Mulligan Manual Therapy
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.
While applying this technique, otherwise known as a mobilisation with movement (MWM) the PILL response is observed for:
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 and SNAGs, 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 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