Mulligan Concept, Principles, Indications

Last updated: July 6, 2026Reviewed date: July 6, 2026Reading time: 3 min read

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Article Summary

Mulligan Concept is the application of the Mulligan's Sustained Natural Apophyseal Glide (SNAG) technique on lumbar flexion ROM. The secondary aim was to measure the intra- and inter-day reliability of lumbar ROM employing the same procedure. For peripheral joints, the Mulligan Concept mainly utilizes the mobilization with movement (MWM) techniques, according to which there is a certain direction of application of mobilization forces, which if...

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This article explains Principles of Mulligan Concept in simple medical language.
This article explains Indications of Mulligan Concept in simple medical language.

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Start here Choose the right pathway for symptoms, reports, medicines, or urgent warning signs. Disease article roadmap Read this topic step by step: meaning, symptoms, warning signs, diagnosis, treatment, prevention, and follow-up. Treatment planner Prepare questions about treatment choices, benefits, risks, side effects, and follow-up. Family & caregiver guide Organize symptoms, reports, medicines, questions, and follow-up safely. Nutrition & diet guide Prepare food, hydration, supplement, and medicine-timing questions safely. Prevention guide Organize risk factors, protective habits, screening, and warning signs. Recovery guide Prepare a safe plan for activity, rehabilitation, warning signs, and follow-up.

Educational health guideWritten for patient understanding and clinical awareness.

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Emergency safety firstUrgent warning signs are highlighted below.

Definition

Mulligan Concept is the application of the Mulligan’s Sustained Natural Apophyseal Glide (SNAG) technique on lumbar flexion ROM. The secondary aim was to measure the intra- and inter-day reliability of lumbar ROM employing the same procedure.

For peripheral joints, the Mulligan Concept mainly utilizes the mobilization with movement (MWM) techniques, according to which there is a certain direction of application of mobilization forces, which if maintained during a painful movement, the patients’ usual pain should be completely resolved. Many repetitions of the pain-free MWM are required to achieve a successful therapeutic result, eventually with the additional application of overpressure, with immediate positive results even within the first treatment session [rx]. The mobilization directions for peripheral joints comprise internal and external lateral glide, internal and external rotation and anteroposterior and posteroanterior glide. Regarding the technical terms of the application, mobilizations are implemented with a specified frequency, on specified sets, repetitions and rest periods between them, depending on the joint and the session [rx].

Principles of Mulligan Concept

A passive accessory joint mobilization is applied following the principles of Kaltenborn. This accessory glide must itself be pain-free.
During the assessment, the therapist will identify one or more comparable signs as described by Maitland. These signs may be; a loss of joint movement, pain associated with movement, or pain associated with specific functional activities
The therapist must continuously monitor the patient’s reaction to ensure no pain is recreated. The therapist investigates various combinations of parallel or perpendicular glides to find the correct treatment plane and grade of accessory movement.
While sustaining the accessory glide, the patient is requested to perform the comparable sign. The comparable sign should now be significantly improved
Failure to improve the comparable sign would indicate that the therapist has not found the correct treatment plane, grade of mobilization, spinal segment or that the technique is not indicated.
The previously restricted and/or painful motion or activity is repeated by the patient while the therapist continues to maintain the appropriate accessory glide.

Indications of Mulligan Concept

The pain of a non-inflammatory nature
Acute pain from injury
Loss of motion due to arthritic conditions
Post-surgical conditions causing loss of pain-free movement, e.g. post scope conditions, spinal surgery
Headaches due to neck problems
Dizziness associated with neck problems
Jaw or TMJ pain and movement restrictions
Acute to chronic ankle sprains
Tennis elbow” or lateral elbow pain

References

Mulligan Concept, Principles, Indications

Safety note: This is not a prescription or diagnosis. For severe symptoms, pregnancy danger signs, children with serious illness, chest pain, breathing difficulty, stroke-like weakness, or major injury, seek urgent care.

Which doctor may help?

Start with a registered doctor or the nearest qualified health center.

What to tell the doctor

Write when the problem started and how it changed.
Bring old prescriptions, investigation reports, and current medicines.
Write allergies, pregnancy status, diabetes, kidney/liver disease, and major past illnesses.
Bring one family member if the patient is weak, elderly, confused, or a child.

Questions to ask

What is the most likely cause of my symptoms?
Which danger signs mean I should go to hospital quickly?
Which tests are necessary now, and which can wait?
How should I take medicines safely and what side effects should I watch for?
When should I come for follow-up?

Tests to discuss

Vital signs: temperature, pulse, blood pressure, oxygen saturation
Basic physical examination by a clinician
CBC, urine test, blood sugar, or imaging only when clinically needed

Avoid these mistakes

Do not use antibiotics, steroid tablets/injections, or strong painkillers without proper medical advice.
Do not hide pregnancy, kidney disease, ulcer, allergy, or blood thinner use.
Do not delay emergency care when danger signs are present.

Medicine safety and first-aid guide

This section is for patient education only. It does not replace a doctor, pharmacist, or emergency care.

Safe first steps

Avoid heavy lifting, sudden bending, and prolonged bed rest.
Use comfortable posture and gentle movement as tolerated.
Discuss physiotherapy, X-ray, or MRI only when clinically needed.

OTC medicine safety

For mild back pain, pain-relief medicine may be discussed with a doctor or pharmacist.
Avoid repeated painkiller use if you have kidney disease, stomach ulcer, uncontrolled blood pressure, or are taking blood thinners.

Avoid these mistakes

Do not start antibiotics without a proper medical decision.
Do not use steroid tablets or injections casually for quick relief.
Do not delay emergency care because of home remedies.

Get urgent help if

Back pain with leg weakness, numbness around private area, loss of urine/stool control, fever, cancer history, or major injury needs urgent care.

Medicine names, dose, and timing must be decided by a qualified clinician or pharmacist after checking age, pregnancy, allergy, other diseases, and current medicines.

For rural patients and family caregivers

Patient health record and symptom diary

Write your symptoms, medicines already taken, test results, and questions before visiting a doctor. This note stays on your device unless you print or copy it.

Doctor to discuss: Orthopedic / spine specialist, physical medicine doctor, or qualified clinician

Tests to discuss with doctor

Neurological examination for leg power, sensation, reflexes, and straight leg raise
X-ray only if injury, deformity, long-lasting pain, or doctor suspects bone problem
MRI discussion if severe nerve symptoms, weakness, bladder/bowel problem, or persistent symptoms

Questions to ask

What is the most likely cause of my symptoms?
Which warning signs mean I should go to emergency care?
Which tests are really needed now?
Which medicines are safe for my age, pregnancy status, allergy, kidney/liver/stomach condition, and current medicines?
Is physiotherapy, posture correction, or activity modification needed?

Emergency warning signs such as chest pain, severe breathing difficulty, sudden weakness, confusion, severe dehydration, major injury, or loss of bladder/bowel control need urgent medical care. Do not wait for online information.

Go to emergency care if you notice:

Severe or rapidly worsening symptoms
Breathing difficulty, chest pain, fainting, confusion, severe weakness, major injury, or severe dehydration

Doctor / service to discuss: Qualified healthcare provider; specialist depends on symptoms and examination.

Step 1
Check danger signs first

If danger signs are present, seek emergency care and do not wait for online information.
Step 2
Record the symptom story

Write when symptoms started, severity, medicines already taken, allergies, pregnancy status, and test results.
Step 3
Visit a qualified clinician

A doctor, nurse, or qualified healthcare provider can examine you and decide which tests or treatment are needed.
Step 4
Do only useful tests

Do tests after clinical assessment. Avoid unnecessary tests, random antibiotics, or repeated medicines without diagnosis.
Step 5
Follow up and return early if worse

If symptoms worsen, new warning signs appear, or treatment is not helping, return for review quickly.

Rural patient practical tips

Take a written symptom diary and all previous prescriptions/test reports.
Do not hide medicines already taken, even herbal or over-the-counter medicines.
Ask which warning signs mean urgent referral to hospital.

This roadmap is for education. A real diagnosis and treatment plan requires history, examination, and clinical judgment.

Internal learning pathway

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