Mulligan MWM for shoulder impingement, painful arc, or just plain LOM
Patient position: sitting on a chair, with good sitting posture
Therapist position: stand at the side opposite the affected shoulder, one hand of the therapist (the heel of the hand) holds the front of the affected shoulder, the other hand at the patient's scapula (on the bad side). This is a position Mulligan calls "acutening the angle".
Procedure: with both hands squeezing the affected shoulder, the therapist asks the patient if there is any pain. If there is none, ask the patient to forward flex the shoulder to the point of limit (while the therapist maintains his hold). If this is still painfree, ask the patient to do it 10x with no hold at the end range.
Reassess ROM after. You may repeat the procedure or proceed with shoulder abduction.
Note:
For Internal Rotation, use a belt (as if doing a towel stretch behind) and this time, have the patient on the edge of the plinth and the therapist is standing at the same side. One of the therapist's hands is in the patient's arm pit, lifting the affected arm up and in. If this is pain free, ask the patient to do an IR (like a towel stretch behind the patient) and if this is still pain-free, have the patient perform it 10x.
Therapist position: stand at the side opposite the affected shoulder, one hand of the therapist (the heel of the hand) holds the front of the affected shoulder, the other hand at the patient's scapula (on the bad side). This is a position Mulligan calls "acutening the angle".
Procedure: with both hands squeezing the affected shoulder, the therapist asks the patient if there is any pain. If there is none, ask the patient to forward flex the shoulder to the point of limit (while the therapist maintains his hold). If this is still painfree, ask the patient to do it 10x with no hold at the end range.
Reassess ROM after. You may repeat the procedure or proceed with shoulder abduction.
Note:
For Internal Rotation, use a belt (as if doing a towel stretch behind) and this time, have the patient on the edge of the plinth and the therapist is standing at the same side. One of the therapist's hands is in the patient's arm pit, lifting the affected arm up and in. If this is pain free, ask the patient to do an IR (like a towel stretch behind the patient) and if this is still pain-free, have the patient perform it 10x.
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