A link to an interview with Brian Mulligan was posted yesterday over at the Chartered Society of Physiotherapy website:
Interviewed by physiotherapist and founder of PhysioUK, Chris Murphy, Mr Mulligan outlined his approach of the Mulligan concept and its importance as a means of combating musculoskeletal (MSK) pain and dysfunction.
He pointed out that when joint surfaces were out of place their movements were often disrupted and painful. Repositioning can remove this pain and restore normal movement at once.
He also expressed frustration about his perception that many physios concentrate exclusively on using exercise therapy for MSK problems.
A full transcript of the interview is available on the PhsioUK website. Here are some exceprts from the interview transcript:
Chris Murphy: Evidence-based medicine. What are your thoughts towards those that say we shouldn’t be doing manual therapy when no robust evidence base exists?
Brian Mulligan: We’ve got robust evidence, so that’s okay. The first article on a manual physiotherapy procedure to get into the British Medical Journal, was on tennis elbow where they compared our mobilisations with movement treatment with steroid injections. And it made the medical journal because at the end of one year when all the patients were reassessed, those that had injections had had a reoccurrence, and not one patient that had our procedures had a reoccurrence. And on those grounds it made the BMJ. (Bisset, L (2006) Mobilisation with movement and exercise, corticosteroid injection, or wait and see for tennis elbow: randomised trial. British Medical Journal. doi:10.1136/bmj.38961.584653.AE)
The full Bisset et al (2006) paper is available open access here. It’s worth a read in light of the statement above, particularly this section “Physiotherapy performed significantly better than wait and see at six weeks for all outcome measures… However, by 52 weeks no difference existed on any primary outcome measure, as most participants had either much improved or completely recovered (wait and see 56/62; physiotherapy 59/63)… Recurrences after injection [47/65 (72%)] were significantly greater than recurrences after physiotherapy (5/66) or wait and see (6/67), which were not significantly different from each other”
Chris Murphy: So with that, just a couple of points that you said there. Over time, obviously with regards to the ankles you talked about the positional fault there. Over time have your thoughts changed about how the techniques you’ve developed work?
Brian Mulligan: Well yes, of course I have. I reposition the joint, and the moment you reposition it, people who’ve got painful with planter flexion and inversion following an ankle sprain, it’s gone. But what we’re achieving with ankles, we’ve got no equal. It’ll all come out in time, and it’s got to because ankle reoccurrences are disgusting. You can damage any other ligament in the body, when it heals it never goes again. And yet the ankle keeps going. And no-one… one surgeon said oh that’s rubbish, I’ve seen that’s the ligament. So he was an idiot.
Chris Murphy: And how else do you respond to those that say what you do is a placebo?
Reading the interview transcript, reading Brian Mulligan speaking in those ‘beautiful absolutes’ I couldn’t help but be reminded of a beat poet.
*The tile of this post was borrowed from Howl, written by Allen Ginsberg.