Mulligan Manual Therapy

Conceptual Overview[edit | edit source]

Fundamentally, the Mulligan Concept technique involves a joint mobilisation or glide. Then if the joint is pain free, it is actively repeatedly moved by the patient in the previously restricted and/or painful motion while the therapist continues to maintain the appropriate mobilisation.

The core of the Mulligan concept is the Mobilization With Movement (MWM).

During the examination the therapist will determine if a joint restriction, range of motion loss, or pain is being generated by a joint. Then, the therapist will reposition of that joint, using their hands or a belt, in order to provide a situation that allows the patient to move further through the range of motion and reduce pain.

To evaluate the effectiveness of our treatment, we observe for a PILL response:

P– Pain free.

I– Instant result.

LL– Long Lasting.

The movement should be found to improve either in pain or range or both


Overview of techniques:

NAGS (Natural Apophyseal Glides) and SNAGs (Sustained Natural Apophyseal Glides),

similar to traditional techniques of joint mobilization, use an oscillatory force to increase the accessory motion of a joint

NAGs mobilise joints mid way through range. A SNAG is then applied to take the joint through full range of motion in a mechanically improved way, so mobility is maximized without producing pain.

NAGs are used at the Cx and upper Tx spine SNAGs at the neck, thoracic and lumbar (mid and low) back, ribs and SI joints/


MWMs

Glides performed on the joint whilst the individual performs the symptomatic movement. More specific MWM’s can be applied at the shoulder, elbow, wrist, hip, knee and ankle, depending on the patients presentation MWMs are used for restricted limb movements that could be restricted due to spinal problems.

Oher techniques include:

home exercise techniques 

Taping Opening glides at the temperomandiublar joint (jaw)


The Mulligan techniques appropriate to specific areas:

Cervical Spine

Cervical Snags for Flexion Restriction: Patient: In Neutral sitting 1. The medial portion of the right thumb is placed on post SP 2. The pad of the left is perpedicular to the right thumb

3. Therapist provides PA glide whilst patient moves nick in direction of symptoms

If symtpom free 0> Patient applies over-pressure into movement restriction If improved pain or motin -? Taught self-snags


NAG Patient: Sits in chair 1. Therapist: faces in step stance stabilising shoulder/trunk Left little finger - SO of mobilised segment Other left fingers - Support occiuput Thenar eminance of right thumb partially covers left finger

2. Painless mobs are applied in the plane of facet joints