Mulligan Concept

An Approach to Manual Therapy

Authors
Affiliations

Nate Yomogida, B.S., SPT

Doctor of Physical Therapy

B.S. in Kinesiology

Chloë Kerstein, B.S., SPT

Doctor of Physical Therapy

B.A. in Neuroscience

Theoretical Approach (C.R.O.C.K.S.)

C - Contraindications

  • Same as HVLATS or high grade joint mobs
  • Hypermobility
  • RA/arthritic dx?
    • Osteoporosis is prob ok?
  • Corticosteroids long term use? → brittle bones
  • Fractures/trauma
  • If they dont want it
  • Pt needs sufficient mm strength, coordination, ability to understand your instructions, adequate sensation in are to properly detect pain

R - Repetition

  • Peripheral joint: 3 sets of 10 reps (first day)
  • Spine 1-3 sets, about 6 reps (first day)
    • Less if very irritable, less in upper C/s
  • SLR : 3 reps only first day
    • For all neural mob ones

O - Overpressure

  • Important : technique must be PAIN FREE
  • Expectation:
    • More ROM
    • Less pain
  • If still painful → reconsider what you are doing
    • Is the direction of force correct? Make slight adjustments
    • Is the technique the right one?
    • Wrong location:
      • Could it be a diff joint that is the source
      • Could it be a different spinal level
  • Is there slight local discomfort that might be eliminated using a foam pad? (d/t pressure of holding the sustained glide)
  • When non-painful:
    • Move to overpressure to maximize ROM (still without pain)

C - Communication & Cooperation

  • Verbal and nonverbal communication
  • NEEDS to be pain free (be very communicative that “no pain no gain” is NOT what we want)

K - Knowledge

Practitioners must have solid anatomy knowledge and pts need to know what to expect

S - Sustain, Skill, Subtle, & Sense

  • Sustain: sustain accessory glide during entire mvmt
    • Apply glide
    • Go in and out of motion
    • Remove glide
  • Skill: takes skill to apply glide but still allow pt to move normally without blocking their mvmt
  • Subtle: if painful, subtle changes in glide direction or force can make all the difference
    • Trial and error
    • Should be pain free instantly
    • At least pain 50% reduced, long lasting he says
  • Sense: Use common sense

Inclusion Criteria (P.I.L.L.)

Inclusion criteria refers to a way to screen if a patient will benefit from MWM. The techniques must demonstrate the “PILL” effect.

L - lasting:

  • Expect improvement sustained to next session
  • 50% better on both pain and function

Citation

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