Mulligan Concept

Introduction to the Mulligan Concept Brian Mulligan ’s concept of Mobilization with Movement (MWM) is the natural continuance of the evolution of manual therapy from its foundations of remedial gymnastics and active exercise to practitioner practit ioner applied passive physiological movement and on to passive accessory mobilization techniques. Mobilization with movement is the concurrent application of a pain-free accessory accessor y mobilization 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: 1. No contraindication for manual therapy exists. 2. A full orthopedic 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. 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 rehabilitation sequences of the recovery of muscular power, endurance and the development 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 or 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 musculoskletal system has yet to be fully full y determined. For further details of the application of the Mulligan Concept as it applies to the spine s pine 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 mulligan.cjb.net.

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Pengantar Konsep Mulligan Brian Mulligan 's konsep Mobilisasi dengan Gerakan (MWM) adalah kelanjutan alami dari evolusi terapi manual dari fondasinya senam perbaikan dan latihan aktif untuk praktisi menerapkan gerakan fisiologis pasif dan ke teknik aksesori mobilisasi pasif. Mobilisasi dengan gerakan adalah aplikasi bersamaan mobilisasi bebas ras a sakit aksesori dengan gerakan fisiologis aktif dan / atau pasif. Pasif end-range overpressure sekarang dapat diterapkan tanpa rasa sakit sebagai penghalang. Teknik ini dikembangkan oleh Mulligan di Selandia Baru lewat perannya sebagai instruktur prinsip klinis untuk program Diploma Selandia Selandia Baru manipulatif Therapy Association 's Graduate dan lebih dari 40 tahun dalam praktek klinis pribadi. Pertama digunakan di tulang belakang leher, MWM 's cepat menemukan cara mereka ke pengobatan pengobatan disfungsi sendi perifer dan telah mengalami perbaikan klinis dan ekspansi ke seluruh area tulang belakang dan sendi ekstremitas kebanyakan. Teknik-teknik ini berlaku bila: 1. Tidak ada kontraindikasi untuk terapi manual ada. 2. Pemeriksaan ortopedi penuh pemindaian telah selesai menunjukkan lokal muskuloskeletal patologi asal mekanik. 3. Sebuah analisis biomekanik spesifik mengungkapkan hilangnya lokal mobilitas dan / atau rasa sakit yang terkait dengan fungsi. 4. Tidak ada rasa sakit yang dihasilkan selama ata u segera setelah aplikasi teknik. t eknik. Nyeri selalu panduan. Teknik MWM sukses harus membuat tanda klien sebanding gejala rasa sa kit sementara secara signifikan si gnifikan meningkatkan fungsi selama penerapan teknik. Setelah dikembalikan fungsi artikular dengan MWM 's, praktisi sekarang dapat berkembang klien melalui urutan berikutnya rehabilitasi atas pemulihan kekuatan otot, daya tahan dan pengembangan yang konsisten konsisten neuro-kontrol motor. Perbaikan berkelanjutan diperlukan diperlukan untuk membenarkan intervensi berkelanjutan Mulligan mendalilkan model kesalahan posisional untuk menjelaskan hasil yang diperoleh melalui konsep. Bergantian, mekanisme pelacakan pantas sendi karena sumbu instan diubah atau rotasi dan model respon neurofisiologis juga telah dipertimbangkan. Penelitian awal ke pendekatan ini menegaskan manfaatnya namun mekanisme melalui yang mempengaruhi sistem musculoskletal belum sepenuhnya ditentukan. Untuk rincian lebih lanjut dari penerapan Konsep Mulligan yang berlaku untuk tulang belakang dan ekstremitas silahkan lihat Terapi Manual, nags, Snags, MWMS, dll dll diterbitkan oleh Planeview Press. Kursus instruksional dalam konsep Mulligan terdaftar di





The Mulligan Concept: Principles of Treatment In the application of manual therapy techniques, manual therapy practitioners acknowledge that contraindications to treatment exist and should be respected at all times. Although always guided by the basic rule of never causing pain, practitioners choosing to make use of the procedures developed by Brian Mulligan must must still know and abide by the basic rules of application of manual therapy techniques. Specific to the application of the Mulligan Concept in clinical practice, the following principles have been developed: 1. During assessment the practitioner will identif y one or more comparable signs as described by Maitland. These signs may be; a loss of joint movement, movement, pain associated with movement, or pain associated with specific functional activities (i.e. lateral elbow pain with resisted wrist extension, adverse neural tension etc.). 2. A passive accessory joint mobilization is applied following the principles of Kaltenborn (i.e. parallel or perpendicular to the joint plane). This accessory glide must itself be pain free. 3. The practitioner must continuously monitor the patient ’s reaction to ensure no pain is recreated. Utilizing his/her knowledge of joint arthrology, a well-developed se nse of tissue tension and clinical reasoning, the practitioner investigates various combinations of parallel or perpendicular glides to find the correct treatment tre atment plane and grade of accessor y movement. 4. While sustaining the accessory glide, the patient is requested to perform the comparable sign. The comparable sign should now be significantly improved (i.e. increased range of motion) and absent of the original pain of complaint. 5. Failure to improve the comparable sign would indicate that the practitioner has not found the correct treatment plane, grade or direction of mobilization, spinal segment or that the technique is not indicated. 6. The previously restricted and/or painful motion or activity is repeat ed by the patient while the practitioner continues to maintain the appropriate accessory glide. Further gains are expected with repetition during a treatment session typically involving three to four sets of ten repetitions. 7. Further gains may be realized through the application of passive overpressure at the end of available range. It is expected that this overpressure is again, pain-free . The anatomical and neurophysiological benefits of articular end-range loading may now be achieved without pain as a barrier. Self-treatment is often possible using MWM principles with sports type adhesive tape and/or the patient providing the glide component of the MWM and the patient ’s own efforts to produce the active physiological movement. Pain is always the guide. guide. Successful Mulligan Concept techniques should render the comparable sign painless while significantl y improving function during the application of the technique. Sustained improvements are necessary to justify ongoing intervention.





The Mulligan Konsep: Prinsip Pengobatan Dalam penerapan teknik terapi manual, praktisi terapi manual mengakui bahwa kontraindikasi untuk pengobatan ada dan harus dihormati setiap saat. Meskipun selalu dipandu oleh aturan dasar tidak menyebabkan rasa sakit, praktisi memilih untuk menggunakan prosedur yang dikembangkan oleh Brian Mulligan masih harus mengetahui dan mematuhi aturan-aturan dasar penerapan teknik terapi manual. Khusus untuk penerapan Konsep Mulligan dalam praktek klinis, prinsip-prinsip berikut telah dikembangkan: 1. Selama penilaian dokter akan mengidentifikasi satu atau l ebih tanda-tanda yang sebanding seperti yang dijelaskan oleh Maitland. Tanda-tanda ini mungkin, hilangnya pergerakan sendi, rasa sakit yang terkait dengan gerakan, atau r asa sakit yang terkait dengan aktivitas fungsional tertentu (misalnya siku nyeri lateral dengan ekstensi pergelangan tangan menolak, ketegangan saraf merugikan dll). 2. Sebuah mobilisasi aksesori pasif sendi diterapkan mengikuti prinsip-prinsip Kaltenborn (paralel yaitu atau tegak lurus terhadap bidang sendi). Ini meluncur akses ori harus dengan sendirinya menjadi sakit gratis. 3. Praktisi harus t erus memantau reaksi pasien untuk memastikan tidak ada rasa sakit yang diciptakan. Memanfaatkan / nya pengetahuan tentang arthrology sendi, rasa dikembangkan dengan baik ketegangan jari ngan dan penalaran klinis, praktisi menyelidiki berbagai kombinasi meluncur sejajar atau tegak lurus untuk menemukan menemukan pesawat pengobatan yang benar dan dan grade gerakan aksesori. 4. Sementara mempertahankan meluncur aksesori, pasien diminta untuk melakukan tanda sebanding. Tanda sebanding sekarang harus meningkat secara signifikan (kisaran yaitu peningkatan gerak) dan absen dari rasa sakit asli keluhan. 5. Kegagalan untuk meningkatkan tanda sebanding akan menunjukkan bahwa praktisi belum menemukan pesawat pengobatan yang tepat, kadar atau arah mobilisasi, segmen tulang belakang atau bahwa teknik ini tidak ditunjukkan. ditunjukkan. 6. Gerakan yang sebelumnya terbatas dan / atau menyakitkan atau kegiatan diulang oleh pasien sementara praktisi terus mempertahankan aksesori yang sesuai meluncur. Keuntungan lebih lanjut diharapkan dengan pengulangan selama sesi pengobatan biasanya melibatkan tiga sampai empat set sepuluh repetisi. 7. Keuntungan lebih lanjut dapat diwujudkan melalui penerapan overpressure pasif pada akhir rentang yang tersedia. Diharapkan overpressure ini lagi, bebas ras a sakit. Manfaat anatomi dan neurofisiologis dari artikular akhir-range pemuatan sekarang dapat dicapai tanpa rasa sakit sebagai penghalang. Self-pengobatan sering mungkin menggunakan prinsip MWM dengan pita perekat olahraga





meningkatkan fungsi selama penerapan teknik. Perbaikan berkelanjutan diperlukan untuk membenarkan intervensi yang sedang berlangsung.





Mulligan Concept Reference List GENERAL CONCEPT

Claassen R. & van Dalen P. (2001). The Mulligan Concept: a safe and effective way of mobilization. Scientific Magazine for Physical Therapy 2(2): 7-17. Exelby L. (1995). Mobilisations with movement a personal view. Physiotherapy , 81(12): 724-729.

Exelby L. (2002). The Mulligan Concept: Its application in the management of spinal conditions. Manual Therapy 7(2): 64-70.

Lewit K. (1985). The muscular and articular factor in movement restriction. Manual Medicine 1: 83-85.

Mann T.W. (2002). Efficacy of the Mulligan Concept: A review of the evidence base. In Proceedings of the 39th Annual Conference of the Malaysian Physiotherapy Association.

Miller J. (1999, March/April). The Mulligan Concept; The Next Step in the Evolution of Manual Therapy. Canadian Physiotherapy Association Orthopeadic Division Review : 9-13.

Mulligan B.R. (1993). Mobilisations with movement (MWMs). Journal of Manual and Manipulative Therapy 1(4): 154-56.

Mulligan B.R. (1989) Treatment Notes: Pain release phenomenon pheno menon techniques “PRP ”. NZ Journal of Physiotherapy : 18.

Mulligan B.R. (1999). Manual Therapy 'NAGs', 'SNAGs', 'MWMs' etc. 4th edition. Plain View Services New Zealand.

Scailble H. Grubb B. (1993). Afferent and spinal mechanism of joint pain. Pai n 55: 5 5: 554.







Wilson E. (2002). The Mulligan Concept: NAGs, SNAGs, MWMs, etc. In Positional Release Techniques: 2nd edition. Churchill Livingstone, London.

Mulligan Concept

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