WHAT IS MANUAL THERAPY?

Manual Therapy is a clinical approach utilizing skilled, specific hands-on techniques, 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 swelling, inflammation, or restriction; inducing relaxation; improving contractile and non-contractile tissue repair, extensibility, and/or stability; facilitating movement; and improving function. 1, 2 Definition form American Physical Therapy Association (APTA) and American Academy of Orthopaedic Manual Physical Therapists (aaompt)

WHY/HOW IS MANUAL THERAPY USED?

Physical Therapists utilize manual techniques during the examination and assessment process to determine whether there are soft tissue restrictions or joint mobility limitations affecting the patient's physical function.  Manual techniques are then selected, prescribed, and implemented into the treatment plan when the examination findings, diagnosis, and prognosis indicate its usage to decrease edema, pain, spasm; enhance health, wellness and fitness; enhance or maintain physical performance, increase ability to move, prevent or remediate impairments or functional limitations, and/or to improve physical function.

Research has demonstrated significantly better outcomes for patients who receive a "multi-modal approach" of care. This means when manual therapy is used in conjunction with other forms of therapy, such as exercise, proprioception training, modalities, etc., compared to manual therapy used alone. 6

MOBILIZATION

The AAOMPT, APTA, and IFOMT (International Federation of Orthopedic Manual Therapy) define this as "a manual therapy technique comprised of a continuum of skilled passive movements to joints and/or related soft tissues that are applied at varying speeds and amplitudes, including a small amplitude/high velocity therapeutic movement." 7 It is described by Grieves4 as "the attempt at restoration of full, painless joint function by rhythmic, repetitive, passive movements within the patient's tolerance and within the voluntary and accessory range, and graded according to examination findings." 2 Mobilization may affect a whole vertebral region or may be localized to a single segment. Manipulation is associated with a high velocity, low amplitude therapeutic movement. 1,2

MUSCLE ENERGY TECHNIQUE (MET)

Muscle Energy Technique is defined as a "direct manipulative procedure that uses a voluntary contraction of the patient's muscles against a distinctly controlled counter-force from a precise position and in a specific direction. This is considered an active technique, as opposed to a passive technique where only the clinician does the work. In contrast to joint mobilization, this technique engages the joint restriction barrier but does not stress it. MET may also be used to lengthen shortened muscles, reduce localized edema, and mobilize restricted joints." 3

STRAIN-COUNTERSTRAIN

Originally developed by Lawrence Jones, D.O., FAAO, this technique is defined as "a passive positional procedure that places the body in a position of greatest comfort, thereby relieving pain by reduction and arrest of inappropriate proprioceptor activity that maintains somatic dysfunction." 5 This technique is uniquely different from other manual techniques as it is considered an indirect technique as positioning occurs opposite the restricted barrier and is thus very comfortable for the patient, even in the acute stage.

SOFT TISSUE MOBILIZATION (STM) / MYOFASCIAL RELEASE (MFR)

Soft Tissue Mobilization and Myofascial Release Techniques help restore soft tissue muscle play, breaks fascial restrictions between muscles and decreases the hypertonus that is associated with muscle tightness. Specific directional manual forces are incorporated to lengthen muscle and connective tissue to restore normal mobility.

PASSIVE RANGE OF MOTION (PROM)

Injury, pain, and prior surgery can lead to impaired and restricted joint mobility and loss of normal range of motion. The physical therapist assesses joint capsule restrictions, boney limitations, and painful compensatory guarding patterns to determine the most appropriate method of treatment. Passive ROM is applied by the skilled physical therapist to safely and effectively promote restoration of normal joint range of motion, and included as one component of the restorative phase of physical therapy treatment plan. The patient is usually expected to perform therapeutic activities as follow up and specific home exercises to augment the physical therapy treatment session.

REFERENCES

  1. American Physical Therapy Association. www.apta.org
  2. American Academy of Orthopaedic Manual Physical Therapists. www.aaompt.org
    Orthopaedic Manual Therapy: Description of Advanced Clinical Practice. 1999 pp: 29
  3. Donatelli R, Wooden MJ. Orthopaedic Physical Therapy.
    Churchill Livingstone, NY. 1989 pp: 360, 463
  4. Greives Grieve's Modern Manual Therapy. Harcourt Publishers Ltd. 1994
  5. Kusunose RS, Wendorf R, Jones L. Strain and Counterstrain Syllabus.
    Jones Institute, Encinitas, CA. 1990 pp: 1
  6. Jull G, Trott P, Potter H, Zito G, Niere K, Emberson J, Marschner I, Richardson C.
    A randomised control trial of physiotherapy management of cervicogenic headache.
    2002 SPINE 27: 1835-1843.
  7. Olson KA. IFOMT 2004: Building Bridges.
    2004 ARTICULATIONS (Official Publication of AAOMPT) 10 (2) pp: 1,3, 21