Friday 5: 5 Ways to Get to End Range | Modern Manual Therapy Blog

Friday 5: 5 Ways to Get to End Range


End Range, it's the 6th "E" of the Eclectic Approach. Perhaps it should be the first as it makes for the rapid changes in function, ROM, DTRs, pain, etc...

Getting a patient to end range is not for those who have difficulty being assertive with their patients. A common mistake in MDT course updates (for credentialed practitioners) is a failure to push the patient to end range. Even PTs who witnessed me pushing several patients (who were clinicians themselves) during my course last weekend were hesitant to push their own partner to end range cervical sidebending. End range is just the end of the available range people! We add a mild overpressure to push into the end range, that's it. It's just the play that any area should have passively. Here are 5 ways to get a patient to move to end range

1) PNF
  • it's not just for neuro-rehab, even though that's how we often learn it in PT school
  • example, cervical retraction with SB left, patient has end range pain
    • have them resist either SB left (my preference) or SB right, then continue to further end range into overpressure SB left, this often gets the last bit of end range that makes the rapid changes
2) MWM
  • it used to confuse me after taking Mulligan Courses when doing a sustained natural apophyseal glide (SNAG) on the ipsilateral side of pain worked better than the contralateral
  • pushing on the involved side around the painful area often takes away a perception of painful block or pinch
  • cervical
    • try pushing lightly up and forward, even just slacking the skin around the area of pain and then having the patient move into retraction, retraction with extension, or cervical sidebending
  • lumbar
    • do a standing MWM for flexion or extension in standing or lying to get a patient over a painful block, then they can get to end range without you
3) IASTM or STM
  • STM or IASTM along the ipsilateral side of pain (lumbar or cervical paraspinals) or adjacent patterns like upper trap, levator scapula for UQ, and QL and distal TL fascia for LQ often reduces pain during the motion or perception of obstruction during the MDT HEP
4) More PNF!
  • feeling blocked during the motion? Try light resistance into the motion, for example
    • cervical rotation left painful block during the motion
    • apply light resistance to the left forehead and resist lightly while they move toward you, and also away on the right side while they move to neutral
    • this is agonist reversals and works great to eliminate pain during motion
5) Thrust manipulation
  • when an area has a painful block, whether the mechanism is a hot facet or something that feels like that, mobilization with oscillations is often very painful
  • IASTM around the pattern of that area to prep, then thrust manipulation after informed consent and premanipulative hold often releases the area so the patient can get to end range with significantly less pain
  • I always explain to the patient any of these effects, are transient, and end range is how they maintain the gains
What are some of the ways you use to get patients to end range?


2 comments:

  1. Timely post. I've got a couple patients right now I swear have directional preferences, but spasms/hyperactive muscle activity causes the movement to be painful. I hate the idea of putting my hands on the patient for STM ala MDT training, but you've inspired me to give it a second chance...

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  2. Using any form of hands on therapy is just another way to get them to end range, in turn letting them self treat better. They will be no more reliant on you

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