Ortho Practical 2 Study Guide
Mulligan Mobilizations
o Goal: To overcome jt tracking problems or positional faults in order to dec pain, stiffness, or
weakness.
o Spinal Mobs are performed in weight bearing positions and directed parallel to the spinal facet
planes.
o Terminology
 NAGS- Natural Apophyseal Glides. Passive accessory movements, oscillatory weight
bearing mobs which can be applied to facet jts between C2-T3. Carried out in mid end
range. Applied post  ant centrally or unilaterally. Push up & in and oscillate 2-3 x a sec
for reps of 8-10. Preferred if mult. Jts involved.
 SNAGS- Sustained Natural Apophyseal Glides. Used for treatment for all spinal
segments, rib cage, and SIJ. Pt. actively moves through the previously painful or
restricted motion with the accessory glide is performed. Push up on s.p. Repeat 5 x and
re-asses. Preferred if only one jt involved. More aggressive
 MWMS- Mobilizations with Movements. Combine sustained accessory mobs with
physiologic movement used with the ribs, SIJ, and extremities
 SMWLMS- Spinal Mobilizations with Limb Movements. Sustained transverse glide to s.p.
of a vertebra is applied while the restricted peripheral jt is mobilized actively or
passively.
o Principles/Procedure of Treatment
 Identify one or more comparable signs ( i.e. loss of ROM, pain, etc)
 All techniques are carried out in the pain-free range.
 Follow parallel-perpendicular rule.
 PT must continuously monitor the rxn of pt
 Pt performed restricted motion while the PT maintains the accessory glide (cept for
NAGS)
 Repetition (3 sets of 10) and passive overpressure are indicated as long as it remains
pain free
 *** Failure to improve the comparable sign would indicate that the clinician has not
found the correct treatment plane, grade, or direction of mobilization or the spinal
segment, or that the technique is not indicated.
o Indications
 Mild resting aches
 Painful restrictions of spinal and peripheral jt mobility sometimes accompanied by
weakness and tracking problems
 Commonly seen orthopedic conditions (i.e. lateral epi, painful arcs)
 SIN factor- Severity, Irritability, and Nature--- Tells what mob to use
o Contraindications
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Hypermobility
DJD
RA
Osteoporosis
Pregnancy
Excressive Pain
Infection, neoplasm, or
recent fx
Not effective with
chronically adaptive
shortened tissues or
serious pathology.
o Effects of Mobilizations
 Physiologic Effects: Induced analgesia
 Mechanical Effects: Inc pain-free ROM and jt mobility. Promotes proper jt
tracking
o Pro’s of Mulligan
 Pragmatic approach
 Focus on performance in weight bearing
 Combination of physiologic and accessory motion
 Techniques are safe and effective
o Con’s of Mulligan
 Lacks specificity
 Lacks sound physiologic rationale
 Does not attempt to identify anatomic cause of impairment
 Techniques may not adhere to biomechanics of jt
McConnell Taping
o Used primarily for neuromuscular reeducation using a highly rigid adhesive two
part taping technique.
o Works on the premise that a low load applied over time results in permanent
elongation of shortened structures
o Common Uses [Knee/Patella]
 Pain Reduction
 Allows early return to training or sports
 Improve patella alignment
 Helpful as a protective tool
 Unloading of compressive forces
 Neuromuscular training/timing of VMO
 ***One limitation of studies is that they were of short duration therefore
long term effects are unknown
o Secondary Effects[Knee/Patella]
 Improvement of quadriceps strength
 Greater pain free recruitment of muscle fibers
 Earlier return to activity and training
 Prevention of disability/ reoccurance
o Common Uses [Shoulder/Scapula]
 Inhibit overactive synergists and antagonists
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Facilitate under-active movement synergies
Promote joint coordination
Optimize joint alignment
Reduce pain associated with movement
***There is conflicting evidence on the effectiveness of scapular taping
Kinesio Taping
o What is it?
 taping method which claims to allow jt movement without restricting the
flow of blood & lymphatic fluid
 used to tx headaches, various sports injuries, CTS, herniated disc, poor
venous circulation & neural pathologies
 applied over muscles to reduce pain & inflammation, relax muscles &
support them during mvt on a 24hr/day basis
o Features of kinesio tape 100% cotton & latex free (prevent possible allergies)
 ~140% elastic (same flexibility of human skin)
 doesn’t stretch width-wise
 usually applied with 10% stretch
 allows skin to breathe
 can be worn for several days (3-4 days per application)
o suggestions for optimal taping results avoid extreme stretching of skin
 clean area to be taped- oil, sweat, & lotion free
 apply 1hr prior to activity, rehab, or shower
 rub tape to activate heat-sensitive glue
 avoid touching the adhesive
o Application
 Origin to Insertion
 used to support acute or chronic weak muscles
 as muscle contracts, tape assists contraction by pulling &
stimulating skin towards point of origin
 state: lengthened; use: muscle facilitation
 Insertion to Origin
 used for acute conditions (i.e. sprains, strains)
 assists in relaxation of muscles damaged due to overuse
 as fibers contract, tape works against the force to relax it &
reduce spasm or edema
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“I” cut
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stretch skin before applying tape
use: muscle relaxation
used for large jt area
muscle spasm, decompression, correction, small muscles, muscle
groups, cross jt for stability or encourage rotation, home
programs
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“Y cut
 used for large muscle groups
 tail reduce skin tension on corrective techniques
 muscle spasm, muscle support
 “X” cut
 stabilization at a jt, decompression, muscle re-education (i.e.
posture taping- CTS)
 “Fan”
 reduce inflammation
 use base point to target direction of drainage
 “Buttonhole” strip
 used to secure I, Y, X, or Fan cut to hand or foot
 needed to prevent tape removal in high use arease
o Method Concepts
 aims to give free range of motion in order to allow the body’s muscular
system to heal itself bio-mechanically
 applying stretched tape to the skin results in convolutions which create
more space b/n skin & muscles to promote flow of lymphatic fluid
 applying unstretched tape to stretched skin & muscles in the affected
area will also form convolutions but will promote skin & muscles to
contract to their normal position
 always best to error towards less tension
o Mechanical Correction
 similar to conservative athletic taping
 used for stabilization to injured jt or muscle
 apply at 75% tension
 promotes muscle re-education in desired mechanical position
o Functional Correction
 assists in joint mvt & ↑ proprioceptive awareness
 apply at 25-50% tension
o Limitations
 body hair needs to be clipped or shaved
 skin integrity
 pt understanding & willingness to wear tape for mx days, or in public
 limited clinical studies
o Kinesio Taping vs. White Athletic Taping
 white athletic taping- currently most commonly used technique in US
 very rigid to prevent acute injuries
 high latex content- skin irritation
 severe compression of skin & entraps moisture- skin cant breathe well
 can only be worn for short periods of time
o Kinesio Taping vs. McConnell Taping
 McConnell- bracing technique ising a rigid, cotton mesh, highly adhesive
tape
 used for neuromuscular re-education
 doesn’t claim to improve lymphatic flow or ↑ ROM (as kinesio taping
does)