PART 2: MWM For wrist fractures: A video case report (Danish) By Josef M. Andersen M. PT. CMP, MCTA ………………………………………………………………………………… I apologize for the lacking translation. The movement restrictions should easily be appreciated when seeing the video. Please feel free to share with your colleagues. ------------------------------------------------------------------------- INFORMATION: Please refer to the following international website: ( bmulligan) to learn more about The Mulligan Concept and Mobilisations With Movement. This film is only an example of a real clinical situation and may therefore differ slightly from the official instructions used by MCTA at courses. ___________________________________________________________________________________________ Acknowledgement: Without Brian R. Mulligan s sharing of his knowledge and experience and the support of my MCTA colleagues, this material would have never been possible to share with you. Also thanks to Rose who consented to be filmed and share her story. Finally, I thank every viewer who takes time to see this film and share it with colleagues. Introduction and background: Recent Danish National Guidelines for wrist fractures failed to show any benefit from occupational therapy or physiotherapy in comparison with one session of exercise instruction. This is however only related to exercise. ======================= Rose presented at the clinic in Holte on the 24th October 2014. Her major complaint was pain and movement restrictions of the left wrist. - Unable to use the hand properly during regular ADL, handling cutlery, washing etc. - Difficulties with making a fist, loosing objects. - Her left hand felt weaker than the right. - She is diagnosed with osteoporosis. In her case, caution is on the essence during the application of any manual therapy procedure. In general, osteoporosis would be a contraindication to manual therapy. MWM is a very mild form of manual therapy and can be trilled by experienced therapists. If MWM can not be administered without pain, it is abandoned. Rose had a fall on the 13 June 2014: the incident resulted in a compound wrist fracture involving radius and ulna. She was treated surgically two days later. Radius was fixed with a titanium plate. She then received weekly OT session at the hospital to regain function since the 29th June. Radiographs appear fine. The film is self explanatory. The film has been edited down to 8 minutes from a 25 minutes session. The viewer should be able to appreciate the immediate change that MWM can achieve within such a short period of time. It is very common that changes seen during MWM therapy will be maintained. Several sessions and home exercise may be necessary to achieve return to near optimal function. Personal opinion: We are not doing justice to many of the patients who are recovering from wrist fractures as we treat today. It is very common to see that patients do not receive any form of manual therapy which is a mistake. Yes exercise is essential to regain power and function. However, without proper manual therapy treatment many patients will never achieve optimal movement. I suggest that MWM should be included as standard procedure for those recovering from wrist fractures. The method is simple, mobilisations are applied with minimal stress to the patient/pain free and the results speak for themselves. The effect seen in this video example is not an exception to what normally happens when MWM is used, provided the therapist is experienced in the application of MWM. For obvious reasons, I urge every therapist to learn and perfect MWM. It will save our patients a lot of time and effort. It is also obvious that the cost of rehabilitation is likely to be drastically reduced by lowering the numbers of treatments needed to get our clients back on track. Kind regards Josef M Andersen Master of Musculoskeletal & Sports Physiotherapy Member of The Mulligan Concept Teachers Association (MCTA) Manager: MCTA Europe.
Posted on: Sun, 26 Oct 2014 10:36:57 +0000
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