The Mulligan Concept of Manual Therapy

Book Preface

In 2011, I had the privilege to write a foreword for a new textbook on my concepts authored by Bill Vicenzino, Wayne Hing, Darren Rivett and Toby Hall. This was a timely, excellent publication enti­tled Mobilisation With Movement: The Art and the Science. My own manual on my concepts, now in its 6th edition, badly needed to be updated to include more detail and an improved format. This task has been undertaken and led by Wayne Hing, with all the above authors again being involved. It has taken over two years to complete this task. These erudite authors also had the wisdom to involve many of my Mulligan Concept international teachers. They have contributed by writing much of the text, each being allocated different regions of the body and different techniques. I must here particularly acknowledge and thank my colleagues Mark Oliver and Frank Gargano for the new tech­niques and material they have contributed.

I believe that the contents in this book, in its new format, are priceless. All who deal with mus­culoskeletal conditions and practise manual therapy should have a copy. What makes our concepts so special is that all the Mobilisation With Movement techniques described within this book are only to be used when they produce no pain on application and because they should be immediately effective if indicated. I know of no other manual therapy pro­cedures for the entire body, which follow these guidelines. What is really special about them is that it only takes about two minutes to decide if they are indicated. Not to be able to use our con­cepts may be denying patients their best treatment option. I now have many hours of video showing the efficacy of our concepts, personally treating patients on stage in many cities in America before my peers. The hundreds who have witnessed these occasions are left in no doubt as to the efficacy of these techniques because of the regular positive and instant pain-free outcomes.

Our concepts have come a long way from 1985 when, by chance, I had an unexpected instant pain-free success with a traumatised finger using what are now known as ‘Mobilisations With Movement’. The patient, who was a young woman in her early twenties, presented with a swollen interphalangeal joint which was painful and would not flex. I tractioned the joint several times which accomplished nothing. I then applied joint (glide) translations in the recommended biomechanically appropriate direction for flexion. Like the trac­tions, these glides were also ineffective and painful. I then tried a medial translation accessory move­ment which was unacceptable to the patient because of pain. Without much enthusiasm I then gently tried a lateral translation which prompted the patient to say ‘it does not hurt’. Something prompted me to sustain this translation and ask her if she could flex her finger. To my astonish­ment and her delight the finger flexed without pain! She then said something like ‘You have fixed me’. ‘Of course!; I replied. She still had a small loss of flexion range due to some residual swelling but she departed my rooms with a smile.

The young woman returned two days later and her finger had completely recovered. Why, I asked myself? The only explanation I could come up with for my chance success was that as a result of her trauma there was a minute positional fault of the joint preventing flexion movement. When this positional fault was corrected it enabled a full recovery to take place. It was a simple hypothesis and because of this I began to look differently at all joints that I treated and experimented to see if I could achieve similar results by repositioning other joint surfaces. I began having unbelievable successes in the clinic. A ‘miracle a day’ I called them. Louis Pasteur once said that chance only favours the prepared mind. When I, by chance, had my first miracle with the young woman and her painfully limited interphalangeal joint, I did indeed have a prepared mind.