Mulligan Concept

Original Editor - Your name will be added here if you created the original content for this page.

Top Contributors - Venus Pagare, Asma Alshehri, Sheik Abdul Khadir, Kim Jackson, Jason Cirolia, Garima Gedamkar, Evan Thomas, WikiSysop, Admin and Wendy Walker  

Description

• MWMs (mobilizations with movement) of the extrmities and SNAGS (sustained natural apophyseal glides) of the spine were first coined by Brian R. Mulligan. 
  
• A key component of Mulligan mobilizations are the absence of pain with motion. While performing the technique it is crucial for the therapist to continually monitor the patient via verbal and non-verbal feedback to ensure there is no pain with movement. The therapist must utilize their clinical understanding of tissue extensibility, anatomy, and joint motion in order to mobilize the joint in it's biomechanical accessory motion. While holding an accessory motion the patient is asked to move the extremity in the painful/limiting direction. A success would be absence of pain and this accessory glide is than reinforced with graded sets and frequent intersession re-assessment. If pain is not eliminated than either the point of contact is incorrect or the technique is not indicated. In the situation where pain is reduced, the therapist reinforces the motion with accessory glides via sets and reps with the goal being full range and pain free. Again to emphasize, this process should be pain free.
  

Principles of Treatment

1. During assessment the therapist will identify one or more comparable signs as described by Maitland. These signs may be; a loss of joint movement, pain associated with movement, or pain associated with specific functional activities

2. A passive accessory joint mobilization is applied following the principles of Kaltenborn. This accessory glide must itself be pain free.

3. The therapist must continuously monitor the patients reaction to ensure no pain is recreated. The therapist investigates various combinations of parallel or perpendicular glides to find the correct treatment plane and grade of accessory movement.

4. While sustaining the accessory glide, the patient is requested to perform the comparable sign. The comparable sign should now be significantly improved

5. Failure to improve the comparable sign would indicate that the therapist has not found the correct treatment plane, grade of mobilization, spinal segment or that the technique is not indicated.

6. The previously restricted and/or painful motion or activity is repeated by the patient while the therapist continues to maintain the appropriate accessory glide.

Clinical Presentation

add text here relating to the clinical presentation of the condition, including pre- and post- intervention assessment measures. 

Key Evidence

add text here relating to key evidence with regards to any of the above headings

Resources

add appropriate resources here, including text links or content demonstrating the intervention or technique

Case Studies

add links to case studies here (case studies should be added on new pages using the case study template)

References

References will automatically be added here, see adding references tutorial.