The Mulligan Concept of Manual Therapy

Mulligan Concept
Concurrent application of sustained accessory mobilization applied by a therapist and an active
physiological movement to end range applied by the patient
How it is Applied
● NAGS- Natural Apophyseal Glides
● SNAGS – Sustained Natural Apophyseal Glides
● MWMS- Mobilization with Movements
Mobilization with movement (MWM) is the concurrent application of sustained accessory
mobilization applied by a therapist and an active physiological movement to end range applied
by the patient. Passive end-of-range overpressure, or stretching, is then conveyed without pain as
a barrier
Benefits
Pain reduction. Joint mobility. Increase in function
Patient Population
Patients with restricted motion caused by an orthopedic or joint issue, including arthritis,
post-spinal surgery pain, headaches and dizziness
Principles of Treatment
A passive accessory joint mobilization is applied following the principles of Kaltenborn.
Kaltenborn established the Convex-Concave Rule to allow ease in identifying the
direction of limitation and subsequently the direction that treatment is to be applied.
When a convex joint surface is moving, the roll and glide transpire in the opposite
direction
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 patients reaction to ensure no pain is
reproduced. The therapist assesses 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 instructed to perform the comparable
sign. Something that can be reproduced/retested that often reflects the primary complaint.

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
Maitland vs Mulligan technique
Mulligan mobilization allows the patients to perform the offending movements in a functional
position. Maitland mobilization aims to reestablish the spinning, gliding and rolling motions of
two joints
Concept of ‘Positional Fault’
Mulligan proposed that injuries or sprains might result in a minor “positional fault” to a
joint causing restrictions in physiological movement
Development in techniques used to overcome joint `tracking’ problems or `positional
faults’ i.e. joints with subtle biomechanical changes

References:
Mulligan, BR: Manual Therapy “NAGS,” “SNAGS,” “MWM’S: Etc., ed 4. Plane View
Press, Wellington, 1999
Exelby, Linda. “Peripheral mobilizations with movement.” Manual Therapy 1.3 (1996):
118-126
Kisner, Carolyn, and Lynn Allen Colby. Therapeutic exercise: foundations and
techniques. FA Davis, 2012
Manual therapy NAGS,SNAGS,MWMS,etc by Brian R.Mulligan, 5th edition, 2004.