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

Information about Musculoskeletal Disorders

Physiotherapy is clinically effective and cost effective in the management and treatment of musculoskeletal disorders (MSD). MSDs are on

Physiotherapy

Early intervention with physiotherapy can reduce the amount of time people are off sick and are vital in order to prevent an acute problem becoming chronic.

Two government departments in Northern Ireland provided early access to physiotherapy for staff
with musculoskeletal disorders. 80 per cent indicated that physiotherapy had prevented them from going absent and, of those already off sick, over 80 per cent indicated that physiotherapy had shortened their absence. Respondents indicated that the service shortened their absence by an average of six weeks.(1)

West Suffolk hospital trust, Bury St Edmunds, was commended in the Boorman report for having achieved savings of £170,000 through a system of priority referrals to a local Physio for injured staff. For a cost of £21,000 it had achieved a 40 per cent reduction in lost days through sickness absence and savings of £170,000 in the cost of MSDs.

Based on the latest available statistics from the HSE (3) 227,000 people have an MSD of the back, 215,000 of the upper limbs or neck and 96,000 of the lower limbs. Low back pain is the number one cause of long term absence amongst manual workers and MSDs are the most common reason for repeat consultations with GPs, accounting

For up to 30 per cent of primary care consultations.

Self referral

Self-referral to physiotherapy has been proven to be clinically successful with high patient satisfaction as well as cost effective. The self referral pilots that took place across six
NHS England sites between 2006 and 2008 were found to reduce the number of associated NHS
costs, particularly for investigations and prescribing, with 75 per cent of patients who self referred not requiring a prescription for medicines. In addition
there was no increase in demand for services and self-referral reduced work absence amongst patients.

An analysis of self-referral in Scotland found that the average cost of an episode of care was established as £95.48 for a self-referral, £113.24 for a GP-suggested referral and £126.17 for a GP referral. The average cost benefit to NHS Scotland of self-referral was identified as being approximately £2.5 million per annum.

Doncaster and Bassetlaw Trust piloted a successful self-referral Physio service for 6500 staff in
2005. The service was

Made permanent after
an evaluation identified
potential savings of more
than £330,000. It is
used by employees from
all corners of the trust,
and it offers an average
waiting time of 2.8 days.
More than half the users say
they would have taken time off
work if the service were not available.

In Cambridge, self-referral for MSD outpatient services has reduced costs due to less GP use of prescribing and diagnostic tests. 75 per cent of patients who self- referred did not require a prescription for medicines, giving an average saving of £12,000 per GP practice.

Telephone assessment and support

Assessing the severity of a patient’s condition over
the telephone has been found to be very resource efficient. This telephone triage saves patient and physiotherapist time as well as costs and ensures those needing the most urgent treatment are prioritized.

Where appropriate, follow up support by telephone has also been found to be a clinically and cost effective way of enabling patients to self manage their condition, helping to prevent relapses.

An occupational health physiotherapy service used telephone triage and follow up support as part of a program to tackle MSDs experienced by staff of NHS Lothian. Over £300,000 was saved in salaries alone by reducing sickness absence and there was a 74 per cent reduction in recurrence of MSDs nine months following the program

Conclusion

Speedy Access to physiotherapy for people with MSDs is clinically and cost effective for the health service, including GPs, for employers and for society. Physiotherapist has helped to pioneer innovative ways of providing speedy access within existing services.

Pregnancy and Back Pain

PREGNANT WOMAN WITH BACK PAINS: CAN YOU AVOID IT?

Many factors predispose the pregnant woman to back pains.  In fact, we know that 70% of the population will come across back pains in their life.  However, even with the predisposing factors, it is possible to go through a pregnancy with a healthy back.  

Some good and practical advice from your physiotherapist can help prevent this problem.

Many changes disrupt a woman during pregnancy.  

For example, the weight of the stomach shifts the gravity centre of the body towards the front, creating the abdominal muscles to release and  the pelvis to tilt provoking a larger lumbar curve (lower back).  This makes the back rounder at the thorax level as well as the chin point towards the front.



On top of all the biomechanical and postural changes, the pregnant woman’s ligaments release with the secretion of a particular pregnancy hormone called relaxin.  The secretion of this hormone increases during the first two trimesters of the pregnancy only to slowly die down until the end.

The releasing of the ligaments is at its peak during the 7th month.  

Result?

The joints of the pelvis and spine become slightly hypermobile and therefore more vulnerable to trauma and pain.

If the woman is not careful, she could suffer from articular pain towards the 6th month of her pregnancy.  

The pain will be more apparent if she is sitting or standing too long, if she is forcing to lift something while turning or simply walking.  

We will observe a waddle in the walk of the pregnant woman.  We must also mention the fact that women with pre-existing back problems should be twice as careful.



What should you do? 

Prevention



Here are some tips from your physiotherapist:

            

            Avoid staying seated or standing too long;

            Avoid wearing high heels (they increase the lumbar curve);

            Adopt a good posture.


To check or correct the posture, do the following exercise:



Standing, back against the wall, feet 5 to 8 cm from the wall, squeeze your stomach, tighten your buttock, slightly bend the knees, shoulders straight and hold your chin in.  While doing this exercise, the back must stay glued to the wall.

            While you are sitting, put a telephone book under your feet so that your knees are slightly more elevated than your hips.  This position reduces tension in your lower back;

            When picking up a child or object, always bend your knees to lower yourself to the child’s level.  When you are holding the child, hold him in the centre.  This will prevent tensions on the articulations of the back.

            Always work facing to what you are doing.  Avoid creating torsions of your trunk when picking up an object.

            If you must stay standing for a long period of time, avoid putting all the weight on one leg.  Balance the weight to both your legs.  There are now anti-fatigue carpets on the market.  Why not try one!

            When you sleep, if you sleep on your side, place a pillow between your legs, and if you sleep on your back, put a pillow under your knees.  This will remove the tension on the articulations of the lower back area.


These are simple tips you can follow.  They are useful to all but the application of these tips is most important while a pregnancy.  


Unfortunately, a woman is predisposed to articular problems which develop back pain.  It is preferable to consult a physiotherapist for an evaluation.  Solutions to this problem exist but we must first determine the cause of the problem