Nags and Snags.pptx

Dpt

1. An Introduction To NAGS and SNAGS By Dr Ayesha Anwer Ali

2. Introduction about Brian Mulligan   Brian R. Mulligan qualified as a physiotherapist in 1954 and gained his diploma in Manipulative Therapy in 1974. He has been the author of numerous articled published in New Zealand Journal of Physiotherapy. He is also the author of two books: "Manual Therapy "NAGS","SNAGS", "MWMS ",etc' (2003) for Physiotherapists. 'Self Treatment for the Back, Neck and Limbs' for Public.

3. Mulligan manual therapy Articular techniques with additional neuromuscular effects Positional fault causing physiological restriction in joint Glide mobilization used along joint plane Reduction / elimination of symptoms guide treatment technique Many techniques are weight bearing

4. Techniques Names NAGS - Natural Apophyseal Glides. SNAGS - Sustained Natural Apophyseal Glides. MWMS - Mobilization with Movements. The concept of (MWM) of the extremities and SNAGS of the spine were first coined by Brian R. Mulligan.

5. NAGS Accessory movement force applied along facet joint plane C2-T3 levels Oscillation 2-3 / second Mid to end range Mild discomfort, never pain Antero-cranial direction (towards eyes)

6. NAGS to Cervical spine Stand side on to pt, stabilizing them with your trunk Reach around their head with your right hand, their head rests on your chest Hook little finger under spinous process below level to be treated Press your thenar eminence against your little finger Oscillate towards pt eyes

7. NAGS to Cervical spine

8. Reverse NAGS to upper Thoracic spine Stand side on to pt, stabilizing them with your trunk Reach around their head with your right hand, their head rests on your chest Hook little finger of right hand across vertebra above Use thumb pad & distal PIP as a ‘V’ shape to contact transverse process of articular pillar of vertebra below Oscillate towards pt eyes

9. Reverse NAGS to upper Thoracic spine

10. SNAGS Active patient, moving through symptomatic ROM Glide is held / sustained Used for C, T, L spine Sustained facet glide with movement Applied at end range, aim to increase pain free ROM Result should be instant and long lasting

11. Cervical rotation SNAGS Stand side on to pt, reaching across to contralateral neck Place side of thumb on spinous process supported by your other fingers Rest of hand alongside patients mandible to add slight traction Patients rotates head applying self overpressure for 2 secs Follow with pressure over spinous process towards eye

12. Cervical rotation SNAGS

13. Cervical side bend SNAGS Stand behind patient Place thumbs on spinous process or articular pillar Rest of hand alongside patients mandible to assist movement Patients side bends head applying self overpressure for 2 secs Follow with pressure over articular pillar directed towards eye

14. Cervical side bend SNAGS

15. Fist traction for C spine Perform on patient first to test reaction – pain should reduce Pt places fist under chin with little finger against top of sternum and hollow of curled 1st finger and thumb Reach behind head and grasp occiput in cupped hand Action is to draw scalp up and into flexion Sustained 10 sec hold & repeat

16. Fist traction for C spine

17. C ervical spine towel SNAG Test using SNAG of C2 on C1 Place edge of towel over C2 spinous process Draw towel forwards and upwards towards eye Active retraction against restraint of towel edge Especially good for cervicogenic headaches

18. C ervical spine towel SNAG