The Mulligan Concept; The Next Step in the （穆里根的概念;）.pdf

The Mulligan Concept; The Next Step in the Evolution of Manual Therapy Jack Miller B.Sc.(PT), Dip. Manip. Ther. (NZ), FCAMT, MCTA Accredited Mulligan Concept Teacher Key Words: Nags, Snags, Manual Therapy, Mulligan, Mobilization with Movement (Published Orthopaedic Division Review May/June 1999) Summary Brian Mulligans novel concept of the simultaneous application of therapist applied accessory mobilizations and patient generated active movements is described. The indications for use of this unique approach and examples of commonly treated clinical presentations are outlined. Increased function and decreased pain are expected to be immediate and sustained with the application of these techniques with no pain experienced during their utilization. Introduction The Physiotherapy treatment of musckuloskeletal injuries has progressed from its foundation in remedial gymnastics and active exercise to therapist-applied passive physiological movement and on to therapist-applied accessory techniques. Brian Mulligans concept of mobilizations with movement (MWMS) is the logical continuance of this evolution with the concurrent application of both therapist applied accessory and patient generated active physiological movements. These techniques were developed by Mulligan in New Zealand through his role as the principle clinical instructor for the New Zealand Manipulative Therapy Associations Graduate Diploma program and over 30 years in private clinical practice. First used in the cervical spine, MWMs 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. Principles of Treatment In the application of manual therapy techniques, Physiotherapists acknowledge that contraindications to treatment exist and sho