Physical Therapy Essay Example

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Physical Therapy

Physical Therapy


Shoulder pain is a very common disorder of musculoskeletal system that affects about 16-20 percent of the general population. The most common form of pain shoulder is the frozen shoulder. Frozen shoulder is a condition typified by major restriction of active and passive shoulder motion that happens without a known intrinsic shoulder disorder (Wies, 2005). Frozen shoulder results to tissue degeneration, capsule thickening, as well as reduced glenoid cavity volume. Clinical symptoms of frozen shoulder include; pain and limited range of motion which can make it difficult to mobilize. This condition progressively causes increasing pain and steadily diminishing range of movement which makes it hard to perform daily activities. Frozen shoulder is more prevalent among office workers and females. There are various interventions used by physiotherapists to decrease pain and disability and these interventions encompass exercise, electrotherapy and various kinds of mobilizations (Moon et al, 2015). This paper presents a case study of a patient who presented with a frozen shoulder and was treated using Mulligans MWM’s intervention.

Case Presentation

The patient was a 50 year old female manager who presented with a one month history of right shoulder pain. The patient reported that the onset of her symptoms was steady. She reported of sharp shoulder pain and limited range of motion (ROM) which made it difficult for her to move the hand and also it was difficult for her to perform her daily activities and take part in his recreational activities because of severity of his symptoms. The patient reported that she was right hand dominant and has never had any history of shoulder pain. Pain and limited ROM aggravated with any activity and the symptoms were relieved by rest. Additionally, the patient complained of residual discomfort. She further reported that she was referred to the physiotherapy services by a friend after the symptoms aggravated and he was unable to mobilize or do activities of daily living. The patient’s main complaint was extremely restricted range of movement for shoulder-hand joint, accompanied by severe pain at the end of active range of movement. In regard to functionality, she could not wash her back, wash her hair, lift relatively light objects or even open a car door. Her social life has been slightly affected.

In regard to history, the patient fell off stairs 15 years ago and she was diagnosed with biceps tear. She also had a right shoulder dislocation after two years following the biceps tear diagnosis. After that, she has been having regular dislocations over the last 13 years. The relevance of history is that it provided the pathophysiology of the patient’s current diagnosis.


Observations indicated that the patient’s right scapular was raised and retracted. There was also some slight muscular atrophy on the right side. Assessment of the mobility of the right gleno-humeral joint indicated that the flexim was restricted to 100 degree because of stiffness and the measurement of abduction was at 50 degree and this cause pain intensity of 8/10. External rotation was restricted to Kumar et al (2012) degrees because of anterior joint paint of intensity of 8/10. The muscle power for the right hand was determined to be at 3 to 4+ grade where the oxford scale was used. The patient’s SPADI score was 82%. This score was used to further asses the shoulder movement. There was no sign of neural sensitivity. Generally, the patient was at good health apart from the right hand shoulder.


The patient was treated twice a week for three weeks for the duration of about thirty to forty-five minutes each session. The patient’s treatment plan consisted of two sessions of one hour per week that lasted for 4 weeks. The treatment of choice for the patient was Mulligans MWM’s using a sustained AP glide of the humeral head that the physiotherapist maintained whereas the patient did active gleno-humeral external in flexion. The management procedure and the repeating sessions of the exercise for the peripheral joint treatment were conducted as per (Mulligan, 1999). The personalized active mobilizations utilized were decisively chosen to represent movements that had been affected by pain or stiffness. During each treatment session, the patient would set on the plinth’s edge and measurement of the ROM for external rotation was done and the pain scale documented. Consequently, the MWM technique would be applied where external rotation was used as the active movement and ROM measured and pain scale documented. This process was repeated for flexion. The session would conclude by educating the patient on home exercises that included active gleno-humeral joint movements to facilitate joint pro-prioception and ensure painless active ROM movement. Finally, the patient was taught about scapular mobility exercises to help in correcting scapular position.


Patient’s response to Mulligan MWM intervention was good and during every treatment session it was observed that the pain intensity was gradually reducing and there was also a rise in active ROM. Basically, there was rapid decrease for the pain and gradual improvement of active ROM.


Treatment of musculoskeletal system disorders in most cases involves usage of manual therapy interventions like Mulligan’s MWM. In Mulligan’s MWM, there is maintenance of a continuous accessory glide to a joint whereas a pain inducing movement is conducted. Mulligan’s MWM concept is to restore a positional fault that results due to symptoms such as pain, stiffness or even post-injury. According to Kumar et al (2012), a positional fault can be caused by changes within the shape of articular surface, cartilage thickness and soft tissue alignment. Evidence shows that MWM technique is effective in reducing pain, improving ROM etc. Moon et al (2015) performed a study to evaluate the first impact of Mulligan’s MWM intervention in ankle sprains and thermal pain and found out this Mulligan’s MWM gradually improved active ROM and rapidly reduced pain scale. Similarly, in Virtuoso et al (2008) there was instant pain improvement after 3 treatment sessions for a patient who presented with shoulder pain. Another study conducted by it was found that Mulligan’s MWM technique improved mobilization in a patient with osteoarthritis and knee joint pain. It is therefore evident that Mulligan’s MWM technique is a treatment of choice for many musculoskeletal system disorders and future research should investigate the value of this intervention (Minerva et al, 2016).

Learning points

  • Mulligan’s MWM technique is a treatment of choice for frozen shoulder and other musculoskeletal system disorders

  • Mulligan’s MWM technique has instant hypoalgesic effect for pain intensity associated with musculoskeletal system disorders

  • Mulligan’s MWM technique positively improves functional disability and range of motion


ISRN Rehabilitation. 2012(2012), 1-8.Kumar A, Kumar S, Anoop A & Das G. (2012). Effectiveness of Maitland Techniques in Idiopathic Shoulder Adhesive Capsulitis.

Moon G, Lim J, Kim D & Kim T. (2015). Comparison of Maitland and Kaltenborn mobilization techniques for improving shoulder pain and range of motion in frozen shoulders. J Phys Ther Sci. 27(5): 1391–1395.

Minerva R, Kumar N & Chaturvedhi. (2016). To Compare the Effectiveness of Maitland versus Mulligan Mobilisation in Idiopathic Adhesive Capsulitis of Shoulder. International Journal of Health Sciences & Research. 236(6).

Mulligan B. (1999). Manual Therapy “NAGS”, “SNAGS“, “MWMS“ etc. 4th edn. pp 99-102. New Zealand: Plane View Services Ltd.

Virtuoso JF, Mosca LS, De Oliviera TP & Sprad F. (2008). Physical therapy and Mulligan technique after bankart shoulder injury surgery — a report case. Fiep Bulletin. 1(78). 236- 244.

Wies J. (2005). Treatment of eight patients with frozen shoulder: a case study series. Journal of Bodywork and Movement Therapies. 9(1):58-64.