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The Mulligan Concept: A Manual Therapy Approach in Physiotherapy

The Mulligan Concept is a manual therapy approach used in physiotherapy. It combines a sustained joint mobilization performed by the physiotherapist with an active or passive movement performed by the patient.

The goal is simple: to improve mobility, reduce pain, and help the person regain better function in daily or sports-related activities. This technique stands out because it is active, gentle, and generally well tolerated. During its application, the movement should not reproduce the patient’s pain.

Developed by Brian Mulligan, a physiotherapist from Wellington, New Zealand. After graduating in 1954, he developed this method in the 1980s based on his clinical experience with many patients.

Originally, according to the model proposed by Mulligan, certain types of pain or movement restrictions may be related to a slight positional fault between joint surfaces, sometimes referred to as a “minor positional fault.” This type of misalignment is not necessarily visible on imaging but may contribute to limited movement or pain. However, the concept has since evolved and it is now considered as a “reboot” of the patient’s nociceptive system. With he application of the accessory articular movement and the passive or active movement added by the patient, the nervous system no longer perceives the movement as sensitive. As a result of this, the movement can then be performed with less pain or no pain at all.

The philosophy behind the Mulligan Concept is based on an important principle: the physiotherapist applies a specific mobilization while the patient performs an active or passive movement. The goal is to achieve a rapid improvement in movement without causing pain during the technique.

If pain persists, the physiotherapist adjusts the approach, changes the direction of the mobilization, or chooses another technique better suited to the patient’s condition.

When Should You See a Physiotherapist?

It may be appropriate to consult a physiotherapist if you experience:

pain that limits your movements;
loss of mobility;
pain in the neck, back, shoulder, knee, or ankle;
discomfort during sports, work, or daily activities;
persistent pain after an injury.

A physiotherapy assessment helps identify the factors contributing to your symptoms and determine whether the Mulligan Concept is an appropriate option for you.

References

Stathopoulos, N., Dimitriadis, Z., & Koumantakis, G. A. Effectiveness of Mulligan’s mobilization with movement techniques on pain and disability of peripheral joints: a systematic review with meta-analysis. Physiotherapy, 2019.

Mulligan Concept Teachers Association. General information on the Mulligan Concept and mobilization with movement techniques.

The Main Techniques of the Mulligan Concept

The Mulligan Concept includes several techniques selected according to the body region, limited movement, and treatment goals.

MWM: Mobilization With Movement

MWM is mainly used for peripheral joints, such as the ankle, knee, shoulder, elbow, or wrist.

The physiotherapist applies a joint mobilization while the patient performs the limited or painful movement. For example, after an ankle sprain, mobilization may be combined with dorsiflexion to improve mobility and reduce pain.

Some research suggests that MWM may help improve range of motion and decrease pain in certain patients.

SNAG: Spinal Mobilization With Movement

SNAGs (Sustained Natural Apophyseal Glides) are used for the cervical, thoracic, and lumbar spine.

The physiotherapist applies a gentle, sustained mobilization to a vertebra while the patient performs an active movement. The goal is to improve spinal mobility without reproducing pain.

SMWLM: Spinal Mobilization With Limb Movement

SMWLM combines a spinal mobilization with active movement of a limb.

This technique may be used when symptoms in a limb are influenced by the spine, such as certain lower-limb symptoms related to the lumbar region.

Self-Treatment Techniques

The Mulligan Concept may also include self-treatment exercises taught by the physiotherapist.

These exercises can help maintain improvements achieved during treatment, improve mobility, and support patient independence when performed correctly.

What Conditions Can Be Treated With the Mulligan Approach?

The Mulligan Concept may be used for various musculoskeletal conditions in athletes, active individuals, and people looking to improve mobility. Its use depends on the physiotherapist’s assessment, symptoms, and treatment goals.

Neck and Spine Pain

This approach may be used for certain types of neck or low back pain, neck stiffness, cervicogenic headaches, and mobility restrictions.

Techniques such as SNAGs may help improve movement and reduce pain during certain activities.

Shoulder, Elbow, and Wrist Pain

The Mulligan Concept may also be used for shoulder pain, mobility restrictions, certain rotator cuff-related symptoms, epicondylitis, and wrist pain or stiffness.

The technique is selected according to the limited movement and the patient’s response to treatment.

Hip, Knee, and Ankle Pain

For the lower limbs, this approach may be used for ankle sprains, stiffness, certain types of knee pain, and hip mobility restrictions.

In athletes, it may be integrated into a complete rehabilitation plan that includes strengthening, balance, and a gradual return to activity.

Frequently asked questions

How Does the Mulligan Technique Work in Practice?

During a session, the physiotherapist begins with an assessment to identify the painful, limited, or problematic movement. They observe mobility, pain, function, and the movements that reproduce the symptoms. They then identify if the patient would be a good candidate for the Mulligan technique, therefore, if the mobility is limited due to pain.

Then, the physiotherapist applies a sustained joint glide while the patient actively repeats the limited or painful movement. This is what makes the Mulligan approach different: the patient actively participates in the treatment from start to finish.

The physiotherapist looks for a response known as PILL:

Pain free: the movement should be performed without pain;
Immediate: the improvement should be rapid or immediate;
Long lasting: the effects should ideally remain after the technique.

If the movement remains painful, the physiotherapist adjusts the direction, amplitude, or intensity of the mobilization. The technique should not reproduce the patient’s pain.

This approach can be used on its own or alongside other physiotherapy interventions, such as mobility exercises, muscle strengthening, education, motor control work, or other manual therapy techniques.

To determine whether the Mulligan Concept is appropriate for your condition, a personalized assessment by a physiotherapist is necessary.

Is the Mulligan Technique Painful?

No. The Mulligan technique should not cause pain during its application.

One of the key principles of this approach is that the movement performed with the mobilization should be comfortable. If pain persists or increases, the physiotherapist adjusts the technique or chooses another intervention.

This makes it a generally well-tolerated approach, but it must always be adapted to the patient’s condition.

Is the Mulligan Technique Effective?

Available research suggests that certain techniques within the Mulligan Concept may have positive effects on pain, mobility, and function in several musculoskeletal conditions.

Results may vary depending on the condition being treated, the duration of symptoms, the body region involved, the patient’s participation, and the overall treatment plan.

In practice, the Mulligan Concept is often used as one tool among many in physiotherapy. It can be combined with therapeutic exercises, advice, muscle strengthening, and a gradual return-to-activity program.

Can the Mulligan Technique Help With Back Pain?

In some cases, yes. Techniques such as SNAGs may be used for certain types of low back pain or mobility restrictions in the back.

However, back pain can have several causes and contributing factors. This is why a complete assessment is essential before choosing the most appropriate treatment.

The physiotherapist can determine whether the Mulligan Concept is relevant to your situation or whether another approach would be more appropriate.

What Do Professionals Think About the Mulligan Concept?

The Mulligan Concept is recognized and used by many physiotherapists around the world. It is part of the manual therapy approaches taught in several professional training programs.

Professionals value it in particular because it actively involves the patient, is based on an immediate clinical response, and should not reproduce pain during its application.

As with any physiotherapy approach, its effectiveness depends on selecting the right technique, the condition being treated, and its integration into a complete treatment plan.