Week 6 MWM Flashcards
What is MWM
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
What does SNAG stand for
Sustained Natural Apophyseal Glide
What to use with a spinal joint disorder
SNAG or NAG
What to use for a peripheral joint disorder
MWM
NAG characteristics
C2-T3
Mid end range techiques
applied antero-cranially
increase ROM, decrease associated pain
definition of MWM
Combination of two actions:
-sustained passive accessory movement (i.e. mobilisation)
with
-Active (or occasionally passive) physiological movement
application
often for ‘apparent soft tissue disorders e,g,
- lateral epicondylalgia
- rotator cuff lesions
- sprained ankle ligaments
SNAGS
applied to the whole spine
active physiological movement with passive accessory overpressure
Passive movement is sustained
end range technique
Basic principles
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
Basic principles 2
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
Basic principles 3
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
Basic principles 4
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
guidelines for application
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
Application force
apply minimum amount of force to alleviate symptoms
Optimal force and direction (trial & error)
66% of maximal force required for MWMLE
Guidelines for application
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
Physical examination
MWM’s easily, quickly integrated into physical examination
Subsequent to
-active/combined/functional movements
-Passive movements (physiological & Accessory
Physical examination 2
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
Treatment
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
Treatment 2
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
Treatment 3
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
Safety
only perform if ‘Painfree’
Be conservative with number of repetitions-first treatment
Reassess regularly
Some technique require careful explanation before gaining consent!
Efficacy
Convention - >200 continuing coursers in 1998 ;
Proposed biological basis
the mechanism by which the MWM exerts its ameliorative effects in clinical practice remains somewhat of an enigma
Proposed biological basis 2
correction of minor bony positional faults?
Facilitate joint gliding - restore function?
Neurophysiologically modulated
-not endogenous opioid systems
Placebo?
Therapist charisma?
