Mulligan's mobilization-with-movement, positional faults and pain relief: current concepts from a critical review of literature.

There are an increasing number of reports espousing the clinically beneficial effects of Mulligan's mobilization-with-movement (MWM) treatment techniques. The most frequent reported effect is that of an immediate and substantial pain reduction accompanied by improved function. Prompted by these dramatic effects are questions regarding the mechanism(s) of action that underpins MWM. It appears timely that a review of the current literature is performed to synthesize and evaluate claims of the effectiveness of MWM and speculation about the proposed mechanisms of action. This article provides an overview of the literature concerning the clinical efficacy, effects and putative mechanisms of action of the MWM approach in the treatment of musculoskeletal conditions. The literature regarding the mechanisms of action in both the biomechanical and pain science paradigms is covered herein by reviewing all available scientific evidence from laboratory-based studies. Limitations of reported studies and directions for further research are also considered.