Table Of ContentEMulligan Concept
H
T
OFManual Therapy, 2e
E Mulligan Concept
H
T
OF Manual Therapy, 2e
textbook of techniques
Wayne Hing, PhD, MSc (Hons), ADP(OMT), Dip MT, Dip Phys, FNZCP
Toby Hall, PhD, MSc, Post Grad Dip Manip Ther, FACP
Brian Mulligan, Dip MT, FNZSP (Hon)
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Foreword
I thank Elsevier for pressuring, in a nice way, Profes- pain. Without much enthusiasm I then gently tried a
sor Wayne Hing and Dr Toby Hall to write a second lateral translation, which prompted the patient to say
edition of this textbook on my concepts. In this edition ‘it does not hurt’. Something prompted me to sustain
are technique improvements that needed to be shared this translation and ask her if she could flex her finger.
as well as new essential techniques. I must again To my astonishment and her delight the finger flexed
acknowledge and thank my teaching colleagues Mark without pain! She then said something like ‘You have
Oliver and Frank Gargano for the new techniques and fixed me’. ‘Of course!’ I replied. She still had a small
material they have contributed. loss of flexion range owing to some residual swelling
I believe the contents of this book, in its second but she departed my rooms with a smile.
edition, are priceless. All who deal with musculoskel- The young woman returned two days later and her
etal conditions and practise manual therapy should finger had completely recovered. Why, I asked myself?
have a copy. The only explanation I could come up with for my
As I stated in the first edition, what makes our chance success was that as a result of her trauma there
concepts so special is that when indicated they are was a minute positional fault of the joint that pre-
immediately effective. The Mobilisation With Move- vented flexion movement. When this positional fault
ment techniques described within this book are only was corrected it enabled a full recovery to take place.
to be used when they produce no pain when indicated It was a simple hypothesis and because of this I began
and, of course, are immediately effective. I know of to look differently at all joints that I treated and exper-
no other manual therapy concepts for the entire body imented to see whether I could achieve similar results
that follow these guidelines. What is really special by repositioning other joint surfaces. I began having
about them is that it only takes about two minutes to unbelievable successes in the clinic. A ‘miracle a day’ I
decide whether they are indicated. Not to be able to called them. Louis Pasteur once said that chance only
use our concepts may be denying patients their best favours the prepared mind. When I, by chance, had
treatment option. I now have many hours of video my first ‘miracle’ with the young woman and her pain-
showing the efficacy of our concepts, from personally fully limited interphalangeal joint, I did indeed have a
treating patients on stage in many cities in America prepared mind.
before my peers. The hundreds who have witnessed Today the concepts that have grown from this
these occasions are left in no doubt as to the efficacy chance finding have come a long way and guidelines
of these techniques because of the regular positive and are now in place for their successful clinical use; these
instant pain-free outcomes. I should add that when I are fully described within this textbook. To optimally
lecture on our concepts I always treat patients on stage succeed with our concepts, you need advanced clinical
to show what we can do – it is much better than telling reasoning and excellent handling skills. The detailed
people what we can do. descriptions in this book will help you immensely in
Forgive the repetition, but our concepts have come both these aspects. Ideally, of course, the reader should
a long way from 1985 when, by chance, I had an attend the courses that are available around the world
unexpected instant pain-free success with a trauma- by accredited Mulligan Concept teachers. Teachers
tised finger using what are now known as ‘Mobilisa- and courses are listed at www.bmulligan.com.
tions With Movement’. The patient, who was a young While on the topic of teachers, I always acknowl-
woman in her early twenties, presented with a swollen edge and thank my mentor Freddy Kaltenborn. Freddy
interphalangeal joint that was painful and would came many times from Europe to teach in faraway
not flex. I applied traction to the joint several times, New Zealand. He taught me how to manipulate every
which accomplished nothing. I then applied joint joint in the spine and to mobilise the extremity joints.
(glide) translations in the recommended biomechan- His able teachings gave me excellent handling skills.
ically appropriate direction for flexion. Like the trac- He also increased my knowledge and the importance
tions, these glides were also ineffective and painful. I he placed on the clinical significance of treatment
then tried a medial translation accessory movement, planes led me to successfully develop Mobilisation
which was unacceptable to the patient because of With Movement. If you do not know each joint’s
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treatment plane you will never be able to successfully have the requisite knowledge and handling skills, can
manipulate or effectively apply the Mulligan concepts. improve upon these techniques then this would be
I must stress that the techniques contained within most welcome. It is hoped these clinicians would share
this book are not set in stone. They are all based on their significant worthwhile improvements with other
repositioning joint surfaces, or muscles and their clinicians and teachers.
tendons, to see whether one can achieve pain-free res- I feel very humble to have the support of such
olution of a musculoskeletal problem. The techniques scholars as Wayne and Toby, and thank them and
described in the book are those we, in the Mulligan Elsevier sincerely for this wonderful publication.
Concept Teachers Association, have clinically found
to be effective. If any clinicians applying them, who Brian Mulligan
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Preface
This second edition of the textbook entitled The Mul- of MWMs were canvassed, and in-depth aspects of its
ligan Concept of Manual Therapy: Textbook of Tech- clinical application were critiqued including guide-
niques presents new techniques in addition to the lines on dosage and troubleshooting. Over half of the
original ones covered in the first edition. More than first text presented the application of MWM in a series
250 Mulligan Concept techniques are shown and these of case reports. These case studies focused on the clin-
include therapist techniques as well as home exercises ical reasoning underlying the application of the Mulli-
and taping techniques. The pictures illustrating this gan Concept, including consideration of the evidence
book have been re-taken for improved clarity, with base. The case studies followed the application of the
the number of images greatly increased to enable the Mulligan Concept from the first session to discharge,
reader to better conceptualise the execution of each showing how the techniques were selected, applied and
technique. The text has also been updated through- progressed over the treatment programme. However,
out each chapter, with new references to inform the the purpose of that first book was not to provide a
reader about the current evidence base for the Mulli- detailed description of all the techniques under the
gan Concept. Mulligan Concept umbrella, which is the scope of the
The book is aimed at being a comprehensive and first and second edition of the current book as it con-
easy-to-follow resource for the novice and the expe- tinues the work of the preceding landmark book Mul-
rienced clinician as well as researchers. It has been ligan’s Manual Therapy: NAGs, SNAGs and MWMs.
written for the clinician, teacher and student interested There was a real need for a comprehensive pres-
in furthering their familiarity with the wide array of entation of the wide array of techniques under the
techniques under the Mulligan Concept umbrella. umbrella of the ‘Mulligan Concept’. These techniques
Mulligan Concept techniques are effective and safe include MWM and other Mulligan techniques such as
when applied in accordance with easy-to-follow guide- pain release phenomenon (PRP). Each technique has
lines and clearly identified underlying principles. been described in a consistent and logical format fully
When Brian Mulligan first described Mobilisation explaining the indications, application and modifica-
with Movement (MWM) in 1984 he shared his tech- tions for each technique. In addition, we have detailed
niques through his original book entitled Mulligan’s the current available evidence for each technique in
Manual Therapy: NAGs, SNAGs and MWMs, of which each chapter.
there have been seven editions over the past 30 years. The book is divided into 14 regional chapters, cov-
This book has been written to expand on and fully ering the whole body and encompassing the whole
describe in a standardised format all the techniques range of musculoskeletal disorders that present to
mentioned in Brian Mulligan’s aforementioned origi- clinical practice, including apparent non-joint disor-
nal texts, as well as including new techniques that were ders such as lateral epicondylalgia. The first chapters
not contained in those earlier landmark editions. This focus on MWM, home exercise and taping techniques
book is also intended as an accompaniment to our first for the upper quadrant, which includes the cervical
book entitled Mobilisation with Movement: the Art and spine through to the thorax. These chapters include
the Science, which was published in 2011. cervicogenic headache and cervicogenic dizziness,
Our first book presented the science underpinning the temporomandibular joint, shoulder complex,
MWM and also described aspects of ‘the art’ inher- elbow, forearm, wrist and hand. The subsequent chap-
ent in its successful implementation. In that book the ters cover the lower quadrant, including the lumbar
basic principles of MWMs were outlined, potential spine, sacroiliac joint, hip, knee, ankle and foot. The
mechanisms underpinning the successful application final chapter covers commonly used PRPs, which are
vviiiiii
distinct to MWM but can be very helpful in the right techniques described, along with an explanation of the
clinical presentation, usually after the condition being rationale underlying the system of annotations.
treated has proved resistant to other Mulligan Concept
techniques. Professor Wayne Hing
The techniques in this text are drawn from those Brisbane, Australia, 2019
presented on the Mulligan Concept courses taught Adjunct Associate Professor Toby Hall
worldwide and as such form the curriculum of the Perth, Australia, 2019
different levels of those Mulligan Concept courses. Brian Mulligan
Also presented is a dictionary of annotations for the Wellington, New Zealand, 2019
ix
Authors
Wayne Hing, PhD, MSc (Hons), ADP(OMT), Dip Brian Mulligan, Dip MT, FNZSP (Hon)
MT, Dip Phys, FNZCP Lecturer, Author, President MCTA, New Zealand
Professor in Physiotherapy and Head of Program,
Bond University, QLD, Australia
Toby Hall, PhD, MSc, Post Grad Dip Manip Ther,
FACP
Adjunct Associate Professor, School of Physiotherapy
and Exercise Science, Curtin University, Perth, WA,
Australia;
Director of Manual Concepts;
Fellow of the Australian College of Physiotherapists
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