THE MULLIGAN APPROACH

DEFINITION: Brain Mulligan, NZ, 1986 first course opened. Passive accessory force combined with active exacerbating movement by patient

ABREVIATIONS

PRINCIPLES (based on McKenzie)

THEORIES

Force

Location

Direction

Amount

Traction

Rotation

Glide

PILL

CROCKS

I = Immediate

L = Long

P = Pain Free

L = Lasting

C = Contra-indications

R = Repetitions

O = Overpressures

C = communication and Cooperation

K = Knowledge

S = Sustain, Skill, Senses, Subtle

Pain Gate Theory: Pain inhibition

Positional Fault Hypothesis: Slight malalignment

ASSESSMENT

TREATMENT

EFFECTS

Immediate pain relief

Long Term Pain relief

Rebound effect (24-48 hours post)

ADJUNCTS

Self Management Exercises

Taping

DOSE

Spinal

Peripheral

Initial: 3 x1

Subsequent 6-10 x 3-5

Initial: 6x3

Subsequent: 6-10 x 3-5

TYPES

NAGS: Natural Apophyseal Glides

SNAGS: Sustained Natural Apophyseal Glides

SMWLM: Spinal Mobilisations with Limb Movements

PPIVMS: Passive Physiological Intervertebral Movements

PAIVMS: Passive Accessory Intervertebral Movements

Symptom Referral

Palpation with AROM from patient

Vertebral Alignment

EVIDENCE

THEORIES: Most evidence surrounding fault theory

CONDITIONS

OTHER: Literature does not support or refute. Good effect demonstrated immediately in some studies, but quality and reliability poor

OA: Good immediate effect on pain and function (ROM)

Ankle Sprains: More anterior fibula associated with ankle sprains and more swelling