Mulligan Manual Therapy: Immediate pain reduction techniques
Contents
1. What makes this method special?
The Mulligan concept is a pain-free manual therapy mobilization technique combined with active movement, primarily used for the treatment of orthopedic or mechanical problems.
The method was developed by Brian Mulligan physiotherapist and manual therapist, and has been taught and used worldwide since the 1980’s. Its basic principle can be summarized with the acronym PILL: pain-free (technique), instant change and long-lasting results.
What does this mean? For all patients, the grip that brings immediate change in the affected, basically painful movement should be identified and applied. The achieved change should be significant, or the pain should cease completely right during the first repetition.
2. When do we use it and what is it used for?
- Mostly to reduce pain and swelling after acute injuries;
- it can be used to improve limited range of motion;
- and it can also be effective for certain chronic complaints, such as tennis elbow, frozen shoulder, stiff neck from sleeping wrong, headache, lockjaw, lower back pain etc.
- It can be integrated well into therapies for certain neurological problems, for example to correct the position of the shoulder during rehabilitation after stroke.
3. Two types of techniques
Two main techniques can be distinguished within the Mulligan manual therapy:
- mobilization with movement, performed on the limbs, and
- natural apophyseal glides performed on the vertebrae.
We combine active and passive techniques: the therapist glides and manipulates the joint into a neutral position in which the movement is free of complaints or can be achieves with significantly less pain. While this grip is being maintained, the patient performs active movements – exactly those that generated the pain originally.
It is important that this gliding does not equal any dislocation, the joint does not move out of its place, and the changes are not visible to the naked eye! Still, this manipulation is already enough for the body to change the incoming stimuli and stop the perception of pain.
The grip and manipulation are most often performed manually, but sometimes we use straps or tape to achieve the desired effect or to ensure access.
We always work in a range ending at the pain-free end position, which can be gradually extended by active movement or passive pushing as well. The loading and the exercise can be more and more complex and functional.
We prescribe exercises to be performed at home if we have confirmed that there actually is an effective technique and that the patient can perform it correctly on their own. At-home exercises consist of performing the problematic movement (e.g. raising the arm) with the learned modification and method, generally several times a day, performing 3×10 repetitions.
4. How the Mulligan manual therapy works
The primary aim of this method is to induce positive changes in the neural plasticity of the central nervous system. This means that it overwrites the incoming stimuli from the body to the brain and the responses to these stimuli: in the modified position, the brain receives a positive message instead of an alarm signal about the same movement (e.g. arm raising), and thus the central response will not be the pain, and the movement will stay free.
With the slight sliding and manipulation, we achieve some changes in the tension of muscles and tendons, thus recovering their length required for normal function and the appropriate position of the joint.
5. The benefits of Mulligan manual therapy
- This is a practice-oriented, dynamic and progressive therapy, primarily aimed at the functional problem of the patient. This means that we do not look for the cause or what is problematic within (our outside) the joint. It works with complete segments, thus its effects do not target a specific structure. but all tissues at the same time.
- It improves the position errors of joints.
- It helps to overcome the fear of pain (and thus, movement).
- It recovers your ability to move pain-free.
- It includes the patient by prescribing exercises that can and should be performed at home, therefore the results rely on this partnership, and the patient is also accountable.
6. When it is not recommended?
When applying the Mulligan concept, the following contraindications should be considered:
- local tumor,
- sudden onset of pain,
- mental, cognitive of perceptive problems,
- taking certain medications (e.g. beta-blockers, antidepressants),
- high-degree osteoporosis,
- fracture in the joint,
- no pain-free position exists,
- tenderness to pressure.
The treatment may not work in acute inflammatory conditions, as there are certain underlying chemical processes involved in these. In such cases, it is worth to wait until the condition ceases.
7. Duration of the therapy and how can it be combined with other methods
The therapy usually consists of 6 to 12 sessions, but in case of neural involvement, it may be more. The improvement can be affected by the nature of the problem, the physical condition of the person and their compliance, whether they perform the prescribed exercises at home.
In addition to the specific exercises to be performed at home, we may give the patient strengthening, stretching and neural mobilization exercises.
Taping can be helpful in maintaining the position, therefore its application is also an option. However, in order to fully reveal and treat the cause of the problem may require other techniques such as the Stecco method, at the discretion of the therapist in all cases.
8. Mulligan manual therapy prices
Status assessment, is the first step to take in every case, which takes 60 minutes.
The status assessment session costs 17.000 HUF.
If a senior physical therapist performs it, it costs 22.000 HUF.
The status assessment includes consultation, testing and treatment.
The further treatment sessions are 50 minutes long and cost 17.000 HUF.
If a senior physical therapist performs them 20.000 HUF.
4.9 / 5
VCT - Visceral Therapy
Stecco Method
McKenzie Method
Maitland Manual Therapy
Neurodynamics
Kinesio-Taping Method