Manual Physical Therapy

Physiofix Academy

Tue, 26 May 2026

The Mulligan Concept: A Modern Evolution in Manual Therapy

Manual therapy has always been shaped by people who were not satisfied with what already existed — clinicians who asked better questions and observed what others overlooked. One such figure is Brian R. Mulligan, a New Zealand physiotherapist whose work fundamentally shifted how we approach pain, movement, and joint dysfunction. His pioneering approach, known globally as the Mulligan Concept, introduced the idea of Mobilisation With Movement (MWM) and SNAGs, techniques that continue to influence physiotherapy practice worldwide.

This blog explores the history, inspiration, and scientific reasoning behind his work.

1. Early Life and Professional Roots

Brian Mulligan qualified as a physiotherapist from the New Zealand School of Physiotherapy in 1954. Early in his career, he worked in private practice in Wellington, where he treated patients presenting with a wide spectrum of musculoskeletal pain.

However, the physiotherapy landscape during the 1950s–1970s relied heavily on:

• Passive mobilizations

• Heat and electrotherapy

• Rest and generalized exercise

Although these methods helped many, some patients showed only temporary improvement. Symptoms would often return within hours or days. Mulligan, like many clinicians, felt there had to be a simpler and more immediate way to restore function.

2. Influences from the Manual Therapy Greats

Mulligan did not create his method in isolation. His thinking evolved in the environment shaped by manual therapy pioneers:

Mulligan absorbed these concepts — but then challenged their limits.

3. The Clinical Question That Changed Everything

By the late 1970s, Mulligan had begun teaching manual therapy and had already completed his Diploma in Manipulative Therapy (1974). Yet clinically, something bothered him:

Why did some joints move poorly even when structurally intact?

This led him to explore what he later called:

Positional Fault Hypothesis

The idea that after an injury or strain, a joint might not be in the ideal mechanical alignment, even though it is not dislocated or visibly altered.

This subtle misalignment could:

• Alter joint mechanics

• Restrict motion

• Trigger pain during movement

But most importantly:

If the alignment is corrected manually, movement can become instantly pain-free.

4. The “Eureka” Moment — Birth of Mobilisation With Movement

The turning point came during a routine clinical session. Mulligan applied a gentle lateral glide to a patient’s painful finger joint while the patient actively moved it.

To his surprise — the pain reduced immediately.

Not 6 sessions later.
Not after complicated strengthening programs.
Instantly.

This single observation sparked the core philosophy of what became:

Mobilisation With Movement (MWM)

Therapist applies a corrective joint glide → Patient performs the painful movement → Movement becomes pain-free and restored.

This was a radical departure from passive-only manual therapy.

5. Expansion to the Spine — The Birth of SNAGs

Once MWM principles were established for peripheral joints, Mulligan extended the idea to the spine.

He developed Sustained Natural Apophyseal Glides (SNAGs) — gentle, sustained facet joint glides performed while the patient moves themselves.

SNAGs became clinically powerful for:

• Neck pain (especially rotation loss)

• Low back stiffness

• Rib and thoracic mobility dysfunction

• Functional movement restoration

The key characteristic remains:
✅ Symptom-free movement during correction

6. Global Dissemination and Academic Recognition

By the early 1980s, Mulligan began teaching internationally.
By the 1990s, research studies on MWMs and SNAGs were emerging.
In 1989/1995 onward, his textbook Manual Therapy: NAGS, SNAGS, MWMs, etc. was published and translated widely.

Over the next decades:

• Mulligan teaching associations formed worldwide

• Certification pathways were established

• Universities integrated MWM into postgraduate programs

• Systematic reviews confirmed positive effects for multiple musculoskeletal conditions

Today, the Mulligan Concept is taught in:

• Physiotherapy programs

• Manual therapy specialization courses

• International conference workshops

7. Why Mulligan’s Work Still Matters

In a clinical world filled with machines, protocols, and passive treatment, Mulligan brought focus back to:

Movement

Patient empowerment

Immediate functional improvement

His method restored confidence — both in patients and clinicians.

8. The Core Clinical Principles (Simple and Powerful)

This is not just manual therapy.
It is clinical reasoning + touch + movement.

Conclusion

Brian Mulligan did not simply create a technique —
he created a shift in thinking.

He showed the world that:

• Pain is not only about damage

• Movement is not only mechanical

• The body can respond to the right manual cue — instantly

Today, every time a therapist performs an MWM or SNAG, they are practicing more than a technique — they are continuing a legacy of innovation, curiosity, and compassion in manual therapy.