Effect Of Maitland Mobilisation Health And Social Care Essay

Effect Of Maitland Mobilisation Health And amicable Care EssayPatient is a 35 years previous(a) golf coach. Patient had a history of going over his articulatio talocruralis on both sides. General health posture of the longanimous is good. Patients occupation ranges from a round of18holes of golf and driving range for 60mins a day snip. Patients practise includes more walk. The primary(prenominal) caper of the patient is imposition and inclementness in right ankle. Patient had a history of slowly developed paroxysm and stiffness over the last 4months during his full time co ache job. The alter factors of his problem were powerful driving range shots for 30mins and walking for 40mins. The easing factors of his problem are rest and heat for 40mins. In the 24hours pattern of bruise, patient has stiffness on rising and which gets easier with gentle activity.On palpation in that respect is flash to anterior and lateral aspect of right ankle. On examination the resisted do rsiflexion is abstemious and atrocious. There is a decreased range of dubiousness of active plantar flexion. In passive plantar flexion fuss is produced after vindication. The resisted plantar flexion is wobbly and painful. Active range of motion of inversion is trim down and painful. During passive inversion pain is felt after resistance. Resisted inversion is weak and painful. Resisted eversion is weak.In accessory consummation of talocrural join, postero-anterior glide is stiff and the pain is produced at the end of range. In the distal tibio-fibular word, longitudinal cephalad glide is painful sooner resistance and during postero-anterior glide the patient feels easier. The muscles are weak on both sides of ankle. The right ankle is weaker compared to left ankle. Anterior talo-fibular ligament and cal fuckingeo-fibular ligaments show symmetrical laxity. On palpation there is puffiness approximately the lateral malleolus. andiron raise of the patient is poor, which is 5 on right and 10 on right side.SEVERITY, IRRITABILITY, AND THE NATURE OF PAINharmonize to Petty (2006) severity and long suit of pain are related together. grimness brook be goaded by the ability of the patient to maintain the position or movement. Severity is a main factor to determine whether the patient whitethorn be able to tolerate overpressure and bring to pass movements up to the initiatory point of pain. consort to Hartley (1994) the perception of pain differs from person to person depending on the individuals emotional status and his previous pain experiences. The fervor of pain depends on the number of nociceptors in the site of trauma and the surrounding tissues. Intensity of pain kitty be more in the areas of high innervation than the area of poor innervations. jibe to Hengeveld Banks (2003) the intensity of pain is subjective and it varies from person to person. In this case the intensity of pain of the patient is 4/10 of visual analogue scale. The patient can play a round of18holes of golf a day and practices on the driving range for 60mins a day. He besides walks for a long distance. In spite of pain the patient was able to perform his activity. So the patients severity of pain may be low to moderate.Hengeveld Banks (2003) says that excitability depends on activity causing the pain, the intensity of the activity and the time taken for the pain to subside after the activity is stopped by the patient. According to Petty (2006) biliousness can be determined by the time taken for pain symptoms to ease. The symptom is said to be irritable, when the symptom fly the coop after the activity producing pain is stopped. If the symptoms are irritable the patient depart not be able to tolerate movements for longer periods. The symptoms may nevertheless(prenominal) get worse with activity. So the testing movements should be through with(p) with caution. In this case the aggravating factors are powerful driving rage shots for 30mins and walking for 90mins. Similarly the easing factors are rest and heat for 40mins. So the pettishness of patient may be moderate to high.However according to Hartley (1995) aching pain is related to the structures like deep ligament, deep muscles, tendon sheath, inveterate bursa, compact fascia. Further Magee (2008) argues that, when pain is caused by an activity and eases with rest indicates that there is a mechanical problem which is related to movements. Occasional pain may indicate that there is a mechanical involvement and it is related to movement and mechanical tenor. In this case the pain is intermittent and deep in nature. The patient has pain after activity and the pain resolves with rest. So the pain may be mechanical, intermittent and deep in nature manual of arms THERAPY give-and-takeIn this case, the main problem of the patient is stiffness quite a than pain, in the right ankle. Maitlands distinguish4 mobilization with postero-anterior glide of talus on ankle mortis e can be given to improve range of motion of plantar flexion. The glide can be given in grade 4, because it is stable and controlled compared to grade3 (Hengeveid Banks, 2003). Here the ankle mortise is a concave get hold and the dome of talus is convex. When ankle mortise is fixed and talus is moved, plantar flexion occurs by concave-convex rule. (http//www.pt.ntu.edu.tw/hmchai/Kinesiology/KINmotion/JointStructionAndFunciton.htm, Date accessed 13/12/2009)However before give-and-take the important factors that should be taken into account are patients quarry marker of pain, loss of range of motion and movements causing pain and these factors should be evaluated after handling sessions. In Maitlands technique, there is no standard duration for the treatment, but the duration of the treatment should not be more than 2minutes. The duration of the treatment can be altered base on the severity, irritability and nature of the symptoms of the patient. Since the irritability of the pat ient is moderate to high, the initial treatment can be given for the duration of 30 seconds, with one or deuce repetitions to avoid exacerbation of the symptoms. After observing the objective marker, duration of the treatment can be progressed to 1 to 2mins and the repetitions can be progressed stepwise. The patient can be positioned in prone lying with knee in 90 degree flexion. The starting position of the therapist can be standing(a) by the side of patients right knee to imbibe close amour with the treatment area. To give proper support to the shin, the left knee is rigid on the couch. The therapist can perform the postero-anterior glide by dimension the posterior surface of the calcaneus in his right hand with his thumb, fingers fanning around the calcaneus and his left hand held in supination, with his heel placed against the tibial anterior surface and the therapists fingers are proximally pointed. These positions can be followed to stabilise the part. The rend can be ap plied by movement of the forearms opposing each other. The movement of the therapists forearms produce postero-anterior glide (Hengeveld Banks, 2003).Even though, there are literatures reenforcement the effectiveness of word mobilisations, there is not enough controlled studies to prove that joint mobilisation can restore the normal range of motion and functions of hypomobile joint effectively (Farrel, J.P Jenson, G.A. 1992)EFFECT OF MAITLAND MOBILISATIONMaitlands technique, are based on restoring arthrokinematic movements. in the main arthrokinematic motion of the joint can be restricted by the ligaments, capsules of the joint and periarticular fascia. The elastic properties of these connectedness tissues are based on the arrangement of the collagen bundles. In ligaments and tendons, the collagen bundles are arranged parallel to each other with elastic bundles in between them. When the connective tissue structures are unloaded, the collagen bundles show a crimp formation in their structure. This crimp results in production of slag in the connective tissue structure. During the phase of loading, slag is stretched first, followed by the stretching of main bundles. In contrast the fascia and aponeurosis have multilayer collagen bundles but have less crimping and slack compared to ligaments. Initially when the load is applied, structures with less slack are first subjected to stress, followed by the other bundles. The bundles of the fascia which have least slag will first resist the tensile stress. If the stress is affixd then the ligaments which have more slag will resist the tensile load. After upgrade deformation, the other bundles will act to resist the stress. To obtain elongation of the connective tissue on the whole, all the bundles should be subjected to required stress. This principle can be explained with the ease of stress strain curve.In this graph, x-axis represents the stress and y-axis represents the comparable strain produced by the load . The curve shows a slope, which indicates the connective tissue resistance to a load. The collagen bundles which are still slag, represent the toe region. The curve also represents the physiological loading range, which is then followed by the stage of microscopic visitation. If the stress still increases the curve will proceed to the stage of macroscopic failure and may even result in the rupture of the connective tissue. base on this concept Maitlands grade 4 technique aims to produce changeless elongation (plastic deformation) of the tissue by inducing low level of micro-failure in the connective tissues, there by increases the range of motion (Therkeld, 1992).There is no enough evidence to prove that Maitlands mobilisation can be done in full weight bearing and functional position. Its reliability is based on the clinicians treatment experience and patients reaction to the treatment (Farrel, J.P Jenson, G.A. 1992)SECONDARY TREATMENTThe other problems of the patient are poor heel raising due(p) to the weakness in the muscles of ankle joint and pain. In this case Maitlands grade1 mobilisation can be given to reduce pain by pain gate mechanism. As the patient is a golf coach, he require good heel rising and strong ankle muscles for good procedure in the game and to prevent further injury to ankle joint. fortify exercises to the muscles of plantarflexion, dorsiflexion, inversion and eversion can be taught to the patient to correct the potent imbalance of the patient. Then the heel raising should be encouraged gradually and can be progressed if there is no pain. Balance training with the help of wobble board can be taught to the patient. The final phase of treatment is functional training. The patient can be trained to gradually increase the intensity and the duration of drive shots in the game. Walking can be encouraged in a stable surface.CONCLUSIONAdditional to manual therapy the effective means of rehabilitation of sports injuries should consist o f soft tissue massage, electrotherapeutic modalities, proprioceptive neuromuscular facilitation, strengthening exercises, co-ordination training, endurance, flexibility, improving stability and educating the patient about the injury mechanism and methods of cake (Farrel, J.P Jenson, G.A. 1992). Sports therapist should mainly concentrate on prevention of the injury rather treating when the injury has occurred.