Mobilization with Movement, Part 1

Mobilization with Movement that Patients Can Take Home

As May is Arthritis Awareness month, it’s worth remembering that more than 20% of people in the United States will have osteoarthritis during their lifetimes. Hip osteoarthritis is one of the most common chronic illnesses in the US today. Unfortunately, our healthcare system is pre-disposed to dismiss it as incurable and only treatable with surgery. Pain medications and NSAIDS are prescribed and the patient is told to wait – and they do wait, an average of three to six years between diagnosis and surgery. As the OA worsens, pain increases, activity decreases and patients are increasingly at risk for other comorbidities.

But there is a more effective way to treat the symptoms of hip osteoarthritis, and that’s physical therapy, using a combination of manual therapies and therapeutic exercise that relieves the pain and improves joint mobility. This starts in a clinic, and patients can continue selected exercises at home. With this approach, patients can stay active and be in better physical condition when they do go in for surgery. Result: better patient outcomes and less cost to our healthcare system. At OPTA 2016, Dr. Tony Rocklin, a passionate advocate for this more effective treatment of hip OA, reviewed a number of the mobilization with movement exercises that patients can do at home. Watch the video or read the transcript below.

So if you go on YouTube you will find thirty five thousand different versions of self-manual therapy and it’s awesome. YouTube used be like, “Oh don’t look at YouTube.” Now I go on Youtube and can find some cool things. And we’re the experts who know which is the cool stuff and which is the crazy stuff, right? Not the patient. We have that ability.

We’re going to talk about, everyone knows Brian Mulligan, right? He is hilarious, by the way. Have you guys been to his classes? He’ll bring you out and say, “Who’s got thumb pain? You’re healed! Go away. Just go. No actually you’re healed, go.” Not going to do that today, if anyone has hip problems, but I’d like to.

So we’re going to do some of these SMWMs, okay? You’re only limited by your own imagination when it comes to this stuff. Go ahead and break the rules that you learn by the end of this. Just break every rule you learn in grad school. You already do. When you’ve been working for a while you realize that the textbooks aren’t always right, right? So if Brian Mulligan or the textbooks say, “Pull laterally early during this thing.”? Try posterior and see what happens. You’re not going to hurt anybody. And all of a sudden, shoulder mobilization right? To improve ER you’ve got to go anteriorally? Well sometimes I go posteriorally and improve ER. It’s just crazy but it works. You’ve got to make some stuff up here.

Alright so let’s hope the videos work. Five minutes before I walked up here, they told me that my laptop doesn’t have the cord that connects to this so I had to do this on somebody else’s computer. So cross your fingers. Alright.

So let’s talk about mobilization with movement for extension. So you guys see these bands, the thick ones? Has anyone ever – Well I don’t want to ask that – Has anyone ever not done this before, not seen it? It’s kind of funny, but when I look at this stuff I’m thinking, “Okay this is all very basic. There’s going to be a big, boring review and people are going to start walking out of here. But the we started to travel around the country, and I travelled around a bit for courses and for teaching and different things and trading shows. In fact I spent time last year in Europe, I’m going again, it’s amazing when I talk about stuff. They look at you like, “Well what do you mean exactly? This Mulligan stuff or this joint mobilization stuff?” I’m like, “Oh my gosh.” There’s a lot of us who that just aren’t in that world or just don’t have that opportunity or their clinic just doesn’t supper – Whatever it is. What I found out is that we have got to get on the same page. Let’s get just on the same page and then all of us start playing and collecting this data. Because again, there’s this massive void of people that are out there suffering and if not for anything else you can have so many more new patients if you just start marketing stuff.

Anyways, these are super bands, they come in different strengths. A lot of times bodybuilders will use these to make this harder. I use them to kind of make things easier, like I can’t do very many pullups so I kind of use this to help me up. They’re really strong. And They’re kind of dangerous too. If you’re messing around, not paying attention, this thing can pull you wherever it’s connected to. They can pull hundreds of pounds. I get them from rogue fitness dot com but you can go on Amazon, there’s just a million different kinds. It’s pretty straightforward. The green and the blue ones from most companies are in that similar sort of fifty to a hundred pounds version. They will dig in a little bit. They’re not that bad but sometimes you put a little towel there, or you know those little leather things on the seatbelts that we use? Just take that off and you can put that on there. You can buy those individually if patients want to take it home. But you can sell those out of your clinic for like, I think they’re like twenty five bucks I sell them for. That is a very inexpensive way they can be very powerful for that patient. So let’s look at this one. This is a model demonstrating this. This is from my clinic. So to take pressure off my knee we do something like this. Now I’m doing a lateral glide. Get as high up into your groin as you can and then this is just a mobilization with movement right? So I’m just working on extension, I usually have my people do about three sets of thirty, two sets of twenty, you kind of just start somewhere. And what’s weird about it is you kind of have to – Your weight bearing through there but you have to relax. If you’re really guarded nothing is going to happen. But if you can relax around it yet move through it and keep your pressure on it, that’s when the magic will happen.

How many people, they come in and they’re walking and they’re just like – Right? They can’t extense, they’ve lost their extension. Have them walk really slow and, “Oh perfect. No pain at all.” But that’s not realistic. So I have them walk really fast. You want to have – Before you do this stuff, before you do any of this stuff, you definitely have got to get that orientation. Have them walk back and forth, have them walk like they’re late for dinner. What do you have right now at this moment, “It’s usually during the –“ No, no. Right now. “Well I don’t know, three on your stupid scale.” What else do you feel in your body, in your knee? Just raise their mind. If they’ve done a good job of trying to forget about their pain and we come along and say, “No, I want you to focus on your pain.” You know what I mean. Then you have them do this and then you walk again and – I love that look when they go halfway down and they stop and they kind of look at you and they look confused a little bit and they’re like, “What just happened? Why does that feel better” But, then sometimes, get ready, they look at you and, “Why’d you do that? That feels worse.” We’ll talk about that too and that’s not a bad thing necessarily. Sometimes it’s a bad thing. So here – I’m breaking rules. I’m going anterior. And you’d think, “Well you’ve got to go anterior for extension, right?” I mean that’s what we learn so that’s why we’re doing it. But what I’ve found is going lateral or even going posterior works better. I don’t know why. We need more research on that, someone needs to do that. But you can have also people just do a static stretch there too. They can just do a hip flexor stretch with that glide at the same time.

Alright so here I’m going to look at some flexion in supine. And again, you have to remember a lot of people with FAI, they don’t want to go internal rotation with flexion, right? They can’t do that. All of our hips would prefer to actually drift out a little bit with a bit of external rotation right? So don’t try to cross it over and do abduction flexion rotation because you’re just really going to upset them. Have them go straight up and down if they can or slightly out. Keep that other knee up, if they’re really limited bring the other knee up just so they can grab their knee. If their leg is down it’s more advanced but sometimes they can’t get to that position. Then here’s – I start with – what is that -anterior or posterior or whatever that is. And then you basically have got to sit down into a child’s pose almost. A modified one. I really didn’t need to put the butt shot in there. When you’re looking at this you don’t think there is a hundred people looking at it too. So let’s turn this way, because no one needs to see that. And then I’m going to do a lateral glide. This one is one of my favorites because it’s so easy to do. It’s like low hanging fruit. People will do this and it just takes a lot of pressure off, especially when they’re sitting and it helps when they’re trying to cross their legs. We’ll talk about the external rotation ones too. Pretty self-explanatory. Totally independent, they don’t need a second person but they do need something solid. If you put this to your kitchen table your kitchen table is going to come across the room with you a little bit. Depending on the person, right?