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

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Hydrotherapy

Hydrotherapy

Hydrotherapy, formerly called hydropathy, involves the use of water for pain-relief and treating illness. The term hydrotherapy itself is synonymous with the term water cure as it was originally marketed by practitioners and promoters in the 19th century. A hydrotherapist therefore, is someone who practices hydrotherapy.

Water cure has since come to have two opposing definitions, which can cause confusion.

(a) Water cure therapy  – a course of medical treatment by hydrotherapy

(b) water cure torture  – a form of torture in which a person is forced to drink large quantities of water.[1]

The sense used in this article is the first one, synonymous with the term hydrotherapy, and which precedes recorded use of the second sense.[a]

Hydrotherapy in general encompases a range of approaches and their definitions. These range from approaches and definitions which are either naturally distinct, or made so for marketing purposes, to approaches and definitions which overlap significantly, and which can be difficult to disentangle.

One such overlap pertains to spas. According to the International SPA Association (ISPA), hydrotherapy has long been a staple in European spas. It is the generic term for water therapies using jets, underwater massage and mineral baths (e.g. balneotherapy, Iodine-Grine therapy, Kneipp treatments, Scotch hose, Swiss shower, thalassotherapy) and others. It also can mean a whirlpool bath, hot Roman bath, hot tub, Jacuzzi, cold plunge and mineral bath. These treatments use physical water properties, such as temperature and pressure, for therapeutic purposes, to stimulate blood circulation and treat the symptoms of certain diseases.[

Hydrotherapeutic mechanisms and modern medicine

Modern medicine's successes, particularly with drug therapy, removed or replaced many water-related therapies during the mid-20th century. Nowadays, water therapy may be restricted to use in physical therapy, and as a cleansing agent. However, it is also used as a medium for delivery of heat and cold to the body, which has long been the basis for its application.

Hydrotherapy involves a range of methods and techniques, many of which use water as a medium to facilitate thermoregulatory reactions for therapeutic benefit. While the physiological mechanisms were initially poorly understood, the therapeutic benefits have long been recognised, even if the reason for the therapeutic benefit was in dispute. For example, in November 1881, the British Medical Journal noted that hydropathy was a specific instance, or "particular case", of general principles of thermodynamics. That is, "the application of heat and cold in general", as it applies to physiology, mediated by hydropathy. In 1883, another writer stated "Not, be it observed, that hydropathy is a water treatment after all, but that water is the medium for the application of heat and cold to the body". Thus, the "active agents in the treatment (are) heat and cold", of which water is little more than the vehicle, and not the only one".

With improved knowledge of physiological mechanisms, practitioners wrote specifically of the use of hot and cold applications to produce "profound reflex effects", including vasodilation and vasoconstriction. These cause changes in blood flow and associated metabolic functions, via physiological mechanisms, including those of thermoregulation, that are these days fairly well understood, and which underpin the contemporary use of hydrotherapy. Although standard anatomy and physiology textbooks make only passing reference, if any, to hydrotherapy, some of the best descriptions of the underlying physiology upon which hydrotherapy relies, are to be found in such textbooks. For example, one of the best succinct descriptions of blood redistribution (which is fundamental to the above-mentioned reflex reaction), quoted below, is from a standard textbook.

...by constricting or dilating arterioles in specific areas of the body, such as skeletal muscles, the skin, and the abdominal region, it is possible not only to regulate the blood pressure but also to alter the distribution of blood in various parts of the body.

British and other hydrotherapy establishments are discussed from another standpoint in a recent history of psychiatry.

Acupuncture in Physiotherapy

Background

Acupuncture may be offered to you as part of your rehabilitation and pain management programme. Acupuncture is one of a number of different types of treatment that the physiotherapist can offer and there is good evidence for its effectiveness. Often a physiotherapist will use acupuncture alongside treatments such as exercise, joint manipulation/mobilisation and general rehabilitation.
Acupuncture is viewed by physiotherapists as a complementary rather than an alternative therapy

What is Acupuncture?

Traditional Chinese Medicine (TCM) acupuncture (which can be traced back as far as 1000BC) developed out of a concept of using needles inserted into the body as a means of balancing the movement and level of 'Qi' (energy life force) within the body – an imbalance of Qi leading to disease, pain or disability.
Recent research is now supporting the effectiveness of acupuncture, particularly in the management of pain, suggesting that it is effective in the treatment of low back pain, neck pain, and knee/hip osteoarthritis.
Acupuncture combined with physiotherapy is now widely accepted within the NHS and private practice.

When Should it Not Be Used?

There are certain circumstances where acupuncture should not be used.

•  If you have a known metal allergy, specifically stainless steel

•  If you have a needle phobia

•  If you have a known infection in the area to be needled

When Should it Be Used With Caution?

You should also inform your physiotherapist if you:

•  Have haemophilia

•  You are pregnant or trying to conceive

•  Suffer from epilepsy

•  Have a deficient/weakened immune system

•  Have a heart pace maker

•  Are taking anticoagulation (blood thinning medication)

•  Are Diabetic

These conditions do not exclude you from having acupuncture but they will influence its application. Your Physiotherapists needs to know.

Does Acupuncture Work?

Yes, but it does not work for all. Success can depend on a number of factors, which include:

•  General health

•  The severity and duration of the condition

•  How the condition has been managed in the past

No two people are the same and it is one of the strengths of acupuncture that we treat people individually to get better results. If you know someone who has experienced acupuncture you may find it helpful to discuss the process before deciding on treatment.

What does Acupuncture Treatment Involve?

Your Physiotherapist will use sterile, single use needles. The needles are fine (a lot finer than an injection needle) and they are inserted quickly through the skin and into the tissues. Acupuncture needling should not be painful although some people do report experience a pinprick or scratch like sensation.
Once the needles are in place you may feel a mild ache, numbness, warm or heavy sensation at and around the needle. This should not be unpleasant. This is referred to as 'De Qi' and is a sign that the body’s inbuilt pain relieving mechanisms are being stimulated.

How Many Needles Will Be Used?

Most commonly a treatment will involve the insertion of between 2-16 needles.

Needle Stimulation?

Once the needles are in place your physiotherapist may gently stimulate the needle until you experience the De Qi. This may be repeated again throughout the treatment.
Needles can also be stimulated using electrical impulses. This is called electro- acupuncture. Here needles are coupled to a battery-operated machine. This causes a tingling sensation to be felt at the site of the needle. Low Frequency impulses can help reduce longstanding chronic pain whilst higher frequency impulses can be more helpful in managing acute pain and muscle spasm.

How Long are The Needles In For?

Needles can be in place for as little as a few seconds or 1-2 minutes. More commonly needles will be in place for between 10-30 minutes.

Where Will The Needles Be Placed?

Needles may be inserted:

•  Around the painful area

•  Away from it (hands or feet)

•  On the opposite side of the body

Recent research suggests that needling away from an area of pain is effective. This can be particularly useful if you feel the painful area is too sensitive.

How Many Treatments Are Needed?

Research suggests that for a longstanding condition such as low back pain, a course of 6 – 10 treatments is required to achieve the best results. If after further assessment/ treatments your symptoms remain the same, it is unlikely that acupuncture will help you. If you do respond positively to acupuncture the period of symptom ease is varied and uncertain. Some people experience lasting relief of symptoms especially when used to manage a recent acute problem. Your physiotherapist will discuss your individual management plan. Acupuncture treatments may vary dependent on the condition being treated and how you respond to treatment. Each treatment should be tailor-made to you and your condition.

Is It Safe?

Members of the Acupuncture Association of Chartered Physiotherapists (AACP) are required to train to a minimum standard and are bound by professional codes of conduct through the Chartered Society of Physiotherapy (CSP) and Health Professions Council (HPC). 
Acupuncture is safer than many of the drug treatments used. However, any procedure that involves inserting needles into the body has some potential problems, but these remain minimal. Acupuncture has been known to produce some ‘side effects’ in certain people.

Minor Side Effects:

•  Some discomfort at needle site

•  Drowsiness and sleepiness following treatment

•  Bruising at the needle site

•  Temporary pain increase

•  Fainting

•  Feeling faint

Exercise and Physiotherapy

Exercise and Physiotherapy

Most people with MS, regardless of their degree of disability, can benefit from some exercise. Many have some degree of ability. The right kind of exercise can bring positive physical and psychological health benefits.

Exercise helps you do the things you want to do and helps to prevent complications that can result from inactivity. It can improve flexibility, fitness, strength and stamina, circulation, muscle tone and mood. It can also help with the stimulation of fluids and excretion of waste products.

Many people with MS think they cannot do any exercise because they will become too fatigued but the strange fact is that it can actually give you energy rather than take it away from you – as long as you exercise sensibly and know your levels of ability. It is important to balance the exercise with rest.

You may wish to only undertake short sessions so you can avoid overheating. Remember, over-exercise can lead to weakness, fatigue, pain and spasticity. Therefore it is sometimes better to build up your exercises slowly.

Even if you are quite inactive, simple exercises like calf muscle lifts and stretches can be done at home on a daily basis. Passive exercisers are useful and there are many good products on the market, which can be used sitting down. If you suffer with spasticity a Physiotherapist can do assisted movements with you.

Good Forms of Exercise:

Physiotherapy

It is quite important to see a neurologically trained Physiotherapist as early on as possible. MS patients are often referred too late. Your G.P. or Neurologist should supply a referral. You can also receive Physio at one of the many MS Therapy Centers around the country, where the number of sessions are not rationed.

If you suffer with spasticity a Physiotherapist can do assisted movements with you and also help you to stand and balance properly, stand up from sitting and lying, walk better, position yourself to sleep, co-ordinate your movements better and help with posture etc.

It is a good idea to speak with your Physio if you are thinking of undertaking any of the under mentioned therapies and also ask their advice on any exercise machines available.

Swimming

Swimming is especially helpful because the water supports your bodyweight – the water will help to stabilize someone with balance problems. Weakened muscles can operate in this environment and will strengthen from the resistance. As swimming involves many muscles in your body, it can help to increase co-ordination.

There are now many more swimming pools and leisure centers having special sessions for people with disabilities or those who require special help and it may be worth trying one of these sessions first.

As a precaution it is best to ascertain the temperature of the water beforehand as many people with MS find water that is too hot or too cold a problem. The most comfortable temperature is about 30°C (86°F).

Pilates

Pilates is a type of exercise program based on correct body alignment. The focus is on co-ordination, moving properly and “core strength”. Good breathing patterns are important also.

As a holistic method of body maintenance, it prioritizes general fitness and body awareness, which contributes positively to rehabilitation.

In MS, Pilates can improve posture, boost the immune system, reduce stress, increase energy and bone density, improve circulation and respiration, improve muscle tone and balance.

T’ai Chi

T’ai Chi is meditation with movement. It concentrates on relaxation and correct breathing while performing graceful, circular, flowing exercises, sometimes to music. It is especially helpful for people with MS who no longer have the stamina to exercise at a high speed and another advantage is that you can exercise without overheating.

Really you need to be able to stand to be able to cope with all the range of moves. However, it is possible, according to the teacher, to do some of the moves sitting down, e.g. the arm movements and breathing exercises.

T’ai Chi can help in MS by improving balance, combating fatigue and giving you more energy. It can also help with spasms, exercises muscles and is very relaxing. Regular practice can also help with depression and maintain a calm and more serene inner state. T’ai Chi is a good method of self-development, focusing the mind and giving people with MS a sense of well being.

Yoga

Yoga is widely used by many people with MS and there are now specialist centers and teachers. It is a unity of mind and body and is as much about your breathing and your outlook on life as it is about postures. It can calm the mind and energies the body as well as helping to counteract stress, fatigue and depression.

It has a good effect on the endocrine glands, circulatory and respiratory systems and improves wellbeing. Yoga also tones the digestive organs and other glands in the body such as the thyroid and adrenals.The main concern with yoga and MS is that you should work well within your limitations in a relaxed way and be careful not to push yourself too far or raise your body temperature, as this may increase fatigue.

Vibration training

Vibration training is becoming more widely used amongst people with MS. You stand on a platform that sends vibrations through the body to tone up muscles, increase blood flow and bone density. This can also be done from a seated position by just placing the feet onto the platform. It helps to make leg muscles stronger, improves flexibility, aids circulation and helps balance by increasing the core stability.

Many People with MS have used these machines and found a reduction in some of their symptoms. Mainly with a reduction of muscle spasms and spasticity. An increase in blood circulation helps provide warmth to the legs and feet as well as reducing swollen ankles. Sessions should ideally be overseen by a trained professional and started with only short sessions so to not overload the body.

More physiotherapy and rehabilitation centers are using the vibration trainers as part of their treatment.