Manual therapy

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See also: Bodywork (alternative medicine)

 

Manual therapy, manipulative therapy, or manual & manipulative therapy is a physical treatment primarily used by physiotherapists, massage therapists, chiropractors, and osteopaths to treat musculoskeletal pain and disability; it most commonly includes kneading and manipulation of muscles, joint mobilization and joint manipulation.[1]

 

Definitions

Manual therapy may be defined differently (according to the profession describing it for legal purposes) to state what is permitted within a practitioners scope of practice. Within the physical therapy profession, manual therapy is defined as a clinical approach utilizing skilled, specific hands-on techniques, including but not limited to manipulation/mobilization, used by the physical therapist to diagnose and treat soft tissues and joint structures for the purpose of modulating pain; increasing range of motion (ROM); reducing or eliminating soft tissue inflammation; inducing relaxation; improving contractile and non-contractile tissue repair, extensibility, and/or stability; facilitating movement; and improving function.

A consensus study of US chiropractors [2] defined manual therapy as "Procedures by which the hands directly contact the body to treat the articulations and/or soft tissues."

Alternatively, Korr (1978) described manual therapy as the "Application of an accurately determined and specifically directed manual force to the body, in order to improve mobility in areas that are restricted; in joints, in connective tissues or in skeletal muscles."

Use

In Western Europe, North America and Australasia, manual therapy is usually practiced by members of specific health care professions (e.g. Chiropractors, Osteopaths, Osteopathic Physicians, Physiotherapists/Physical Therapists, and Physiatrists).[1] However, some lay practitioners (not members of a structured profession), such as bonesetters also provide some forms of manual therapy.

A survey released in May 2004 by the National Center for Complementary and Alternative Medicine focused on who used complementary and alternative medicine (CAM), what was used, and why it was used in the United States by adults age 18 years and over during 2002. According to this recent survey, manipulative therapy was the 3rd most commonly used NCCAM classification of CAM categories (10.9%) in the United States during 2002 ([1] table 4 on page 10) when all use of prayer was excluded. Consistent with previous studies, this study found that the majority of individuals (i.e., 54.9%) used CAM in conjunction with conventional medicine (page 6)

Information

A number of professional peer-reviewed journals specialize in the dissemination of information associated with manual therapy. The Journal of Manual and Manipulative Therapy, Manual Therapy, and the Journal of Manipulative and Physiological Therapeutics are PubMed indexed journals that have provided readers with useful research on manual therapy for over 15 years. Peer reviewed information has improved the quality of information that is provided to practicing clinicians and has dispelled a number of myths commonly associated with manual therapy.

 

Styles of manual therapy

There are many different styles of manual therapy. It is a fundamental feature of ayurvedic medicine, traditional Chinese medicine and some forms of New Age alternative medicine as well as being used by mainstream medical practitioners. In one form or another it is probably as old as human culture itself and is a feature to some degree of therapeutic interactions in traditional cultures around the world.

 

• Acupressure
• Anma
• Body work (alternative medicine)
• Bone setting
• Bowen Technique
• Chiropractic
• Cranio-sacral therapy
• Dorn method
• Joint manipulation
• Joint mobilization
• Spinal manipulation
• Spinal mobilization
• Massage therapy
• Manual lymphatic drainage
• Medical acupuncture
• Muscle energy technique
• Myofascial release(MFR)
  • Naprapathy
  • Osteopathic manipulative medicine
  • Polarity therapy
  • Rolfing Structural Integration
  • Seitai
  • Sotai
  • Shiatsu
  • Traction
  • Tui na

Pregnancy & Low Back Pain: They Go Together Like Pickles & Ice Cream

Ask any pregnant woman if her back hurts and the majority of them will scream “YES!!!!!”  Especially those who are further along in their pregnancy.  Pregnancy and low back pain seem to go together like pickles and ice cream.

So, what causes back pain during pregnancy?

It is usually caused by strain on the back muscles.  In mid-pregnancy, an expectant mom’s center of gravity changes.  In response to that, her posture changes.  Most women begin to lean backward in the later months of pregnancy, which makes their back muscles work harder.

Pregnancy hormones may contribute to back pain as well.  A hormone relaxes the ligaments in the strong, weight-bearing joints in the pelvis.  This loosening makes the joints more flexible, but it can cause back pain if the joints become too mobile.

What can a pregnant woman do to prevent back pain during pregnancy?

To help prevent or ease back pain, be aware of how you stand, sit, and move.  Here are some tips that may help:

▪   Wear low-heeled (but not flat) shoes with good arch support

▪   Ask for help when lifting heavy objects

▪   When standing for long periods, place one foot on a stool or box

▪   If your bed is too soft, have someone help you place a board between the mattress and box spring

▪   Do not bend over from the waist to pick things up – squat down, bend your knees, and keep your back straight

▪   Sit in chairs with good back support, or use a small pillow behind the low part of your back

▪   Try to sleep on your side with one or two pillows between your legs for support

▪   Exercise – walking, light weight-lifting, and water aerobics are safe to do for most pregnant women

What can a pregnant woman do to ease back pain?

Apply heat or cold to the painful area or massage it*.  If that doesn’t work, ask your OB/GYN to refer you to a Licensed Physical Therapist who has experience with pregnant women.   An experienced Physical Therapist can help an expectant mother do exercises that can help lessen backache.  Such exercises strengthen and stretch muscles that support the back and legs and promote good posture – keeping the muscles of the back, abdomen, hips, and upper body strong.

When should a pregnant woman contact her healthcare provider about back pain?

If you have severe pain, or if pain persists for more than 2 weeks, you should contact your healthcare provider.

*Massage Therapy should NOT be performed during the first trimester.

Sources:

August 2011: American College of Obstetricians & Gynecologists

Journal of Physical Activity and Health, 2011, 8 309-320.