PAIN RELEASE PHENOMENON (PRP)

Original Editor - Sheik Abdul Khadir

Top Contributors - Sheik Abdul Khadir and Evan Thomas

Introduction

The Pain Release Phenomenon Techniques (PRPs) is a manual therapy technique introduced by Brian Mulligan for the Chronic pain management in the extremities. In this technique, joint compression, muscular contraction or stretch is used as an the pain provoking stimuli and the stimuli is maintained for 15- 20 seconds. If indicated, the pain will reduce in this period and the patient would have gained a new P1.

Background

As stated by Brian Mulligan in his textbook [1] "PRPs began for me when I started using compressions in treatment regimes after reading the excellent article of G D Maitland's "The Hypothesis of Adding Compression when examining and treating synovial joints" in 1981 [2]. As stated in Maitland's Article , when assessing extremity joints you should try a compression test to see if this produces pain. To do this ,the joint is placed in a biomechanical resting position where all the structures surrounding it are maximally relaxed. Stabilise the proximal facet with one hand and apply a compressive force on the joint using the other. While maintaining the compression, a series of joint movements is tried to see if they produce pain. The movements can be either physiological (Flexion, abduction,etc) or accessory (glides). By chance I discovered that if I applied an acceptable pain producing compression force with movement for 20 seconds the pain would often disappear or would be significantly reduced."

Indications and Contraindications

Any chronic neuromusculoskeletal pain, not responding to conventional Physiotherapy.
Acute pain is strictly contraindicated i.e., less than 6 weeks of onset of symptoms and patients with moderate to high severity , Intensity and Nature of the pain.

Procedure[3]

  1. The technique which provokes pain is selected; and the pain provoked should settle down within 15-20 seconds (for smaller joints) and 25-30 seconds (for larger joints).
  2. The range at which "THE" pain starts is evaluated.
  3. Therapist maintains pressure at P1 for 15- 20 seconds.
  4. If pain reduces within 15 -20 seconds, start new PRP in new available range with increased force.
  5. If pain doesn't reduce within 15-20 seconds ,it implies that pressure being applied is too high. Hence the pressure should be reduced to a level so that provoked pain gets reduced within 20 seconds.
  6. If pain reduces before 10 seconds, it implies that pressure being applied is too low. Hence the pressure should be increased to a level so that provoked pain gets reduced within 15 - 20 seconds and not before 10 seconds.
  7. In addition to applied pressure , Physiological movement or accessory movement may be added along with the selected PRPs.
  8. Continue to perform PRPs until a substantial amount of pain relief is achieved during a session.

Compression PRPs[1]

This can be applied for:
  1. Metatarso-phalengeal Joint
  2. Sesamoids
  3. Metatarso-cuboid joint
  4. Trapezium-1st Metacarpal joint
  5. Pisiform-triquetrum Joint
  6. Patello- femoral Joint. 
  7. Cervical Spine

Muscular Contraction / Stretch PRPs[1]

  1. Extensor longus hallucis tendonitis
  2. Hip Pain
  3. De Quervain's tenosynovitis
  4. Tennis elbow
  5. Golfer's elbow
  6. Chronic Painful shoulder
  7. Acute wry neck

References

  1. 1.0 1.1 1.2 Manual Therapy NAGS,SNAGS,MWMS etc .Brian R Mulligan. Sixth Edition.2010
  2. The Hypothesis of Adding Compression When Examining and Treating Synovial Joints.G. D. MAITLAND,I AUA, FCSP, FACP, SASP, MTAA. JOSPT Vol. 2, No. 1. 1981.
  3. Manual of Mulligan Concept ; Dr.Deepak Kumar , Brian R.Mulligan. first edition: 2014.