Brian Mulligan’s concept of mobilization with movement (MWMS) at limb level and sustained natural apophyseal slips (SNAGS) at spine level is a logical next step in the evolution of treatment of musculoskeletal disorders.
For this purpose, the therapist applies accessory movements at the same time as the patient performs physiological movements on his own.
Principles of treatment
1. In the course of his or her assessment, the therapist will identify a notable sign. This sign may be a loss of joint movement, pain associated with movement, or pain associated with functional activity.
2. Incidental passive mobilization is applied to the joint. This mobilisation should be painless.
3. The therapist will look for different combinations of parallel or perpendicular slips to find the appropriate treatment plan and grade of movement.
4. While the accessory glide is maintained, the patient is asked to perform his or her notable sign. This should then be significantly improved (improved range of motion, and a significant reduction in pain).
5. The previously restricted and/or painful movement is repeated by the patient while the therapist maintains the appropriate accessory glide. Increasing gains can be expected during the session.
6. Even greater gains can be achieved through the application of passive overpressure at the end of the range of motion. This overpressure should also be painless.
Self-treatment is often possible using the principles of MWM with a tap and/or with the patient himself providing the accessory sliding component of MWM. Pain always serves as a guide. Well performed MWMs should make the noticeable sign painless while significantly improving function during the application of the technique. Sustained improvements over time are necessary to continue mobilization.