Mulligan Technique

Historical Perspectives
• The Mulligan concept approach to orthopaedic manual physical
therapy (OMPT) was conceived by a New Zealand physiotherapist by
the name of Brian R. Mulligan.
• Mulligan qualified as a physiotherapist in 1954 and achieved his
Diploma in Manipulative Therapy in 1974.
• Mulligan credits Freddy M. Kaltenborn of Norway as being his
primary mentor in the area of practical learning.
• Mulligan concept approach is based on a firm understanding of functional
anatomy and kinematics.
• The first edition of Mulligan’s book entitled, Manual Therapy: NAGS,
SNAGS, MWMS, etc.,1 was published in 1989.
 Mobilization with Movement

• MWM can be defined as the application of sustained passive

accessory force/glide to a joint while the patient actively perform a
task that was previously identified as a being problematic.
• The Passive accessory force usually exert glide at the joint as such
must be applied close to the joint line. It may be applied manually
with the therapist hand or via a treatment belt.
• The glide should be applied parallel to the treatment plane which is
line draw across the concave joint surface.
Positional Fault Theory
• Mulligan further developed the theory that a joint may assume a faulty position that
might restrict movement and produce pain.
• Such a positional fault may be the result of trauma, aging, muscle imbalance, or
poor posture and may not be detectable through traditional diagnostic imaging
procedures.
• Mulligan’s description of the positional fault theory is neither new nor unique to
this approach.
• The concept that articular malalignment may lead to altered kinematics and eventual
dysfunction is a fundamental principle within several OMPT approaches.
Mobilization With Movement Clinical
Practice Guidelines
• The manual therapist must be sure to gain contact and apply force as close to the
joint as possible.
• The mobilizing force must be applied parallel to the treatment plane, which is
defined by the line that extends across the concave articular surface of the joint.
• MWMs are performed in weight-bearing whenever indicated.
• The physiologic motion performed is the symptomatic and/or restricted
movement.
• Accessory glides are applied in combination with active or passive physiologic
motion
Con…..

• Mobilizing force is often applied directly to the region of pain.

• Accessory glides are performed in accordance with the treatment plane of
the joint.
• Mobilizing force must be maintained with the correct amount of force and
direction throughout the entire range of provocative physiologic motion.
• Passive overpressure should be applied at the end range.
Con….

• The mobilization must be entirely pain free.

• Efficacy is immediately determined through patient response.
• Once efficacy is determined, MWM is performed for 5 to 10 repetitions and
may be followed with self mobilization or taping if function is not
normalized on release of mobilization.
• Importance of therapist knowledge and skill, patient therapist collaboration
and patient co-operation highlighted in the acronym CROCKS.
• C- Co-ordination
• R- Repetition
• O- Over-pressure
• C- Communication and cooperation
• K- Knowledge
• S- Sustain, skill, Sensibility
CROCKS
• Contraindication
• Therapist must familiar with the condition that are contraindication to the manual
therapy and those in which caution is required.
• Repetition
• The number of repetition per set and number of sets per session varies between
technique.
Con…..
• Overpressure
• The max. passive range is achieved by the therapist applied firm overpressure at the end
of active range. If pain free over pressure can be achieved at the symptomatic joint as a
consequence of MWM technique, then this is believed to ensure optimal recovery.
• Communication and Co-operation
• Practitioner must inform patients of expected effects and patient must communicate with
the practitioner the presence of discomfort, symptom or pain during each treatment
session.
• Knowledge
• Practitioner must have knowledge of anatomy, biomechanics, pathology,
musculoskeletal medicine.
• Sustain
• MWM incorporate accessory glide with active movement. Ensure the glide is
maintained during the entire duration of movement even no return to starting
position.
• Skill
• Manual handling of the physical application of technique. The more the therapist
perfect their technique, the better the technique will be performed.
• Sensibility
• The therapist will gain greater sense and feeling through their hands.
• The Mulligan PILL acronym is related to the desired response from the
technique's application.
• P- Pain free
• I- Instant Effect
• LL- Long lasting
Mulligan’s Manual Therapy Technique

• MWM’s ( Mobilization with movement)

• Natural apophyseal glides (NAGs)
• Sustained Natural Apophyseal Glides (SNAGs)
• Spinal Mobilization With Extremity Movement (SMWAM and
SMWLM)
Thank you for your
attention