1. The Mulligan concept provides pain-free restoration of comfort and mobility through gentle mobilization techniques. 2. It can be used to treat neuromusculoskeletal pain, hypomobility after injuries or surgery, arthritis, and conditions like ankylosing spondylitis. Contraindications include bone diseases, fractures, and certain medical conditions. 3. The techniques work by stimulating mechanoreceptors in and around the joint to reduce pain and increase range of motion. They also improve joint nutrition and alignment through gentle sustained mobilization in the available range of motion.

1. Mulligan Concept
Ashutosh Singh

2. MULLIGAN CONCEPT
• Comfort and capabilities restored instantly in a pain-free way.
Brian R. Mulligan, FNZSP (Hon.), Diploma MT,CMP,MCTA

3. Indications
• Any neuromusculoskeletal pain(if not contraindicated).
• Hypomobility (due to any post operative pain/ joint stiffness)
• To maintain mobility (arthritis/aging)
• Delaying the hypomobility (Ankylosing Spondylitis).
IF NOT CONTRAINDICATED IT IS INDICATED
AND ITS WORTH TRYING

4. Contra Indications
• Yellow Flags – Osteopenia, Hypermobility, pregnancy and if the
patient is on anti coagulant therapy.
• Red Flags- Osteoporosis, Active Inflammation, Metabolic bone
diseases, myelopathies, neurological deficit, unstable joint/fracture
site and non united fracture.

5. Pain is our friend not Enemy

6. Is MRI in back pain ALWAYS relevant?

7. HOW DOES MULLIGAN CONCEPT WORK ?

8. Neurophysiological Effect
• Pain gate theory (given by Melzack & Wall)
• Express highway theory – believed by various manual schools that
Stimulation of the mechanoreceptors and proporioceptors in and
around the joint which probably releases much stronger chemicals,
which not only relieve pain but also increases ROM.

9. Joint Nutrition
• Cartilage gets nutrition through synovial
fluid, by movement of synovial folds.

10. Joint Range of Motion
• No Medicine can increase joint range of motion.

11. The Positional Fault theory
• Micro malalignment of the two joint surfaces which can not be seen
on radiological investigations.
• Corrects the joint alignment by mulligan concept and later, strengthen
the weak muscles and stretch the tight muscles.
• Biomechanical faults cannot be corrected Biochemically.

12. Patho mechanics example
• Barbara Hetherington
1. She said that the lateral ligament of
ankle is very strong ligament. It is so
strong that it avulses the fibula then
how such ligament can get sprained?
2. Why less pain when push fibula back
and do offending movements?

13. Salient features of Mulligan Concept
1.Weight Bearing
Eg- In case of OA knee or hip patient complains of pain in walking,
ascending or descending stairs So Why should we treat them in lying
postions?

14. 2.Active movements followed by Passive over
pressure

15. 3.Pain free
• Whenever you give the glide, it must reduce pain to great extent and
increase the range of motion. If any of it does not occur then you are
not give glide correctly.

16. 4.Treat in available End range of motion
• If you are not in end range , you will not gain new range of motion.
Hence you need to work in the available end range of motion at any
joint.

17. 5.Sustain your Glide
• The very difference between mulligan concept and other concepts is
that the glides are sustained (instead of repeated oscillations) while
patient performs the offending/restricted movement.
• Once you find the correct glide, correct force and direction, sustain it
for at least 6-10 reps. Repeat 3 times

18. 6. Teach Self Treatment
• You are applying glide only for 5-10 minutes but what about the other
23 hours and 50 minutes of the day.
• In mulligan concept the glide is sustained with the help of tape, and
the patient is able to do the offending movements, leading to speedy
recovery.

19. 7. Follow the Treatment Plane
• Majority of the time the glide is parallel to the treatment plane and
perpendicular to the movement plane
• There is a treatment technique for each loss of motion.
Cervical Spine- 1. Gross loss of motion – NAGS
2. Loss in particular plane – SNAGS
3. Radiating Pain - SMWAM

20. Focus on following points for the best results
1. Always treat your patient in weight bearing or in painful positions,
perform offending movements in a pain free way.
2. Movements must be pain free. If not change the
pressure/hold/angle/level/side(spine). If worse please reverse.
3. Check the resultant vector /angle of push/parallel position of the
treatment belt to floor.
4. Don’t forget to sustain glide, until you return to the starting
position.
5. Always work in available end range of motion.

21. 6. Don’t forget the passive overpressure at the end of the range, it
works like cream on milk.
7. Be parallel to treatment plane and perpendicular to movement
plane.
8. Synchronize properly between your hand/ forearm/ pelvis/body and
the treatment plane.
9. Your position or handgrip must not block the patients movement.
10. Take care of amount of pressure applied on the joints.
11. After the good stabilisation only you can have a good mobilisation.
12. Grip must be firm but painless.
13. Hand / belt placement must be close to the treatment plane/ joint
line. Ensure proper translation avoid rotation.

22. 14. Check The Pain and A Pain.
15. Do not over treat follow Rule of Three.
16. You must teach self treatment, whenever possible.
17. Finally STOP Acting START Treating.