Mobilizations are manual therapy techniques used by physical therapists to improve the movement of joints and soft tissues, reduce pain, and promote healing. The goal of joint mobilizations is to restore normal joint function, alleviate pain, and improve the range of motion, particularly in cases where joint stiffness or musculoskeletal dysfunction is present.

Two widely used types of mobilization techniques are Mulligan's Mobilization with Movement (MWM) and Sustained Natural Apophyseal Glides (SNAGs), both of which are part of a larger family of manual therapy techniques.

1. Mulligan's Mobilization with Movement (MWM)

Mulligan's MWM is a specialized manual therapy technique developed by New Zealand physiotherapist Brian Mulligan. The MWM technique involves applying a glide (mobilization) to a joint while the patient actively moves that joint through its range of motion. The idea is to combine passive manual therapy (the therapist’s intervention) with active movement by the patient, which facilitates improved movement patterns and reduces pain.

• How it works: The therapist applies a specific, sustained, and controlled glide (a gentle movement in a particular direction) to the joint while the patient actively moves the joint in the opposite direction. This combined movement often restores function and reduces pain by “unblocking” restricted movements or by facilitating a more normal range of motion.

• Indications for MWM:

  • Joint stiffness and pain (e.g., following injury, surgery, or from chronic conditions like osteoarthritis).
  • Limited range of motion in a joint.
  • Dysfunctional movement patterns causing pain or restriction.
  • Acute or subacute musculoskeletal conditions (such as sprains or strains).

• Example of MWM: A common example is the application of MWM to the shoulder joint. The therapist might apply a posteriorly directed glide to the shoulder joint while the patient actively abducts (raises) their arm. This can help improve shoulder mobility and reduce pain during overhead motions.

2. Sustained Natural Apophyseal Glides (SNAGs)

SNAGs are another manual therapy technique developed by Brian Mulligan. This technique involves applying a sustained glide to the spine or other joints while the patient actively moves the joint. The glide is applied in the direction of the joint’s natural movement or in a direction that reduces pain and improves function.

• How it works: The therapist applies a sustained, gentle traction or glide to the spine or peripheral joints. While the therapist applies the glide, the patient is instructed to move their body or the affected joint in a specific direction. The movement should be pain-free or less painful, and the glide is maintained throughout the movement to enhance joint mobility and decrease discomfort.

• Indications for SNAGs:

  • Spinal stiffness, particularly in the cervical (neck) or lumbar (low back) regions.
  • Headaches, dizziness, or pain from restricted neck movements.
  • Thoracic or lumbar spine dysfunction.
  • Pain and dysfunction due to posture imbalances or repetitive strain injuries.

• Example of SNAGs: One common use of SNAGs is to treat cervical (neck) pain. For example, the therapist may apply a lateral glide to the cervical spine while the patient rotates their head to the opposite side. This technique is often used to reduce pain and improve neck range of motion, particularly in cases of cervicogenic headaches or stiffness.

Key Principles of MWM and SNAGs:

• Active Movement with Passive Mobilization: Both MWM and SNAGs are characterized by the combination of active movement from the patient and passive mobilization from the therapist. This combination is thought to help the patient regain functional movement patterns while also improving joint mobility and reducing pain.

• Pain Reduction: The primary therapeutic aim of MWM and SNAGs is to reduce pain during movement. If pain is reduced during or immediately after the mobilization, it suggests that the technique is effective. Pain reduction often leads to improved function and better outcomes in rehabilitation.

• Immediate Results: Both techniques are often associated with immediate improvements in range of motion and reduction in pain. This makes them effective for acute musculoskeletal issues where rapid relief is needed.

Differences Between MWM and SNAGs:

• MWM (Mobilization with Movement): Typically applied to peripheral joints (like the shoulder, knee, or ankle). The therapist uses a glide in one direction while the patient actively moves the joint in the opposite direction to improve mobility and reduce pain.

• SNAGs (Sustained Natural Apophyseal Glides): Primarily used for spinal mobilization, particularly the cervical, thoracic, or lumbar spine. The therapist applies a sustained glide (traction or translation) to a spinal segment while the patient performs an active movement.

Other Mobilization Techniques (Related to MWM/SNAGs):

While MWM and SNAGs are highly effective and popular techniques, there are other joint mobilization techniques often used in clinical practice:

1. Grade I – IV Joint Mobilizations:

   • Grade I: Small amplitude oscillations or glides within the beginning range of movement. Used to reduce pain.
   • Grade II: Larger amplitude oscillations within the mid-range of movement. Used for pain relief and stretching.
   • Grade III: Larger amplitude oscillations into the end range of movement. Used to improve joint mobility.
   • Grade IV: Small amplitude oscillations at the end range of movement. Focuses on increasing range of motion and joint mobility.

   These grades are based on the Maitland classification system for joint mobilization. Grades I and II are generally used for pain relief, while Grades III and IV are used to increase mobility and restore normal joint function.

2. Grade V Mobilization (Manipulation):

   • A high-velocity, low-amplitude thrust technique (often referred to as a "manipulation"). This technique is applied at the end of the joint’s range of motion, typically with a quick, controlled thrust. It is often associated with chiropractic care but is also used by physical therapists in certain cases.

Benefits of MWM and SNAGs:

• Pain relief: Both techniques can provide immediate pain reduction, particularly in conditions involving joint stiffness or acute pain.
• Improved range of motion: By restoring normal movement patterns and reducing joint restriction, these techniques help increase the range of motion in a joint.
• Functional improvement: The combination of pain reduction and increased mobility can help patients return to normal activities and prevent long-term disability.
• Non-invasive: These techniques are gentle and typically cause little discomfort or risk when performed properly.

Summary:

• MWM (Mobilization with Movement) and SNAGs (Sustained Natural Apophyseal Glides) are specialized, effective manual therapy techniques developed by Brian Mulligan that combine joint mobilization with active patient movement to relieve pain, restore mobility, and improve function.
• MWM is typically used for peripheral joint issues, while SNAGs are often used for spinal conditions.
• Both techniques are widely used for treating conditions like joint stiffness, pain, and musculoskeletal dysfunction, with immediate results in many cases.