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What is Manual Therapy?

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.^1,2 (Definition from American Academy of Orthopedic Manual Physical Therapy (AAOMPT) and American Physical Therapy Association (APTA).

WHEN IS MANUAL THERAPY USED?

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

Type of Manual Therapy we provide:

MOBILIZATION / MANIPULATION

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."¹ 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)

Originally developed by Fred L. Mitchell, Sr., D.O., FAAO and T. J. Ruddy, D.O., this technique is defined as a "direct manipulative procedure that uses a voluntary contraction of the patient's muscles against a distinctly controlled counterforce 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)

STM: restoration of med/lat muscle play, breaking fascial restrictions between muscles and decreasing hypertonus that is associated with muscle tightness. Specific directional manual force is used in the direction of fascial restriction. Functional STM combines active lengthening of the muscle tissue with manual work at the same time.

MFR: similar to STM, but a larger area of tissue is targeted as opposed to very localized primary restrictions.

Research in the Netherlands has demonstrated cadaver dissection analysis of fascia to contain actin and myosin. If this research has validity, one could speculate fascia to be a contractile tissue instead of inert, connective tissue as previously theorized.

REFERENCES

1. American Academy of Orthopaedic Manual Physical Therapists. www.aaompt.org
   Orthopaedic Manual Therapy: Description of Advanced Clinical Practice. 1999 pp: 29
   
   
2. American Physical Therapy Association. www.apta.org
   
   
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
   
   
8. Hinz B, Gabbiani G Fibrosis: recent advances in myofibroblast biology and new therapeutic perspectives.
   F1000 Biology Reports 2010, 2:78
   (Giulietti, rev. 12/2011)
   

MANUAL THERAPY LINKS

Manual Therapy Research, University of Sydney: Evidence Database Search Engine

North American Institute of Orthopaedic Manual Therapy (NAIOMT)

American Academy of Orthopedic Manual Physical Therapists

International PNF Association

Institute of Physical Art

Jones Institute

Jim Meadows, PT, FCAMT. MCPA