Brian R. Mulligan's Contributions to Chiropractic Continuing Education Posted on Oct 20, 2023
Introduction | Mulligan Method & Chiropractic Continuing Education!
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Introduction
Brian R. Mulligan, a distinguished physiotherapist, has left an indelible mark on the field of chiropractic continuing education. With a career spanning decades and a commitment to advancing the understanding of musculoskeletal disorders, Mulligan has significantly contributed to the chiropractic community. In this blog, we'll explore innovative techniques, including Natural Apophyseal Glides (NAGs), Sustained Natural Apophyseal Glides (SNAGs), and Mobilization with Movements (MWMs), and their impact on chiropractic care.
Understanding NAGs, SNAGs, and MWMs
Brian R. Mulligan's techniques, abbreviated as NAGs, SNAGs, and MWMs, have become integral to the practice of chiropractic care. Let's dive into each of these methods to gain a deeper understanding of their significance.
NAGs - Natural Apophyseal Glides
NAGs, which stand for "Natural Apophyseal Glides," are utilized for the cervical and upper thoracic spine. These techniques involve oscillatory mobilizations that are targeted at the facet joints between the 2nd cervical and 3rd thoracic vertebrae. Unlike SNAGs, which we'll discuss shortly, NAGs employ mid-range to end-range facet joint mobilizations applied antero-superiorly in the treatment planes of the selected joint.NAGs are particularly useful for addressing grossly restricted spinal movement. They are often the treatment of choice in highly irritable conditions where sustained glides, such as SNAGs, may not be suitable.
SNAGs - Sustained Natural Apophyseal Glides
SNAGs, or "Sustained Natural Apophyseal Glides," may be applied to various spinal joints, including the rib cage and the sacroiliac joint. These techniques involve the doctor applying the appropriate accessory zygapophyseal glide while the patient performs the symptomatic movement. The goal is to achieve full-range, pain-free movement.SNAGs are most successful when symptoms are aggravated by a specific movement and are not multilevel. However, they may not be the prime choice for highly irritable conditions.
MWMs - Mobilization with Movements
Mobilization with Movement (MWM) is a technique that combines sustained accessory mobilization administered by the therapist with active physiological movement performed by the patient. During MWM, passive end-of-range overpressure or stretching is delivered without inducing pain, serving as a barrier.Mulligan proposed that minor "positional faults" to a joint, resulting from injuries or sprains, could lead to restrictions in physiological movement. MWM techniques aim to address these positional faults by realigning joint surfaces in a less provocative manner.
Principles of Treatment
The principles guiding Mulligan's techniques are rooted in well-established chiropractic practices: A passive accessory joint mobilization should align with Kaltenborn's principles, ensuring it remains pain-free.During assessment, therapists identify comparable signs, such as a loss of joint movement or pain associated with movement or specific functional activities.The doctor continuously monitor patients' reactions to ensure no pain is recreated during treatment.The therapist explores various combinations of parallel or perpendicular glides to identify the correct treatment direction and grade of accessory movement.While sustaining the accessory glide, patients are asked to perform the comparable sign, which should show significant improvement if the technique is correct.
Evaluating Treatment Progress with PILL and CROCKS
Incorporating evaluation into treatment is crucial in Mulligan's approach. One way to assess progress is through the PILL response:P - Pain-freeI - Instant resultLL - Long-lastingIf a technique does not elicit a PILL response, it is not recommended. Additionally, the CROCKS principle guides treatment:C - Contraindications (No PILL response is a contraindication)R - Repetitions (Limited to three reps on day one)O - OverpressureC - CommunicationsK - Knowledge (of treatment planes and pathologies)S - Sustain the mobilization throughout the movement
Exploring Specific Techniques
Mulligan's techniques encompass a wide range of applications, including:
- Headache SNAG: Effective for patients with headaches of upper cervical origin, this technique includes gentle pressure applied to the spinous process of C2 while the patient's head remains still.
- Peripheral MWM: Used to address aggravating movements, the choice between weight-bearing and non-weight-bearing movements depends on the condition's nature and irritability.
- Spinal Mobilization with Limb Movement (SMWLMs): This approach applies transverse pressure to the side of the relevant spinous process as the patient moves their limb through a restricted range of motion, addressing spinal structural/mechanical restrictions.
- MWM for the Lumbar Spine: Mulligan's techniques extend to the lumbar spine, involving various movements and pressure applications to alleviate pain and improve range of motion.Brian R. Mulligan's contributions to chiropractic continuing education have ushered in a new era of effective treatment techniques. Chiropractors worldwide have embraced NAGs, SNAGs, and MWMs to enhance patient care and address musculoskeletal issues more effectively than ever before. As the chiropractic community continues to evolve, Mulligan's techniques remain a cornerstone of modern chiropractic practice.
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