BASIC MULLIGAN, INDIKASI DAN KONTRAKINDIKASI

FITRI YANI, M.FIS

Mulligan Concept
Mulligan Concept
•Background
–Manual therapy technique
–Developed by physiotherapist Brian Mulligan
–Addresses his joint ‘positional fault’ hypothesis
–A sustained passive accessory joint mobilization
WITH an active or functional movement (Vicenzino, et
al, 2011)
Foundational Principles
•The Mulligan Concept was influenced by James
Cyriax, Fredrick Kaltenborne, Geoffrey Maitland, and
Robin McKenzie (Hing, et al, 2015)
•Cyriax
–passive joint mobilization
•Kaltenborn
–appreciation of joint mechanics
•Maitland
–proper treatment application produces a change in
pain
•McKenzie
Theories of Efficacy
A Neurophysiological Component
–The general nature of manual therapy contributing
to hypoalgesia and stimulation of the sympathetic
nervous system (large A beta fibers) resulting in a
decrease of symptoms (Paungmali,Vicenzino & Smith,
2003; Paungmali, O’Leary, Souvlis & Vicenzino, 2003).
–A change in bone position may produce a non-opioid
mechanical hypoalgesia by instantaneously triggering
processes within the CNS
Theories of Efficacy

A Positional Fault
–Injury results in a positional fault -minor bony
incongruity -at a joint
–A minor bony incongruity resolved with his
sustained glide and the patient active movement thus
eliminating the source of a patient’s presenting
problem (Mulligan, 1993)
 Treatment Indications
MWMs can be used to treat:
–Joint pain with motion or weight bearing
–Loss of joint ROM
–Any conditions and/or symptoms associated with joint restriction
•sub-acute sprains, tissue derangement, referred pain, headaches, vertigo,
breathing restrictions (Mulligan, 2010)
–Mulligan discovered MWMs through finger dislocation
–Will treat pain associated with loss of ROM, but may not treat chemical and
thermal pain (Collins, Teys, Vicenzino, 2004)
•Must assess for fractures, comorbidities, and underlying conditions prior to
application
 Principles of Treatment
•PILL (Mulligan, 2010)
–Pain-free
–Immediateeffect
–Long
–Lasting

•Client Specific Impairment Measure (CSIM) ( Hing, et al., 2015)

 Principles of Treatment

CROCKS (Mulligan, 2010)

–Contraindications
–Repetitions
–Over-pressure
–Communication and cooperation
–Knowledge
–Sustain, skill, sense, and subtle
Theories of Efficacy
A Psychological Component
–All interventions are influenced by non-physical
factors such as existing beliefs on injury, tissue
damage and pain from both the patient and the
clinician (Vincenzino, et. al, 2011)
–Patient willingness to please ie. placebo effect