Introduction:
It was developed by a physiotherapist named Brian Mulligan, hence the name. Mulligan technique is a type of manual therapy that helps treat several injuries and painful conditions like back pain, neck pain, and hand and leg injuries. Mulligan technique improves the range of motion without the pain range motion. It also helps in reducing pain and improving function.
What Are the Principles of the Mulligan Technique?
The principles of the Mulligan technique are termed PILL by abbreviating, pain-free, immediate effect, and long-lasting. These are the goals achieved through the Mulligan technique. If the patient still does not benefit from the therapy or has no pain reduction; if so, the treatment should not be continued. Only a maximum of three repetitions should be done in a single session. Overpressure should not be applied if the patient feels pain during end-range movement. The mobilization should be sustained throughout the movements. Adequate knowledge of the problems and outcomes is a must for the therapist. Communicating with the patient throughout the procedure also helps prevent unwanted complications.
How Is It Done?
Mulligan's technique progressed based on the response to the treatment. Once a type of mobilization or passive glide is pain-free, then the therapist progresses to the next level of mobilization. Mulligan therapy uses aids such as foam pads and mobilization belts for mobilization. The therapist finds the painful joints and applies mobilization in parallel and perpendicular glides, and the movements will be pain-free. The following types of glides are applied in the Mulligan technique:
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Mobilization with movement (MWM).
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Natural apophyseal glides (NAGS).
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Sustained natural apophyseal glides (SNAGS).
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Peripheral mobilization with movements.
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Spinal mobilization with limb movement (SMWLMs).
Mobilization With Movement (MWM):
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Signs of disability like pain in movement, loss of function, and reduced range of motion are considered before the start of therapy.
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A passive accessory joint mobilization is done by the therapist such that it is a pain-free movement.
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The therapy starts with fewer repetitions during the first treatment session.
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After this initial glide, the patient is asked to perform the painful movements. If the patient reports pain reduction or feeling better, the treatment is progressed to the next level.
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The next level would be the patient to perform those movements while the therapist applies the accessory movement. Then the patient is questioned about improvement or pain reduction.
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This mobilization with movement technique helps in improving the function.
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Taping the joint in a direction where it is pain-free will help reinforce the mobilization technique.
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The self-application can be made by the patients at home.
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The minimal force will be enough to achieve the necessary glide.
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Overpressure at the end range of motion is adequate to restore the normal range of movement.
Natural Apophyseal Glides (NAGs):
Mulligan recommends mid-range to end-range manual therapy in an oscillating pattern performed on the cervical spine. The therapist performs a gliding force parallel to the apophyseal joint surface. They are used for post-injury rehabilitation in older patients and painful conditions in the thoracic, mid, and lower cervical spine.
Sustained Natural Apophyseal Glides (SNAGs):
The spinal manual therapy technique is applied by the combined efforts of the patient and the therapist. The therapist applies apophyseal joint gliding forces while the patient makes an end-range active movement. These are done until the pain is elicited. They can be used during weight-bearing.
Peripheral Mobilization With Movements:
This also involves accessory gliding movement by the therapist with peripheral joint movement by the patients. They help improve mobility and joint function.
Spinal Mobilization With Limb Movement (SMWLMs):
A transverse pressure is applied to the spine while the patient moves the limbs through a previously restricted range of movements. These restricted movements have to be due to spinal problems. It can also be used in neural problems too.
What Are the Indications?
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Low Back Pain: Patients who have a history of lower back pain that are of spinal origin can be treated through the Mulligan technique.
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Shoulder Impairment: Shoulder impairment caused due to repetitive movements and that is caused due to abnormalities in the spine can be treated through this technique.
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Elbow Dysfunction: Elbow dysfunction can be treated with the Mulligan technique effectively.
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Ankle Pain: Ankle pain caused due to musculoskeletal origin can be treated with Mulligan mobilization.
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Traumatic Finger Injuries: Finger injuries caused due to trauma can be treated once the wound is healed and closed fully. Finger mobility can be improved through Mulligan mobilization.
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Cervical Radiculopathy: This is a condition caused due to a pinched nerve that may precipitate symptoms like pain and numbness that may speed up to the chest and arms.
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Cervicogenic Headaches: Cervicogenic headaches are characterized by reduced neck movement and headaches of cervical origin.
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Tenosynovitis: Tenosynovitis is a condition in which there is inflammation of a tendon, most commonly affecting hands, feet, and wrist, that presents as pain, swelling, and restricted range of motion.
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Plantar Fasciitis: Plantar fascia is present as a thick tissue band that connects the heel to the toes. Plantar fasciitis is a condition presenting with inflammation of the plantar fascia, producing stabbing pain.
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Locked Facet Joints: It is a type of joint dislocation that causes dislocation in the vertebra.
What Are the Benefits?
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Musculoskeletal pain disorders can be relieved through the Mulligan technique.
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Soft tissue inflammation and injuries can be healed through mobilization.
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A sense of relaxation is felt after mobilization.
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The function of the joints can be improved through the Mulligan technique.
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The range of motion of the muscles and joints is improved through the Mulligan technique.
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Quality of life is improved by eradicating painful conditions.
Conclusion:
Mulligan technique has been used in almost any condition to relieve painful symptoms. While reducing pain, joint mobility and range of motion are also improved through physiotherapy. The Mulligan technique brings about immediate relief and healing. The patient can return to normal activities in a shorter number of visits. Strengthening of the muscles is also facilitated through the Mulligan technique.
