Innovative treatment of clinically diagnosed meniscal tears: a randomized sham-controlled trial of the Mulligan concept 'squeeze' technique.

Objective: The purpose of this study was to assess the effects of the Mulligan Concept (MC) 'squeeze' technique compared to a sham technique in participants with a clinically diagnosed meniscal tear.Methods: A multi-site randomized sham-controlled trial of participants (n = 23), aged 24.91 ± 12.09 years, with a clinically diagnosed meniscal tear were equally and randomly divided into two groups. Groups received a maximum of six treatments over 14 days. Patient outcomes included the numeric pain rating scale (NRS), patient-specific functional scale (PSFS), the disablement in the physically active (DPA) scale and the knee injury osteoarthritis outcome score. Data were analysed using univariate ANOVA, univariate ANCOVA, and descriptive statistics.Results: All participants in the MC 'squeeze' group met the discharge criteria of ≤2 points on the NRS, ≥9 points on the PSFS, and ≤34 points or ≤23 on the DPA Scale for chronic or acute injuries, respectively within the treatment intervention timeframe. A significant difference was found in favor of the MC 'squeeze' technique in PSFS scores (F(1, 21) = 4.40, p = .048, partial eta squared = .17, observed power = .52) and in DPA Scale scores (F(1, 21) = 7.46, p = .013, partial eta squared = .27, observed power = .74).Discussion: The results indicate the MC 'squeeze' technique had positive effects on patient function and health-related quality of life over a period of 14 days and was clinically and statistically superior to the sham treatment. Further investigation of the MC 'squeeze' technique is warranted.

Novel treatment of lateral ankle sprains using the Mulligan concept: an exploratory case series analysis.

OBJECTIVE: The purpose of this study was to examine the effect of the Mulligan Concept (MC) Mobilization with movement (MWM) in the treatment of clinically diagnosed acute lateral ankle sprains in competitive athletes. METHODS: A prospective case series of 5 adolescent patients, ages ranging from 14 to 18 years (mean = 15.8 ± 1.64), that suffered an acute lateral ankle sprain (LAS). Patients were treated with the MC lateral ankle MWM. Mobilization was directed at the distal fibula or, using a modified MWM, 2-3 inches proximal to the distal fibula. Using paired t-tests and descriptive statistics (mean and standard deviation) results were analyzed. RESULTS: Treatment lasted an average of 9 days (mean = 9.2, ±SD 3.96) from intake to discharge. During that time frame, patients reported decreases in pain on the numeric pain rating scale (NRS), disability on the Disablement in the Physically Active (DPA) scale and an increase in function on the patient-specific functional scale (PSFS); and an immediate decrease in pain on the NRS within the first treatment. The minimal detectable change for the PSFS and NRS were exceeded from intake to discharge. Additionally, the minimally clinical important differences were exceeded on the NRS and DPA scale. DISCUSSION: The evidence presented in this Level-4 case series supports the use of the MC lateral ankle MWM to treat patients diagnosed with acute grade II LAS. Patients in this case series reported immediate decreases in pain and immediate increases in function. Therefore, further investigation of the MC lateral ankle MWM is warranted.

TREATMENT OF ANTERIOR SHOULDER SUBLUXATION USING THE MULLIGAN CONCEPT AND REFLEX NEUROMUSCULAR STABILIZATION: A CASE REPORT.

BACKGROUND AND PURPOSE: Shoulder instability, a common issue among athletes who engage in contact sports, may lead to recurrent subluxations, or partial dislocations of the shoulder. Young athletic patients generally respond poorly to the nonsurgical treatments for shoulder instability that are commonly utilized. The purpose of this case report is to describe the effects of the treatment guided by the Mulligan Concept (MC) coupled with reflex neuromuscular stabilization (RNS) also known as reactive neuromuscular training (RNT), on an adolescent football player with glenohumeral joint (GHJ) instability who sustained a traumatic anterior subluxation. CASE DESCRIPTION: The MC shoulder Mobilization with Movement (MWM) and RNS were applied in the treatment of an anterior shoulder subluxation injury sustained by a competitive adolescent football player. The Numeric Pain Rating Scale (NPRS), the Disability in the Physically Active (DPA) scale, the Patient specific Functional Scale (PSFS) and the Shoulder Pain and Disability Index (SPADI), were administered in order to identify patient-reported outcomes. OUTCOMES: The shoulder MWM and RNS provided immediate relief of all of the patient's pain and increased ROM after the first treatment. The use of the coupled treatments resulted in a resolution of pain, an increase in range of motion (ROM) and improvement in perceived stability. A minimal clinically important difference (MCID) was reported on the NPRS and minimal detectable changes (MDC) were reported on the NRS and PSFS, after the first treatment. Equally important, MCIDs were reported on the DPA scale and SPADI scale over the course of treatment. DISCUSSION: In this case report, the MC shoulder MWM, coupled with RNS, was an effective treatment for this patient and provided a short time to resolution (6 treatments; 19 days) compared to other descriptions of recovery in the literature. Clinicians treating patients who display anterior shoulder instability can consider this as a viable treatment option. Even though current literature indicates that surgery is an optimal treatment for reducing recurrent subluxations, in young athletes who participate in contact sports, the effects of surgery are substantial. Therefore, the consideration of the presented option for non-operative treatment is important. LEVEL OF EVIDENCE: 4-Case Report.

AN ALTERNATIVE APPROACH TO THE TREATMENT OF MENISCAL PATHOLOGIES: A CASE SERIES ANALYSIS OF THE MULLIGAN CONCEPT "SQUEEZE" TECHNIQUE.

BACKGROUND: Partial meniscectomy does not consistently produce the desired positive outcomes intended for meniscal tears lesions; therefore, a need exists for research into alternatives for treating symptoms of meniscal tears. The purpose of this case series was to examine the effect of the Mulligan Concept (MC) "Squeeze" technique in physically active participants who presented with clinical symptoms of meniscal tears. DESCRIPTION OF CASES: The MC "Squeeze" technique was applied in five cases of clinically diagnosed meniscal tears in a physically active population. The Numeric Pain Rating Scale (NRS), the Patient Specific Functional Scale (PSFS), the Disability in the Physically Active (DPA) Scale, and the Knee injury and Osteoarthritis Outcomes Score (KOOS) were administered to assess participant pain level and function. OUTCOMES: Statistically significant improvements were found on cumulative NRS (p ≤ 0.001), current NRS (p ≤ 0.002), PSFS (p ≤ 0.003), DPA (p ≤ 0.019), and KOOS (p ≤ 0.002) scores across all five participants. All participants exceeded the minimal clinically important difference (MCID) on the first treatment and reported an NRS score and current pain score of one point or less at discharge. The MC "Squeeze" technique produced statistically and clinically significant changes across all outcome measures in all five participants. DISCUSSION: The use of the MC "Squeeze" technique in this case series indicated positive outcomes in five participants who presented with meniscal tear symptoms. Of importance to the athletic population, each of the participants continued to engage in sport activity as tolerated unless otherwise required during the treatment period. The outcomes reported in this case series exceed those reported when using traditional conservative therapy and the return to play timelines for meniscal tears treated with partial meniscectomies. LEVELS OF EVIDENCE: Level 4.