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does Mulligan Therapy work?
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does Mulligan Therapy work? - February 1, 2001 2:21:00 AM
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chrishkpt
Posts: 23
Joined: January 29, 2001
From: hong kong SAR
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Just want to know if anyone of you have experiences of treating patients wtih mulligan therapy. is it better compared to traditional static manual therapy like Maitland mobilisation?
Welcome to give comment or share your clinical experiences
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Re: does Mulligan Therapy work? - February 1, 2001 12:01:00 PM
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bonmar
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From: Boston, MA
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I am going to a seminar for the next 2 days on the "Mulligan" approach. The speaker is Russell Woodman. I will bring up your question and let you know.
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Re: does Mulligan Therapy work? - February 1, 2001 5:35:00 PM
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chrishkpt
Posts: 23
Joined: January 29, 2001
From: hong kong SAR
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bonmar
thanks so much. =)
in fact, my friend tells me that he had a patient with Cx spondylosis. He tried the mulligan mob and found that it can really relieve the pain , but it takes him at least one log to achieve this effect.
Anyway, that is encouraging.
[This message has been edited by chrishkpt (edited February 01, 2001).]
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Re: does Mulligan Therapy work? - February 1, 2001 6:52:00 PM
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Betty Smoot
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From: Sonoma CA
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I'm curious about your question and have questions of my own, if you don't mind...
What is Mulligan therapy? Are there specific techniques that make this approach to manual therapy unique, or superior? What are the principles behind this approach? What do you mean by static manual therapy?
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Re: does Mulligan Therapy work? - February 4, 2001 4:16:00 PM
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bonmar
Posts: 137
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From: Boston, MA
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Chris,
The difference between Maitland and Mulligan techniques are as follows:
Mulligan: 1)No oscillation is used
2)The mobilizations are wt bearing
3)The joint treatment plane is
considered.
These were the differences the instructor gave at the seminar this weekend. I do have to add, however, that NAGS (acronym for natural apophyseal glides) are oscillatory in nature but are wt bearing. SNAGS (sustained natural apophyseal glides) are obviously not oscillatory and again wt bearing.
As far as whether to mobilize using the Maitland techniques or Mulligan techniques, it was stated, "whatever works best for you at the time." It is the belief, however, that using wt bearing techniques will increase the chance that the mobilization will remain effective once the patient stands up!!
I have utilized SNAGS for cervical patients (I will have to let you know how the T/L patients do as I have just learned these techniques) and have found them to be fairly successful. If you are treating the proper joint with the proper hand placement, etc., improved painfree ROM is achieved(sometimes total). The techniques (NAGS, SNAGS) are very gentle, completely painfree in nature (unless you are doing them wrong), and very easy to use. If one technique does not prove to be successful, you can easily try another one.
I have just purchased Brian Mulligan's book titled, "Manual Therapy "NAGS", "SNAGS", "MWMS" etc. (Fourth Edition). It has all the techniques enclosed (although I do feel you should be trained by someone knowledgable with Mulligan's techniques). It can be purchased through OPTP at 1-800-367-7393. With S&H, the price was $35.90.
Betty, Brian R Mulligan, FNZSP (Hon),Dip MT teaches manual therapy internationally (since 1972) and has published numerous atricles. I'm sure you can find some of these articles in the New Zealand Journal of Physiotherapy (I would help you here but I do not know how to hyperlink...as well as the fact that I could not find this journal through an internet search [IMG]http://www.rehabedge.com/forums/frown.gif[/IMG] ).
I will keep you posted, if interested, regarding the success I am having with the new techniques learned this past weekend.
One other thing to add: The instructor, Russell Woodman, strongly advised any manual therapist to purchase the following book titled "Ombregt: System of Orthopedic Medicine" published by W.B. Saunders. Apparently, it would be well worth the $160.00. I plan on ordering it. Good luck!!
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Re: does Mulligan Therapy work? - February 5, 2001 7:15:00 AM
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chrishkpt
Posts: 23
Joined: January 29, 2001
From: hong kong SAR
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Thanks Bonmar for your reply and sharing on your experience =) i am happy for your succes in delivering the therapy.
In fact, how do you feel about mulligan approach? Do you prefer this to Maitland approach?
Personally, i like mulligan approach better since it is more functional. I also want to add somethings you didnt mentioned, i.e. the spinal mobilisation with arm movement(SMWAM).
Since this technique involves moving the patient's arm and at the same time glide the facet jt, i will think that the effect will be more able to be generalised or transferred to patient's functional movement. Besides, the idea of gliding the facet superiorly as well as anteriorly sounds logical to release the facet jt and glide it.
Betty, i think Bonmar have answered your question well. And i just want to share that I will think this approach is more funcional and one important point is that this approach emphasize the PAIN FREE movement; if pain is present during the therapy, it is either the gliding is in wrong treatment plane or teh level choosen is wrong. So, the patient can really feel better and have a better outcoome as a result of increased pain free movement.
Bonmar, i have a problem here. I find that unilateral SNAG is quite difficult, and i am really not sure if i can really hook the articular pillar with my fingers. How do you feel about that?
[QUOTE]Originally posted by bonmar:
Chris,
The difference between Maitland and Mulligan techniques are as follows:
Mulligan: 1)No oscillation is used
2)The mobilizations are wt bearing
3)The joint treatment plane is
considered.
These were the differences the instructor gave at the seminar this weekend. I do have to add, however, that NAGS (acronym for natural apophyseal glides) are oscillatory in nature but are wt bearing. SNAGS (sustained natural apophyseal glides) are obviously not oscillatory and again wt bearing.
As far as whether to mobilize using the Maitland techniques or Mulligan techniques, it was stated, "whatever works best for you at the time." It is the belief, however, that using wt bearing techniques will increase the chance that the mobilization will remain effective once the patient stands up!!
I have utilized SNAGS for cervical patients (I will have to let you know how the T/L patients do as I have just learned these techniques) and have found them to be fairly successful. If you are treating the proper joint with the proper hand placement, etc., improved painfree ROM is achieved(sometimes total). The techniques (NAGS, SNAGS) are very gentle, completely painfree in nature (unless you are doing them wrong), and very easy to use. If one technique does not prove to be successful, you can easily try another one.
I have just purchased Brian Mulligan's book titled, "Manual Therapy "NAGS", "SNAGS", "MWMS" etc. (Fourth Edition). It has all the techniques enclosed (although I do feel you should be trained by someone knowledgable with Mulligan's techniques). It can be purchased through OPTP at 1-800-367-7393. With S&H, the price was $35.90.
Betty, Brian R Mulligan, FNZSP (Hon),Dip MT teaches manual therapy internationally (since 1972) and has published numerous atricles. I'm sure you can find some of these articles in the New Zealand Journal of Physiotherapy (I would help you here but I do not know how to hyperlink...as well as the fact that I could not find this journal through an internet search [IMG]http://www.rehabedge.com/forums/frown.gif[/IMG] ).
I will keep you posted, if interested, regarding the success I am having with the new techniques learned this past weekend.
One other thing to add: The instructor, Russell Woodman, strongly advised any manual therapist to purchase the following book titled "Ombregt: System of Orthopedic Medicine" published by W.B. Saunders. Apparently, it would be well worth the $160.00. I plan on ordering it. Good luck!![/QUOTE]
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Re: does Mulligan Therapy work? - February 7, 2001 9:05:00 AM
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bonmar
Posts: 137
Joined: August 15, 2000
From: Boston, MA
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Chris,
SMWAMS were not covered in the course that I took. However, there is information on the technique in Brian Mulligan's book that I mentioned. SMWAMS also do look to be easy to do and useful when there is pain with extremity movement that could have a spinal origin. Two(of three) examples given on pg 29 of Brian Mulligan's book, "NAGS", "SNAGS", "MWMS", etc. are, "Pain radiating from the upper fibres of trapezius to the forearm when the arm is abducted above the horizontal." and "Pain radiating down to the hand with arm movements that involve moving the shoulder girdle."
To answer your question re: unilat SNAGS: you should be using the ulnar border of your hand just distal to the pisiform over the t-process. I did not find that my hand was slipping nor difficult to "SNAG". I did feel it required more force from my body in general, however, than "SNAG-ging" in the c-spine.
I feel Mulligan's techniques are much easier to perform than Maitland's because of the wt bearing position used. You do not have to flip the pt every which way in order to perform a mobilization.
Please feel free to ask any other questions re: Mulligan's techniques. I am certaintly far from an expert but the techniques for the T/L spine are fresh in my head.
Take care....
I
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Re: does Mulligan Therapy work? - February 7, 2001 5:10:00 PM
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mcap
Posts: 652
Joined: February 8, 2000
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Chris:
I took a Mulligan course about a year and one half ago and I use the techniques from time to time. When dealing with Mulligan there are a few things to consider:
Advantages:
1. The techniques are very gentle and painfree.
2. Some of them are relatively simple compared to other techniques.
3. I have seen them acheive very good results.
4. The joint planes are considered, particularly the cervical z-joint planes.
5. There is plausible theory behind a lot of it.
6. It fits nicely into other frameworks. I use it with McKenzie treatment at times.
Disadvantages/considerations:
1. It is a treatment only. There is no related evaluative paradigm. For example, you may decide that you want to perform a MWM for rotation at a certain level. How, other than pain, do you select the level? Manual therapists may want to use PIVMs or other techniques. I am not such a big fan.
2. There is no substantial body of research that supports the use of pretty much any manual therapy. And Mulligan is no exception.
Unless you really want to pursue a lot of training you will probably just pick a few that you use regularly. For me I prefer MWM for rotation at the C-Spine, MWM for internal rotation of the hip. Post fibular glide for anke sprains and the torticollis release. I find the lumbar techniques to be unweildy and cumbersome. I much perfer the mobs I learned in McKenzie classes.
Hope that helps......
Marc
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Re: does Mulligan Therapy work? - February 8, 2001 4:33:00 AM
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chrishkpt
Posts: 23
Joined: January 29, 2001
From: hong kong SAR
Status: offline
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Thx, mcap & bonmar for your nice reply
how would you two comment on the transfersiblity of the treatment effect comparing the maitland & mulligan approach, soley from your own clinical experience?
Is it that the treatment effect of Mulligan approach can be transfered better which is becos it is usually done in a functional position than maitland's approach?
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Re: does Mulligan Therapy work? - February 8, 2001 4:35:00 AM
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chrishkpt
Posts: 23
Joined: January 29, 2001
From: hong kong SAR
Status: offline
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Thx, mcap & bonmar for your nice reply
how would you two comment on the transfersiblity of the treatment effect comparing the maitland & mulligan approach, soley from your own clinical experience?
Is it that the treatment effect of Mulligan approach can be transfered better which is becos it is usually done in a functional position than maitland's approach?
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