La rotación axial de la clavícula que plantea la maniobra de Mulligan ¿produce una reducción de la presión en el espacio subacromial? Un estudio ex vivo exploratorio / Does the axial rotation of the clavicle posed by the Mulligan maneuver produce a pressure reduction in the subacromial space? An exploratory ex vivo study

RESUMEN: El pinzamiento de hombro es la principal causa del hombro doloroso. Dentro de las estrategias terapéuticas propuestas se encuentra la terapia manual. En este contexto, la maniobra de Mulligan, implica una rotación axial en sentido anterior de la clavícula, emulando la acción del músculo subclavio, lo cual hipotéticamente aumentaría el espacio subacromial. Sin embargo, no existen antecedentes que proporcionen sustento experimental a dicha hipótesis. El objetivo del presente estudio fue explorar si la rotación axial de la clavícula, producida por la maniobra de Mulligan, tiene efecto sobre la presión registrada en el espacio subacromial, con el propósito disponer de antecedentes metodológicos que puedan contribuir al diseño de futuros estudios que aborde la problemática expuesta y consideren un mayor tamaño de muestra. Mediante un estudio exploratorio ex-vivo, se evaluaron dos preparados anatómicos que comprendían la escapula, la clavícula y los dos tercios proximales del humero, ambos con indemnidad de la articulación glenohumeral y acromioclavicular. En estos se registraron la presión en el espacio subacromial y la rotación axial de la clavícula, todo durante la realización de una maniobra de rotación axial clavicular en sentido anterior. Se analizaron las diferencias de presión entre una condición basal y durante la maniobra, como también la máxima rotación axial de clavícula. Dichas variables fueron registradas mediante un sensor de presión y un sistema de análisis de movimiento. La presión en el espacio subacromial durante la maniobra, disminuyó en todas las repeticiones en un rango comprendido entre el 21-51 % de la presión basal. La máxima rotación axial registrada estuvo entre los 3.9-10°. Los resultados de este estudio exploratorio, dan pie para hipotetizar que la maniobra de rotación axial anterior de la clavícula produce una disminución de la presión subacromial, en el área comprendida inmediatamente bajo el acromion.

SUMMARY: Shoulder impingement is the main cause of shoulder pain. Manual therapy is one of the proposed therapeutic strategies. In this context, the Mulligan maneuver implies anterior axial rotation of the clavicle, emulating the action of the subclavius muscle, which hypothetically would increase the subacromial space. However, there are no antecedents that provide experimental support for this hypothesis. The objective of the present study was to explore whether the axial rotation of the clavicle, produced by the Mulligan maneuver, has an effect on the pressure registered in the subacromial space, with the purpose of having methodological antecedents that can contribute to the design of future studies that address the problem exposed and consider a larger sample size. Through an ex-vivo exploratory study, two anatomical preparations comprising the scapula, clavicle, and proximal two-thirds of the humerus, both with glenohumeral and acromioclavicular joint sparing, were evaluated. In these, the pressure in the subacromial space and the axial rotation of the clavicle were recorded, all during the performance of an anterior clavicular axial rotation maneuver. Pressure differences between a basal condition and during the maneuver were analyzed, as well as the maximum axial rotation of the clavicle. These variables were recorded using a pressure sensor and a movement analysis system. The pressure in the subacromial space during the maneuver decreased in all repetitions in a range between 21-51% of the basal pressure. The maximum axial rotation recorded was between 3.9-10°. The results of this exploratory study give rise to the hypothesis that the anterior axial rotation maneuver of the clavicle produces a decrease in subacromial pressure, in the area immediately below the acromion.

“To compare the effect of mulligan’s mobilization with mulligan’s taping and diamond taping on grip strength in patients with chronic lateral epicondylitis”: A randomized clinical trial.

Background and objectives: Lateral epicondylalgia or tennis elbow is a prevalent musculoskeletal disorder that is characterized by lateral elbow pain often associated with gripping tasks. This study was done to compare the effect of Mulligan’s mobilization with Mulligan’s taping and Diamond taping in chronic lateral epicondylitis grip strength. Methods: Forty (n=40) participants with chronic lateral epicondylitis were randomly allocated in two groups. Group ‘A’ received Mulligan’s mobilization with Mulligan’s taping and Group ‘B’ received Diamond taping and both the group received stretching exercise of the common extensors muscle of wrist prior to taping technique. The outcome measure was assessed in terms of Pain free grip strength (PFGS) for grip strength. Results: 20 subjects (n=20) were taken in both the groups with a mean age of 39.3 years in Mulligan’s Mobilization group and 41.95 years in Diamond taping group. Comparison of the pre and post values showed significant improvement (p<0.05) in grip strength in both the groups. When comparison of pre-test grip strength were done, there was no significant difference (p>0.05) in both the groups, this proves the fact that both the group started with the same intensity of grip strength while the post intervention comparison showed a significant improvement in grip strength (p<0.05) in both the groups. Conclusion: Mulligan’s Mobilization and Diamond taping intervention were equally beneficial in improvising the grip strength in patients with lateral epicondylitis.

Efeito imediato da MWM de Mulligan em pacientes com dor no ombro / MWM Mulligan immediate effect on shoulder pain patients

Introdução: a dor no ombro leva a limitações e incapacidades entre adultos e idosos, merecendo atenção do fisioterapeuta. Objetivo: Avaliar o efeito imediato da técnica de Mulligan em pacientes com dor no ombro. Metodologia: trata-se de resultados preliminares de um ensaio clínico realizado entre julho de 2018 a julho de 2019. Pacientes com dor no ombro (n=44), de ambos os sexos, foram randomizados e submetidos a dois protocolos de tratamento: exercícios terapêuticos (n=22) e MWM de Mulligan (n=22), atendidos na Clínica Escola de Fisioterapia da UFBA. Todos os participantes responderam a um questionário clínico e sociodemográfico e realizaram avaliação da dor pela escala visual analógica (EVA) e algometria. Os pacientes foram tratados por dois fisioterapeutas experientes na área e, depois, foram reavaliados imediatamente. Resultados: mulheres predominaram, a média de idade foi de 56 anos no grupo Mulligan e 57 no grupo exercícios terapêuticos. Síndrome do manguito rotador predominou: 19 (86,4%) no grupo Mulligan e 15 (68%) no grupo exercícios. O ombro mais acometido foi o direito no Grupo Mulligan, (17 (77,3%); já no grupo exercícios, foi o esquerdo com 12 (55%). A cor negra foi a mais autorrelatada pelos pacientes, e poucos tinham o ensino superior completo. No grupo Mulligan, as ocupações mais informadas foram dona de casa, seguida de aposentados e autônomos. No grupo exercícios, não houve dona de casa, e sim mais aposentados e autônomos. Os dois grupos mostraram ser mais sedentários. Não houve diferença da dor pela EVA entre os grupos, antes e após o tratamento (p=0.79, p=0.56, respectivamente). Já a intensidade da dor mensurada pela algometria, tanto antes do tratamento (p=0.008) quanto depois do tratamento (p=0.04), foi diferente entre os grupos, com predomínio de melhora no grupo Exercícios. Conclusão: a MWM não foi mais eficaz que os exercícios terapêuticos na redução da dor do ombro, sendo que o exercício apresentou mais eficácia quando medido através da EVA e sem melhora significativa ao ser mensurada pela algometria após aplicação de uma única sessão de tratamento.

Introduction: shoulder pain leads to limitations and disabilities among adults and the elderly deserving attention from the physiotherapist. Objective: to evaluate the immediate effect of the Mulligan technique in patients with shoulder pain. Methodology: these are preliminary results of a clinical trial conducted from July 2018 to July 2019. Patients (n=44) with shoulder pain of both sexes were randomized and submitted to two treatment protocols: therapeutic exercises (n = 22) and Mulligan's MWM (n = 22) attended at the UFBA School of Physiotherapy Clinic. All participants answered a clinical and sociodemographic questionnaire and underwent pain assessment by visual analog scale (VAS) and algometry. The patients were treated by two experienced physiotherapists and then reassessed immediately. Results: women predominated, the average age was 56 years in the Mulligan group and 57 in the therapeutic exercises group. Rotator cuff syndrome predominated, 19 (86.4%) in the Mulligan group and 15 (68%) in the exercise group. The most affected shoulder was the right shoulder in the Mulligan Group (17 (77.3%), while in the exercise group was the left shoulder with 12 (55%).The black color was the most self-reported by the patients and few patients had higher education. In the Mulligan group the most informed occupations were housewife followed by retirees and self-employed. In the exercise group we had no housewife but more retired and self-employed. The two groups were more sedentary. There was no difference in VAS pain between the groups before and after treatment (p = 0.79, p = 0.56, respectively), while pain intensity measured by algometry both before treatment (p = 0.008) and after treatment (p = 0.04) was different between Conclusion: Mulligan's MWM was not more effective than exercise in reducing shoulder pain, and exercise was more effective when measured by VAS and without significant improvement when measured by algometry after applying a single treatment session.

Comparative Effect of Static Stretching and Mulligan Stretching on Hip Adductor Flexibility in Footballers - A Two Group Trial

Groin pain due to adductor strain is commonly seen in footballers. Many methods of stretching a muscle likeballistic stretching, static stretching etc are used to increase flexibility of hip adductors and prevent groinstrain. Static hip adductor stretching till now is more favored technique whereas mulligan adductor stretchingis very new and popular method of increasing muscle flexibility. The present study was undertaken to comparethe effectiveness of 2 stretching programs i.e. Mulligan adductor stretching and static stretching on tight hipadductor. In this trial, 42 athletes who fulfilled the selection criteria were selected and then divided into twogroups based on block randomization. Group-1 received Mulligan’s adductor stretching while Group-2 receivedstatic stretching of hip adductors for 3 alternative days. Hip abduction range of motion (Abd-ROM) wasmeasured on baseline, after first day treatment and finally after third day treatment by a universal goniometer.Mean difference of Abd-ROM within groups on baseline, 1st day after treatment and 3rd day after treatmentwere -8.07, -12.76, -4.69 which shows highly significant difference (p = 0.00) between 3 sessions. MeanAbd-ROM between two groups has not shown significant different (F = 2.99, p > 0.05). It is concluded thatMulligan’s adductor stretching and static stretching both are equally effective in increasing Abd-ROM

Effect Of Motor Control Retraining Of Scapular Stabilizers Versus Mulligan Mobilisation With Movement In Shoulder Impingement Syndrome

Background: Shoulder Impingement is one of the most common causes of shoulder pain in adults. Scapular muscle imbalances results in impaired scapular orientation with altered scapular kinematics and altered glenohumeral rhythm. Purpose of study: To study the effect of motor control retraining of scapular stabilizers versus mulligan mobilisation with movement in shoulder impingement patients. Methodology: 60 patients with positive Hawkins, kinetic medial rotation and/or Neer impingement test were taken for the study as subjects. They were then divided into two groups of 30 each- Group A and Group B. Both the groups were assessed and reassessed for(i) pain status using VAS (Visual Analogue Scale) both at rest and on internal rotation, (ii)Shoulder Flexion, Extension, Shoulder Abduction, Adduction, Internal and External Rotation Range Of Motion (ROM), (iii)Functional Scale SPADI( Shoulder Pain and Disability Index) pre and post the intervention. Group A received motor control retraining of scapular stabilizers whereas group B received Mulligan’s mobilization with movement for 6 weeks (3 times in a week). Both the groups received conventional physiotherapy. Data analysis was done using Wilcoxon sign ranked test for intragroup comparison and Manwhitney test for intergroup comparison. Results: The results showed statistically significant improvement in shoulder pain, ROM and shoulder function in motor control retraining as compared to mulligan mobilisation with movement. Conclusion: Motor control retraining of scapular stabilizers is more effective treatment technique as compared to mulligan mobilisation with movement in shoulder impingement.

Morphological relationship between the superficial cortical and deep grey matter structures in adult human brains: a cadaveric study / Relación morfológica entre las estructuras superficiales de la sustancia gris cortical y profunda en los cerebros humanos adultos: un estudio en cadáveres

While various neurodegenerative diseases affect cortical mass differently, finding an optimal and accurate method for measuring the thickness and surface area of cerebral cortex remains a challenging problem due to highly convoluted surface of the cortex. We therefore investigated cortical thickness in a sample of cadaveric specimens at the Discipline of Clinical Anatomy, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, South Africa to provide some clue as to possible variations in the parameters. Following ethical approval, 60 brain samples were uniformly sectioned (5 mm thickness) and eight slices taken from each brain across regions of interest (ROI) prepared and stained by Mulligan's technique. Thickness was measured at selected angles (0º, 45º, 90º, 135º and 180º) for both right and left cerebral hemispheres. Mulligan's stain produced good cortical differentiation and clear images that enabled manual delineation of structures. Cortical thickness ranged from 3 to 5 millimeters across the ROI. Interestingly, there was rightward hemispheric asymmetry of cortical thickness of selective slices at suggested angles which is related to structurally and functionally important brain regions. Moreover, there was no significant correlation between the surface area of superficial cortex and the deep nuclei at the same level. The superficial cortex and deep nuclei are manifested independently in normal aging, neuropsychiatric or developmental disorders. Providing accurate morphometric evaluation of cortical thickness and area based on gross staining of the brain slices could provide qualitative data that may support the study of human cerebral cortex even in disease conditions.

Si bien varias enfermedades neurodegenerativas afectan a la masa cortical de manera diferente, encontrar un método óptimo y preciso para medir el grosor y el área de la superficie de la corteza cerebral sigue siendo un problema difícil debido a la superficie altamente enrevesada de la corteza. Por lo tanto, investigamos el grosor cortical en una muestra de cadáveres del Departamento de Anatomía Clínica de la Facultad de Medicina Nelson R. Mandela de la Universidad de KwaZulu-Natal, Sudáfrica, para proporcionar alguna pista sobre posibles variaciones en dichos parámetros. Después de la aprobación ética, 60 muestras de cerebro se seccionaron uniformemente (5 mm de grosor) y se tomaron ocho cortes de cada cerebro en regiones de interés (ROI) preparadas y teñidas con la técnica de Mulligan. El espesor se midió en los ángulos seleccionados (0º, 45º, 90º, 135º y 180º) para los hemisferios cerebrales derecho e izquierdo. La tinción de Mulligan produjo una buena diferenciación cortical e imágenes claras que permitieron la delineación manual de las estructuras. El grosor cortical osciló entre 3 y 5 milímetros a través del ROI. Curiosamente, hubo una asimetría hemisférica hacia la derecha del grosor cortical de los cortes en ángulos sugeridos que se relacionan con regiones cerebrales estructural y funcionalmente importantes. Además, no hubo una correlación significativa entre el área de la superficial de la corteza superficial y los núcleos profundos en el mismo nivel. La corteza superficial y los núcleos profundos se manifiestan de manera independiente en el envejecimiento normal, en los trastornos neuropsiquiátricos o del desarrollo. Realizar una evaluación morfométrica precisa del grosorcortical y el área basada en la tinción macroscópica de los cortes del cerebro, podría proporcionar datos cualitativos que puedan respaldar el estudio de la corteza cerebral humana incluso en condiciones de enfermedad.

The Effect Of Mulligan’s Bent Leg Raise [BLR] Versus Instrument Assisted Soft Tissue Mobilization [M2T] In Subjects With Hamstring Tightness In Non - Specific Low Backache: A Randomized Clinical Trial

Background: Nonspecific low backache is a pain, muscle tension, or stiffness localized between the costal margin and inferior gluteal folds, without sciatica. Only 10% of the cases have a specific cause. One of the risk factors is poor hamstring flexibility. Mulligan’s BLR and IASTM have shown to improve hamstring flexibility. No studies have compared both. Therefore the study was undertaken. Methods: 48 subjects, mean age 34.27 ± 5.30 were recruited. Group A (24 - 15 male and 9 female) received TENS, Mulligan’s BLR and conventional exercises. Group B (24 - 12 male and 12 female) received TENS, M2T for Hamstrings and conventional exercises. Outcome measures were taken pre-treatment session 1 and post-treatment session 6. Results: Pre and post mean the difference in group A [BLR] was 5.96 ± 0.95 for NPRS, 19.38 ±7.28 for Right AKET, 20.54 ± 6.78 for Left AKET, 2.07 ± 6.49 for Lumbar lordosis and 28.38 ± 9.73 for QBPDS. Pre and post mean the difference in group B [M2T] was 5.71 ± 1.20 for NPRS, 17.00 ± 6.94 for Right AKET, 15.75 ± 6.50 for Left AKET, 1.20 ± 4.76 for Lumbar lordosis and 26.42 ± 11.38 for QBPDS. The intragroup comparison was statistically significant, p = 0.0001 for all outcome measures. Intergroup comparison was statistically significant, p < 0.05 for Left AKET (p=0.0161). Conclusion: Interventions given were equally effective in reducing pain, improving hamstring flexibility, and reducing disability within the group but not between the groups except left AKET.

Efficacy Of Muscle Energy Techniques As An Adjunct With Mulligans Mobilization In Adhesive Capsulitis Of Shoulder

Background: Adhesive Capsulitis most commonly referred to as ”Frozen Shoulder” is an insidious Painful Condition with progressive and gradual restriction of all planes of movement in the glenohumeral joint. Evidence shows Mulligan's mobilization with movement (MWM) mobilization technique is more effective than muscle energy techniques (MET) and conventional therapy in improving shoulder function. Therefore the present study intends to determine the efficacy of muscle energy techniques along with Mulligan’s mobilization with movement, in adhesive capsulitis of the shoulder joint. Methods: The present randomized controlled trial was conducted among 30 subjects including both sex groups aged between 40-60 years diagnosed with adhesive capsulitis of the shoulder. They were randomly assigned into two groups with 15 subjects each. Group A received Mulligan’s mobilization alone, and Group B received Mulligan’s mobilization along with MET. Both the groups received the treatment protocol six times a week for three weeks. Pre and post evaluation of pain was done by using the short-form McGill pain questionnaire, range of motion by the Universal Goniometer and the functional disability by using Shoulder Pain and Disability Index (SPADI). Results: There was a significant improvement (P<0.05) in pre and post-intervention levels in both groups. Between groups analysis, the results are: a range of motion improved 30%, and the values are flexion with a p-value of 0.010, for abduction, internal and external rotations with a p-value of 0.000 except for extension with a p-value of 0.109. On comparison of SPADI using Mann Whitney U test, it showed 50% improvement with a significant difference with a p-value of 0.001 and McGill improved for more than 70% with a p-value of 0.000. Conclusion: Mulligan’s mobilization along with Muscle Energy Technique is found to be more effective in improving quality of life among subjects with adhesive capsulitis of shoulder than Mulligan’s mobilization alone.

Comparison of Sit and Reach Test, Straight Leg Raise Test and Visual Analogue Scale When Applying Static Stretching and Mulligan's Two Leg Rotation in Young Adults with Hamstring Shortness

PURPOSE: This study compared the effects of Static stretching and Mulligan's Two-leg rotation about the Hamstring flexibility, Hip range of motion, and pain.METHODS: The subjects were allocated randomly into two groups: Static stretching group (n=13) and Mulligan's two leg rotation group (n=14). The study was designed with stretching protocols for four minutes and thirty seconds per day five times a week for three weeks in total. Measurements, including the Sit and reach test, Active/Passive Straight leg raise, and Visual analogue scale, were conducted before and after the intervention. The data were analyzed using a paired t-test and independent t-test.RESULTS: The flexibility of the two leg rotation group was higher than the static stretching group after the intervention. The post-sit and reach test value of the two leg rotation group was significantly higher than the pre-sit and reach test value of the static stretching group. In addition, the variance of the sit and reach test of the two leg rotation group was significantly higher than that of the static stretching group.CONCLUSION: These results showed that two leg rotation techniques have a positive effect on the changes in the sit and reach test and active straight leg raise test. Two leg rotation techniques can be recommended as a self-stretching and easier way to stabilize the lumbopelvic rhythm, reduce the stiffness of the muscle and relieve pain. This is effective in preventing muscle damage, enabling muscle relaxation and reducing the risk of injury to the spine during daily lives and in sports activities.

The clinical efficacy of the Mulligan technique for treating cervical vertigo in an environment containing hyperbaric oxygen / 中华物理医学与康复杂志

Objective@#To observe the clinical efficacy of the Mulligan technique in treating cervical vertigo (CV) in a hyperbaric oxygen (HPO) environment.@*Methods@#Sixty-eight CV patients were randomly divided into a control group and an observation group, each of 34. Both groups were given routine treatment with ultrashortwave irradiation, but the observation group was additionally provided with 15 minutes of treatment based on the Mulligan technique in an environment with oxygen at 0.2 MPa, five days a week for two weeks. Both groups were assessed using the cervical vertigo symptoms and functional assessment scale (ESCV) and the daily frequency of vertigo was recorded before the treatment and 2, 4, 7, 14 and 60 days after treatment began. Moreover, the mean blood flow velocity in the patients′ vertebral (VA) and basilar arteries (BA) was detected using transcranial Doppler sonography before the treatment and after two weeks and two months.@*Results@#There were no significant differences between the two groups in any of the measurements before the intervention. Afterward, however, significant improvement in all of the measurements was observed compared with before the treatment. After two weeks and two months the average ESCV score, daily occurrence of CV and mean VA and BA blood flows in the observation group were all significantly superior to those of the control group at the same time points.@*Conclusion@#Treatment based on the Mulligan technique in an environment with 0.2 MPa partial pressure of oxygen is a more effective way to relieve the symptoms of cervical vertigo and reduce the frequency of its occurrence. Such treatment is worthy of application in the clinic.

The clinical efficacy of the Mulligan technique for treating cervical vertigo in an environment containing hy-perbaric oxygen / 中华物理医学与康复杂志

Objective To observe the clinical efficacy of the Mulligan technique in treating cervical vertigo ( CV) in a hyperbaric oxygen ( HPO) environment. Methods Sixty-eight CV patients were randomly divided into a control group and an observation group, each of 34. Both groups were given routine treatment with ultrashortwave irra-diation, but the observation group was additionally provided with 15 minutes of treatment based on the Mulligan tech-nique in an environment with oxygen at 0.2 MPa, five days a week for two weeks. Both groups were assessed using the cervical vertigo symptoms and functional assessment scale ( ESCV) and the daily frequency of vertigo was recorded before the treatment and 2, 4, 7, 14 and 60 days after treatment began. Moreover, the mean blood flow velocity in the patients' vertebral ( VA) and basilar arteries ( BA) was detected using transcranial Doppler sonography before the treatment and after two weeks and two months. Results There were no significant differences between the two groups in any of the measurements before the intervention. Afterward, however, significant improvement in all of the measurements was observed compared with before the treatment. After two weeks and two months the average ESCV score, daily occurrence of CV and mean VA and BA blood flows in the observation group were all significantly superi-or to those of the control group at the same time points. Conclusion Treatment based on the Mulligan technique in an environment with 0.2 MPa partial pressure of oxygen is a more effective way to relieve the symptoms of cervical vertigo and reduce the frequency of its occurrence. Such treatment is worthy of application in the clinic.

Shoulder joint pain of rotator cuff injury treated with electroacupuncture and Mulligan's mobilization: a randomized controlled trial / 中国针灸

<p><b>OBJECTIVE</b>To verify the clinical therapeutic effects on shoulder joint pain of rotator cuff injury treated with electroacupuncture (EA) and Mulligan's mobilization.</p><p><b>METHODS</b>A total of 120 patients of shoulder joint pain of rotator cuff injury were randomized into an EA group, a rehabilitation group and a combined therapy group, 40 cases in each one. In the EA group, EA was applied to Jianzhen (SI 9), Jianliao (TE 14), Jianyu (LI 15), Tianzong (SI 11), Jianqian (extra) and Binao (LI 14) in the affected side. Of these acupoints, Jianliao (TE 14) and Jianyu (LI 15), Jianzhen (SI 9) and Tianzong (SI 11) were stimulated with's electric apparatus. In the rehabilitation group, Mulligan's mobilization was used, including scapular mobilization, static joint mobilization and dynamic joint mobilization. In the combined therapy group, EA was used in combination with Mulligan mobilization. The treatment was given once a day in each group, 5 sessions a week, totally for 6 weeks. The pain intensity of shoulder joint (VAS), the University of California at Los Angeles shoulder rating scale (UCLA) and the range of motion (ROM) of shoulder joint were evaluated before and 6 weeks after treatment separately. The adverse reactions were recorded in each group.</p><p><b>RESULTS</b>VAS scores were all reduced, UCLA scores increased and ROM improved after treatment as compared with those before treatment in the patients of the three groups (all<0.05). After treatment, VAS score, UCLA score and ROM in the combined therapy group were remarkably improved as compared with those in the EA group and the rehabilitation group (all<0.05). Regarding the improvements of VAS and UCLA scores, the results in the EA group were better than those in the rehabilitation group (both<0.05). Regarding ROM improvement, the results in the rehabilitation group were superior to those in the EA group (all<0.05). There was no adverse reaction in the two groups.</p><p><b>CONCLUSION</b>The combined therapy of EA and Mulligan's mobilization relieves shoulder joint pain of rotator cuff injury, better than the simple application of either EA or Mulligan's mobilization.</p>

Effectiveness of Mulligans Mobilizations with Upper Limb Movement and McKenzie Exercises with Neural Mobilizations in Patients with Cervical Spondylitis

Background: Cervical Spondylitis (CS) is a common term that denotes degenerative changes that develop with of trauma-centre patients, specific age groups, and head injury patients. A study done on Indian population reported 78% of radiological changes of CS at C5-C6 and C6-C7 levels in asymptomatic individuals. These degenerative changes in the cervical spine may remain asymptomatic or can present as pure axial neck pain, cervical radiculopathy, cervical myelopathy, or cervical myeloradiculopathy. So, the aim of the study was to check the effectiveness of Mulligans Mobilizations with Upper Limb Movement and McKenzie Exercises with Neural Mobilizations in Patients with Cervical Spondylitis. Materials and methods: 60 patients were included in the study which was divided into two groups ; Group A and Group B, 30 patients in each group. Subjects were randomly selected and assigned to each group A pre-test measurement with the help of two measures - Northwick Park Neck Pain Questionnaire (NPNPQ) for disability and Visual Analog Scale (VAS) Inclinometer for a range of Sreenivasu Kotagiri, Anup Kumar Songa, Mayuri Vijay Gad, Nazz Sulthan. Effectiveness of Mulligans Mobilizations with Upper Limb Movement and McKenzie Exercises with Neural Mobilizations in Patients with Cervical Spondylitis. IAIM, 2018; 5(5): 146-155. Page 147 motion cervical spine movements was done in each group. Subjects in Group-A were given Mulligan Mobilization with Upper Limb Movement for cervical regain for 45 minutes 4 days for one week in four weeks subject were sitting Subjects in Group-B was given McKenzie Exercises with Neural Mobilization for 45 minutes 4 days for one week in four weeks subject were in supine position and remains relaxed with the feet uncrossed. Result analysis was done by Wilcoxon Sum Rank Test (Mann Whitney U Test). Results: On comparing Group A and Group B for post-treatment VAS score and NPNPQ score, results showed a significant difference (p=0.001) in improvement in terms of VAS and NPNPQ. The overall study proved that both Mulligan mobilization with upper limb movement and McKenzie exercises with neural mobilization were effective in improving Pain and decreasing the disability level in cervical radiculopathy subjects. Conclusion: McKenzie exercise with neural mobilization is better than mulligan mobilization with upper limb movements in cervical radiculopathy. Results supported that McKenzie exercise with neural mobilization was more effective than mulligan mobilization to improve pain and disability in a patient with cervical radiculopathy.

Effectiveness of Mobilization with Exercise V/S Mulligan Internal Rotation MWM with Stretching in Patient with Glenohumeral Internal Rotation Deficit

Background: The glenohumeral joint consists of dynamic and static stabilizer, which works, in concert to allow for stability and mobility through a large arc of motion, in recent years there has been significant focus on shoulder motion, particularly in overhead throwing athletes. Glenohumeral internal rotation deficits (GIRD) are common physical impairments in evaluated both adolescent and overhead sports such as baseball, cricket, and tennis. Therefore the aim of the study firstly was to determine the effectiveness of mobilization with exercise in patients with glenohumeral internal rotation deficit and secondly to determine whether mulligan internal rotation MWM with stretching in patients with glenohumeral internal rotation deficit. Materials and methods: 60 patients were included in the study which was divided into two groups; Group A and Group B, 30 patients in each group. All the subjects were randomly selected and assigned to each group. A pretest measurement with the help of two measures - Oxford Shoulder Instability Score (OSI) for disability, and inclinometer for an internal range of motion shoulder was Sreenivasu Kotagiri, Anup Kumar Songa, Mayuri Vijay Gad, Jaideep Lad. Effectiveness of Mobilization with Exercise V/S Mulligan Internal Rotation MWM with Stretching in Patient with Glenohumeral Internal Rotation Deficit. IAIM, 2018; 5(5): 138-145. Page 139 done in each group. Subjects in Group-A were given mobilizations with stabilization exercise for capsule for a total of 12 minutes a minimum of 4 times per week over a 4-week period and Group-B were given mulligan mobilization with Posterior Capsule Stretching As follows, 1st day 3 glides, 2 nd day 3 sets of six glides, 3rd day 3 sets of 10 glides were given and 4th day again 3 sets of 10 was given. A patient who failed to come for 4 days with stretching performed 3–5 repetitions each repetition was held for 30 seconds, four days a week for four weeks total 16 sessions. Results: On comparing Group A and Group B for post-treatment OSI score, results showed a significant difference (p=0.001) in improvement in terms of OSI. On comparing Group A and Group B for post-treatment inclinometer score, results showed a significant difference in improvement in terms of the inclinometer. This study showed that Mulligan MWM along with stretching exercises was more effective to that patient as compared to mobilization with strengthening exercises given to a patient with glenohumeral internal rotation deficit. Conclusion: The study showed a significant difference between both the groups when the values obtained were analysed. It indicated that Group B in Range mulligan mobilization with Posterior Capsule Stretching of Motion in internal rotation and external rotation. Their scores in Index Oxford Shoulder Instability Score (OSI) have reduced which indicates the decreased level of disability and better functional ability.

Effectiveness of Mulligan Mobilization with conventional physiotherapy in knee osteoarthritis – A Case series.

Osteoarthritis (OA) is the most common joint disease causing disability. Current Physical therapy management for knee OA is aiming to increase range of motion and improve functional performance. So the purpose of this study to assess the effectiveness of Mulligan Mobilization along with Conventional Physiotherapy in Knee osteoarthritis patients. Method: Patients of knee pain who fulfilled inclusion criteria were taken in study. Outcome like The Knee Injury & osteoarthritis Outcome Score (KOOS) Index, ROM with the help of Universal Goniometer, Manual muscle testing with Medical Research Council (MRC) scale &time up and Go test were taken at baseline and after 4 wks. Mulligan Mobilization along with conventional Physiotherapy was given to all patients for 4 wks. Result: Showed there was significant improvement 25.08% in Koos Index, while in knee flexion ROM, improvement on right side was 9.94% or in left side 6.20%. while muscle strength in MMT with 25% on right side or 4% on left side improvement seen for knee flexor and 5% on right side or no any improvement seen on left side for knee extensor. Time up and go test also showed 10.89% improvement compared to baseline. Conclusion: Improvement is seen in patients with knee osteoarthritis by Mulligan Mobilization along with Conventional Physiotherapy.