Mulligan concept
Brain Mulligan, physiotherapist and manual therapist in New Zealand, developed a new system for the treatment of complaints of the musculoskeletal system in the 1980s. What is striking about his concept is that the theory plays a subordinate role. It is all about the practical and directly complaints-oriented actions.
Other noteworthy points are that the actions often occur while the patient adopts normal postures and is treated while there is (normal) load on the area to be treated.
Examination
The examination is no different than usual in manual/musculoskeletal medicine, in short: a discussion about the complaints and a physical examination of pain and limitations in the mobility of joints. What is added is an investigation into the joint play during movement of the affected joint, and in particular with which joint play the symptoms disappear. This can involve complaints of the arm or leg, but also of the spine.
Mobilisations with movements (MWM)
When it has been established under which (joint play) conditions and loads the symptoms disappear, this is done in therapy form. The doctor/therapist embraces the joint in a specific way, and allows the patient to perform the normal movements. These movements can ultimately also be carried out under load. For example, in case of pain on the ankle, the therapy can take place with the foot on the floor. The doctor/therapist places is hands on the ankle, and the patient bends the ankle and loads it with its full body weight. During the therapeutic process it is important that the movement does not hurt. If this is the case, the doctor/therapist will have to look for a joint play. The mobilisations with movements are used for complaints and limitations on the arms and legs.
Example of a MWM for the shoulder
Sustained natural apophyseal glides (SNAG)
Similar techniques are applied to the spine in neck or back complaints. Here too, the pain is the guiding principle because the therapy must be pain-free. And here too, the patient is invited to actively participate in the therapy. On the one hand, this happens to move the joint by the patien, on the other hand the patient receives exercises to maintain or further develop the effect.
Example of a SNAG for the neck
Effectiveness
There is discussion in the scientific literature about the effectiveness of this method. My experience is that, if correctly applied and on the right indication per person, the techniques can be a useful addition in musculoskeletal medicine
References
Mulligan BR. Manual therapy; NAGS, SNAGS, MWMS, etc. Orthopedic Physical Therapy Products, 6th ed 2010.
Exelby L. The Mulligan concept: its application in the management of spinal conditions. Manual Therapy 2002;7:64-70.
Pourahmadi MR et al. Effectiveness of mobilization with movement (Mulligan concept techniques) on low back pain: a systematic review. Clin Rehabil. 2018 Oct;32(10):1289-1298.