Mulligan Concept IFI Kudus, 29 Oktober 2017-1

Disampaikan oleh: Saifudin Zuhri, SKM, SSt FT, M.
Kes (Dosen
1
Poltekkes Surakarta)
Introduction about Brian Mulligan
• Brian R. Mulligan qualified as a physiotherapist in 1954 and gained his

diploma in Manipulative Therapy in 1974. He has been the author of
numerous articled published in New Zealand Journal of
Physiotherapy. He is also the author of two books:
• "Manual Therapy "NAGS","SNAGS", "MWMS", etc' (2003) for
Physiotherapists.
• 'Self Treatment for the Back, Neck and Limbs' for Public.
2
Disampaikan oleh: Saifudn Zuhri, SKM, SSt FT, M. Kes (Dosen
3
Description
• NAGS- Natural Apophyseal Glides.
• SNAGS - Sustained Natural Apophyseal Glides.
• MWMS- Mobilization with Movements.
• The concept of mobilizations with movement (MWM) of the extremities
and sustained natural apophyseal glides (SNAGS) of the spine were first
coined by Brian R. Mulligan
• Mobilization with movement (MWM) is the concurrent application of
sustained accessory mobilization applied by a therapist and an active
physiological movement to end range applied by the patient. Passive end-
of-range overpressure, or stretching, is then delivered without pain as a
barrier.
4
Concept of Positional Fault & Injury
• Mulligan berpendapat bahwa cedera/sprain akibat "kesalahan posisi"

menyebabkan gerakan fisiologis sendi terbatas.
• Teknik ini dikembangkan untuk mengatasi 'masalah sendi/kesalahan
posisi', dengan perubahan biomekanik.
• Sendi meliputi bentuk permukaan artikular, ketebalan tulang rawan,
ligamen-kapsul, arah tarikan otot & tendon, terkait fasilitasi gerakan
• Feedback proprioseptif akan mempertahankan keseimbangan.
Perubahan posisi sendi atau lintasan gerak akan memprovokasi gejala
nyeri, kekakuan atau kelemahan.
Disampaikan oleh: Saifudin Zuhri, SKM, SSt FT, M. Kes (Dosen

5
Alur
problem
nyeri pasca
injury

6
Principles of Treatment
• Aplikasi mobilisasi pasif sendi yaitu glide -- > bebas nyeri.

• Terapis mengidentifikasi tanda gangguan gerakan, nyeri gerak, atau
nyeri aktivitas fungsional.
• Terapis memonitor reaksi penurunan nyeri.
• Terapis menganalisis teknik gliding yang tepat & gradasi gerak sendi.

7
• Saat mempertahankan gliding sendi, pasien diminta melakukan

evaluasi, perihal perbaikan kondisi
• Jika tidak terjadi perbaikan kondisi, menunjukkan terapis belum

menemukan teknik yang tepat, arah mobilisasi, segmen sendi atau
teknik tidak indikasi.

8
Manual Therapy Setup
•Patient position
• Physiotherapist position
• Hand position
• Mobilization
• Joint motion
• Outcome

9
While applying "MWMS" as an assessment, the
therapist should look for PILL response to use the
same as a Treatment.
The first principle is PILL
• P- Pain free.
• I- Instant result.
• LL- Long Lasting.
If there is No PILL response, that technique should not be advocated.
10
Relief pain with Mulligan
Concept

11
Gate Control Theory
Figure 10-7
© 2011 McGraw-Hill Higher Education. All rights

reserved.
Gate Control Theory
 Sensory information
coming from A fibers
is transmitted to higher
centers in brain
 “Pain message" carried
along A & C fibers is
not transmitted to
second-order neurons
and never reaches
sensory centers
Conditions that Open the Gate
• Physical conditions
• Extent of injury
• Inappropriate activity level
• Emotional conditions
• Anxiety or worry
• Tension
• Depression
• Mental Conditions
• Focusing on pain
• Boredom
Conditions that Close the Gate
• Physical conditions
• Medications
• Counter stimulation (e.g., heat, message)
• Emotional conditions
• Positive emotions
• Relaxation, Rest
• Mental conditions
• Intense concentration or distraction
• Involvement and interest in life activities
Mekanisme penurunan nyeri release β
endorphine
• Mulligan concept dengan intensitas (strong but comfort) akan
merangsang A delta dan C fiber, terjadi transmisi impuls menuju ke
reticular formation dilanjutkan menuju ke hipotalamus dan
terlepasnya endogen opioid ß endorphin yang menginhibisi nyeri
lewat celah sinap.
• ß endorphin yang terlepas dari hipotalamus akan merangsang
periaquaductal grey untuk melepas dinorphin, menuju ke raphe
magnus & traktus dorso lateral merangsang lepasnya serotonin dan
enkephalin yang menginhibisi nyeri lewat menutupnya SG, sehingga
nyeri mereda (Zuhri, 2015).
Descending Pain Control Mechanisms
• Efferent fibers in dorso-
lateral tract synapse with
enkephalin interneurons
 Serotonin is a neuro-
transmitter
• Interneurons release
enkephalin into the dorsal
horn, inhibiting the
synaptic transmission of
impulses to second-order
afferent neurons
-Endorphin and Dynorphin
• Stimulation of A and C
afferents can stimulate
release of endogenous
opioid ß-endorphin from
hypothalamus Dynorphin
• Dynorphin released from

released
periaqueductal grey
The second principle is CROCKS
• C - Contra-indications (No PILL response is a contraindication)
• R - Repetitions (Only three reps on the day one)
• O - Over pressure
• C - Communications
• K - Knowledge (of treatment planes and pathologies)
• S - Sustain the mobilization throughout the movement.
19
CROCKS  C: Contraindications
no absolute contraindication for manual therapy

In general:
Infection
Inflammation
fracture
CROCKS  R: repetitions
• Several repetition should be done during the mobilization
• The purpose of symptom-free repetition of movement and
mobilization is ultimately to sedate the CNS, to reestablish
dynamic natural
• Rule of 3
• 6 – 10 repetition for 3 sets depends on SIN
CROCKS  O: Overpressure
• To gain max movement
• It is equal to manipulation
• It is must to gain full recover
• Done by patients
CROCKS  C: Communication and
Cooperation
• Give a clear command
• Use an easy language
• Be sure that your patient is cooperative
CROCKS  K: Knowledge
• Anatomy (joint planes)
• Biomechanics
• Positional fault
CROCKS  S: Sense ...
• Sustain
• Sense
• Skill
• Slow
• Subtle Change
Mulligan Concept
• Positional fault
• Treatment plane
• Pain free
• Repetition
Positional fault hypothesis (PFH)
• Mulligan (1995) proposed that minor positional fault of
the joint occurs following injury or strain resulting in
movement restrictions or pain
• Mulligan’s mobilization can correct the positional fault
and restore a restricted, painful movement to a pain
free and full range state
... PFH
• PFH envolved out of MWM improving motion, relieving pain
and restoring function
• Preliminary evidence (LOW LEVEL) that most effective direction
in MWM will be direction opposite to existing PF
• Amelioration of symptoms does not prove a positional fault
• Some evidence PF may exist at some joint (PF, GH, inf Tib-Fib)
... PFH
• Measuring of PF is achieved by imaging techniques
• There is evidence that PF exist at:
Hip joint: decrease distance between acetabulum and femoral head
Treatment plane (Tr Plane)
• Joint and facet planes not universal; therapy technique is
usually applied in the direction that is parallel to articular
plane
• Peripheral joints
• Glide should be parallel to the Tr Plane on
concave part
• AP glide can be used
• Glide force should be close to the Tr Plane and
in a different direction
Tr Plane
• Lumbar Spine
• Glide force should be in the same direction of
active movement..
• Glide can be on the SP or TP
• Changing the curve involve changing in the
glide direction
Tr Plane
• Lumbar spine
• Sacroiliac joint
• Hip joint
• Knee joint
• Ankle joint
• Tarsal bones
• Metatarsal bones
• Phalanxes, etc
Pain Free
• All mulligan’s techniques must not reproduce the patient’s
symptomes.
• Mild palpation discomfort might be experienced upon application of
the techniques
Repetition
• Several repetition should be done during the mobilization

• The purpose of symptom free repetition of movement and
mobilization is ultimately to sedate the CNS, to reestablish
dynamic natural
• Rule of 3
• Acute: 3-6 repetition, chronic: 6-10 repetition for 3 sets
• Do you full assesment and identify the comparable sings
• Mobilization should not cause pain
• Follow the treatment plane
• In SNAGs & MWM sustain glide while active movement then
overpressure is taken place... Maintain until the joint returns
to the starting position
• Failure to improve the comparable sign would indicate that
treatment plane was not correct or the technique is not fit
• Look at the source of the problem
• Self-treatment should be taught to maintain the results
• Taping is important to maintain the correction that gain form
the mobilization
• If you are unable to improve the comparable sign with
Mulligan approach, try another approach
• Follow the rule of 3
• Treatment session typically involving 3 sets of 6 – 10
repetitions
• You can always perform other type of physiotherapy with the
Mulligan techniques
Terminology
• NAGS, reverse NAGS (central, lateral)  Cervical & Upper Thoracal
• SNAGS (central, lateral) : flexion, extension, side flexion, rotation
• MWM
• SMWMs
Techniques: SNAGs
• SNAGs stand for Sustained Natural Apophyseal Glides.
• SNAGs can be applied to all the spinal joints, the rib cage and the
sacroiliac joint.
• Terapis melakukan gliding sesuai gejala apophyseal saat pasien
melakukan gerakan.
• Gerakan full ROM dan bebas rasa sakit.
• SNAGs berhasil ketika gejala terprovokasi oleh gerakan, tidak meningkat.
• SNAGs bukan pilihan dalam kondisi yang sangat iritasi.
• SNAGs biasanya dilakukan posisi weight bearing, namun dapat diadaptasi
untuk posisi non weight bearing.

38
Lumbar Spine SNAGs
Used to improve functional limitation:
• Flexion
• Extension
• Side bending left/right
• Axial twist left/right

39
SNAGs Lumbar Spine
• Grip
• Central contact: primary contact on spinous process
• Unilateral contact: primary mobilising contact is on facet
& TP using hypothenar eminence
• Direction: Glide cranially
• Postural variations: sitting, standing, prone, 4 point kneel
position
• Consider SNAGs in opposite direction first (F to E; or E to F)
40
Hypothenar eminence Thumbs
Handling

41
Lumbar SNAG

42
SNAGS – Lumbar spine flexion
• Hypothenar eminence on the spinous process – can use thumbs –

force in line with joint plane
• Vary angle with the plane of the joint, as the segment moves:
dynamic treatment plane

43
Lumbar Flexion SNAGs
• Mobilisation
• Anterior-superior glide (cephalic glide)
• Movement
• Lumbar flexion
• Comments
• Stand beside PT
• Vary contact SP, TP

44
Self SNAGs – Flexion (with belt)
in 4-point kneeling

45
Lumbar Extension SNAGs
• Mobilisation
• Anterior-cephalic glide
• Movement
• Lumbar extension
• Comments:
• Follow joint plane
• Vary contact SP, TP

46
Self SNAGs – Extension (with belt)
Position: Patient standing
using belt, belt under Sp to
be mobilized (hnd at chest
throughout movement). If
standing, some knee
flexion diminishes
hamstring influence)
Direction: Cranially glide

after pulling belt anteriorly

47
Self SNAGs – Extension without belt
• Essentially only possible in standing
• Central: use the lateral aspect of the 1st
phalynx of indeks in a clenched fist to
contact SP
• Unilateral: use the MCP or PIP of the
indeks in a semi-cleched fist to isolate
(right hand for right unilateral etc).

48
SNAGs – Extension - Prone
 Position: at side of patient at the level of
the mobilization
Stabilization: PT’s stabilizing arm under
patients’s torso superior to mobilizing hand
Grip: SNAG facet plane glide (cranial) on
central or unilateral + can provide some
distraction
 Movement: Patient performs extension

49
SNAGs - Rotation
Initial contact point

spinos process
Thoraco-lumbar region
is most common region
of dysfunction

50
Self SNAGs -
Rotation

51
SNAGs – Lateral bending

52
Lumbar Belt Traction
• Belt around PT shoulders; and positioned above suspected spinal
level
• Cephalic glide produced by belt
• Localizes involved segment (only distal segments in decompression)
• Patient arms preferably on bed
Lumbar Belt Traction

54
Spinal mobilization with leg
movement (SMWLMs)
• Tekanan melintang diterapkan ke sisi prosesus spinosus yang relevan

secara bersama digerakkan tungkai sisi lesi/terbatas.
• Asumsinya pembatasan gerak adalah dari spinal.
• Teknik ini untuk struktur/pembatasan mekanik tulang belakang,
potensial memiliki implikasi saraf.

55
SMWLMs
Processus
spinosus
medial-lateral:
Meralgia
SMWLMs
Processus
spinosus ke
lateral
(side lying):
Ischialgia
SMWLMs Processus
spinosus ke lateral
(side lying): Ischialgia
SACRO – ILIAC JOINT
• No conclusive evidence to support the specificity or accuracy

of current clinically based SI joint tests
(Levangie, 1999)
• Use cluster of tests
Tests only become significant if changing “the position fault”
reduces the symptoms and increases the limited
flexibility/function

59
The common Sacro-iliac Dysfunctions
- Posterior Rotation
- Anterior Rotation

60
SACROILIACA
TORSI POSTERIOR

61
SACROILIACA TORSI ANTERIOR

62
Peripheral MWM
• Identifikasi gerakan yang terbatas, gliding dipilih yang tepat.
• Gliding dengan kekuatan berat badan atau menggunakan bantalan
tergantung tingkat keparahan, iritasi dan kondisi klinis.
• Setelah gliding dipilih, dipertahankan gerakan fisiologis sampai
kembali seperti sebelumnya.
• Mobilisasi dilakukan tanpa rasa sakit
• Diharapkan terjadi efek langsung penurunan rasa sakit dan perbaikan
ROM.
• Jika ini tidak tercapai, glide dievaluasi
63
Indications
Transverse MWM
• It is painful/limited @ 50-75% of normal AROM
• Loss of combined movements-rotation, extension
• SNAG not effective
• Resistant loss of movement
• Non- irritable cases
Tips – take up “skin slack” by starting quite lateral

- use foam pad for comfort
MWM Hip Joint
MWM loss internal rotation
• Posisi berdiri/ terlentang
• Hip dan knee fleksi, letakkan belt
mengitari poksimal paha, dan pantat
terapis.
• Tangan terapis pada lateral os ilium
• Gliding femur ke latelal dan Pasien
menggerakan ke internal rotasi.

66
MWM Hip Internal Rotation & Flexion NWB
• Mobilisation
• Lateral glide femur
• Movement
• Internal hip rotation
• Tips
• Belt high in groin
• Sabilize pelvis

67
MWM restore hip flexion
• Gliding ke
lateral dan
dilakukan
gerakan fleksi.
• Bisa juga
dalam posisi
berdiri
68
To Restore hip extension (WB)
• Posisi pasien berdiri satu tungkai yang
tidak diterapi di atas kursi
• Belt diletakan mengitari femur
proksimal.
• Terappis menggliding femur ke lateral,
lalu pasien menambah fleksi knee
pada kaki yang tidak diterapi dan
ekstensi trunk

69
MWM Hip Extension (NWB)
• Mobilisation
• Lateral glide femur on stabilized
pelvis
• Movement
• Hip extension in Thomas test
position
• Tips
• Ensure to control pelvic tilt to
avoid lumbar extension

70
To restore hip abduction
(chronic adductor strain)
• Pasien berdiri, fiksasi pada oss illium
• Gliding femur ke posterior dan
pasien bergerak ke arah abduksi

71
MWM Knee Joint
Joint involved
-- Tibio – femoral
-- Patello – femoral
-- superior tibio – fibular
Physiological movements
-- flexion – extension
-- rotation (tibia on femur)

72
The proximal tibio fibuar joint
(posterolateral knee pain)
• Pasien dalam posisi fleksi knee, selanjutnya terapis melalukan gliding
fibula ke anterior dari tibia.
• Untuk gejala skiatik yang menjalar ke sisi lateral tungkai.

73
Knee pain
• Posisi pasien tidur tengkurap dan lutut pada bantal.
• Letakkan belt di proximal tibia.
• Lakukan gliding ke medial untuk nyeri medial lutut, dan gliding ke
lateral untuk nyeri di lateral lutut.
• Bersamaan dengan gliding, pasien diminta memfleksikan lutut.

74
MWM Anterior – Posterior Glide
Knee Flexion
• Mobilisation
• postero/cephalic glide of tibia
• Movement
• Patient pulls belt around foot to assist
flexion of the knee
• Tips
• May benefit from internal tibia rotation
• Mobilization force tracks with the
dynamic treatment plane
75
Self MWMS: Knee Flexion
• Fleksikan lutut sebatas nyeri
• Pegang tungkai bawah pada kaput fibula dan
gerakan ke arah internal rotasi.

76
Squeeze technique for meniscus
• Technique: pressure on meniscus to reposition it + active flexion
• Lakukan penekanan pada sisi medial celah sendi lutut ke central jika
nyeri pada medial sendi lutut.
• Jika nyeri pada sisi lateral lakukan penekanan pada sisi lateral lutut
Medial Meniscus
Lateral Meniscus

77
“Squeeze” technique
• Indications: for loss of knee flexion or extension due to meniscal
displacement
• Position: patient supine
• Grip: Medial border of one thumb, reinforced by the other over
tender joint space
• Direction: patient actively flexes knee and when you feel the joint
space open up beneath your thumbs squeeze centrally
• Variation: progress weight bearing from table to chair to squat

78
MWM Ankle joint

79
Plantar Flexion Loss
• Posisi lutut dan ankle fleksi 90º dan tumit di bed.
• Posisi tangan: hipotenar tangan terapis di proksimal ankle
heterolateral pasien
di gliding cruris ke posterior sejauhnya
• Tangan terapis yang lain memegang dengan thumb dan jari-jari
pada subtalar dengan gerakan roll slide ke ventral (plantar)

80
Dorsal flexion loss
• Pasien berdiri satu kaki di atas kursi
• Belt 4 cm di atas insertio tendon achiles pasien dan di pantat terapis
• Pegang antara thumb & jari telunjuk terapis mengitari talus
• Tarik cruris forward dengan belt dan pasien menggerakkan cruris ke
anterior, terapis menahan talus.

Poltekkes Surakarta) 81
MWM Sprained Ankle
• Mobilisation
• Posterior and cephalic glide of
fibula on tibia
• Movement
• Plantar flexion / inversion with
overpressure
• Tips
• Use belt to assist with inversion Overpressure
82
MWM Pedis
Metatarsals DF/PF toes

83
References
• Exelby, Linda. "Peripheral mobilizations with movement." Manual Therapy 1.3

(1996): 118-126.
• Kisner, Carolyn, and Lynn Allen Colby. Therapeutic exercise: foundations and
techniques. FA Davis, 2012.
• Mulligan, BR: Manual Therapy “NAGS,” “SNAGS,” “MWM’S: Etc., ed 4. Plane View
Press, Wellington, 1999
• Mulligan, BR: Manual therapy NAGS, SNAGS, MWMS, etc, 5th edition, 2004.
• Mulligan, BR: Manual therapy NAGS, SNAGS, MWMS, etc, 6th edition, 2010.
• Wilson, Ed. "The Mulligan concept: NAGS, SNAGS and mobilizations with
movement." Journal of bodywork and movement therapies 5.2 (2001): 81-89.
84

Mulligan Concept IFI Kudus, 29 Oktober 2017-1

Transféré par

Informations du document

Titre original

Copyright

Formats disponibles

Partager ce document

Partager ou intégrer le document

Options de partage

Avez-vous trouvé ce document utile ?

Ce contenu est-il inapproprié ?

Droits d'auteur :

Formats disponibles

Mulligan Concept IFI Kudus, 29 Oktober 2017-1

Transféré par

Droits d'auteur :

Formats disponibles

Disampaikan oleh: Saifudin Zuhri, SKM, SSt FT, M.

• Brian R. Mulligan qualified as a physiotherapist in 1954 and gained his

• Mulligan berpendapat bahwa cedera/sprain akibat "kesalahan posisi"

Disampaikan oleh: Saifudin Zuhri, SKM, SSt FT, M. Kes (Dosen

Disampaikan oleh: Saifudin Zuhri, SKM, SSt FT, M. Kes (Dosen

• Aplikasi mobilisasi pasif sendi yaitu glide -- > bebas nyeri.

Disampaikan oleh: Saifudin Zuhri, SKM, SSt FT, M. Kes (Dosen

• Saat mempertahankan gliding sendi, pasien diminta melakukan

• Jika tidak terjadi perbaikan kondisi, menunjukkan terapis belum

Disampaikan oleh: Saifudin Zuhri, SKM, SSt FT, M. Kes (Dosen

Disampaikan oleh: Saifudin Zuhri, SKM, SSt FT, M. Kes (Dosen

If there is No PILL response, that technique should not be advocated.

Disampaikan oleh: Saifudin Zuhri, SKM, SSt FT, M. Kes (Dosen

© 2011 McGraw-Hill Higher Education. All rights

• Dynorphin released from

no absolute contraindication for manual therapy

• Several repetition should be done during the mobilization

Disampaikan oleh: Saifudin Zuhri, SKM, SSt FT, M. Kes (Dosen

Disampaikan oleh: Saifudin Zuhri, SKM, SSt FT, M. Kes (Dosen

Disampaikan oleh: Saifudin Zuhri, SKM, SSt FT, M. Kes (Dosen

Disampaikan oleh: Saifudin Zuhri, SKM, SSt FT, M. Kes (Dosen

• Hypothenar eminence on the spinous process – can use thumbs –

Disampaikan oleh: Saifudin Zuhri, SKM, SSt FT, M. Kes (Dosen

Disampaikan oleh: Saifudin Zuhri, SKM, SSt FT, M. Kes (Dosen

Disampaikan oleh: Saifudin Zuhri, SKM, SSt FT, M. Kes (Dosen

Disampaikan oleh: Saifudin Zuhri, SKM, SSt FT, M. Kes (Dosen

Direction: Cranially glide

Disampaikan oleh: Saifudin Zuhri, SKM, SSt FT, M. Kes (Dosen

Disampaikan oleh: Saifudin Zuhri, SKM, SSt FT, M. Kes (Dosen

Disampaikan oleh: Saifudin Zuhri, SKM, SSt FT, M. Kes (Dosen

Initial contact point

Disampaikan oleh: Saifudin Zuhri, SKM, SSt FT, M. Kes (Dosen

Disampaikan oleh: Saifudin Zuhri, SKM, SSt FT, M. Kes (Dosen

Disampaikan oleh: Saifudin Zuhri, SKM, SSt FT, M. Kes (Dosen

Disampaikan oleh: Saifudin Zuhri, SKM, SSt FT, M. Kes (Dosen

• Tekanan melintang diterapkan ke sisi prosesus spinosus yang relevan

Disampaikan oleh: Saifudin Zuhri, SKM, SSt FT, M. Kes (Dosen

• No conclusive evidence to support the specificity or accuracy

Disampaikan oleh: Saifudin Zuhri, SKM, SSt FT, M. Kes (Dosen

Disampaikan oleh: Saifudin Zuhri, SKM, SSt FT, M. Kes (Dosen

Disampaikan oleh: Saifudin Zuhri, SKM, SSt FT, M. Kes (Dosen

Disampaikan oleh: Saifudin Zuhri, SKM, SSt FT, M. Kes (Dosen

Tips – take up “skin slack” by starting quite lateral

Disampaikan oleh: Saifudin Zuhri, SKM, SSt FT, M. Kes (Dosen

Disampaikan oleh: Saifudin Zuhri, SKM, SSt FT, M. Kes (Dosen

Disampaikan oleh: Saifudin Zuhri, SKM, SSt FT, M. Kes (Dosen

Disampaikan oleh: Saifudin Zuhri, SKM, SSt FT, M. Kes (Dosen

Disampaikan oleh: Saifudin Zuhri, SKM, SSt FT, M. Kes (Dosen

Disampaikan oleh: Saifudin Zuhri, SKM, SSt FT, M. Kes (Dosen

Disampaikan oleh: Saifudin Zuhri, SKM, SSt FT, M. Kes (Dosen

Disampaikan oleh: Saifudin Zuhri, SKM, SSt FT, M. Kes (Dosen

Disampaikan oleh: Saifudin Zuhri, SKM, SSt FT, M. Kes (Dosen

Disampaikan oleh: Saifudin Zuhri, SKM, SSt FT, M. Kes (Dosen

Disampaikan oleh: Saifudin Zuhri, SKM, SSt FT, M. Kes (Dosen

Disampaikan oleh: Saifudin Zuhri, SKM, SSt FT, M. Kes (Dosen

Disampaikan oleh: Saifudin Zuhri, SKM, SSt FT, M. Kes (Dosen

Disampaikan oleh: Saifudin Zuhri, SKM, SSt FT, M. Kes (Dosen

Disampaikan oleh: Saifudin Zuhri, SKM, SSt FT, M. Kes (Dosen

• Exelby, Linda. "Peripheral mobilizations with movement." Manual Therapy 1.3

Vous aimerez peut-être aussi