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Jena A. Hansen-Honeycutt, Alan M. Nasypany and Russell T. Baker

Two physically active patients presented with low back pain (LBP) and were previously diagnosed with a herniated disc. A unique treatment combination of a muscle energy technique (MET) and MyoKinesthetic (MYK) treatments were used to decrease pain and improve function. The treatment combination displayed clinically significant short-term improvements in four treatments or less and both patients reported no recurrence of pain at their 1-year follow-up. It is questionable if the presence of an anatomical abnormality, such as a herniated disc, is truly the source or unrelated to those experiencing LBP; utilizing a MET and MYK treatment may be beneficial for other patients reporting similar symptoms.

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James May, Ryan Krzyzanowicz, Alan Nasypany, Russell Baker and Jeffrey Seegmiller

Context:

Although randomized controlled trials indicate that the Mulligan Concept (MC) of mobilization with movement can improve pain-free grip strength and pressure pain threshold in patients with lateral epicondylalgia of the elbow, improve ankle dorsiflexion in patients with subacute ankle sprains, and decrease the signs and symptoms of patients with cervicogenic headache, little is known about the clinical application, use, and profile of certified Mulligan practitioners (CMPs) in America.

Objective:

To better understand the use and value of applying the MC philosophy in clinical-care environments from the perspective of American CMPs while establishing a clinical profile of a CMP.

Design:

Quantitative descriptive design. Setting: Online survey instrument.

Participants:

American CMPs.

Data Collection and Analysis:

Online survey instrument.

Results:

CMPs use the MC to treat a broad spectrum of spinal and peripheral clinical pathologies in primarily outpatient clinics with an active and athletic population. American CMPs also find value in the MC.

Conclusions:

American CMPs continue to use and find value in the MC intervention strategy to treat a broad spectrum of spinal and peripheral conditions in their clinical practices.

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Lindsay Warren, Russell Baker, Alan Nasypany and Jeffrey Seegmiller

The core is central to almost all extremity movements, especially in athletics. Running, jumping, kicking, and throwing are dependent on core function to create a stable base for movement. Poor core strength, endurance, stiffness, control, coordination, or a combination thereof can lead to decreased performance and increased risk of injury. Due to the core’s many complex elements, none of which are more or less important than the next, it is imperative that athletic trainers have a systematic and comprehensive plan for assessing and treating patients with stability or motor control dysfunctions of the entire spinal stabilizing system. The purpose of this clinical commentary is to outline the structural (anatomical) components of the core and their functions, establish the elements of core stability (functional), review these elements’ importance in decreasing the risk of injury, and discuss the application of this information in athletic training.

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James M. May, Alan Nasypany, Julie Paolino, Russell Baker and Jeffrey Seegmiller

Context:

While the incidence and reinjury rates of lateral ankle sprain (LAS) continue to persist at high rates across many sporting activities, further exploration of assessment and treatment beyond the traditional ligamentous and strength/proprioceptive model is warranted. Further, assessing and treating both arthrokinematic and osteokinematic changes associated with LAS can provide insight into a more diverse approach to treating ankle pathology.

Objective:

To examine the clinical use of the Mulligan Concept mobilization with movement (MWM) while treating patients diagnosed with an acute grade I or II LAS through authentic patient care.

Design:

An a priori case series.

Setting:

Intercollegiate athletic training clinic.

Patients:

Intercollegiate patients diagnosed with an acute grade I or II LAS.

Intervention:

The Mulligan Concept distal fibular anterior to posterior MWM.

Main Outcome Measures:

Pain-Intensity Numeric Rating Scale (NRS) with Non-Weight Bearing (NRS-NWB) and Weight Bearing (NRS-WB), Disablement of the Physically Active Scale (DPAscale), Foot and Ankle Ability Measure (FAAM) with Activity of Daily living (FAMM-ADL) and Sport (FAAM-Sport), Client Specific Impairment Measure (CSIM), Y-Balance Composite (YBC), and Weight Bearing Measure for Dorsiflexion (WBDF).

Results:

Patients who are diagnosed with an acute grade I or II LAS and are treated with the Mulligan Concept report immediate and long-lasting minimal clinically important differences in patient outcome measures.

Conclusion:

Clinicians who examine and use the Mulligan Concept MWM to treat acute LAS can expect immediate positive results that are progressively retained over time specific to patient-centered outcome measures as well as functional clinicianbased measures. Based on the immediate and positive results, clinicians should examine associated osteokinematic and arthrokinematic changes beyond that of the traditional ligamentous model.

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Patti Syvertson, Emily Dietz, Monica Matocha, Janet McMurray, Russell Baker, Alan Nasypany, Don Reordan and Michael Paddack

Context:

Achilles tendinopathy is relatively common in both the general and athletic populations. The current gold standard for the treatment of Achilles tendinopathy is eccentric exercise, which can be painful and time consuming. While there is limited research on indirect treatment approaches, it has been proposed that tendinopathy patients do respond to indirect approaches in fewer treatments without provoking pain.

Objective:

To determine the effectiveness of using a treatment-based-classification (TBC) algorithm as a strategy for classifying and treating patients diagnosed with Achilles tendinopathy.

Participants:

11 subjects (mean age 28.0 ±15.37 y) diagnosed with Achilles tendinopathy.

Design:

Case series.

Setting:

Participants were evaluated, diagnosed, and treated at multiple clinics.

Main Outcome Measures:

Numeric Rating Scale (NRS), Disablement in the Physically Active Scale (DPA Scale), Victorian Institute of Sport Assessment–Achilles (VISA-A), Global Rating of Change (GRC), and Nirschl Phase Rating Scale were recorded to establish baseline scores and evaluate participant progress.

Results:

A repeated-measures ANOVA was conducted to analyze NRS scores from initial exam to discharge and at 1-mo follow-up. Paired t tests were analyzed to determine the effectiveness of using a TBC algorithm from initial exam to discharge on the DPA Scale and VISA-A. Descriptive statistics were evaluated to determine outcomes as reported on the GRC.

Conclusion:

The results of this case series provide evidence that using a TBC algorithm can improve function while decreasing pain and disability in Achilles tendinopathy participants.

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Monica A. Matocha, Russell T. Baker, Alan M. Nasypany and Jeff G. Seegmiller

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Monica A. Matocha, Russell T. Baker, Alan M. Nasypany and Jeff G. Seegmiller

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Marcie B. Fyock, Jeffrey G. Seegmiller, Alan M. Nasypany and Russell T. Baker