Manual therapy

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Manual Therapy encompasses the diagnosis and treatment of the ailments of various etiologies through hands-on intervention. Manual Therapy is practiced by people within various health care professions, including Chiropractors, Physiotherapists/Physical Therapists, Massage Therapists, Occupational Therapists, Osteopaths, Physiatrists and more.

Manual Assessment uses a variety of hands-on tests in an effort to determine which structure may be responsible for the pain being assessed. Unfortunately, there are no reliability studies demonstrating the ability of such tests to accurately determine the structure responsible for the pain. In fact, the scientific literature has shown that palpation as a manual assessment tool is unreliable and that the underlying cause of 85% of low back pain cannot be determined by any means. Several manual tests that provoke or relieve pain have been shown to be reliable.

Treatment includes all the means of hands-on work and could include, but is not limited to, soft tissue mobilization, various connective tissue techniques, myofascial release, craniosacral mobilizations (developed by cranial osteopaths, including Harold I Magoun), mobilization of joints or spinal segments, mobilization of neural tissue, visceral mobilization, strain and counterstrain (developed by Lawrence Jones, DO), and Integrative Manual Therapy (developed by an American PhD Physical Therapist, Sharon W. Giammatteo). Advocates of the therapy claim that these techniques, when correctly applied, often result in dramatic improvement of the patient's signs and symptoms. On the other hand, properly designed prospective studies are equivocal as to the therapeutic benefits of manual therapy.

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“Beyond all doubt the use of human hand, as a method of reducing human suffering, is the oldest remedy known to man; historically no date can be given for its adaptation.”

                                                                                                                      - Mennell

Manual Therapy 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. – Korr, 1978

Manipulation Use of hands to passively to move a joint for a therapeutic purpose- Cyriax.

Skillful application of passive movement to a joint.- Paris

“An accurately localized, single, quick movement of small amplitude following careful position of the patient. Not necessarily an energetic and is completed before patient can stop it.”- Grieve

A sudden movement or thrust, of small amplitude, performed at a speed that renders the patient powerless to prevent it.- Maitland

It is a brief, sudden, and carefully administered thrust that is given at the end of the normal passive range of movement in which the joint complex is suddenly carried beyond the normal physiological range of movement without exceeding the boundaries of anatomical integrity.- Sandoz

Mobilisation

Art of imparting movement actively/passively to a joint/ soft tissue.- APTA

Passive oscillatory movements repeated two or three per second, of small or large amplitude, are applied anywhere in the range and at all times are within the control of patient.- Maitland

It uses low velocity passive movements within or at the limit of joint range-Ottenbacher and Di fibrio

To work with the hands; to handle or manage.- Oxford dictionary.

Manipulation helps by . Releasing minor adhesions . Altering position of an intraarticular loose body . Reducing a displaced articular meniscoid. . Reducing discrete muscle spasm by affecting the input through the gamma loop system( Rahlmann 1987)

Mobilisations helps by . Affect the hydroststics of the disc and the vertebral bodies. . Activate the type I and type II mechanoceptors in the capsule of the facet joint influencing the spinal gating mechanism( melzack and wall) . Altering the activity of the neuromuscular spindle in the intrinsic muscles of the segment subsequently affecting bias in the grey matter cells. . Assist the pumping effect on the venous plexus of the vertebral segment.

Indications of Manipulative Therapy

. Zygapophysial and sacroiliac joint dysfunction . Paraspinal muscle syndromes . Joint dysfunction in lateral and central stenosis . Joint dysfunction in spondylolisthesis. . Sacroiliac syndrome in post-operative low back pain. . Joint dysfunction( restriction of accessory joint motion causing pain or restriction of motion during normal physiologic movement).

                  . Capsular. Internal derangement. Spasm. Bony. Degeneration.
    
                                   Contraindications of Manipulative Therapy

Relative . Osteopenia . Advanced arthropathies . Spinal anomalies . Patients on anticoagulant medication . Vascular disorders . Psychological overlay and undiagnosed pain . Pregnancy

Absolute . Neoplastic lesions of the spine, ribs, and pelvis . Non-neoplastic bone disease ( e.g osteomyelitis, tuberculosis, osteoporosis) . Inflammation (Rheumatoid arthritis, ankylosing spondylitis, septic arthritis) . Healing fracture or dislocation . Gross segmental instability and spinal anomalies . Cauda equina syndrome (Spinal cord compromise signs in limbs) . Large abdominal aneurysm . Visceral referred pain . Obvious spinal deformity . Congenital generalized hypermobility

Manual therapy involves the use of body work or massage therapy and other physical manipulation of the body for healing, such as those techniques used in osteopathy, chiropractic, and physical therapy.

1 Usage
2 Styles of manual therapy
3 See also
4 Further reading
5 External links

[edit] Usage

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).

[edit] 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. It may rely partially upon the placebo effect and can be effective in providing both short and long term relief.

Different forms of manipulative therapy are available to choose from: