Technique Highlight: Functional Mobilization for Repeated Extension | Modern Manual Therapy Blog

Technique Highlight: Functional Mobilization for Repeated Extension


This is a very useful technique to help with patients who have very stubbornly blocked extension. It may be performed in standing or lying.


Indications: The patient is unable to overcome blocked extension in derangement syndrome when treating with the extension principle.

Pt: Standing

PT:

  • Mob belt placed around your hips and the patient's hips, standing behind the patient and off to the side slightly
  • Mob hand on the level above the suspected restricted segment.


Technique:

  • P/A pressure applied with the mob hand with simultaneous superior pressure as the patient active backward bends
  • Use your hips to apply counterforce so the patient does not lose balance from the P/A force
  • Apply both P/A and superior traction force during the entire 10-15 reps
  • Attempt for at least 3 sets, recheck extension to see if they are now able to reduce or maintain derangement reduction on their own
Pt: Lying prone

PT:
  • One hand on the abdomen (explain to patient before you put it there - they expect to be touched in the back, not the front!)
  • Other hand on the corresponding segment above the suspected blocked level (hands should be at the same level anteriorly and posteriorly)
Technique:
  • As the patient performs the repeated extension in lying, apply A/P force with anterior hand and P/A force with posterior hand
  • Also perform superior traction force
  • Both forces maintained during the entire 10-15 reps
  • Attempt for at least 3 sets, recheck extension to see if they are now able to reduce or maintain derangement reduction on their own
Like any MWM, this should be pain free other than the feeling of a stretch. I have found this to be very useful with seemingly irreducible derangements!



4 comments:

  1. I love the standing technique, I use this daily in my practice. Just looking back at my Mulligan manual...I cant believe that I have forgotten the REIS with traction. Will definitely be using that for a few pts who have difficulty with WBing postures.

    Just a Q: Do you tend to ensure that the REIS with traction is pain free as per Mulligan or just as long as the pain reduces/range improves as per McKenzie?

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  2. Yeah, I use the Mulligan rules, if you can't get it to be pain free with several modifications (more force, less force, different area of application, I abandon the technique after 3-5 sets.

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  3. Hmmm, for us abnormally tall guys it works much better if you are sitting with the patient standing in front of you.

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  4. Yes, your sitting is like my standing. Unless you are also treating a freakishly tall patient.

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