PHYSICAL THERAPY
The Mulligan Concept, developed by Brian Mulligan in the 1980’s, is a manual therapy approach that integrates passive mobilization with active movement to restore joint function and alleviate pain. This method, known as Mobilization with Movement (MWM), has gained significant recognition for its efficacy in treating various musculoskeletal conditions, including those affecting the upper extremity. This blog post explores the principles of MWM and its application in the rehabilitation of a variety of upper extremity conditions.
Understanding the Mulligan Concept and MWM
MWM is based on the premise that joint dysfunction and pain often arise from minor positional faults that can be corrected with sustained accessory mobilization while the patient performs active movement. These positional errors can often be a leading cause for discomfort and limited range of motion. The therapist applies a gentle, pain-free force to the joint, often via use of a belt or manual pressure, while the patient engages in functional movement. If the technique is effective, the movement becomes pain-free and is often immediately improved with sustained and lasting effects (Mulligan, 1999; Vicenzino et al., 2017).
Application of MWM in Upper Extremity Rehabilitation
MWM is particularly beneficial for upper extremity conditions, as it facilitates pain-free movement and enhances functional mobility. Below are some common applications:
Shoulder Impingement Syndrome
Shoulder impingement, often caused by subacromial space narrowing, can lead to pain and restricted movement. MWM techniques, such as sustained lateral glides of the humeral head during shoulder elevation, can improve range of motion and reduce pain (Vicenzino et al., 2017).
Tennis Elbow (Lateral Epicondylitis)
Mulligan’s lateral glide technique has been shown to be effective in reducing pain and improving grip strength in individuals with lateral epicondylitis. Studies suggest that MWM applied to the elbow joint leads to immediate pain relief and functional gains (Bisset et al., 2006).
Carpal Tunnel Syndrome
MWM techniques addressing the wrist, such as sustained lateral or posterior glides while the patient actively moves the fingers or wrist, can reduce symptoms of carpal tunnel syndrome by improving median nerve mobility and decreasing compression (Pekyavas & Baltaci, 2016).
Post-Surgical Stiffness and Adhesive Capsulitis
Patients recovering from upper extremity surgeries or frozen shoulder benefit from MWM, as it helps restore pain-free movement and improve joint mobility by addressing underlying positional faults and aiding in opening up the shoulder capsule.
Clinical Evidence Supporting MWM
Several studies support the efficacy of MWM in treating upper extremity conditions. For example, a systematic review by Hanchard et al. (2011) found that MWM is effective in improving function and reducing pain in musculoskeletal disorders. Additionally, MWM has been found to produce immediate and lasting improvements when integrated into rehabilitation programs.
Conclusion
The Mulligan Concept and MWM offer an effective, non-invasive treatment strategy for upper extremity conditions. By correcting joint positional faults and facilitating pain-free movement, MWM enhances functional recovery and improves patient outcomes. As research continues to validate its efficacy, MWM remains a valuable tool for hand and upper extremity therapists in optimizing rehabilitation strategies.
References
Bisset, L., Paungmali, A., Vicenzino, B., & Beller, E. (2006). A systematic review and meta-analysis of clinical trials on physical interventions for lateral epicondylalgia. British Journal of Sports Medicine, 40(11), 995-1000. https://doi.org/10.1136/bjsm.2006.029306
Hanchard, N. C., Goodchild, L., Thompson, J., & O'Brien, T. (2011). A systematic review of the effectiveness of Mulligan’s Mobilization with Movement in the treatment of musculoskeletal conditions. Manual Therapy, 16(2), 173-180. https://doi.org/10.1016/j.math.2010.10.009
Mulligan, B. R. (1999). Manual therapy: NAGS, SNAGS, MWMS, etc. Wellington, NZ: Plane View Services.
Pekyavas, N. O., & Baltaci, G. (2016). Short-term effects of Mulligan mobilization with movement technique on pain, grip strength and function in women with carpal tunnel syndrome: A double-blind, randomized controlled trial. Journal of Hand Therapy, 29(1), 47-53. https://doi.org/10.1016/j.jht.2015.09.002
Vicenzino, B., Paungmali, A., Teys, P., & Mulligan, B. (2017). Mulligan Concept: A contemporary manual therapy intervention. Journal of Manual & Manipulative Therapy, 25(2), 55-67. https://doi.org/10.1080/10669817.2017.1296954
