The Mulligan concept is a relatively new method of treatment of muscle, joint or tendon pain focusing on correcting altered movement patterns by mobilizing joints during active movement.
Principles for application of the Mulligan concept techniques: Physical Therapist must identify the signs; a loss of joint movement, pain associated with movement, or pain associated with specific functional activities during assessment.
A passive motion is applied to a joint and must be pain free.
- Physical Therapist must pay an extra attention to the patient’s reaction to ensure no pain is felt.
- While the accessory glide is maintained, the patient is requested to move into the restricted direction to check if the restriction has been improved (i.e. increased range of active motion, muscle contraction and free of the original pain). The goal is to have the movement performed without presence of the original complaint.
- If the pain is still provoking, it indicates that the physical therapist has not found the correct direction (treatment plane), mobilization grade, spinal segment or that the technique is not indicated.
- Once the physical therapist discovered the correct pain-free movement, the previously limited and/or painful movement is repeated by the patient while the physical therapist continues to maintain the appropriate hands on movement. Further gains are expected with repetition during a treatment session particularly when pain-free overpressure is applied. This technique is repeated for about 3-4 sets of ten repetitions.
- The patient is encouraged to ‘remember’ the position of the joint when it moves in its pain-free position. The physical therapist can then gradually reduce the assistance given as the patient is able to actively take over.
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