Week 6 MWM Flashcards

1
Q

What is MWM

A

MWM is a manual therapy treatment technique in which a manual force, usually in the form of a joint glide, is applied to a motion segment and sustained while previously impaired action is performed

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2
Q

What does SNAG stand for

A

Sustained Natural Apophyseal Glide

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3
Q

What to use with a spinal joint disorder

A

SNAG or NAG

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4
Q

What to use for a peripheral joint disorder

A

MWM

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5
Q

NAG characteristics

A

C2-T3
Mid end range techiques
applied antero-cranially
increase ROM, decrease associated pain

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6
Q

definition of MWM

A

Combination of two actions:
-sustained passive accessory movement (i.e. mobilisation)

with

-Active (or occasionally passive) physiological movement

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7
Q

application

A

often for ‘apparent soft tissue disorders e,g,

  • lateral epicondylalgia
  • rotator cuff lesions
  • sprained ankle ligaments
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8
Q

SNAGS

A

applied to the whole spine
active physiological movement with passive accessory overpressure
Passive movement is sustained
end range technique

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9
Q

Basic principles

A

specific to the application of MWM and SNAGS in clinical practice, the following basic principles have been developed

during assessment the therapist will identify one or more comparable signs as described by Maitland. These signs may be a loss of joint movement, pain associated with movement, or pain associated with specific functional activities (lateral elbow pain with resisted wrist extension, neuropathodynamics

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10
Q

Basic principles 2

A

as passive accessory joint mobilisation is applied following the principles of Kaltenborn (i.e. parallel or perpendicular to the joint plane). This accessory glide must itself be pain free

The therapist must continuously monitor the patient’s reaction to 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 parallel or perpendicular glides to find the correct treatment plane and grade of movement

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11
Q

Basic principles 3

A

while sustaining the accessory glide, the patient is requested to perform the comparable sign/movement.
the comparable sign should now be significantly improved (i.e. increased range of motion, and or a significantly decreased or absence of the original pain)

Failure to improve the comparable sign would indicate that the therapist has not found the correct contact point, treatment plane, grade or direction of mobilisation, spinal segment or that the technique is not indicated

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12
Q

Basic principles 4

A

the previously restricted and or painful motion or activity is repeated by the patient while the therapist continues to maintain the appropriate accessory glide. Further gains are expected with repetition during a treatment session typically involving three sets of ten repetitions

further gains may be realised through the application of passive overpressure at the end of available range. it is expected that this overpressure is again, pain-free

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13
Q

guidelines for application

A

periphery - appropriate accessory movement is usually perpendicular to physiological movement direction

Spine - appropriate accessory movement is usually in direction of facet planes
-dysfunctional segment in weightbearing/ loaded position

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14
Q

Application force

A

apply minimum amount of force to alleviate symptoms
Optimal force and direction (trial & error)
66% of maximal force required for MWMLE

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15
Q

Guidelines for application

A

To ensure a painfree response, may need to explore
-different accessory movements
-subtle variations in angle of accessory movement
Therapist/patient applies sustained, gentle overpressure at EROM
Sustain accessory glide on return movement

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16
Q

Physical examination

A

MWM’s easily, quickly integrated into physical examination
Subsequent to
-active/combined/functional movements
-Passive movements (physiological & Accessory

17
Q

Physical examination 2

A

Aim for an immediate elimination of pain on active/functional movement while performing the MWM
(not provocation of pain)
Also an immediate marked increase in ROM
Implicated source of symptoms

18
Q

Treatment

A

Both movement components should be painfree
Local tissue tenderness possible (use padding to overcome)
For lower limb and spinal problems progress MWM to weightbearing position

19
Q

Treatment 2

A

Reassess active or functional movement after a few repetitions of MWM (>6)

Number of repetitions depends on irritability, stage of disorder, stability of disorder, severity of pain

Modify technique first, discard if no immediate change on reassessment

20
Q

Treatment 3

A

progress to home exercises quickly (self - management )
Taping may help in some cases - aim to maintain the accessory movement / position

Thus, MWMs combine mobilisation, active exercise and taping

21
Q

Safety

A

only perform if ‘Painfree’
Be conservative with number of repetitions-first treatment
Reassess regularly
Some technique require careful explanation before gaining consent!

22
Q

Efficacy

A

Convention - >200 continuing coursers in 1998 ;

23
Q

Proposed biological basis

A

the mechanism by which the MWM exerts its ameliorative effects in clinical practice remains somewhat of an enigma

24
Q

Proposed biological basis 2

A

correction of minor bony positional faults?
Facilitate joint gliding - restore function?
Neurophysiologically modulated
-not endogenous opioid systems

Placebo?
Therapist charisma?

25
Q

Proposed biological basis 3

A

immediate effect suggests
:mechanical
: reflexogenic

26
Q

Positional fault theory

A

although MWM’s may alter positional faults during their application, the long - term pain relieving effects are independent of position

27
Q

Truth or fiction

A

the level of evidence for the clinical efficacy of MWM treatments is presently low, consisting in the main of case reports

More studies such as RCTs are required to substantiate or refute the positive claims from preliminary reports