Radio-Carpal Side Glide
         1. Open Kinetic Chain
         2. Closed Kinetic chain
         3. Taping
      3. Rotation
         1. Taping
      4. Distal Radio‐Carpal Rad/Ulnar glide
         1. Taping
      5. Side Glide in Closed Kinetic Chain WB
   6. Distal Radio‐Ulnar Supination MWM
      1. Taping

1. Elbow and TE
   1. Elbow Extension MWM: Side Glide
   2. Elbow Flexion MWM: Side Glide
   3. Elbow Extension MWM: Radio‐Humeral
   4. Elbow Flexion MWM: Radio‐humeral, alternative handposition
   5. Proximal Radio‐Ulnar Supination MWM

• Review of evidence for Tennis elbow
  • Proposed mechanisms
    • Positional fault
    • Concept of pain free tendon loading
  • Principles of treatment- clear painful movement through range first

1. Tennis Elbow MWM
   1. Manual glide
   2. Belt Assistance
   3. Taping
   4. Self -treatment TE:
      1. Starting Position
      2. Treatment Position

• Principles of loading and progressing treatment for MWM’s based on tolerance:
  • NWB=>PWB=>FWB

1. Shoulder and AC joint
2. AP Lat gl Glenohumeral Elevation MWM:
   1. Starting Position sitting- NWB
   2. Half Range Position 4 point lying- PWB
   3. Half Range Position Frisk standing- FWB
   4. Supine- End range technique
3. Shoulder Internal Rotation MWM: Hand behind back
   1.  Van Dalen method for severe restriction
   2. Belt Assisted
   3. Alternative Starting Position for a Gross loss of Movement
4. Shoulder painful Arc MWM
   1. Active assisted: Resistance Training
5. Shouldergirdle Boxing MWM
6. Acromio‐Clavicular Flexion MWM

Day 2

8:45

Continue course

10:30

Break

12:30 – 13:15

Lunch

4:00

Finish

• Introduction of NAGs
  • ‘Classical mobilisation in weight-bearing’
  • Evidence for effectiveness
    • The concept of the positional fault
    • Alternative mechanisms of the effect of Manual therapy
      • Non-specific effects of Manual Therapy
      • Neurophysiology
  • Reminder of Delivery of treatment- the golden rules:
    • CROCKS
      • Note therapists expected to know their red flags and efficacious examination techniques prior to coming onto course
    • PILL

1. NAGS / Reverse NAGS
   1. NAG’s
      1. Central
      2. Unilateral
   2. Reverse NAG’s: Lower Cx
   3. Reverse NAG’S: Upper Tx

• Introduction of NAGs
  • MWM of the spine
  • Minimal effective treatment

1. SNAGS Cx
   1. Cervical Flexion SNAG
   2. Cervical Extension
      1. SNAG
      2. Self‐SNAG
   3. Cervical Rotation
      1. Central SNAG
      2. Unilateral SNAG, Universal grip
      3. Self‐SNAG
   4. Cervical Side Bend SNAG
   5. Positional/transverse SNAG
   6. Spinal Mobilisation With Arm Movement (SMWAM)
      1. Self‐SMWAM
   7. Spinal Mobilisations with Arm Movement (SMWAM)
      1. Shoulder
      2. Tennis Elbow

1. Thoracic SNAGS
   1. Thoracic Rotation SNAG
   2. Thoracic Unilateral Rotation SNAG, Zooming in on Handposition
   3. Thoracic Extension SNAG
   4. Rib Cage Trunk Rotation MWM
   5. Rib Cage trunk Bend MWM
   6. Rib Cage Anterior Chest Wall Pain MWM
   7. Rib Cage First Rib MWW

1. Headache and Dizziness
   1. Headache SNAG
   2. Headaches Self‐SNAG
   3. Reverse Headache SNAG
   4. Self-Reverse Headache SNAG
   5. Upper Cervical Traction
   6. Test for C1/2 Rotation
   7. Cervical 1/2 Rotation SNAG
   8. Cervical 1/2 Rotation Self‐SNAG
   9. Cervical 2 Extension SNAG: for dizziness or other vertebral artery signs with Cx extension
   10. Cervical 1 Rotation SNAG: for dizziness or other vertebral artery signs with Cx rotation