Clinical examples of SMWAM

Описание: Exapmles of Spinal Mobilisations With Arm Movements (SMWAM)
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by Josef M Andersen
Master of Musculoskeletal & Sports Physiotherapy (UNISA)
MCTA, Manager MCTA Europe
[email protected]
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SMWAM: is a technique described by a great master physiotherapist Brian R Mulligan (NZ).

This technique can be considered as a test of neck involvement in a presentation suggesting an upper limb problem such as pain or movement restriction of the shoulder.

A transverse glide is applied to the sp in the opposite direction of the restricted upper limb. A similar technique is also described for the lower limb SMWLM is commonly used to decrease symptoms radiating to the lower limb.

SMWAM should show immediate results when indicated.
It is important to test several levels of the spine because there may be considerable overlap between levels. Even if we think that a certain movement is a C4 related movement we should test adjacent levels.

Mechanisms of action are not understood but Brian Mulligan suspects that this type of action may be acting on the muscles controlling the movement given the anatomical relation between the neck and shoulder and it can also be related to a specific manipulation of that level when movement occurs.
One can also speculate that stabilising the spine at a certain level may allow the movement to occur.

In any case, the observed results can not be disputed and one can use these as a treatment once the effect is confirmed.
Clients can do the technique as a home exercise when the level and grip is determined by a therapist.

Obviously, the techniques can be combined with other techniques, advise and exercise as necessary.


During my interview with Jason Ward, I promised to make available such an example of this clinical technique.

We discussed the values of knowledge derived from clinical trials and clinical experience. If one considers any of these presentations being enrolled in an RCT, the results are likely to show negative or no effect of an intervention directed at the shoulder. Which will in term conclude that MWM or SMWAM or even manual therapy as ineffective.

However, a carefull clinical investigation and relevant knowledge in manual therapy may identify the problems core issue and allow for effective utilization of described manual therapy techniques.

In brief: The values of RCTS, Review etc and the values of clinical knowledge should be appreciated within the relevant context.

I would advocate that clinical studies should adapt to a more realistic scenario when trying to understand or describe clinical effects. Case reports series supported with video evidence could be a very good option to shrink the gap between RCT s and case reports.

Similarly, levels of evidence should be reviewed in terms of clinical applicability.

Kind regards
Josef M Andersen
MCTA