Successful management of a professional viola player with a complex playing related musculoskeletal disorder

Objective: This paper presents the case of a 53-year-old female professional violist with chronic disabling neck and shoulder pain who had failed standard conservative management. A multimodal approach including Mulligan Concept manual therapy techniques resulted in a successful return to the workplace. Methods: Mobilization with Movements and Sustained Natural Apophyseal Glides as part of Mulligan Concept manual therapy approach, were the main treatment techniques utilized. Neuro-dynamic exercises, strengthening exercises, ergonomic interventions, alterations in playing load, and posture training were also implemented. Pain, range of motion and disability levels were monitored throughout treatment. Results: Significant improvements were seen in both neck and shoulder range of motion alongside considerable pain reduction in both regions. Clinically meaningful improvements were also noted in Neck Disability Index and Shoulder Pain and Disability Index scores. Discussion: Ergonomic intervention with postural correction and replacement with a lighter viola also contributed to patient recovery and return to the workplace. The Mulligan approach has proved to be effective in a wide variety of conditions. Still, it has not previously been considered in managing complex neck and upper limb disfunctions in string players. Conclusion: This paper highlights how an intensive manual therapy program had better results compared with standard conservative management. Multimodal intervention with occupational, ergonomic, and physiotherapy approaches was effective, leading to progressive re-integration into the workplace. Mulligan Concept manual therapy techniques should be considered in the management of playing related musculoskeletal disorders.

Effects of mulligan concept in classical ballet dancers with pain in the lower limbs

Introduction: The Mulligan concept is a manual therapy technique that addresses the restoration of arthrocinematic processes and inadequate osteocinematic movements, resulting in reduced muscle tension, postural failure and pain relief. Objectives: To analyze the effectiveness of the Mulligan concept in reducing lower limb pain processes in classical dancers. Methods: Longitudinal study, approved by the Ethics and Research Committee of the Universidade Estadual do Piauí, according to the decision of No. 2064503, composed by 4 classical dancers. An evaluation of the pain level was performed using a digital algometer (Wagner Instruments) with a ten-kilogram-force (Kgf) capacity in dancers who presented painful symptoms in the knee. The level pain before and after the intervention with the Mulligan concept was verified in the following points: patellar ligament (PL), medial collateral ligament (MCL) and lateral collateral ligament (LCL). The Mulligan concept was performed actively, painlessly, with adjustments by the therapist and was maintained at the end of the knee amplitude for 10 seconds. This protocol was repeated 3 times in the first attendance, in the second 10 times, in the third there were 2 repetitions of 10 slides and in the subsequent attendances there were 3 repetitions of 10 slides. Results: An increase in the average of the pain threshold in patellar, medial collateral and lateral collateral ligaments was observed in all participants of the study, when comparing the initial values of the 1st care and the final values of the 12th Mulligan session. The lateral collateral ligament presented the most significant result, with p = 0.02. Statistical analysis was performed through the BioEstat 5.0 program. The Shapiro-Wilk tests were applied to assess the normality of variables, and the t-student test was considered statistically significant p<0.05. Conclusion: statistically the lateral collateral ligament showed an immediate and lasting significant improvement in the pain threshold of the dancers with the therapeutic intervention of the Mulligan concept.

The effects of the Mulligan concept in ankylosing spondylitis: a report of two cases

Introduction/Aims The first complaint in ankylosing spondylitis is usually sacroiliac joint pain and morning stiffness. Aside from inflammation, sacroiliac joint pain is related to joint damage and mechanical stress. Many different methods are applied in the treatment of sacroiliac joint pain. This study aimed to investigate the effects of sacroiliac joint mobilisation on pain, function and mobility in patients with ankylosing spondylitis. Methods Two patients presented with sacroiliac joint pain: a 46-year-old male and a 34-year-old female. Both patients received eight sessions of mobilisation with movement, according to the Mulligan concept (sacroiliac joint mobilisation and mechanical correction). Sessions were held at 4-day intervals over a 28-day period. The patients were assessed for sacroiliac joint mobilisation immediately before and after the first session and their pain, function and mobility were assessed at the second and eighth sessions. Findings A decrease in pain and increases in functional performance and mobility were noted in both cases at the end of eight sessions. Conclusions Sacroiliac joint mobilisation might be effective in improving pain, function and mobility in patients with ankylosing spondylitis. Further studies should be conducted with an increased number of participants to confirm these findings.

The Effects of Hip Mobilizations on Patient Outcomes: A Critically Appraised Topic

Clinical Scenario: Hip osteoarthritis currently affects up to 28% of the population, and the number of affected Americans is expected to rise as the American population increases and ages. Limited hip range of motion (ROM) has been identified as a predisposing factor to hip osteoarthritis and limited patient function. Clinicians often apply therapy techniques, such as stretching and strengthening exercises, to improve hip ROM. Although traditional therapy has been recommended to improve hip ROM, the efficiency of the treatments within the literature is questionable due to lack of high-quality studies. More recently, clinicians have begun to utilize joint mobilization and the Mulligan Concept mobilization with movement techniques to increase ROM at the hip; however, there is a paucity of research on the lasting effects of mobilizations. Given the difficulties in improving ROM immediately (within a single treatment) and with long-lasting results (over the course of months), it is imperative to examine the evidence for the effectiveness of traditional therapy techniques and more novel manual therapy techniques. Focused Clinical Question: Is there evidence to suggest manual mobilizations techniques at the hip are effective at treating hip ROM limitations? Summary of Clinical Findings: 5 Randomized Controlled Studies, improved patient function and ROM with the Mulligan concept, high velocity low amplitude improved. Clinical Bottom Line: We found moderate evidence to suggest favorable outcomes following the use of hip mobilizations aimed at improving hip ROM and patient function. Strength of Recommendation: Strength of the studies identified are 1B.