Dpt

1. An Introduction To NAGS and
SNAGS
By Dr Ayesha Anwer Ali

2. Introduction about Brian
Mulligan
Brian R. Mulligan qualified as a physiotherapist in
1954 and gained his diploma in Manipulative
Therapy in 1974. He has been the author of
numerous articled published in New Zealand Journal
of Physiotherapy. He is also the author of two books:
"Manual Therapy "NAGS","SNAGS", "MWMS",etc'
(2003) for Physiotherapists.
'Self Treatment for the Back, Neck and Limbs' for
Public.

3. Mulligan manual therapy
•Articular techniques with additional
neuromuscular effects
•Positional fault causing physiological
restriction in joint
•Glide mobilization used along joint plane
•Reduction / elimination of symptoms guide
treatment technique
•Many techniques are weight bearing

4. Techniques Names
NAGS- Natural Apophyseal Glides.
SNAGS - Sustained Natural Apophyseal Glides.
MWMS- Mobilization with Movements.
The concept of (MWM) of the extremities and
SNAGS of the spine were first coined by Brian R.
Mulligan.

5. NAGS
•Accessory movement force applied along
facet joint plane
•C2-T3 levels
•Oscillation 2-3 / second
•Mid to end range
•Mild discomfort, never pain
•Antero-cranial direction (towards eyes)

6. NAGS to Cervical spine
•Stand side on to pt, stabilizing them with your
trunk
•Reach around their head with your right hand,
their head rests on your chest
•Hook little finger under spinous process below
level to be treated
•Press your thenar eminence against your little
finger
•Oscillate towards pt eyes

7. NAGS to Cervical spine

8. Reverse NAGS to upper Thoracic
spine
•Stand side on to pt, stabilizing them with your trunk
•Reach around their head with your right hand, their
head rests on your chest
•Hook little finger of right hand across vertebra above
•Use thumb pad & distal PIP as a ‘V’ shape to contact
transverse process of articular pillar of vertebra below
•Oscillate towards pt eyes

9. Reverse NAGS to upper Thoracic spine

10. SNAGS
Active patient, moving through symptomatic
ROM
Glide is held / sustained
Used for C, T, L spine Sustained facet glide with
movement
Applied at end range, aim to increase pain free
ROM
Result should be instant and long lasting

11. Cervical rotation SNAGS
Stand side on to pt, reaching across to contralateral
neck
Place side of thumb on spinous process supported by
your other fingers
Rest of hand alongside patients mandible to add
slight traction
Patients rotates head applying self overpressure for 2
secs
Follow with pressure over spinous process towards
eye

12. Cervical rotation SNAGS

13. Cervical side bend SNAGS
Stand behind patient
Place thumbs on spinous process or articular
pillar
Rest of hand alongside patients mandible to
assist movement
Patients side bends head applying self
overpressure for 2 secs
Follow with pressure over articular pillar
directed towards eye

14. Cervical side bend SNAGS

15. Fist traction for C spine
Perform on patient first to test reaction – pain
should reduce
Pt places fist under chin with little finger against
top of sternum and hollow of curled 1st finger
and thumb
Reach behind head and grasp occiput in cupped
hand
Action is to draw scalp up and into flexion
Sustained 10 sec hold & repeat

16. Fist traction for C spine

17. Cervical spine towel SNAG
Test using SNAG of C2 on C1
Place edge of towel over C2 spinous process
Draw towel forwards and upwards towards
eye
Active retraction against restraint of towel
edge
Especially good for cervicogenic headaches

18. Cervical spine towel SNAG