Manual therapy

Manual therapy is a skilled, specific hands-on approach used by physical therapists to diagnose and treat soft tissues and joint structures for the purpose of reducing pain, improving joint range and alignment, improving contractile and non-contractile tissue repair, extensibility and stability and facilitating function. Thus, manual therapy means to heal or treat with hands.

The techniques applied are:

1. To soft tissues:

  • Muscle energy techniques (MET)
  • Myofascial release techniques  (MFR)
  • Cranio-sacral techniques

2. To joints:

  • Mobilisation- A low velocity and high amplitude multidirectional movement within physiological range.
  • Manipulation- A unidirectional high velocity and low amplitude thrust beyond physiological limits within anatomical range.

(The amount of force applied depends on the form of technique used and on the age and condition of the patient. The goal of the treatment is to relieve pain and improve physical functioning.)

CONCEPTS OF MANUAL THERAPY

    • CYRIAX : This concept states that orthopaedic medicine was founded upon the structural (anatomical or morphological) disturbances of the neuromusculoskeletal  system. In 1960, he envisaged derangements of the intervertebral disks as the primary spinal pathology to account for the vast majority of mechanical back pain and nerve root pain. According to him, the vast majority of spinal derangements were due to annular disc tear, nuclear disc prolapse and dural tension as the pathologies.
    • McKENZIE : According to robin McKENZIE, the disabling and recurrent disorders that affect the spine can produce disability and mental anguish in all who experience the problem. It is estimated over 80% of the world’s population will at some stage of their lives develop atleast one episode of severe back pain necessitating bed rest. In late 1970s, he gave the concept of spinal extension exercises for the treatment of low back pain. He felt the centralization of the pain or symptoms often follows repetitive motion due to reducing disc protrusions. He focused mainly on posture, dysfunction and derangement syndromes. He further stated that the posterior bulging of the disk was aggravated by flexion (Forward Bending) due to hydrodynamics of the disk which was compressed anteriorly (Forward) by the vertebral bodies. He felt that extension (Backward Bending) hence compressed the posterior (backwards) elements, which minimised the risk of disk moving further posterior towards the pain sensitive structures.
    • MULLIGAN: in 1990s, Brian mulligan developed the concept of mobilization with movement (MWM), sustained neutral apophyseal glide (SNAG). According to him, the notion that applying manipulative pressure to the joint or soft tissue during the performance of an active movement will greatly facilitate its return to normal function.
    • MAITLAND: G.D  MAITLAND in 1964 published vertebral manipulation, in which he defined the art of the oscillatory manipulation and used it almost exclusively to treat “reproducible signs”. His main focus was to improve articular mobility.
    • OSTEOPATHY : Andrew Taylor Still founded osteopathic medicine in 1874. He focussed mainly on restricted joints. He theorised that as long as a joint was restricted due to mechanical locking or other related causes were normalised, it favoured congestion and diminished arterial blood flow to the area. This deprived the muscle, ligament, nerve and the artery of nourishment leading to disease. He believed that the body has within itself the power to control all diseases. He also considered that anatomical lesions caused physiological malfunction. Thus, he briefly stated that the body is a unit and the structure and function are reciprocally interrelated. The body possess self-regulatory mechanisms for rational therapies based on and understanding of body unity, self-regulatory mechanisms, and the interrelation of structure and function.
    • CHIROPRACTIC TECHNIQUES: founded by Janes, Wells, and Houser stated that the vertebra may become subluxated (partially dislocated) which tends to impinge other structures passing through intervertebral foramina resulting in impairment of the function of the nerve impulse due to the interference with the function of the corresponding segment of the spinal cord and its connecting spinal and autonomic nerves. Thus, the innervation to certain parts of the organism is abnormally altered and such parts become functionally diseased. That adjustment of the subluxated vertebra removes the impingement of the structure passing through the intervertebral foramina, thereby restoring to diseased parts their normal innervation and rehabilitating them functionally and organically.

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