The Transversus: It's Not Just for Strengthening Anymore
While performing the MWM passively for 1-2 reps to test her movement, it was pain free. When I asked her to move with me, she stated the movement was painful in her lumbar spine.
A rule for any Mulligan MWM is that it should be 100% pain free. Instead of abandoning the technique, I instructed her on a transversus abdominus contraction. While actively contracting, she was able to IR her left hip during the technique with no pain in her lumbar spine. Her hip IR improved after 3 quick sets and remained better for her HEP.
Another patient I was treating several years ago had LBP and radiating right LE pain. After 6 visits of MDT and OMPT she was completely pain free in all ADLs except crossing her right LE over her left at the ankle; this caused radiating pain to below her knee. All repeated motions and neurodynamic testing was normal and pain free. I suggested she try the same activity with a transversus contraction which made it pain free. She performed this 2-3 times/day and within 2 days, it was firing as normal during this minimal ADL.
Just a quick clinical pearl! Hope it helps with some of your patients!