Mulligan

Question 1

Mulligan pioneered the idea of _ with _ and _ _ to address musculoskeletal disorders with pain free manual joint repositioning techniques for restoration of _ and abolition of _.

Answer 1

Idea of MOBILIZATIONS WITH MOVEMENT AND MANUAL THERAPY to address musculoskeletal disorders with pain free joint repositioning techniques for restoration of FUNCTION AND ABOLITION OF PAIN

Question 2

_ or _ _ _, can be applied from _ to _ (the functional cervical spine). These techniques are _ to _ _ mobilizations

Answer 2

NAGS or NATURAL APOPHYSEAL GLIDES can be applied from C2-T3 (the functional cervical spine. Techniques are MID- TO END RANGE mobilizations

Question 3

NAGS may cause _ _ but they should never cause _

Answer 3

May cause MILD DISCOMFORT but they should never cause PAIN

Question 4

What is the patient position for NAG’s?

Answer 4

Always performed in sitting

Question 5

A _ _ may also be added to the NAG technique.

Answer 5

TRACTION FORCE

Question 6

NAGS are indicated where _ (_) techniques may be too aggressive or _. Are indicated in patients with _ _ _ or with _ associated with _ _ _.

Answer 6

NAGS are indicated where PAIVM (PA) techniques may be too aggressive or INEFFECTIVE. Are indicated in patients with CERVICAL MOVEMENT IMPAIRMENTS or with PAIN associated with CERVICAL MOVEMENT IMPAIRMENTS

Question 7

With NAG techniques the _ facets glides _ upon the _ joint partner. Facet plane is at a _ _ _.

Answer 7

The SUPERIOR facet glides ANTERIOR-CEPHALADLY upon the INFERIOR joint partner

Facet plane is at a 45 DEGREE ANGLE

Question 8

_ _ are indicated for the upper thoracic spine (_ or _ impairment) or on the extremely rare occasion where the _ made the patient worse. Is _ the _ of a NAG

Answer 8

REVERSE NAGS are indicated for the upper thoracic spine (STIFFNESS OF MOVEMENT impairment) or on the extremely rare occasion where the NAG made the patient worse.

Is BIOMECHANICALLY OPPOSITE of the NAG

Question 9

With reverse NAGS the _ facet glides anterio-cephaladly _ the _ joint partner. With a _ _ _ such as cervical rotation, focus the reverse NAG on the _ side.

Answer 9

The INFERIOR facet glides anterio-cephaladly UNDER THE SUPERIOR joint partner. With a UNILATERAL MOVEMENT IMPAIRMENT, such as cervical rotation focus the reverse NAG on the RESTRICTED SIDE.

Question 10

A _ or _ _ _ _ the technique is essentially mobilization with movement. They are indicated in the _ of movement impairments of the _ _. Technique must be __ _.

Answer 10

A SNAG or SUSTAINED NATURAL APOPHYSEAL the technique is mobilization with movement

Are indicated in the RESTORATION of movement impairments of the ENTIRE SPINE

Technique must be PAIN FREE

Question 11

SNAGS are unique to other mobilization techniques in regards to: _ _, active movements followed by _ -, follow _ _ rule, the mobilization component is sustained at the _ _ (maintain _ _ until the cervical spine has returned to the _ _).

Answer 11

Unique in regards to:

• WEIGHT BEARING
• active movements followed by PASSIVE OVER-PRESSURE (OP)
• follow the TREATMENT PLANE RULE
• the mobilization component is sustained at the END RANGE (maintain STATIC OVERPRESSURE until the cervical spine has returned to the RESTING POSITION)

Question 12

SNAGS are unique to other mobilization techniques in regards to: _, immediate _, occur in the range where the patient _ _ _(either _ or _), is easily _ and extremely _.

Answer 12

Unique in regards to:

• PAINLESS
• immediate REASSESSMENT
• occur in the range where the patient EXPERIENCES THEIR SYPTOMS (either STIFFNESS OR PAIN)
• is easily MASTERED and extremely EFFECTIVE

Question 13

Though the cervical facet is 40-45 degrees to the horizontal in neutral, at _ _ _ the facet plane is near or at _. PT must _ the _ of the mobilization force throughout the _.

Answer 13

At END RANGE EXTENSION the facet plane is near or at VERTICAL

PT must ADJUST THE DIRECTION of the mobilization force throughout the PROCEDURE

Question 14

If the patients impairments are not _, than mobilize the _ _ or _ and _. If still no improvement?

Answer 14

If patients impairments are not REDUCED, than mobilize the JOINT ABOVE OR BELOW and REASSESS

If still not improvement discard the technique

Question 15

With this technique be sure _ _ _ _ on day one.

Answer 15

Be sure NOT TO OVER TREAT on day one

Question 16

With cervical rotation application of the SNAG should be applied with a _ _ in the treatment plane. Treatment should be held for _ _ and repeated _ _.

Answer 16

Applied with CEPHALAD FORCE in the treatment plane.

Treatment/ force should be held for 6 SECONDS and repeated 6 TIMES

Question 17

For self-rotation SNAGS (ex. At C2/ C3 Right sided pain Ipsilateral technique) towel should fixate _ _ with _ force and _ hand, and mobilize _ _ with force directed at _ _ and with the _ hand.

Answer 17

Towel should fixate RIGHT C3 with DOWNWARD force and OPPOSITE hand, and mobilize LEFT C2 with a force directed at 45 DEGREES and with the OPPOSITE hand.

Question 18

With pain with Ipsilateral rotation you should block the _ _ the facet you want to affect, and with pain with contralateral rotation you should block the _ _ the facet you want to affect.

Answer 18

Ipsilateral you should BLOCK THE JOINT BELOW

Contralateral you should BLOCK THE JOINT ABOVE

Question 19

How does self-rotation SNAG with towel change when you are trying to affect the C1/ C2 facet joint?

Answer 19

Upper hand is no longer at a 45 degree angle, it changes to horizontal to align with the angle of the treatment plane.

Question 20

If you want to apply a _ _ in addition to the NAG you should have the patient sitting with forehead facing PT’s / and your hand grasping the _ _ of the patients _. Then use your _ _ to stabilize the superior joint partner and with the _ _ of the opposite hand apply an _ _ force.

Answer 20

If you want to apply a TRACTION FORCE in addition . . .
Have patient sitting with forehead in PT’S ELBOW/ BICEPS and your hand grasping the POSTERIOR ASPECT of the patients head.

Then use your 5TH RAY to stabilize the superior joint partner and with the THENAR EMINENCE of the opposite hand apply an ANTERO- CEPHALAD.

Question 21

With NAG plus traction technique the oscillation force is applied at a rate of -/ _, for - _. Repeat _ or _ times and then _.

Answer 21

Oscillation force is applied at a rate of 1-3/ SECOND for 10-30 SECONDS. Repeat 6 OR LESS times and then REASSESS

Question 22

If you want to perform a _ _ with traction you use the same set up as a regular NAG with the exception of the inferior hand, instead of using thenar eminence you make a _ with the _ of your _ and the _ _ _ of your _ _

Answer 22

If you want to perform a REVERSE NAG with traction, use the same set-up …

With inferior hand make V WITH THE PAD OF YOUR THUMB and the PROXIMAL PHALANGEAL JOINT of your FIRST RAY

Question 23

To apply traction force using your forearm: place forearm _ patients _, with patient in _. Using the _ _ of your forearm start in a _ _ position and _ _. Other hand is on patients _ for stability.

Answer 23

Place forearm UNDER patients HEAD, with patient in SUPINE

Using the DISTAL 1/3 of your forearm start in a FULLY SUPINATED POSITION and SLOWLY PRONATE.

Other hand is on the patients FOREHEAD for stability.

Question 24

To apply a “headache SNAG”: have the patient in _ position, with their face in PT’s _ stabilizing the _ of the patients head with your _ using the _ _ of your _ _, place the _ _ of the opposite hand on top and apply an _ _ pressure.

Answer 24

Have the patient in a SITTING POSITION, with their face in PT’s BICEP using the MIDDLE PHALANX of your 5TH DIGIT, place the THENAR EMINENCE of the opposite hand on top and apply an ANTERIORLY DIRECTED pressure.

Question 25

With headache SNAGs pressure is maintained for _ _, and repeated - times.

Answer 25

Pressure is maintained for 10 SECONDS, and repeated 6-10 times

Question 26

With self-headache snag, patient places towel at _ vertebrae and pulls it _ in front of the body, then _ _.

Answer 26

Places towel at C2 VERTEBRAE and pulls it HORIZONTALLY in front of the body, the RETRACTS HEAD

Question 27

A reverse “headache SNAG” patient is seated and head is stabilized facing PT’s bicep and hand it stabilizing the occiput, but instead with the opposite hand the PT uses _ _ to grasp the _ vertebrae and _ _ _ _ with the arm that is _ _ _ _.

Answer 27

PT uses WEB SPACE to grasp the C2 vertebrae and PULLS PATIENTS HEAD FORWARD with the arm that is AROUND THE PATIENTS HEAD.

Question 28

Mulligans headache Intervention: _ SNAG, then _ _ SNAG, then upper cervical _ with _ and _, then upper cervical _ SNAG, Upper cervical - SNAG and _ _ _ SNAG

Answer 28

• HEADACHE SNAG
• REVERSE HEADACHE SNAG
• Upper cervical TRACTION with FOREARM and FIST
• Upper cervical ROTATION SNAG
• Upper cervical SELF-ROTATION SNAG
• SELF C2 HEADACHE SNAG

Question 29

22 minute recipe for Acute Torticollis/ wry neck:

• 2 minutes of _ _ with _
• 20 minutes of _ _ _ short of _
• _ brace and _ as needed

Results in -% improvement

Answer 29

2 minutes of LYING SUPINE WITH HEAD
20 minutes of SMALL AROM ROTATION short of R1
TOWEL brace and REPEAT as needed

Results in a 80-90% IMPROVEMNT