Brian Mulligan is a name that needs no introduction to physiotherapists across the globe. His concept of mobilisation with movement (MWMS) in the extremities and sustained natural apophyseal glides (SNAGS) in the spine have progressed physical therapist-applied passive physological movements and accessory techniques in the treatment of musculoskeletal injuries. No.we didn't travel to New zealand to do the interview but were able to connect with brian through email, where he shared some of the less known facts about his extra-ordinary journey of life and his road to fame. Presented are the excerpts from the email interview taken by Mukesh nayak, Director, PHYSIOTIMES.
Brian Mulligan is a registered physical therapist who lives in wellington, New zealand. He has been on the international lecture circuit since 1972. He has taught in the USA (over 85 cities) as well as UK, Australia, Netherland, Germany, Ireland, Malta, Sweden, Singapore, UAE, Italy, Canada, Switzerland and India. He is a honorary teaching fellow of otago University.
For his service to the physiotherapy profession in New zealand Brian Mulligan was made an "Honorary Fellow of the New Zealand Society of Physiotherapists" in 1996. The "World Confederation for physical Therapy" Presented him with an International service Award in 2007 in recognition for his exceptional contribution to physical therapy. You can visit the website www.bmulligan.com to know more.
1) To start with, please tell our readers something about Brian Mulligan, the person.
I have been happily married to a wonderfully supportive wife for over 50 years. We have two daughters, one son, five granddaughters and one grandson. I have been blessed with excellent health which I attribute to having by CHANCE become a physiotherapist resulting in what has proved to be a most rewarding and exciting career.
2) How did you come in the profession of physical therapy?
At college my desire was to join the army but this option was not possible because I was slightly short sighted. I then joined a large company and began to study commerce at University. I soon realised that a career behind a desk was not for me. By sheer chance I met an old school friend who told me he was leaving Wellington (my city) the next day for Dunedin where he would study to be a Physiotherapist. I asked him what was physiotherapy all about. He told me enough about this new career to make me find out more. I did and a year later began my studies. Physiotherapy was really in its infancy compared to today and there was so much learn. New Zealand being so far away from the rest of the world made us want to travel and seek ways to become better therapists. Yes I became involved in the musculoskeletal field and as the years passed learned by attending courses run by my mentors like Freddy Kaltenborn to mobilise and manipulate the joints of the body.
Stanley Paris’s role in the early days was invaluable. In New Zealand a group of us founded the NZ Manipulative Physiotherapists’ Assn about 41 years ago. This group included R McKenzie, Ian Searle (many years secretary of IFOMT) Ace Neame and others. We soon became responsible for running post graduate programs in manual therapy and in the early years I was director of education and responsible for teaching all the extremity joint techniques. We had a syllabus to cover and as years passed I found myself teaching many techniques with enthusiasm and other with less and less. My lack of total enthusiasm was due to the fact that I did not always get the expected results with real patients. I could justify techniques biomechanically but why did they not always work?
3) When and how did you get the idea about the Mulligan concept and how it evolved from a one person technique to a globally acclaimed practice?
My first “miracle”. The year was 1985. A young woman came to see me in my practice with a painful grossly swollen proximal inter-phalangeal joint which would not bend. She injured her finger playing basketball. After some ultra-sound I applied a sustained traction technique several times. No change. I then applied a ventral glide to the joint’s distal facet as this was the direction that the facet would move when flexed. Several uncomfortable repetitions produced no change. Bother, I was frustrated. I then tried gently to glide her joint medially. Very painful. As a last resort I glided the appropriate facet laterally. She made the comment that it was not painful. By CHANCE I asked her to bend her finger while I was sustaining the glide. It started to bend and she was experiencing no pain. Wow! She returned her finger to the starting position while I still maintained the translation. We did several repetitions. She left my rooms with a functional finger. Two days later she came to see me. Most of the swelling had gone. She was experiencing no pain with movement.
Years ago Louis Pasteur said that “in the field of discovery CHANCE only favors the prepared mind.”
I can assure the reader that I had a prepared mind. After restless nights and days of thought the only explanation for my success was, to me , that the injury to the girls finger had resulted in a minor positional fault. When corrected no pain was felt and if the correction was sustained painless function would again be possible. Yes this was the birth of “Mobilisations with Movement” (MWMs). It took many years but I found ways to apply MWMs to all parts on the musculoskeletal system. It changed my professional life and today gives me immense satisfaction to know that literally thousands and thousands of patients around the world are better off because of the outcomes we are getting from correctly applied MWMs. Not to be able to apply MWMs may be denying patients their best treatment option because we have mounting supportive evidence.
4) How do you view the Mulligan concept vis-à-vis the other manual therapy concepts like Mackenzie, Maitland, and Cyriax etc.
When lecturing I always acknowledge the contributions made to my knowledge and effectiveness as a therapist by Freddy Kaltenborn, Robin McKenzie, Geoff Maitland, James Cyriax and others.I and my teachers now teach the clear indications we have for the use of MWMs as a treatment. When they are not appropriate one should have available treatment options. Thus the acknowledgement of the people above.
5) What was the thought behind establishing the Mulligan Concept Teachers Association (MCTA)?
The participant satisfaction from my courses was such that the demand for courses grew so rapidly that I had to have teachers to teach my concepts. In 1995, I met in the UK with 7 colleagues who had post-graduate qualifications in manual therapy and after learning from me were teaching my concepts. We all realised the need to promote the concepts internationally and the need to have teachers of the highest standard. To ensure this we set up the MCTA (Mulligan Concept Teachers Assn.) to accredit teachers, promote research and develop even further the concepts. Today we have 48 teachers.
6) There is a growing network of Accredited Mulligan Practitioners worldwide. What are the critical attributes required to become a successful CMP?
I personally get requests from patients around the world who have heard of our approach and ask to whom they could go for treatment. Up till now this has been an impossible question to answer. We all know that just because you have done a course with someone does not make you an expert. Today we offer an exam to become a CMP (Certified Mulligan Practitioner). To be accredited you must have done all the courses and a pass written and practical exam. Those who pass are listed on our webpage. www.bmulligan.com. Numbers are growing and I can refer patients who approach me to my webpage.
7) You wrote your first textbook on your techniques in 1999 and it is now in its 6th edition. What are the new things being covered up in the latest edition?
This year the 6th edition of my book became available. It has new material including revised text, clear indications for the use of MWMs and technical information. New techniques for the hip area and headaches are within and references have been updated.
8) You have also written the book "Self Treatments for the Back, Neck and Limbs.” for patients. What inspired you to write this book?
I wrote the book, Self Treatments for the Back Neck and Limbs in 1995. My patients wanted me to write this. It is now in its second edition. It is for the public to make them aware of our concepts. It contains useful advice on self treatments. It suggests that the reader should seek therapists who are able to use our concepts. Therapists can buy this book at wholesale prices to retail to their patients.
9) You have extensively travelled across the world. Do you do so even now? How do you manage to get these energy levels at this age?
My days of running courses are virtually over. My capable teachers now fill this role. These days I am on a lecture circuit where I speak on the concepts. These are not workshops for those attending. I demonstrate and treat patients. In the USA I share the podium with a fantastic rehabilitation therapist Kevin Wilk. My role is to inspire those present to undertake the courses that are available. All the patients that I treat are filmed for our archives. We have some amazing footage.
Yes I am in my late 70’s and still love talking about and showing what I can do with the concepts. When speaking I get high levels of adrenalin because of my enthusiasm to share knowledge. What good fortune. This level of involvement keeps me “young”. One of the drawbacks to lecturing overseas is the distances one has to travel. My promoters look after me by having me travel first class.
10) You had visited India in 2006. How was the experience? Any plans of visiting India in the near future?
My wife Dawn and I visited India In 2006 at the invitation of Deepak Kumar to teach and speak at an international conference. What a memorable, incredible experience that was. The enthusiasm of all the therapists that we met was astonishing. We were treated like royalty and had the additional pleasure of seeing many of the tourist attractions that India is noted for . We would love to return to India but alas time is running out.
11) How has been your experience working with Deepak Kumar, the only Accredited Mulligan concept teacher from India? What are your views on him as a practitioner and a teacher?
Deepak, I regard as a good friend and respected colleague. He has worked extremely hard to get the concepts taught in India. He is highly intelligent, with excellent handling skills and boundless energy. He is totally committed to the concepts and we are lucky to have him as one of our teachers.
12) You love outdoors. What are your favourite pass times?
I love the outdoors and enjoy golf. My favourite spectator sport is cricket in all its forms which would also be the love of many in India.
13) You hold a private pilot license. Do you regret not being able to fly due to your professional commitments?
My days of flying are long over but I often would like to again be at the controls of a plane. A couple of years ago I spent an hour in a Boeing 737 flight simulator. Great fun. I have a 20 year old grandson who has just got his commercial pilot’s license. He has just started out as a pilot flying planes over game farm reserves in Africa looking for poachers. I can live my flying dream through him.
14) Today, Brian Mulligan is not just the name of an individual but a concept followed world-wide by physical therapists to help relieve pain and gain mobility. Looking back at the hard work all these years, how do you feel?
I look back on my life with unbelievable satisfaction and humility. I am only an ordinary guy who had the good fortune to by chance become a physiotherapist and by chance develop a new manual therapy concept due to a prepared mind. This is a professional interview but I must mention my wife and family who have enriched my life. Their love and support have driven me to do better.
15) What are the future plans and how do you intend to take the legacy of Mulligan concept further?
My future plans are to travel and speak until I am 80 years. My role is to support my teachers and encourage them to take on a greater research role. I know that much research is in the pipe line supporting our concepts and I am looking forward to the publication of the results.
16) How does a typical day of Brian Mulligan passes by currently?
A typical day for me now is to deal with emails, run my publishing company, gardening, find time for playing my piano, fine tuning lectures and playing as much golf as time and weather permits.
17) What would be your words of wisdom to our young physios in India?
To the younger members of our profession I would say. Work hard and update your skills and knowledge, always keep a prepared mind and have time for fun. Never forget that your aim is to get you patients better as quickly as possible and like me be proud of your profession.