Mulligan Taping

Original Editor - Naomi O'Reilly

Top Contributors - Yvonne Yap, Naomi O'Reilly and Wanda van Niekerk

Introduction

Mulligan Concept was initially developed by Brian Mulligan from New Zealand. It is now recognized world wide in manual therapy approaches. His concept of Mobilization with Movement (MWM) is the application of manually applied accessory joint glide with concomitant pain free active movement.

During the development of MWMs, Mulligan discovered that tape was a good tool in sustaining the positional changes in the joint, and also to compliment the directional forces provided after the MWM treatment. The tape is usually applied in the direction of the pain-free joint glide for the patient as an adjunct to manual therapy.

Taping can be used as part of the treatment and may be used for a week or two while the joint mobilizations are applied still during therapy or whilst following a prescribed home exercise program.

Principles

Type of tape utilized

Rigid tape is commonly used in Mulligan taping as it sustains the joint glides better mechanically. Kinesiotape has also been used in the same manner, with 100% stretch. The usage of kinesiotape might be preferable in active users as the elastic nature of the tape and composition of more waterproof materials may lead to increased comfort.

Common uses of Mulligan tape

Mulligan taping is used more commonly in peripheral joints.

Joint Common directions of taping Movement or pain improved
Elbow
  • Elbow joint lateral glide tape
  • Proximal radius posterior-anterior tape
  • Medial or lateral olecranon tilt
  • Elbow flexion or extension
Wrist and hand
  • Posterior-anterior ulnar glide of inferior radioulnar joint
  • Carpal medial or lateral glide, internal or external rotation
  • Internal or external rotation of metacarpo-phalangeal joint
  • Pronation or supination
  • Flexion or extension of elbow or finger
Sacroiliac
  • Anterior or posterior glide (with or without rotation) of innominate on sacrum
  • Pelvis or trunk movement
Knee*
  • Tibial internal rotation
  • Usually in non-specific knee pain
Ankle
  • Fibula repositioning,anterior glide of fibula on tibia
  • Heel taping: calcaneus medial or lateral rotation on tibia
  • Navicular or cuneiform dorsal or ventral glide
  • Metatarsal on cuboid dorsal or ventral glide
  • 1st metatarso-phalangeal joint medial or lateral rotation
  • Lateral ankle pain
  • Plantar heel pain
  • Medial foot pain
  • Lateral foot pain
  • Big toe pain

*Mulligan patellofemoral taping differs from McConnell taping of the knee. It is thought to improve the alignment of the tibia and femur, and decreases Q angle and patella displacement and used in non-specific knee pain (PFPS), only if the patient has knee pain relieved by tibia-femoral internal rotation MWM.

Precautions

  • Check with patient for skin allergies before application
  • Warn patient about potential skin irritation and to remove tape if allergies arise (skin itch, burning or other sensations). Some patient might not be sentitive to kinesiotape, which can be a substitute to rigid tape
  • Apply two layers of tape in the same location, with equal tension on both layers for maximum effect
  • Ensure that the tape does not restrict the blood and nerve supply to the extremities such as fingers or toes
  • Check circulation to the fingernail beds after taping, and caution patient to remove tape at any adverse signs and symptoms

Evidence for Mulligan Taping

As with most taping techniques, the evidence is conflicting. There has only been a few randomised control trials investigating the effects of Mulligan taping.

Mulligan taping has been shown to be effective at reducing pain in PFPS[1], improving balance and gait in subacute stroke patients[2]. In healthy subjects, Mulligan ankle taping (fibular repositioning taping) seems to have a role in prevention of ankle sprains[3] but did not have an immediate effect in improving balance in healthy subjects.[4] In chronic ankle instability[5], there was no difference between Mulligan taping and placebo taping.

References

  1. Hickey A, Hopper D, Hall T, Wild CY. The effect of the Mulligan knee taping technique on patellofemoral pain and lower limb biomechanics. The American journal of sports medicine. 2016 May 1;44(5):1179-85.
  2. Hyun KH, Cho HY, Lim CG. The effect of knee joint Mulligan taping on balance and gait in subacute stroke patients. Journal of physical therapy science. 2015 Nov;27(11):3545.
  3. K.R. Moiler, T.M. Hall and K.W. Robinson, (Curtin University of Technology, Perth, Australia), "The Role of Mulligan Fibular Repositioning Tape in the Prevention of Ankle injury in Basketball." The Journal of orthopaedic and Sports Physical Therapy, Vol. 36 (9), p: 661-8, 2006.
  4. de-la-Morena, J. M. D., Alguacil-Diego, I. M., Molina-Rueda, F., Ramiro-González, M., Villafañe, J. H., & Fernández-Carnero, J. (2015). The Mulligan ankle taping does not affect balance performance in healthy subjects: a prospective, randomized blinded trial. Journal of Physical Therapy Science27(5), 1597–1602.
  5. Alves Y, Ribeiro F and Silva AG. Effect of fibular repositioning taping in adult basketball players with chronic ankle instability: a randomized, placebo-controlled, crossover trial. J Sports Med Phys Fitness 2017 Jul 05.