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Introduction |
Introduction to the Mulligan Concept |
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Brian Mulligan’s concept of Mobilisation with Movement (MWM) is the natural continuance of the evolution of manual therapy from its foundations of remedial gymnastics and active exercise to practitioner applied passive physiological movement and on to passive accessory mobilisation techniques. Mobilisation with movement is the concurrent application of a pain-free accessory mobilisation with active and /or passive physiological movement. Passive end-range overpressure may now be applied without pain as a barrier.
These techniques were developed by Mulligan in New Zealand through his role as the principle clinical instructor for the New Zealand | | Manipulative Therapy Association’s Graduate Diploma program and over 40 years in private clinical practice. First used in the cervical spine, MWM’s quickly found their way into the treatment of peripheral joint dysfunctions and have undergone clinical refinement and expansion to all areas of the spine and most extremity joints.
These techniques are applicable when:
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1) No contraindication for manual therapy exists.
2) A full orthopaedic scanning examination has been completed indicating local musculoskeletal pathology of mechanical origin.
3) A specific biomechanical analysis reveals localized loss of mobility and/or pain associated with function.
4) No pain is produced during or immediately after application of the technique.
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Pain is always the guide. Successful MWM techniques should render the client’s symptomatic comparable sign painless while significantly improving function during the application of the technique. Having restored articular function with MWM’s, the practitioner may now progress the client through the ensuing rehabilitation sequences of the recovery of muscular power, endurance and the development of consistent neuro-motor control. Sustained improvements are necessary to justify ongoing intervention.
Mulligan postulates a positional fault model to explain the results gained through his concept. Alternately, inappropriate joint tracking mechanisms due to an altered instantaneous axis of rotation and neurophysiological response models have also been considered. Early research into this approach confirms its benefits however the mechanism through which it affects the musculoskeletal system has yet to be fully determined.
For further details of the application of the Mulligan Concept as it applies to the spine and extremities please refer to Manual Therapy, NAGS, SNAGS, MWMS, etc. published by Planeview Press. Instructional courses in the Mulligan concept are listed at www.bmulligan.com , www.canzed.on.ca and www.mulliganconcept.nl
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