The Concept of Manual Therapy

Introduction

Orthopedic manual physical therapy (OMPT), also known as simply “manual therapy” is a specific kind of “hands-on” treatment implemented by a physician in order to stimulate particular body parts, induce a state of relaxation in muscles and joints, and improve muscle activation and timing, among other effects. This type of therapy has been known for centuries, the first written accounts of it going to ancient Greece and Rome. It is very popular among physical therapists as a primary treatment or as a part of CAM (Complementary and Alternative Medicine) (Kisner, Colby, & Borstad, 2017). The purpose of this paper is to investigate the concept of OMPT, its definition, examples, scope of treatment, and provide a detailed case study that proves its effectiveness.

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What is Manual Therapy?

The international federation of orthopedic manipulative physical therapists (IFOMPT) defines OMPT is a specialized area of physical therapy implemented in the management and treatment of various neurological and musculoskeletal conditions while utilizing specific manual techniques and exercising in order to achieve a therapeutic effect (IFOMPT, n.d.). It is an evidence-based practice that includes all available scientific and clinical evidence as well as personalized biological and psychosocial frameworks created for each individual patient. The mechanisms of OMPT and its therapeutic effects on the body are not fully understood. Some studies report that the placebo effect plays an important role in the effectiveness of the treatment (Bialosky, Bishop, & Penza, 2017).

Examples of Manual Therapy Techniques

Orthopedic manual physical therapy is a very multifaceted discipline, with different practitioners using various techniques pertaining to their specialization. However, these techniques can be grouped up in several subcategories, based on the mechanisms of physical influence and the target areas. Some of these subcategories are as follows (Kisner et al., 2017):

  • Soft tissue mobilization. These techniques are aimed at influencing muscles and attaching tissue around the joints. The end goal is to treat muscle tension and spasms that result from it. STM breaks up myofascial adhesions, which are often present in inelastic muscle tissue, in order to help relax the rest of the muscle (Kisner et al., 2017). Examples of inelastic muscles can be found in scar tissue from injury. STM helps move muscle fluids, which results in relaxation. Soft tissue mobilization is frequently used to relax the musculature around the patient’s spine through a series of rhythmic pressure. The treatment begins by locating the “knots” – areas of greater strain and contraction, before applying pressure to these areas in order to restore normal texture to the muscle tissue, alleviating pain and tension in the process (Kisner et al., 2017).
  • Strain and counter-strain techniques. This form of treatment is aimed at improving and normalizing neuromuscular reflexes in a patient’s body. If left untreated, they can cause structural and postural problems as well as points of pain and contraction (Kisner et al., 2017). The mechanism behind strain and counter-strain techniques is relatively simple – the patient’s muscles are removed from strain and into the position of comfort for about 2 minutes, before slowly being brought back to normal, where a certain tenderness exists (Kisner et al., 2017). The gentleness of the technique as well as the gradual improvement in the muscle tenderness makes it effective for acute pains and back problems.
  • Joint mobilization. This technique is often used in patients diagnosed with a pulled muscle when rest, ice, and massage prove to be ineffective. In sprains, muscle spasms are often caused by restrictions in joints. Joint mobilization helps to loosen joints and increasing the muscle’s range of motion. The technique is based on slow velocity movements and a gradual increase in amplitude (Kisner et al., 2017). As a result, the joints are enabled to move in ways previously deemed impossible by the patients. The procedure is relatively painless unless the joint barrier is approached too close.
  • Muscle energy techniques. Mets are used to lengthen shortened muscles caught in a contraction spasm (Kisner et al., 2017). They are primarily used in arms and legs during treatments of sprains and pulled muscles. The patient is asked to contract their muscles against a carefully-measured counterforce applied by the therapist, for no longer than 5 seconds. After that, the joint is brought to its barrier, and the procedure repeats itself. This technique requires the patient to actively participate in the process, which METs from joint mobilization techniques, where the therapist has to do all the work. These techniques do not cause excessive discomfort and do not stress the joint.

This shortlist of examples does not cover the entirety of techniques available to manual therapists. However, it does provide information about various subcategories most commonly used in practice. The range of techniques is usually defined by the scope of practice and treatment.

Education, Scope of Practice, and Treatment Claims

In Europe, Australia, the USA, and other regions with a well-developed and structured healthcare system, OMPT are used in specific healthcare professions, such as motion therapists, massage therapists, psychiatrists, physiotherapists, osteopaths, and others. Their education allows them to utilize OMPT within the scope of their practice, which may differ based on the profession. The way in which a motion therapist uses OMPT is different from that of a psychiatrist. The former treats disabilities related to the limited range of motion in a patient, while the latter seeks to treat mental disabilities and psychological disorders. In addition, there are practitioners not formally covered by the medical certification, such as chiropractors, bonesetters, masseurs, and others (Kisner et al., 2017). Their education, scopes of practice, and treatment claims vary from one another and are not strictly regulated. As a group, these practitioners fall under the parameters of alternative medicine. In general, treatment claims of manual therapists are as follows (Kisner et al., 2017):

  • Increasing the comfortable range of motion in a patient;
  • Reducing pain and alleviating muscle spasms;
  • Providing rest and relaxation to muscles;
  • Facilitating restorative processes after an injury or a trauma;

The degree of effectiveness of these treatments depends on the condition of the patient, the experience of the manual therapist, and the choice of techniques used to treat particular conditions.

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Case Study

The following case study serves as proof of the effectiveness of manual therapy against shoulder pain, which is considered to be among some of the most common diagnoses in physical therapy. Approximately 15 to 20 percent of all physical therapy diagnoses are related to shoulder pain in one way or another (“The effectiveness of thoracic manipulations,” n.d.). In this case study, the patient is a 58-year-old male, who was prescribed physical therapy after having been bothered with shoulder pain for a period of over two months. The goals and aims of the intervention include the improvement and strengthening of periscapular musculature, improving the range of motion, decreasing levels of pain and tension, and returning the patient to a stable and comfortable condition (“The effectiveness of thoracic manipulations,” n.d.).

The manipulations utilized as a part of manual therapy included cervicothoracic junction motions coupled with an exercise regimen. The regimen consisted of several sessions that began with heating up the shoulders in order to alleviate pain, exercises using staff and a rope in order to increase flection and external rotation. As a result, the periscapular and general upper portion of the body were expected to increase in strength (“The effectiveness of thoracic manipulations,” n.d.). Follow-up exercises were aimed at improving the closed chain scapular as well as the rotator cuff.

The outcomes were measured utilizing the VAS pain scale, DASH measurements, and the overall improvement of the patient rating. According to the post-intervention analysis, the patient reported a 2/10 pain level, as opposed to a 6/10 VAS scale rating prior to the administration of the treatment. Overall improvement was measured at 60% (“The effectiveness of thoracic manipulations,” n.d.). The report indicates that manual therapy and particularly the manipulation intervention aimed at the thoracic spine region is an effective way of treating patients with shoulder pain when coupled with a pragmatic training regimen.

Conclusion

Manual therapy is a medical practice with a long history and tradition, which is trusted by the general populace and is supported by empirical data. It consists of a variety of techniques in order to fit a variety of diagnoses and situations. As presented in the case study, manual therapy is a healthy addition to practical exercise regimens, which have resulted in the alleviation of pain in the patient. Manual therapy practices deserve further study and certification, as the current legal state of the practice is relatively chaotic, with lay practitioners offering their services without any appropriate medical accreditation to support their practices, which may result in an escalation of potential injuries.

References

Bialosky, J. E., Bishop, M. D., & Penza, C. W. (2017). Placebo mechanisms of manual therapy: A sheep in wolf’s clothing? Journal of Orthopaedic & Sports Physical Therapy, 47(5), 301-304.

The effectiveness of thoracic manipulations on shoulder pain: A case report. (n.d.). Web.

IFOMPT. (n.d.). OMPT definition. Web.

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Kisner, C., Colby, L. A., & Borstad, J. (2017). Therapeutic exercise: Foundations and techniques (7th ed.). Philadelphia, PA: F. A. Davis Company.

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