Mulligan Concept Lower & Upper Quadrant
MULLIGAN CONCEPT AND MOBILISATION WITH MOVEMENT
Brian Mulligan is the creator of the Mobilisation With Movement" (MWM) as we know it today. MWM examination and treatment techniques integrate manual therapy, functional exercise, and cognitive therapy elements.
These two-day practical workshops provide clinical reasoning strategies and detailed hands-on instruction on unique examination and treatment techniques.
MWM is one of the most popular approaches physiotherapists use to treat neuromusculoskeletal conditions. Mark has presented Mulligan courses for over 30 years and assisted Brian worldwide on numerous occasions. The approach is easy to learn and integrate into existing examination and treatment models. There is a large body of research validating the concept (https://bmulligan.com/references-list/).
The 7th edition of Brian's textbook is available at Plane View Services (https://planeviewservices.co.nz/). There are two comprehensive books by eminent physiotherapy researchers detailing the theory, principles, concepts, and relevant research relating to the evidence-based practice of MWM (Vicenzino et al 2011, Hing et al 2020).
Mulligan B R. Manual Therapy: "NAGS", "SNAGS", "MWMS" etc. (revised 7th Ed). Plane View Services, Wellington; 2018
Vicenzino B, Hing W, Rivett D & Hall T. Mobilisation with Movement: The Art and Science. Elsevier Publishing; 2011.
Hing W, Hall T, Mulligan B. Introduction. In: Hing W, Hall T & Mulligan B, editors. The Mulligan Concept of Manual Therapy: textbook of techniques. Elsevier Publishing; 2020.
Course Goals
- Present the principles of the Mulligan Concept
- Demonstrate clinical applications of Mulligan Concept principles
- Explain the clinical reasoning process of the Mulligan Concept
- Develop and refine manual skills
- Offer theoretical models to explain the clinical results achieved
- Demonstrate integration of the Mulligan Concept into established treatment regimes
- Present information in an open non-threatening collegial dialogue and provide participants with a stimulating and fun learning experience.
The Upper Quadrant course includes:
- MWM techniques for the shoulder girdle, shoulder, elbow, wrist, and hand
- SNAGS (a form of MWM for the spinal column) for the cervical and thoracic (including ribs) region
- NAGs and SNAGs for the cervical and thoracic regions
- Techniques for cervicogenic headaches and dizziness
- Techniques for treatment of upper limb neural elements.
The Lower Quadrant course includes:
- MWM techniques for the foot, ankle, knee, and hip regions
- SNAGS for the lumbar spine region.
- Examination and treatment techniques for lumbar neural elements
- Treatment of muscular and soft tissue elements, including calf and tendoachilles injuries and hamstring injuries.
Brian performing the first MWM - The finger
Hip MWM FABER
Ankle taping
Lumbar SNAG lateral shift correction
Mobilisation With Movement made simple!
- Identify symptomatic or dysfunctional movement or activity
- Apply and sustain pain-free mobilization forces
- With the mobilization forces applied and sustained, repeat the symptomatic movement or activity
- If the movement is then PAIN-FREE, repeat the activity three times and at the end of each movement, apply end-of-range overpressure
- When the symptomatic movement is re-tested, there should be a significant lessening of pain and improvement in movement
- Depending on the presentation and response to treatment, the MWM can be repeated, modified, and progressed/integrated into self-treatment techniques and functional exercise.
Mobilisation With Movement
- Combines passive mobilization with active movement
- Performed in weight-bearing positions if possible and if indicated
- A "no pain" guideline is used as a basis for sound clinical reasoning in examination and treatment
- Clinically facilitates normal muscle function and eliminates maladaptive movement patterns and movement "fear avoidance".
A theoretical model for the effectiveness of MWM
- The mobilization component of the MWM alters stress & strain on the joint and surrounding structures, alters joint mechanoreceptor & nociceptor activity, and consequently alters motor responses, including anticipatory postural adjustments (APAs)
- The applied forces provide support, and the clinician guides the patient as they move painlessly in a direction that may have otherwise been painful
- An appropriate MWM technique can eliminate fearful responses, bracing patterns, and other maladaptive compensatory strategies in real-time
- The technique's effectiveness may not depend on the length of time it has been present, bringing into question the definition of chronic pain
- Positive reinforcement of painless functional movement reinforced by self-MWM, increasing loading and movement sophistication, progression to functional and goal-directed activities.
Links:
Mulligan Concept Teacher Association: https://bmulligan.com/
AAP Education: https://www.aapeducation.com.au/
Plane View services: https://planeviewservices.co.nz/
Linkedin: https://www.linkedin.com/in/mark-oliver-1b714b1a3/