Brian Mulligan’s concept of mobilizations with movement (MWMS) in the extremities and
sustained natural apophyseal glides (SNAGS) in the spine are the logical continuance of this evolution with the concurrent application of both therapist applied accessory and patient-generated active physiological movements.

Brian and six of his original USA MCTA teachers will guide you through the specific application
of MWM and SNAGS in clinical practice, the following basic principles that have been developed:

• During the assessment, the therapist will identify one or more comparable signs as described by Maitland. These signs may be a loss of joint movement, pain associated with movement, or pain associated with specific functional activities (i.e., lateral elbow pain with resisted wrist extension, adverse neural tension).
• A passive accessory joint mobilization is applied following the principles of Kaltenborn (i.e., parallel or perpendicular to the joint plane). This accessory glide must itself be pain-free.
• The therapist must continuously monitor the patient’s reaction to ensure no pain is recreated. Utilizing his/her knowledge of joint arthrology, a well-developed sense of tissue tension and clinical reasoning, the therapist investigates various combinations of parallel or perpendicular glides to find the correct treatment plane and grade of movement.
• While sustaining the accessory glide, the patient is requested to perform the comparable sign. The comparable sign should now be significantly improved (i.e., increased range of motion, and a significantly decreased or better yet, absence of the original pain).
• Failure to improve the comparable sign would indicate that the therapist has not found the correct contact point, treatment plane, grade or direction of mobilization, spinal segment or that the technique is not indicated.
• The previously restricted and/or painful motion or activity is repeated by the patient while the therapist continues to maintain the appropriate accessory glide. Further gains are expected with repetition during a treatment session typically involving three sets of ten repetitions.
• Further gains may be realized through the application of passive over-pressure at the 
• end of the available range. It is expected that this over-pressure is again, pain-free.