Physiotherapy Instrument Mobilisation

Transcription

1 Physiotherapy Instrument Mobilisation PIM - SAVE YOUR THUMBS! For the first time in Hong Kong - 10 & 11 September 2011 Presenter: Tim Mann Grad Dip App Sci (Manip Physio) M App Sci (Manip Physio) Titled Musculoskeletal Physiotherapist Accredited Mulligan Concept Teacher Some typical participant feed back: "Evidence-based, great clinical reasoning and appropriateness of treatment modalities using sound biomechanical principles (no voodoo explanations!)" "Excellent new treatment option, the gun will definitely enhance my techniques and save my hands "Fun and informative, the material was very easy to understand" "So well prepared, enjoyed a course with good valid studies to back up techniques" Australian-developed Instrument Mobilisation will increase your clinical effectiveness. Innovative methods have been developed to combine this mechanical device with established physiotherapy biomechanical models such as Nordic concave-convex, Combined Movements, Osteopathic upslope/downslope treatment planes and Brian Mulligan s concepts of Mobilisation with Movement and Positional faults. The courses have been run in Australia over the last 15 months and have enabled 150 participants from all states to enjoy the benefits from linkage of an effective mobilising instrument to established physio manual therapy models. Surveys show that physios who have done these courses and make PIM one of their main treatment options report exciting clinical outcomes, increased patient (and clinician) satisfaction, referring GP acceptance, practice growth, greater treatment efficiency and an excellent complement to their other clinical management skills whilst saving their thumbs. Course includes Physiotherapy Instrument Mobiliser worth HK$2,500, course notes and refreshments, all for HK$7,000 (HK$6,300 for early bird). For further information or to secure your place: on.lau@hemaxhealth.com Tel: (852) Fax: (852) Coming Two Day Courses: 2011 Perth 5&6 Feb Lower Q Brisbane 26&27 Feb Upper Q Wellington, NZ 12&13 Mar Upper Q Newcastle 26&27 Mar Upper Q Singapore 30Apr&1May Upper Q London,UK 18&19 June Upper Q Hong Kong Upper Q 10& 11 Sept 2011

2 Physiotherapy Instrument Mobilisation (PIM) Course Outline Upper Quadrant Course Aims: I am a titled manipulative physiotherapist and lecturer in the Mulligan Concept. I am setting up courses to teach the use of mechanical mobilising instruments to physiotherapists. The aim is to provide another effective efficient mobilising skill to physiotherapists and an effective alternative to many manipulative physiotherapy procedures. I have developed methods of using these devices along orthodox articular physiotherapy paradigms primarily Kaltenborn concave-convex, Brian Edward s Combined Movements, some Maitland, Osteopathic upslope / downslope treatment planes similar to NAGs and a smaller component with the Mulligan Concept of positional faults. I have over 25 years of experience of instrument mobilising and have been researching the evidence base intensively and feel that I am in a position to make a needed contribution to the growth of our profession. I have been using a chiropractic activator type instrument according to physiotherapy principles for 25 years I would like to make the use of a mechanical device mainstream in physiotherapy. I will teach the benefits, efficacy and safety of using these devices in physiotherapy. Learning Objectives Physiotherapy Impact Mobilisation (PIM): At the conclusion of this course each participant is expected to: 1. Have acquired an understanding of the potential place of PIM in physiotherapy musculo-skeletal practice 2. Have acquired an understanding of mechanical characteristics of the PIM instrument 3. Achieved competency in the utilisation of PIM according to orthodox physiotherapy biomechanical principles 4. Have a good theoretical understanding of the PIM Concept of treatment for spinal and peripheral techniques 5. Be able to examine, select and correctly administer appropriate PIM techniques to the following regions: Cervical and Thoracic spine, Shoulder, Elbow, Wrist and Hand 6. Be able to apply PIM techniques in relation to specific clinical presentations.

3 Format of the Course: The format of the course is as follows: There is a comprehensive introduction of background and basic PIM principles. Thereafter each area is introduced by a discussion of the anatomy, biomechanics, relevant conditions, demonstration of the assessment and treatment techniques and supervised practice of each participant using their own PIM instrument. Day One 9.00am Welcome Introduction History of Instrument Mobilisation Differences between PIM and Chiropractic use of similar devices. Principles of joint mobilisation: Biomechanical and Neurophysiological aspects of mobilisation and manipulation Comparisons of force magnitude and duration in manual and instrumentbased mobilisation techniques The PIM instrument: unique characteristics of instrument mobilisation, mechanism of action, forces applied, basic principles of application and indications for use. Clinical Efficacy of Instrument mobilisation: a review of the literature Safety of Instrument mobilisation: a review of the literature, comparison with manual techniques The benefits of instrument mobilisation in Physiotherapy The legal status of instrument mobilisation in Physiotherapy, the insurers perspective. Outline of Assessment procedures and protocols 11.00am Morning Tea The Cervical Spine. Upper cervical syndromes:the complex O1 to C2: Biomechanics, combined movements, indications, assessment and treatment techniques, safety issues Headaches, facial and ear pain, dizziness Mid to lower cervical spine: biomechanics, Osteopathic upslope and downslope concepts vs Maitland/Kaltenborn

4 1.00pm LUNCH The TMJ: Analysis of biomechanics of abnormal movement and positional faults PIM techniques, Treatment protocols 3.15pm Afternoon Tea The tricky cervico-thoracic junction: PIM substitutes for facet lock manipulative techniques The Thoracic Spine: Combined movement analysis and PIM techniques 4.30pm Close Day Two 9.00am The Shoulder Complex Neck / Arm Spinal mobilization The A-C joint 11.00am Morning Tea Elbow: humero-radio-ulnar and humero-ulnar, olecranon-humeral 1.00pm LUNCH Wrist/Hand The Kaltenborn 10 test, carpal mobilisation techniques 3.pm Afternoon Tea Some Clinical Syndromes: Carpal Tunnel Radiculopathies Upper Limb Neural Tension issues Putting it all together, incorporation in to clinical practice, other forms of instrument adjusting, future directions, other courses. Questions and feedback 4.00pm Close

5 Why Instrument mobilising? Ten reasons for incorporating this technique in to Musculo-skeletal Physiotherapy. By Tim Mann Tim Mann is an APA-titled Musculo-skeletal physiotherapist in private practice in Wollongong NSW. He has had an interest in instrument mobilisation since acquiring his first spring-loaded instrument in 1983 and has developed techniques to use this instrument according to respected physiotherapy manual therapy models. Instrument adjusting is rare in physiotherapy despite mobilization simulating mechanical indenting instruments in clinical trials in the 90 s (Latimer, Maher et al) and the physiothumb device to reduce injury to physios performing passive accessory mobilisations. So why bother about instrument mobilisation in Physiotherapy? I believe that instrument mobilisation provides benefits of ease of use and added safety whilst expanding the treatment options available. This will add a new dimension to physiotherapy clinical practice. Here are ten good reasons why you might choose to incorporate instrument mobilisation into your practice.

6 1. Easier on you. Manual therapy is hard work The mobilising device substitutes speed for force ensuring effective joint mobilisation. What would you prefer, an effective dose controlled repeatable reliable 2 second instrument application or 4 sets of 40 grade IV Passive Accessory mobs with your thumbs? Check Matyas and Bach 1985 Reliability in Clinical Biometrics Jou APA to see the poor intra-tester reliability of Passive Accessory mobs with experienced manual therapists. 2. Save time. There is a place for soft tissue techniques that take up to 20 to 30 minutes to administer but any technique that can achieve similar results more rapidly saves both yours and the patient s time. Instrument mobilising has the potential to enable you to give fast and effective manual therapy saving your energy and time for treating more patients in a day with less fatigue. 3. Easier on the patient. Because of the high velocity and lower forces generated with instrument mobilising, the mobilisation is easier on the patient. This equates with less muscle and joint soreness during the mobilisation and afterwards. Mobilisation which is easier on the patient will increase patient satisfaction and compliance with the rest of your physiotherapy programme.

7 4. Adding Technology to your practice. It s a technological age and adding instrument mobilisation to your practice gives the impression to your patients of yours being an innovative and progressive practice. Breathe new life in to your practice with instrument adjusting. 5. Expand the range of services you provide. Perhaps you are looking for more effective ways of treating plantarfasciitis, anterior rib pain, tmj dysfunction, tricky shoulder problems and many others. Adding instrument mobilising into your practice gives more options for a broader range of conditions, enhancing your reputation as the go-to Physiotherapist in your area. 6. Increase the Range of Patients you can treat effectively. The low force mobilisation makes treating older patients safer and more effective. Additionally the instrument can be effectively applied in functional sitting positions (like Mulligan techniques) and through light clothing if desirable. 7. Evidence-based techniques. A number of studies have investigated instrument mobilization for its effectiveness and found it to be equivalent to manual mobilising techniques in reducing pain and improving function in patients. Ongoing researches in to the basic science of instrument mobilisation and clinical trials have quantified intervertebral motions, electromyographic and neurophysiological responses to instrument mobilisation. 8. Easy incorporation in to your existing knowledge base and experience. You may apply instrument mobilisation in a Maitland-based passive accessory mobilisation, or to correct an upslipped ilium or sacral torsion according to Muscle Energy Technique, or in an upslope/downslope mobilisation according to Monaghan-Duncan Reid Osteopathic technique. 9. Safety. Generally physiotherapy mobilisation is extremely safe. Still, there are instances where you may be hesitant in mobilising a particular patient. Mann Refshauge 2001 VA no rotation, prone position, osteoporosis. Increased safety for your patient and increased peace of mind for you as the evidence base supports the safety of these techniques compared to other passive physiological techniques. 10. Accurate dosage and direction of mobilisation. If you were presented with a way to mobilize joints the same amount as you can manually but with less force would you be interested? Adjusting instruments take advantage of the acceleration component of the

8 F=MA equation in providing large accelerations with substantially smaller mass (weight). Increasing the speed component also uses the inertia of the adjacent bone to allow a greater displacement for lower force, in other words, a truer passive accessory of a single joint rather than a physiological migration of many joint segments. This is especially evident in mobilisation of a single lumbar vertebra (eg L5) Lee et al 1992 For interested candidate, please prepare the cheque in the name of HEMAX Health Products Company Limited, with your name, address, and telephone number on the back and send to Rm 1508, Hollywood Plaza, 610 Nathan Road, Mong Kok. Please feel free to visit or contact Mr. LAU at / on.lau@hemaxhealth.com for any questions. HEMAX Bringing the best courses worldwide to Hong Kong