Use of Mulligan Snags
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Transcript of Use of Mulligan Snags
Lumbar Facet Dysfunction & the Use of Mulligan’s SNAG Technique: A Case Report Bedard, R, Lazenby, T, Millspaugh, R & Geisler, P (2009). Athletic Training Education Program Department of Exercise and Sport Sciences
Background: 18 y. o., female collegiate volleyball player presented with
chronic low back pain x 4 yrs Prior treatment unsuccessful alleviating symptoms Impact landing increased low back pain
Physical Exam:
PTP over L. SI jt, sacrum, & L4-5 facets R. inominate anteriorly rotated Pain with trunk flex, ext, & combined ext/rot
movements bilaterally (+) Stork Standing Test bilaterally (-) SLR bilaterally (-) Radiculopathy bilaterally
Differential Diagnosis: Intervertebral disc lesion Facet sprain Spondylolysis Spondylolisthesis SI Joint Sprain Muscle strain/imbalance
Case Management: Initial Management:
Ice & IFC E-stim for pain management post activity Muscle Energy techniques to correct SI alignment issues Lumbopelvic core stability training & progression
Uniqueness: Use of a weight bearing manual mobilization technique that
incorporates movement, while the mobilization force is applied to restore facet joint mechanics
Conclusions: Applied mobilizations released entrapped meniscoid w/in the jt Once pain generator is released, normal function returns--> muscle spasms resolve
Facet jt dysfunctions respond well to the Mulligan SNAG technique
References: Mulligan, B. R. (2004). The Lumbar Spine. In Manual Therapy: "NAGS", "SNAGS", "MWMS" etc. (5th ed., pp. 42-53). Wellington, New Zealand: Plane View Services Ltd. (Original work published 1989)
Exelby, L. (2001, February). The Locked lumbar facet joint: intervention using mobilizations with movement. Manual Therapy, 6(2), 116-121. doi: 10.1054/math.2001.0394
SNAGs Performed in a Sitting Position
L4-5 Lumbar Spine Facet Joint
Facet Gliding with Spinal Movement
Facet Joint Function: To guide & limit movement of a spinal segment Lumbar spine facet joints:
Prevent significant rotation in the transverse plane Permit flexion & extension in the saggital plane Permit minimal lateral flexion
Mulligan’s Sustained Natural Apophyseal Glides (SNAGs):
Provide a sustained superior glide to the superior articular facet while patient moves through painful motion
Functional technique, as the facet is bearing weight Can be performed seated or standing Motion must be pain-free for technique to be successful
Facet Joint Injury Theories: Both theories may cause pain and reflex muscle spasms Entrapment Theory:
Joint meniscoid becomes trapped within the joint Extrapment Theory:
Joint meniscoid becomes trapped within the subcapsular space, pinched between the capsule and bony lip
Facet Joint Anatomy
Reassessment after 1 wk w/no Improvement: Suggested facet jt involvement Initiated SNAGs for L4-5 superior facet Muscle Energy & Core Stabilization Noted decrease in Sx & Pt. participated w/minimal pain Ice and e-stim post activity
Outcome: Pain-free AROM restored immediately w/mobilization Pt returned to play effectively w/decreased symptoms Sx managed for remainder of season utilizing technique coupled w/core strengthening w/TA emphasis