Manual Therapy Techniques and Scope of Practice


Manual therapy can be broadly described as the physical treatment of musculoskeletal illnesses and pain related to them through the muscle and joint manipulation and mobilization (Lederman, 2005). It utilizes the application of hands as a therapeutic tool and is often used to modulate pain, eliminate inflammation of soft tissue, facilitate movement and improve range of motion (Lederman, 2005). Manual therapy can be either an independent therapeutic method or serve as a supplement to other modalities. It is commonly applied in a wide range of disciplines such as physiotherapy, osteopathy and chiropractic (Lederman, 2005). Sometimes, manual therapy is being used by registered nurses who are sometimes required to apply controlled pressure to support prematurely born infants or provide care for terminally ill. A broad range of manual therapy technics allows their application to a large variety of medical conditions.

Ailments

Therapeutic aims of the manual therapy are two-pronged: repair process and adaptation process. The conditions such as sore muscles, disc pain or “swollen knees” could be treated by directing the repair process of damaged tissues with the application of different manual techniques (Lederman, 2005). It is important to realize that the patients with joint stiffness are faced with dysfunctional adaptation process in their tissues (Lederman, 2005). Manual therapy could be used in such cases for stimulation of proper adaptation that might occur either in neuromuscular system of in the tissues themselves (Lederman, 2005). For example, a person undergoing a frozen shoulder treatment might experience muscle wasting exacerbated by the lack of proper functioning of the shoulder’s motor control (Lederman, 2005). Such patient has to regain functional motor patterns with the help of manual therapy. Another example that can help illustrate the process of repair and adaptation is the case of chronic trapezius myalgia (Lederman, 2005). It can be regarded as “psychomotor adaptation to psychological stress” that has manifested in the shift on normal motor patterns (Lederman, 2005). The altered state of motor function leads to the excessive use of muscles that can result in significant changes of adaptive issues or even muscle damage (Lederman, 2005).

Scope of Practice

The scope of practice of manual therapy is extremely broad. It approaches every illness from the three different dimensions: local, neurological/neuromuscular and psychological/psychomotor. Therefore, one of the core principles of manual therapy is to approach repair and adaptation process on the multidimensional level. The dimensional model allows application of the manual therapy methods in a way that would address the nuances of each specific level (Lederman, 2005).

Manual therapy practitioners claim that following ailments show a favorable response to application of some of its techniques: pain, allergies, arthritis, cardiovascular disease, temporomandibular disorders and various injuries among others (Lederman, 2005). There are many post-graduate programs that can offer manual therapy education for clinicians (Lederman, 2005).

Manual Therapy Techniques

Manual therapy practitioners perform an assessment of bone and muscle structures as well as the circulation of blood in the damaged tissues to decide on the proper technique for dealing with a condition (Daul, n.d.). Based on their evaluation they might perform some of the following techniques: soft tissue mobilization, strain-counterstrain, joint mobilization, muscle energy techniques, high and low-velocity amplitude thrusting (Daul, n.d.). They also encourage patients to perform a set of exercises aimed at the prevention of recurring pain. The individuals wishing to maintain a long-term relief from their back pain are especially encouraged to enroll in stretching and strengthening programs (Daul, n.d.).

Mobilizations with Movement (MWM)

Mobilizations with Movement (MWM) is a set of widely used manual therapy techniques that can be applied to the treatment of patients with musculoskeletal pain (Bandy & Sanders, 2013). The method commonly known as Mulligan Concept was developed by a physiotherapist Brian R. Mulligan in 1954 (Bandy & Sanders, 2013). He believed that even insignificant injuries might lead to a “positional fault” of a joint that might restrain physiological movements (Bandy & Sanders, 2013). The shape of the articular surfaces and the pull direction of muscles and tendons allow reducing compressive forces of movement thus making it unrestricted (Bandy & Sanders, 2013). The damage in the joint might change the balance provided by proprioceptive feedback and result in muscle stiffness and pain (Bandy & Sanders, 2013). Such dysfunctions can be treated with the forced mobilization of a joint supported by simultaneous movement generated by the patient. The health care specialists with training in the MWM can significantly improve the capacity for movement for individuals who experience various functional restrictions.

Myofascial Release (MFR)

Myofascial Release is a therapeutic approach to the treatment of soft tissue restrictions by stimulating relaxation of contracted muscles and unrestricted lymphatic circulation (Shea & Pinto, 2012). MFR is concerned with influencing extremely thin and elastic type of connective tissue that envelopes almost all functional structures in human body – fascia. According to the osteopathic theory that provides a theoretical framework for MFR, this tissue is highly responsive to the external forces (Shea & Pinto, 2012). Therefore, under the negative influence of physical or emotional factors, it can harden and loose some of its fluid transportation abilities. Myofascial Release therapy specialists argue that body can retain or “memorize” some of its postural positions with the help of the “microscopic cells containing energy” (Shea & Pinto, 2012).

MWM Case Study

The randomized controlled and double-blind study conducted by Kachingwe, Phillips, Sletten and Plunkett compared the effectiveness of MWM technique to other approaches to the treatment of primary shoulder impingement syndrome (2008). Thirty-two participants were randomly assigned to the following groups: exercise, exercise with the use of glenohumeral mobilizations, exercise with MWM method and control group (Kachingwe et al., 2008). Repeated-measures analyses showed that the group using MWM and glenohumeral mobilization techniques showed a significant change in pain measured with three different scales: VAS, Neer, Hawkins-Kennedy (Kachingwe et al., 2008).

Trigger Point Manual Therapy

A randomized controlled clinical study conducted by Renan-Ordine, Alburquerque-SendÍn, Rodrigues De Souza, Cleland and Fernández-de-las-PeÑas explored the effectiveness of trigger point (TrP) manual therapy in the treatment of plantar heel pain in comparison with the self-stretching program (2011). Fifteen male and forty-five female participants with clinically diagnosed plantar heel pain were randomly assigned to one of the two groups: self-stretching group and self-stretching group who received TrP treatment (Renan-Ordine et al., 2011). The study results showed that the group receiving TrP protocol reported a higher level of improvement of physical function in comparison to the group receiving only self-stretching therapy (Renan-Ordine et al., 2011).

Conclusion

Manual therapy is a physical treatment with the extremely broad scope of application. It utilizes numerous methods and techniques that allow it to be used either independently or in the conjunction with other therapeutic practices. It is utilized in a wide range of disciplines such as physiotherapy, osteopathy and chiropractic. The effectiveness of manual therapy has been confirmed by numerous studies.

References

Bandy, W., & Sanders, B. (2013). Therapeutic exercise for physical therapist assistants. Philadelphia: Wolters Kluwer/Lippincott Williams & Wilkins Health.

Daul, R. (n.d.). Specific Manual Physical Therapy Techniques. Web.

Kachingwe, A., Phillips, B., Sletten, E., & Plunkett, S. (2008). Comparison of Manual Therapy Techniques with Therapeutic Exercise in the Treatment of Shoulder Impingement: A Randomized Controlled Pilot Clinical Trial. Journal of Manual & Manipulative Therapy, 16(4), 238-247.

Lederman, E. (2005). The science and practice of manual therapy. Edinburgh: Elsevier/Churchill Livingstone.

Renan-Ordine, R., Alburquerque-SendÍn, F., Rodrigues De Souza, D., Cleland, J., & Fernández-de-las-PeÑas, C. (2011). Effectiveness of Myofascial Trigger Point Manual Therapy Combined with a Self-Stretching Protocol for the Management of Plantar Heel Pain: A Randomized Controlled Trial. Journal of Orthopaedic and Sports Physical Therapy, 41(2), 43-50.

Shea, M., & Pinto, H. (2012). Myofascial release therapy. New York, NY: Penguin Press.