What is Manual therapy
The International Federation of Orthopaedic Manipulative Physical Therapists defines manual therapy techniques as:
“Skilled hand movements intended to produce any or all of the following effects: improve tissue extensibility; increase range of motion of the joint complex; mobilize or manipulate soft tissues and joints; induce relaxation; change muscle function; modulate pain; and reduce soft tissue swelling, inflammation or movement restriction.”
According to the American Academy of Orthopaedic Manual Physical Therapists Description of Advanced Specialty Practice, orthopedic manual physical therapy is defined as any “hands-on” treatment provided by the physical therapist.
Treatment may include moving joints in specific directions and at different speeds to regain movement (joint mobilization and manipulation), muscle stretching, passive movements of the affected body part, or having the patient move the body part against the therapist’s resistance to improve muscle activation and timing.
Selected specific soft tissue techniques may also be used to improve the mobility and function of tissue and muscles.”
Three Paradigms for Manual Therapy Therapeutic Effects:
1. Physiological: positive placebo response
2. Biomechanical and Physical: facilitates repair and tissue modeling
3. Psychological: pain relief via- stimulates gating mechanism; muscle inhibition; reduction of nociceptive activity; reduced intraarticular or periarticular pressure
Techniques Include:
• Traction
• Massage
• Trigger point therapy
• Active release technique
• Assisted Active Range of motion
• Passive Range of motion
• Lymph drainage
• Stretches
• Instrumental assisted soft tissue mobilization
• Joint Manipulation
• Joint Mobilisation
• Trans-anal/trans-vaginal massage/manipulations
• Intraoral manipulations
Manual therapy can include:
• Chiropractic
• Kinesiotherapy
• Massage
• Myofascial release
• Osteopathy
• Tendon-ligament gymnastics
• Stretching
etc.
Guide to Grading of Mobilisations/Manipulations
Maitland Joint Mobilization Grading Scale:
Grade I – Small amplitude rhythmic oscillating mobilization in the early range of movement
Grade II – Large amplitude rhythmic oscillating mobilization in the midrange of movement
Grade III – Large amplitude rhythmic oscillating mobilization to the point of limitation in range of movement
Grade IV – Small amplitude rhythmic oscillating mobilization at the end of the available range of movement
Grade V (Thrust Manipulation) – Small amplitude, quick thrust at the end of the possible range of movement
Kaltenborn Traction Grading Scale:
Grade I – Neutralises joint pressure without separation of joint surfaces
Grade II – Separates articulating surfaces, taking up the slack or eliminating play within the joint capsule
Grade III – Stretching of soft tissue surrounding joint
Contraindications to Manual Therapy:
• Neurological disease-causing potential cord compression Eg. Syringomyelia
• Myelopathy (eg.acute spinal injury, Myelitis)
• Cauda equina syndrome
• Osteoporosis
• Some surgical interventions
• Psycho-emotional excited state
• Marked hypermobility and severe Instability
• Spinal Stenosis
• Local malignancy
• Local infection
• Fracture
• Vertebral artery vascular compromise
• Inflammatory Processes
• Destructive Processes Eg. tumor or metastatic spread
If elicited through history, further workup is necessary. It should include the appropriate laboratory tests, radiographs, as well as CT scans and bone scans, MRI, etc., depending on the individual clinical situation.
