The Efficacy of the Mulligan Concept to Treat Meniscal Pathology: A Systematic Review.
Nathan C Reep, Sydney N Leverett, Rebecca M Heywood and 3 others
PMID 36518834WHAT IT FOUND
Six small studies, mostly case reports, found that Mulligan mobilizations reduced pain and improved function in people with clinically diagnosed meniscal injuries.
The evidence is weak, lacks long-term follow-up, and does not prove these techniques work better than standard care.
Key findings
01All six included studies reported decreases in pain that were either statistically significant or met the minimal clinically important difference.
02Patient-reported improvement in function was found on the Patient-Specific Functional Scale in all six studies, with results either statistically significant or meeting the MCID.
03The quality of evidence is limited because only two randomized controlled trials were identified, while case reports and case series made up two-thirds of the studies.
STILL TO COME
How it was doneWhat they foundWhat it means for PTs
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What it does not show
The evidence base is very weak, with four of the six studies being case series or case reports without control groups. The two randomized controlled trials had low methodological quality scores (PEDro 4 and 6). There was no long-term follow-up in the RCTs, so it is unknown if the benefits last or if the treatment prevents further joint damage. The studies included young, physically active participants, so results may not apply to older adults or those with other knee pathologies. Heterogeneity in treatment protocols and outcome measures prevented a meta-analysis.
Declared interests
The authors searched the Mulligan Concept website for studies, which identified one additional paper. No other specific conflicts of interest or funding sources were declared in the text.
The easy way to misread this
Do not interpret the positive results as proof that Mulligan techniques are superior to standard care. The majority of the evidence comes from case reports and series without control groups, and the two RCTs had low methodological quality and inconsistent results regarding statistical significance compared to sham or control treatments.