The Mulligan Concept of Manual Therapy

Description:

Endorsed by the Mulligan Concept Teachers Association (MCTA)

The MCTA is the accredited body of Mulligan Concept teachers.

A comprehensive and easy-to-follow resource for the manual therapist seeking to improve patients’ movement using pain-free hands-on techniques.

The Mulligan Concept of manual therapy was developed by Brian Mulligan in 1983 and is now used by health practitioners globally to assist individuals in improving movement restrictions, pain with movement and functional restrictions.

Designed as a companion to Mulligan Concept training courses, the text is divided by body regions, with techniques highlighting key information to assist with clinical reasoning and assessment, patient and practitioner positioning, guidelines for application and further adjustments.

New To This Edition:

• All techniques comprehensively revised to align with current evidence-based practice
• 13 New Mulligan techniques
• An digital version included in all print purchases

Table Of Contents:

Mulligan Concept annotations

References

Introduction

Mobilisation With Movement

Clinical Reasoning and the Mulligan Concept

Patient-centred approach to healthcare

Promotion of knowledge organisation

Proposed Mechanisms by Which MWM Work

MWMs and peripheral mechanisms

Altered mechanoreceptive input during MWM

MWMs and central mechanisms

Does pain alleviation by MWM prove peripheral dysfunction?

Extinguishing movement–pain associations

Centrally mediated inhibitory mechanisms

MWMs, placebo and reassurance

MWMs and output (response) mechanisms

Pain and the motor system

Mechanoreceptors and the motor system

The possibility of sustained benefit

Conclusion

Aims and Structure of the Book

References

1 Cervicogenic headache

Introduction

Levels of evidence

Level 2: four RCTs and one case report

Flexion–Rotation Test

C1 / 2 Self-SNAG

Headache MWM

Headache SNAG

Reverse Headache SNAG

Upper Cervical Traction

References

2 Cervicogenic dizziness

Introduction

Levels of evidence

Level 2: four RCTs

C1 SNAG for Cervical Rotation Dizziness

C2 SNAG for Cervical Extension Dizziness

C2 SNAG for Nausea, Light-Headedness or Visual Disturbances (Rescue Manoeuvre)

References

3 Cervical spine

Introduction

Levels of evidence

Level 2: eight RCTs, one case report and two laboratory-based studies

Cervical Snags

C2–7 SNAGs for cervical motion restriction – flexion, extension, lateral flexion and rotation

C5 / 6 or C6 / 7 transverse (positional) SNAG

Fist Traction

Natural Apophyseal Glides (NAGs) (Central and Unilateral)

Reverse Nags (Central and Unilateral)

Cervicothoracic Junction Mobilisation: Bridge Technique

Cervical Traction: Upper Extremity Pain

Spinal Mobilisation With Arm Movement (Smwam)

Shoulder abduction

Smwam: Horizontal Extension and Neurodynamic Dysfunction

References

4 Temporomandibular joint

Introduction

Levels of evidence

Level 4: one case series and one case report

Temporomandibular Joint: MWM

MWM for reduction of internal derangement limiting mandibular depression

MWM for painful limitation of mandibular depression

MWM scream stretch: movement limitation and pain on mandibular depression

MWM for pain on jaw closure

References

5 Shoulder complex

Introduction

Levels of evidence

Level 2: five RCTs, one pilot RCT, one multi-case series, one case report

MWM to Shoulder Girdle

Scapular depression, retraction and downward rotation with clavicle and scapular approximation for s

Scapular depression, retraction and downward rotation with clavicle and scapular approximation for s

Acromioclavicular Joint

MWM for Shoulder Flexion / Abduction / Scaption and / or Elevation

Mid-range mobilisation in sitting: posterolateral glide

Mid-range elevation mobilisation in sitting: posterolateral–inferior glide with a belt

End-range elevation mobilisation in sitting: posteroinferior glide

Movement Limitation: Hand Behind Back

Inferior glide MWM to restore a loss of hand-behind-back (HBB) movement

Movement Limitation: Internal or External Rotation

Inferior glide MWM to restore a loss of internal rotation and HBB movement

Sleeper stretch MWM to restore a loss of internal rotation

Contraction combined with MWM to restore a loss of internal or external rotation

References

6 Elbow region

Introduction

Levels of evidence

Level 2: six RCTs, two case series

Tennis Elbow: Lateral Elbow Pain

Lateral elbow pain: manual lateral glide MWM with gripping

Proximal radioulnar joint posteroanterior MWM

Golfer’s Elbow: Medial Elbow Pain

Olecranon medial and lateral tilt (lateral and medial rotation)

Elbow Movement Dysfunction

Elbow extension manual lateral and medial glide

Elbow flexion manual lateral and medial glide

Elbow flexion and extension manual olecranon lateral tilt / medial rotation

Elbow flexion and extension manual olecranon medial tilt / lateral rotation

Forearm: Treated Proximally

Proximal radioulnar joint posteroanterior MWM to improve supination and pronation

References

7 Wrist and hand

Introduction

Levels of evidence

Level 4: three case series, three case studies

Distal Forearm / Wrist

Inferior radioulnar joint: pain or limitation of movement during pronation or supination

Carpal lateral glide for non-weight-bearing wrist flexion and extension

Carpal medial glide for non-weight-bearing wrist flexion and extension

Carpal lateral glide for weight-bearing wrist extension

Carpal rotation for wrist flexion and extension

Scaphoid PA or AP glide non-weight-bearing

Hand

Metacarpal PA and AP glide with fist clenching

Finger – Proximal Interphalangeal (PIP) Joint Pain and / or Restriction

Finger PIP joint pain / restriction with flexion manual lateral / medial glide

References

8 Thoracic spine and rib cage

Introduction

Levels of evidence

Level 4: one case series and one case report

Thoracic Spine

Thoracic traction with a belt

Thoracic SNAG central (and unilateral) for flexion, extension, lateral flexion or rotation

Thoracic SNAG – central for flexion

Thorax – Rib and Spine

Upper and lower rib MWM

Costovertebral MWM for first or second rib

References

9 Sacroiliac joint

Introduction

Levels of evidence

Level 2: three RCTs, one case series and two case studies

Posterior Glide MWM Innominate in Relation to Sacrum With Trunk Extension in Prone Lying

Lateral Glide MWM Innominate in Relation to Sacrum With Trunk Extension in Prone Lying

Posterior Glide and / or Posterior Rotation MWM Innominate in Relation to Sacrum During Walking

Taping: Posterior Glide and / or Posterior Rotation Innominate in Relation to Sacrum

Taping: Anterior Glide and / or Anterior Rotation Innominate in Relation to Sacrum

Home Exercise: Posterior Rotation Innominate MWM in Step Standing

Posterior Rotation Innominate / Anterior Rotation Sacrum With Appropriate Glides for Trunk Extension

Anterior Rotation Innominate for Trunk Movement in Standing

Posterior Rotation Innominate / Anterior Rotation Sacrum With Appropriate Glides for Hip Flexion in

Posterior Rotation Innominate / Anterior Rotation Sacrum With Appropriate Glides for Hip Extension i

References

10 Lumbar spine

Introduction

Levels of evidence

Level 2: five RCTs and two pilot RCTs

Lumbar Snags

L1–5 SNAGs for lumbar motion pain and / or restriction for extension (or flexion and lateral flexi

SNAG in four-point kneeling (‘lion position’)

Lumbar Spine Pain With Leg Symptoms

SLR-induced symptoms proximal to the knee

Gate (two-leg rotation) technique

Bent leg raise (BLR)

Traction straight leg raise (TrSLR)

Spinal Mobilisation With Leg Movement (SMWLM) for SLR

SLR-induced distal leg symptoms

SLR SMWLM in side lying

Femoral nerve test-induced anterior leg symptoms

Femoral SMWLM in side lying

References

11 Hip region

Introduction

Levels of evidence

Level 2: four RCTs and one case report

Lateral Glide MWM for Hip Flexion and Internal / External Rotation in Supine Lying

Lateral glide MWM for hip flexion in supine lying

Lateral Glide MWM for Hip Extension in Weight-Bearing

Lateral Glide MWM for Hip Flexion in Weight-Bearing

Lateral Glide for Hip Internal and External Rotation in Weight-Bearing

Hip MWM in Supine Lying for Abduction and Adduction

Hip Extension and Rectus Femoris / Hip Flexor MWM in Prone, Supine and Side Lying

Hip extension and rectus femoris MWM in prone lying

Hip extension and rectus femoris / hip flexor stretch MWM in side lying

References

12 Knee

Introduction

Levels of evidence

Level 3: six RCTs, two case series, two case reports

Lateral and Medial Glide (Non-Weight-Bearing / Weight-Bearing) – Flexion and Extension (Supine)

Lateral glide MWM for flexion / extension

Medial glide MWM for flexion / extension

Knee Anteroposterior MWM for Flexion and Posteroanterior MWM for Extension

Knee anteroposterior MWM for flexion

Knee posteroanterior MWM for extension

Tibial Rotation – Non-Weight-Bearing / Weight-Bearing

Internal rotation MWM for flexion

Internal / external rotation MWM for extension

Internal rotation MWM for extension

Knee Squeeze Technique for Meniscal Pain

Proximal Fibular MWM – Ventral or Posterior Glide During Knee Flexion and Extension

References

13 Ankle and foot

Introduction

Levels of evidence

Level 2: six RCTs, three case series, two case reports

Talus posterior glide with dorsiflexion

Posterocephalad fibula glide

Talocrural Joint

Anteroposterior glide for ankle dorsiflexion in non-weight-bearing

Ankle dorsiflexion MWM in weight-bearing

Plantarflexion MWM in non-weight-bearing

Inferior Tibiofibular Joint – Ankle Sprain

Fibula posterior glide MWM for dorsiflexion / plantarflexion–inversion in non-weight-bearing

Mid-Tarsal

Medial – cuneiform on navicular

MWM dorsal / plantar glide medial cuneiform on navicular

Lateral – fifth metatarsal on cuboid

MWM dorsal / ventral glide fifth metatarsal on cuboid

First Metatarsophalangeal Joint

Lateral glide for flexion and extension

References

14 Pain release phenomenon

Introduction

Levels of evidence

Trapezium – First Metacarpal Joint PRP

Tennis Elbow PRP With a Muscle Contraction (Lateral Epicondylalgia)

Chronic Painful Shoulder PRP

Hip Pain (Faber Position) PRP

Hip Pain (Posterior Shear) PRP

References

Index

A

B

C

D

E

F

G

H

I

J

K

L

M

N

O

P

R

S

T

U

V

W

Z