This accessory glide must itself be pain free. The therapist must continuously monitor the patients reaction to ensure no pain is recreated. While sustaining the accessory glide, the patient is requested to perform the comparable sign. Failure to improve the comparable sign would indicate that the therapist has not found the correct treatment plane, grade of mobilization, spinal segment or that the technique is not indicated. Further gains are expected with repetition during a treatment session particularly when pain-free overpressure is applied.
Pain is always the guide.
Successful MWM techniques should render the comparable sign painless while significantly improving function during the application of the technique. Sustained improvements are necessary to justify ongoing intervention. In the cervical spine, Mulligan describes an occilatory mid to end range manual therapy technique performed in seated weight bearing. Their application is well described by Mulligan and therapists using these this technique find excellent results in both the mid and lower cervical as well as upper thoracic spine. NAGS provide the therapist with an opportunity to both assess and treat the patient in the closed kinetic chain weight bearing position where most patients experience their symptoms.