Mobilizations with Movement ...

Mobilizations with Movement Mulligan techniques, Dokumenty

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Mulligan
Techniques
Explanation of the Mulligan techniques.
The idea of combining mobilizations with movement was being
developed in New Zealand in the late eighties and early nineties
by Brian Mulligan, a New Zealand manual therapist. He stated
that posttraumatic stiffness of joints can be caused by so-
called tracking problems. By accident he noticed that such an
off-track joint could regain its full range of motion by
applying a lateral shear force on that joint during active
movements under physiological load.
Mulligan himself never gave an explanation for this phenomenon.
Seeking for such an explanation we believe that it is more a
sort of Neurophysiologic reeducation of movement than a joint
mobilization technique. Beevor’s axioma already states that our
brain does not think in muscles but in movement. To our opinion
we can add that the brain does also not think in joints.
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After a trauma there is most likely a reason for stiffness.
Cyriax already described it as a so-called posttraumatic
capsular pattern. Brügger also recognized that the Nocisensoric
Motoric Blocking effect (NSB), such as described by him, can
stay present long after the primary lesion has healed. Together
with the fact that there can be a subluxation present after a
trauma whereby the natural glide can be disturbed, brings us to
a better understanding of this treatment.
By applying a lateral shift during active movement we force the
joint to make a natural glide again.
A second, very important, rule of this method is that the
technique is performed painless. When so, it means that the
brain does not associate this movement with pain anymore.
Therefore this movement will not be limited by the NSB the next
time it will be made without the application of the lateral
force.
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How to decide the direction of the lateral force?
As stated before, the movement is carried out actively and under
physiological weight bearing where possible. When the direction
of the subluxation can not be analyzed out of the trauma, the
direction of the lateral shearing force is made empirical. The
therapist starts with one direction. When painless this
direction will be used further. When pain arises the direction
of the lateral shear will be changed to the opposite direction.
When no direction can be performed without pain and or no gain
of mobility is seen after 10 repetitions this therapy will not
be our first choice.
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Describing of techniques:

With every technique shown there is a short instruction of
how to place the hands of the therapist.

With many of the techniques a traction belt is used.

When the mouse of the computer is placed on the picture and
the instructions of the computer are being followed, a short
instruction film, showing the technique, will start.
In this book not all of the techniques taught by Mulligan are
being shown. We decided only to describe those techniques which
have proven them self during practice. Some of the techniques
have been modified according to the authors.
30
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