Mulligan in Sports_2026.12.20-22_需完成上半身或下半身課程(台北)

這是一門高階的運動物理治療工作坊。

1. 課程全程提出一套臨床推理架構，以促進循序漸進地選擇適當的測試與治療技術。
2. 完成課程後，學員應能建立／發展個別化的 MWMS／CWM 治療技術與自我治療技術。
3. 將學習應用多種新的運動相關 MWM 技術（MWMS），用於上肢與下肢區域。
4. 將學習應用多種運動相關的 CWM，用於上肢與下肢區域。
5. 將學習使用治療帶與阻力帶來施作 Sports MWMS 與 CWM 的特定技術。
6. 將學習在適當情況下運用貼紮技術，以支持 MWMS 與 CWM 的應用。
7. 將學習在適當情況下教導病人自我治療，以支持 MWMS 與 CWM 的應用。
8. 將練習在相關運動情境中，以及臨床常見之各種運動傷害中，應用 MWMS 與 CWM。

Contraction With Movement

Adding Muscle activation to MWM.

Introduction to the use of muscle activation in symptom modification.

▲CWM is exploring the field of adding muscle contraction to Mobilization With Movement (MWM) In assessment and treatment of sport related injuries based on symptom modification.

▲There is a growing base of evidence that an important part of mechanisms of effect and efficacy of MWM lays on its effect on muscle function, and muscle recruitment.  Eliminating or substantially reducing pain associated with movement has been demonstrated to have an effect on pain inhibition.  This "pleasant active experience" created, may lead to functional adaptation via motor learning creating a linkage between "pain free" and active movement. (1,2). 

▲One of the proposed mechanisms of effect of MWM on regulating muscle function is due to reduced pain inhibition as suggested by Zusman (1-2). This "pleasant active experience" may lead to functional adaptation due to motor learning effects creating a linkage between "pain free" and active movement.

Using Muscle contraction to modify symptoms, reduce pain, improve range of motion and enhance function has been previously described mainly in complains related to the low back (3-5) & Shoulder (6-8)

Combining MWM's with Contraction with movement (CWM) to allow pain free movement is suggested as one way of increasing the immediate as well as the long-lasting effect of patient response.  This is suggested to be linked with recovering muscle and joint memory (9-12) aspects thought to be addressed with the Mulligan concept (12).  This way of treatment could be applicable in all musculoskeletal complains that symptoms are provoked by movement, muscle contraction or change of loads, and particularly relevant in sports where participants are required to perform in high loads.

Mobilization With Movement (MWM) as first described by Brian Mulligan (13) is an external force, usually applied manually or by a treatment belt close to a joint aiming at modifying the patient ability to perform movement or function.

It has been demonstrated in research that MWM effects muscle function.
Increased grip strength with LG MWM of the elbow (14), facilitation of hip lateral muscle function with knee Mulligan IR Taping (15-17) and changes in muscle reflex as shown in Inferior Tibio-Fibular joint (Ankle sprain) MWM (18) are some examples of its effect. It was also demonstrated that applying rotation of the tibia, as in knee internal rotation MWM, effects hamstrings muscle recruitment (19), and adding compression around the pelvic influences activity of the muscle attached as the hamstrings, gluteus maximus and erector spinae (20-21).

▲Adding a voluntary, specific, muscle activation during performance of MWM should be a natural progression of treatment especially when in context with patient required functional needs (22).  This activation can be modified by its direction, force and type of contraction.
The effect of MWM on muscle function is the basis for the idea that muscle contraction can be used separately or as an addition to MWM in obtaining pain free movement.

As MWM is an external force the use of an internal force can be used in the same fashion.  This is named Contraction With Movement (CWM)

▲The phrase "Contraction With Movement" (CWM) was coined to describe a specific muscle contraction obtained in a constant force level while once a painful movement or function is executed painlessly, this is described in the same way a "Mobilization With Movement" is effecting movement by applying a manual/belt accessory glide force.
The use of muscle contraction solely and in addition to MWM has been clinically found highly relevant in treating athletes and active individuals bringing treatment into their context of performance. It was further described as an effective approach in treatment of nonspecific neck pain (23)

It is important to note that a positive effect of CWM on function does not mean that the muscle facilitated is weak and needs strengthening, but rather that by adding a specifically directed voluntary contraction to achieve pain free movement can lead to improved movement outcome.

The application of CWM is usually first applied manually as an assessment.  Looking optimally for a total elimination of pain as in MWM. If partial effect is achieved changes in contraction force or type can be explored.  If pain level or limitation is alleviated due to the contraction, an opposite direction contraction should be assessed.

The Contraction in CWM can be performed with various contraction types. The effect of isometric contraction is the first to be assessed since it’s the easiest to perform and control.  Once isometric contraction is found to be effective additional types of contractions (concentric or eccentric) could be explored related to patient functional need and most important achieving the main purpose of pain free movement, the PILL Effect.

CWM is indicated:

• When MWM has no 100% immediate PILL effect
• When MWM has no Long-Lasting effect
• As an additional option of achieving symptom free movement
• In high demand performance
• Use muscle to facilitate movement
• Self treatment and encouragement of Autonomy, self-efficacy and adherence.