PAIN RELEASE PHENOMENON (PRP)
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.
Indications and Contraindications
- 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).
- The range at which "THE" pain starts is evaluated.
- Therapist maintains pressure at P1 for 15- 20 seconds.
- If pain reduces within 15 -20 seconds, start new PRP in new available range with increased force.
- 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.
- 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.
- In addition to applied pressure , Physiological movement or accessory movement may be added along with the selected PRPs.
- Continue to perform PRPs until a substantial amount of pain relief is achieved during a session.
- Metatarso-phalengeal Joint
- Metatarso-cuboid joint
- Trapezium-1st Metacarpal joint
- Pisiform-triquetrum Joint
- Patello- femoral Joint.
- Cervical Spine
Muscular Contraction / Stretch PRPs
- Extensor longus hallucis tendonitis
- Hip Pain
- De Quervain's tenosynovitis
- Tennis elbow
- Golfer's elbow
- Chronic Painful shoulder
- Acute wry neck
- Manual Therapy NAGS,SNAGS,MWMS etc .Brian R Mulligan. Sixth Edition.2010
- 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.
- Manual of Mulligan Concept ; Dr.Deepak Kumar , Brian R.Mulligan. first edition: 2014.