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Mobilization With Movement: NAGS and SNAGS

What Is Mobilization?

The term “mobilization” is often used within the profession of Physiotherapy. Most often the term is used to describe a physical force which is applied to a pair of bones at their articulation (joint) in order to improve the ability of that joint to move.

Traditional Mobilization Methods

In the more common and traditional context, mobilizations are applied to joints in a non-weight bearing position where the patient is instructed to “relax”. It is also common for these mobilization forces to be applied in an oscillatory fashion and not held or sustained. It is important to realize that these traditional methods of mobilization are not wrong and that they do produce the desired result of improving range of motion. However, there is a new and very interesting technique being used by physiotherapists to regain range of motion.

The Mulligan Concept

In the last ten years a new approach to joint mobilization has been developed by Brian Mulligan, an expert manual therapist from Auckland New Zealand. What is now referred to as The Mulligan Concept takes joint mobilization in a new and exciting direction.

Mulligan treatment techniques have emerged from many years of clinical practise and refinement (1). Over the years many of these techniques have been clinically proven to be effective (2,3,4,5,6) with some having recently undergone scientific validation (7,8,9).

Some key differences between the Mulligan techniques and more traditional mobilizations are as follows;

  1. Mulligan techniques are often performed in weight bearing
  2. Mulligan techniques are generally sustained
  3. Mulligan techniques are never performed through pain
  4. Mulligan techniques must produce immediate improvements

These attributes are partly what make Brian Mulligan’s methods so clinically effective.

NAGS and SNAGS

Initially Mulligan developed techniques to treat spinal dysfunction which resulted in loss of range of motion and/or pain.  These techniques are referred to as NAGS and SNAGS which are acronyms for Natural Apophyseal GlideS  and Sustained Natural Apophyseal GlideS.

As previously mentioned these techniques are applied to joints that in weight bearing and thus the patient with spinal dysfunction is treated in a sitting or standing position.  NAGS are similar to the more traditional technique of joint mobilization utilizing an oscillatory force in attempt to increase the accessory motion of a joint. The SNAG is then applied to take the joint through full range of motion in a mechanically improved way such that mobility is maximized without producing pain. When performed correctly these techniques result in fast painfree improvement in spinal mobility. Each Mulligan technique is followed by instruction in a home exercise for the patient to perform in order to maintain or further the treatment effect.

Treating all the major peripheral joints

Mulligan has also developed techniques which are used to treat all the major peripheral joints. Clinical experience and scientific studies have shown high levels of success using these techniques for the treatment of lateral elbow pain (tennis elbow), shoulder disorders, hip restrictions, as well as injuries which result in loss of range of motion of ankles wrists and knees (1).

The basic technique is for the therapist to apply the corrective mobilization force to one of the joint partners while the joint is taken through the full range of motion and sustained with overpressure at the limit of the movement. Once again the technique is never performed in the presence of pain and is considered appropriate only if there is an immediate painfree increase in range of motion.

It should be mentioned that although these techniques are truly powerful and provide significant benefit for many of our patients, they are rarely used in isolation. For allour patients a detailed and thorough assessment must be performed in order to diagnose the pathology, identify all underlying causes and establish safety.

One of Symetrics’ many tools:

Our well trained and experienced physio will then priorize a treatment protocol which will utilize a combination of treatment tools. At SYMETRICS we have always believed in a manual therapy and exercise based approach. The Mulligan Concept is yet another tool which we employ in helping our patients achieve their optimal physical health and function.