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

Exercises for Back Pain

The best way to deal with back pain is to stay active and continue doing regular exercise.

The advice 20 years ago was to rest, but research has shown that inactivity only makes things worse,” says Dries Hettinga of BackCare, a charity that offers support and information to people with back pain.

“When you’re in pain you may want to stay in bed and not move around, but that results in further [loss of mobility] and will only prolong the pain.”

Staying active means continuing with regular day-to-day activities to avoid becoming sedentary. Examples include walking to the shops rather than taking the car, getting off the bus one stop early, gardening and taking the dog for a walk.

If you experience moderate pain, take painkillers that are available over the counter from your pharmacist or supermarket. Your pharmacist or GP can advise you on how to use your medication effectively.

Exercise program

In addition to maintaining an active lifestyle, try to exercise. You can do any activity that gives your body a good workout.

“It’s important to pick an exercise you enjoy,” says Hettinga. “If you do something you enjoy, you’re more likely to stick with it. There’s no quick fix for back pain so you need to work at it.”

Ideally, your choice of activities should involve elements of endurance, strength and flexibility. Examples include walking, running or jogging, cycling, dancing, swimming, hydrotherapy (exercising in water) and aquarobics.

Consider a variety of exercises as part of a weekly exercise programme, which could include yoga, t’ai chi, working out in a gym and sport in general.

Hettinga says exercise programmes are most effective if performed regularly and over prolonged periods of time.

Aim for at least three to five sessions a week (approximately 30 minutes each session). You may want to build this up over a number of weeks.

Hettinga says an individually designed exercise programme gives the best results. A physiotherapist or exercise professional can help you with this.

Manual therapy

Hettinga suggests combining an exercise programme with a course of manual therapy, especially when the pain is persistent. Manual therapy is provided by chiropractors, osteopaths and physiotherapists.

“Evidence suggests manual therapies can be effective. Your back is examined to see if any joints need to be freed up.

"They can do it with a gentle massage, mobilisation or manipulation. It’s especially helpful if your back is stiff and flexibility is an issue," she says.

Manual therapists are also qualified to advise you on the type of exercises that will be most effective at dealing with your type of back pain.

“You should see improvements after a few weeks,” says Hettinga. “If the pain hasn’t disappeared after a few weeks of treatment, seek further medical advice to explore alternatives.

"There is always something that can be done about back pain, but it requires some work and dedication from you.”