Technique Highlight: SLR with Traction

This technique is a favorite of mine. It is a Mulligan mobilization with movement, a LOT of movement! You have to choose your patient wisely and it's not for everyone. Naturally, Mulligan doesn't offer much in the way of explanation for why it works. I would say the dramatic improvements you see are neurologic inhibition of the hamstrings and hip flexors from firing type III mechanoreceptors. It could also be due to the ipsilateral lumbar gapping which improves nerve root mobility through the lateral foramen. As the rule goes with all Mulligan techniques, it is only indicated if it works and if it is 100% pain free (other than stretch).

Indications:

• limited SLR
• "tight" hamstrings
• sciatic peripheral neuropathic pain (careful not to peripheralize or worsen the complaints)

The rapid improvement you see on this patient is obviously neurologic. Especially as it rapidly changes both sides, but to a lesser extent on the contralateral or non-treated side. We know from histology studies that even a constant stretch over several days does not grow new sarcomeres, which is the only way a muscle gains more length. You could also be stretching type III collagen found in connective tissue and capsule, which is more easily deformed with force than the more organized type I collagen. 

Recommended follow up treatments

• IASTM to hamstrings, hip flexors
• psoas release
• hip mobilizations
• HEP to maintain improvements

By itself, the improvement from the technique will probably only last 10-30 minutes. Other treatments, plus HEP are needed to maintain lasting improvement!