kaltenborn, parris, etc.

Maitland

Geoff Maitland’s concept of manipulative therapy has been established as one of the standard approaches to spinal manipulative techniques. His textbook, Vertebral Manipulation, is an indispensable and authoritative guide to his approach. His worldwide best-selling book Peripheral Manipulation forms one of the cornerstones of modern manual therapy.

Maitland’s approach focuses on detailed assessment, clinical reasoning, and reassessment to determine the physical dysfunction and efficacy of manual physiotherapy techniques.

Advocates of his approach emphasize that it is the clinical reasoning component that is the hallmark of his philosophy. The communication, interaction, and reasoning processes which accompany the Maitland techniques create a very effective manual physiotherapy approach.

The International Maitland Teacher’s Association (IMTA) was founded in 1992 in Zurzach, Switzerland. The IMTA teaches the Maitland Concept in several countries throughout the world. Their web site is www.imta.ch.

In the United States, Maitland-Australian Physiotherapy Seminars (MAPS) is recognized as the national leader in teaching Mr. Maitland’s approach. Further information is available at the MAPS web site www.ozpt.com.

http://www.influentialgiant.com/physicaltherapistlist.html

McKenzie

The McKenzie Method® is not merely extension exercises. In its truest sense, McKenzie is a comprehensive approach to the spine based on sound principles and fundamentals that, when understood and followed accordingly, are very successful. In fact, most remarkable, but least appreciated, is the McKenzie assessment process.

Assessment

Unique to the McKenzie Method® is a well-defined algorithm that leads to the simple classification of spinal-related disorders. It is based on a consistent “cause and effect” relationship between historical pain behavior as well as the pain response to repeated test movements, positions and activities during the assessment process.

A systematic progression of applied mechanical forces (the cause) utilizes pain response (the effect) to monitor changes in motion/function. The underlying disorder can then be quickly identified through objective findings for each individual patient. The McKenzie classification of spinal pain provides reproducible means of separating patients with apparently similar presentations into definable sub-groups (syndromes) to determine appropriate treatment.

McKenzie has named these three mechanical syndromes:

• Postural: End-range stress of normal structures
• Dysfunction: End-range stress of shortened structures
• Derangement: Anatomical disruption or displacement within the motion segment (All three mechanical syndromes, postural, dysfunction, and derangement, occur in the cervical, thoracic, and lumbar regions of the spine.)

Each distinct syndrome is addressed according to its unique nature with mechanical procedures, utilizing movement, and positions. The Derangement syndrome where the phenomenon of “centralization” occurs is most common.

Well-trained McKenzie practitioners will be able to identify those more difficult cases where advanced McKenzie techniques might benefit the patient versus those patients whose diagnosis is non-mechanical in nature (those patients are then quickly referred for alternate care, thus avoiding unnecessary periods of inappropriate or expensive management).

Treatment

McKenzie treatment uniquely emphasizes education and active patient involvement in the management of their treatment in order to decrease pain quickly, and restore function and independence, minimizing the number of visits to the clinic. And if a problem is more complex, self-treatment may not be possible right away. However, a certified McKenzie clinician will know when to provide additional advanced hands-on techniques until the patient can successfully manage the prescribed skills on their own.

Ultimately, most patients can successfully treat themselves when provided the necessary knowledge and tools. An individualized self-treatment program tailored to the lifestyle of the patient puts the patient in control safely and effectively.

Prevention

By learning how to self-treat the current problem, patients gain hands-on knowledge on how to minimize the risk of recurrence and to rapidly deal with recurrence if it occurs. The likelihood of problems persisting can more likely be prevented through self-maintenance.

http://www.mckenziemdt.org/

Mulligan

Brian Mulligan’s concept of mobilisations with movement (MWMS) in the extremities and sustained natural apophyseal glides (SNAGS) in the spine are the logical continuance of this evolution with the concurrent application of both therapist applied accessory and patient generated active physiological movements.

Principles of Treatment

In the application of manual therapy techniques, Physiotherapists acknowledge that contraindications to treatment exist and should be respectphyed at all times. Although always guided by the basic rule of never causing pain, therapist choosing to make use of SNAGS in the spine and MWMs in the extremities must still know and abide by the basic rules of application of manual therapy techniques.

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

1. 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 (i.e., lateral elbow pain with resisted wrist extension, adverse neural tension).
2. A 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.
3. 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.
4. While sustaining the accessory glide, the patient is requested to perform the comparable sign. The comparable sign should now be significantly improved (i.e., increased range of motion, and a significantly decreased or better yet, absence of the original pain).
5. 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.
6. 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.
7. 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.

Self-treatment is often possible using MWM principles with adhesive tape and/or the patient providing the glide component of the MWM and the patient’s own efforts to produce the active movement. Pain is always the guide. Successful MWM and Snags techniques should render the comparable sign painless while significantly improving function during the application of the technique. Sustained improvements are necessary to justify ongoing intervention.

http://www.bmulligan.com/about/concept.html