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Functional Manual Medicine™ (FMM)

Functional Manual Medicine™ (FMM)

by drspinecareDecember 29, 2016

Functional Manual Medicine™ (FMM) is the multi-dimentional approach, to  help your body to function normally and optimally. we address the root cause of the problem. With this approach we are able to communicate and understand every symptom or sign of the disease process that signals us what is wrong with the tissue; be it a muscle, joint or any structure.

Close attension is paid to the fascia network and its abnormal features. its change from normal to abnormal can be very well understood.

functional aspect of muscle tissue integrated with nervous coordination  forms the key concept in functional manual medicine with the basis of understanding the signals of dysfunction

understanding and helping the tissues to function again is the core concept of the functional Manual Medicine

Dr. Ahmad

Founder of Functional Manual Medicine (FMM)


Functional Manual Medicine™

The Functional Manual Medicine™ programme is aimed at merging the examination of the joint, muscle and neural systems into an integrated wholistic examination procedure. We place strong emphasis on performing  an accurate and specific manual therapy examination. The examination process developed by Manual Concepts draws on the work of Edwards, Monaghan, Elvey, O’Sullivan, Lee, Jull, Maitland, Mulligan and Mckenzie among others. We believe that the merger of various manual therapy approaches and techniques into one concept provides a more realistic, multifactorial approach to the examination and treatment procedure.

Joint System

As part of the assessment of the joint system we aim  at  range of passive motion testing procedures to include provocative tests for specific structures as well as tests to determine specific motion segment dysfunction. Categorizing dysfunction into joint hyper or hypomobility is a basic requirement for diagnosis of the nature of the spinal disorder. A significant aspect of the assessment procedure is the use of combined movements as developed by Brian Edwards. Equally important is the use of specific passive segmental motion testing and provocative tests for pain reproduction.

Neural System

Neural tissue dysfunction is an important aspect of the physical examination. A comprehensive overview of neural tissue pain disorders, particularly with respect to recent developments in the understanding of pain physiology and neuropathic pain are developed. Assessment procedures and differential diagnosis for three types of neuropathic disorders are presented; nerve trunk sensitisation with axonal mechanosensitivity; denervation and axonal compromise; neuropathic pain associated with denervation and significant central and peripheral pain mechanisms. The clinical relevance of classifying neuropathic disorders into three sub-groups is in relation to providing appropriate treatment or management. Neural mobilisation techniques should only be used under appropriate circumstances. Case studies are presented to illustrate the classification process.

Muscle System 

An emphasis of this programme is a functional approach to the assessment of the spinal muscle system and motor control. As well we address the theoretical concept of spinal instability and the signs and symptoms that are commonly found on clinical examination, including assessment procedures for the local muscle system. It is important to understand that not all patients require motor control retraining. There is ample evidence to suggest that only a small proportion of patients with low back pain have instability. Treating all chronic low back pain patients with stabilisation exercises involving multifidus and transversus abdominis is not appropriate and the literature shows this does not work. Determining which patients need a muscle retraining approach is an important part of this programme. Classification of spinal pain disorders into specific sub-groups is the latest hot topic in musculoskeletal medicine, in particular manual therapy. This course will teach participants how to identify patients with motor control impairments and classify these into specific sub-groups that can be managed with appropriate retraining. A systematic graded, functional approach to the management of patients with spinal motor control impairment will be taught.

This programme does not provide the participants with a recipe approach to treatment. Students will be able to develop though sound methodology, appropriate treatment strategies with logical progression over time.

Proprioceptive Neuromuscular Facilitation Technique (PNF)”

  • Exercise that uses proprioceptive, cutaneous, and auditory input to produce functional improvement in motor output
  • Used to increase strength, flexibility and coordination
  • Based on the physiological properties of the stretch reflex
  • Strengthening Techniques

–        Rhythmic initiation

  • Progressive series, first of passive movement then active assistive movements, followed by active movement through an agonist pattern
  • Helps athlete w/ limited movement progressively regain strength through ROM

–        Repeated Contraction

  • Used for general weakness at one specific point
  • Move isotonically against maximum resistance of the ATC until fatigue is experienced
  • At point of fatigue, stretch is applied at that point in range to facilitate greater strength production
  • Must be accommodated resistance

–        Slow Reversal

  • Movement through a complete range against maximal resistance
  • Promotes normal reciprocal coordination
  • Reversal of movement pattern is initiated before previous pattern completed


–        Slow-reversal-hold

  • Part is moved isotonically using agonists, immediately followed by and isometric contraction
  • Used to develop strength at a specific point in the ROM

–        Rhythmic stabilization

  • Uses isometric contraction of agonists and antagonists – repeated contraction to strengthen at a particular point

Stretching techniques

–        Contract-relax

  • Passively moved until resistance is felt; athlete contracts antagonist isotonically against resistance for 10 seconds or until fatigue; athlete relaxes for 10 seconds and then the limb is pushed to a new stretch
  • Repeated 3 times

–        Hold-relax

  • The athlete moves until resistance is felt; athlete contracts isometrically against resistance for 10 seconds; athlete relaxes for 10 seconds and then the limb is pushed to a new stretch actively by the athlete or passively by the clinician
  • Repeated 3 times

–        Slow-reversal-hold-relax

  • Athlete moves until resistance is felt; athlete contracts isometrically against resistance for 10 seconds; athlete relaxes for 10 seconds, relaxing the antagonist while the agonist is contracted moving the limb to a new limit
  • Repeated 3 times
  • Basic Principles for Using PNF Technique

–        Patient must be taught through brief, simple descriptions (starting to terminal positions)

–        Patient should look at limb for feedback on directional and positional control when learning

–        Verbal commands should be firm and simple

–        Manual contact will facilitate the motions

–        ATC must use correct body mechanics

–        Resistance should facilitate a maximal response that allows smooth, coordinated motion

–        Rotational movement is critical

–        Distal movement should occur first and should be completed no later than halfway through pattern

–        The stronger components are emphasized to facilitate weaker components of movement

–        Pressing the joint together causes increased stability, while traction facilitates movement

–        Giving a quick stretch causes a reflex contraction of that muscle


  • PNF Patterns

Involves 3 components

–        Flexion/extension

–        Abduction/adduction

–        Internal/External rotation

  • Distinct diagonal patterns w/ rotational movements of upper & lower extremities, upper & lower trunk and neck
  • D1 and D2 patterns for each body part
  • Named according to movement occurring at hip or shoulder

Joint Mobilization

  • Used to improve joint mobility or decrease pain by restoring accessory motion -allowing for non-restricted pain free ROM
  • Mobilization may be used to

–        Reduce pain

–        Decrease muscle guarding

–        Stretch or lengthen tissue surrounding a joint

–        Produce reflexogenic effects that either inhibit or facilitate muscle tone or stretch reflex

–        For proprioceptive effects that improve postural and kinesthetic awareness

Mobilization Techniques

–        Used to increase accessory motion about a joint

–        Involve small amplitude movements (glides) w/in a specific range

–        Should be performed w/ athlete and athletic trainer in comfortable position

–        Joint should be stabilized as near one articulating surface as possible; other should be held firmly

–        Treatment occurs in parallel treatment plane

–        Maitland Grading System

  • Grade I (for pain) – small amplitude  at beginning of range
  • Grade II (for pain) – large range at midrange
  • Grade III (treating stiffness) – large amplitude to pathological limit
  • Grade IV (treating stiffness) – small amplitude at end range
  • Grade V (manipulation) – quick, short thrust
  • Mobilization based on concave-convex rule

–        When concave surface is stationary, convex surfaces is glided in opposite direction of bone movement

–        When convex surface is stationary, concave surface is glided in direction of movement

Myofascial Release

  • Group of techniques used to relief soft tissue from abnormal grip of tight fascia
  • Specialized form of stretching
  • Fascia is essentially a continuous connective tissue network that runs throughout the body, encapsulating muscles tendon, nerves, bone, and organs
  • If damage occurs in one section it can impact fascia in sites away from the affected area
  • Form of soft tissue mobilization

–        Locate restriction and move into the direction of the restriction

–        More subjective and relies heavily on experience of the clinician

–        Focuses on large areas

–        Can have a significant impact on joint mobility

–        Progression, working from superficial to deep restrictions

–        As extensibility increases in tissue should be stretched

–        Strengthening should also occur to enhance neuromuscular reeducation to promote new more efficient movement patterns

–        Acute cases resolve in a few treatments, while longer conditions take longer to resolve

–        Sometimes treatments result in dramatic results

–        Recommended that treatment occur 3 times/wk


  • Technique used to decrease muscle tension and normalize muscle function
  • Passive technique that places body in a position of comfort – thereby relieving pain

–        Locate tender points (tense, tender, edematous spots, <1cm in diameter, may run few centimeters long in muscle, may fall w/in a line, or  have multiple points for one specific joint)

–        Tender points monitored as athlete placed in position of comfort (shorten muscle)

–        When position is found, tender point is no longer tense

–        After being  held for 90 seconds, point should be clear

–        Patient should then be returned to neutral position

  • Physiological rationale based on stretch reflex

–        Muscle relaxed instead of stretched

–        Muscle spindle input is reduced allowing for decreasing in tension and pain

Positional Release Therapy

  • PRT is based on the strain/counterstrain technique
  • Difference is the use of a facilitating force (compression) to enhance the effect of positioning
  • Osteopathic mobilization technique
  • Technique follows same procedure as strain/counterstrain however, contact is maintained and pressure is exerted

–        Maintaining contact has therapeutic effect

Active Release Therapy

  • ART is relatively new type of therapy used to correct soft tissue problems caused by formation of fibrotic adhesions

–        Result of acute injury and repetitive overuse injuries or constant pressure/tension Deep tissue technique used for breaking down scarring and adhesions

–        Locate point and trap affected muscle by applying pressure over lesion

–        Athlete actively moves body part to elongate muscle

–        Repeat 3-5 times/treatment

–        Uncomfortable treatment but will gradually soften and stretch scar tissue, increase ROM, strength, and improve circulation, optimizing healing

–        Must follow up w/ activity modification, stretching and exercise

–        Disrupt normal muscle function affecting biomechanics of  joint complex leading to pain and dysfunction

–        Way to diagnose and treat underlying causes of cumulative trauma disorders


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