Mulligan Concept, Principles, Indications

Cosmetic Surgery, Types, Procedures, Indications

Mulligan Concept, Principles, Indications

Mulligan Concept is the application of the Mulligan’s Sustained Natural Apophyseal Glide (SNAG) technique on lumbar flexion ROM. The secondary aim was to measure the intra- and inter-day reliability of lumbar ROM employing the same procedure.

For peripheral joints, the Mulligan Concept mainly utilizes the mobilization with movement (MWM) techniques, according to which there is a certain direction of application of mobilization forces, which if maintained during a painful movement, the patients’ usual pain should be completely resolved. Many repetitions of the pain-free MWM are required to achieve a successful therapeutic result, eventually with the additional application of overpressure, with immediate positive results even within the first treatment session [rx]. The mobilization directions for peripheral joints comprise internal and external lateral glide, internal and external rotation and anteroposterior and posteroanterior glide. Regarding the technical terms of the application, mobilizations are implemented with a specified frequency, on specified sets, repetitions and rest periods between them, depending on the joint and the session [rx].

Principles of Mulligan Concept

  • A passive accessory joint mobilization is applied following the principles of Kaltenborn. This accessory glide must itself be pain-free.
  • During the 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
  • The therapist must continuously monitor the patient’s 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.
  • While sustaining the accessory glide, the patient is requested to perform the comparable sign. The comparable sign should now be significantly improved
  • 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.
  • The previously restricted and/or painful motion or activity is repeated by the patient while the therapist continues to maintain the appropriate accessory glide.
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Indications of Mulligan Concept

  • The pain of a non-inflammatory nature
  • Acute pain from injury
  • Loss of motion due to arthritic conditions
  • Post-surgical conditions causing loss of pain-free movement, e.g. post scope conditions, spinal surgery
  • Headaches due to neck problems
  • Dizziness associated with neck problems
  • Jaw or TMJ pain and movement restrictions
  • Acute to chronic ankle sprains
  • Tennis elbow” or lateral elbow pain

References

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