19 Jul The Mulligan Concept
As physiotherapists, we have various assessment and treatment principles that we can apply to manage our patients. Maitland, McKenzie, Kaltenborn and Mulligan are a few of the techniques that are widely practiced.
A physiotherapist will be able to select the treatment principle that is best suited to the patient and their specific condition.
What is the Mulligan concept?
Brian Mulligan is a physiotherapist from New Zealand who has specialised in Manipulative Therapy and has written numerous articles and books about the treatment concept that he has developed.
The underlying premise of the Mulligan concept is that healthy joints have a normal axis of movement which allows full pain free range of movement. Mulligan proposed that injuries or sprains to any of the soft tissues surrounding a joint may result in a “positional fault” causing an abnormal axis of motion which in turn causes abnormal stress on tissues leading to pain and restrictions in movement.
The positional fault may be a translation or a rotation force which may be subtle in its presentation. Mulligan treatment techniques have been developed to overcome ‘positional’ faults and restore normal joint alignment. These techniques can be applied to spinal and peripheral joints.
Mulligan Techniques
The spinal mobilisation techniques developed by Mulligan are called NAGS (Natural Apophyseal Glides) and SNAGS (Sustained Natural Apophyseal Glides). The Apophyseal joints (also called Facet joints) are synovial joints on the posterior aspect of the spine between the vertebra. There are two facet joints in each spinal motion segment. NAGS and SNAGS are glides applied by the physiotherapist to these joints
Another Mulligan technique is termed Mobilisation with Movement (MWM) and is used in the treatment of the peripheral joints. A MWM is the application of a sustained mobilization applied by a therapist and an active movement to end range applied by the patient.
Principles of Mulligan Treatment
If applied correctly, the Mulligan treatments named above should be pain free, have instant results and be long lasting. If the treatment technique is not pain free or does not have an immediate effect, then the application of the treatment is incorrect. Subtle changes in the angle of the glide applied will ensure an effective technique.
Evidence for Mulligan Treatment
Current evidence supports MWM’s in providing not only immediate benefits but also improving outcomes at short- and long-term follow-up in the management of lateral epicondylitis (tennis elbow). There is also evidence to support the use of Mulligan MWM techniques in the management of frozen shoulder, post ankle sprain and patellofemoral pain as well as cervicogenic dizziness.
At Halo, our Physiotherapists are trained in Mulligan techniques and apply them alongside other treatment modalities to assess and treat our patients.
Blog compiled by Laura Woods, Senior Physiotherapist and Pilates Instructor at Halo
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