Spinal Mobilisation With Arm Movement (SMWAM): A clinical example: By Josef M Andersen (MCTA) SMWAM was described by Brian R. Mulligan (NZ) as an assessment for neck involvement in presentations involving shoulder or arm pain during movement. SMWAM should commonly be used as part of the screening process to reveal possible neck involvement in presentations involving the arm or shoulder. The procedure takes only few seconds as a test, SMWAM is abandoned if no clear change is achieved during the testing procedure. However, when SMWAM is relevant, a clear change in symptoms and movement is spotted and SMWAM becomes the treatment or part of the treatment. The technique is quite simple, a transverse glide is applied at a relevant SP, the direction of the glide is opposite to the involved limb, the glide is maintained while the relevant movement is assessed. Several levels can be tested for several movement restrictions. ------------------------------------------------------------------------------------------ This short movie was recorded as a live demonstartion of techniques commonly used by Mulligan Concept practitioners, this was done during a Mulligan Concept course at Thiested hospital, Denmark August 2014. The client is not previously known to the therapist, she volunteered to be filmed and connected to have her story shared on the internet prior to assessment and treatment. The film was edited down to 5 min from 15 min. Key history: Due to two breast keeping surgeries due to CA approximately 5 years ago, the client was still experiencing symptoms related to lifting the arm at end range in Abduction and extension during abduction. She also complained of loss of power of the L arm in comparison to R arm. No P/N or other symptoms distally to the shoulder or Elbow. Previous management: She received regular physiotherapy and manual therapy directed at releasing scar tissue that was though to be the major cause of movement restrictions. In my personal experience, I rarely give any importance to the idea of scar tissue! Because I often find shoulder joint restrictions or neck or thoracic spine involvement in similar presentations. What is seen in the film is the first trial of SMWAM and the increased range of abduction. The hypothesis of scar tissue as the reason for the restriction can clearly be rejected. Results: Initial retest was painful but few more repetitions could clear that. It was also difficult for her to retest the movement when switching from sitting to stance, this could be related to the increased requirements of power, control and stability in stance. SMWAM in stance was therefore indicated. A home exercise of self mobilization was given, as seen here. Follow up: A phone interview by the treating therapist was made two days later and revealed that she was completely fine with using the arm and needed no further therapy. A strength exercise program could be advised. Best regards Josef M Andersen Master of Musculoskeletal and Sports Physiotherapy Mulligan Concept Teachers Association (MCTA) Manager, MCTA Europe. For more information about the Mulligan Concept please visit the official international website: bmulligan Denmark and Norway: mulligan.dk & mulligan.no
Posted on: Mon, 20 Oct 2014 13:32:10 +0000
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