At the completion of this chapter, the reader will be able to:
Give definitions for commonly used biomechanical terms used in manual therapy (MT).
List the criteria that are important for the correct application of a manual technique.
Summarize the various types of MT.
Describe the importance of knowing the shapes of the various articular surfaces and how that determines the direction of the application of a technique.
Apply the knowledge of the various MTs in the planning of a comprehensive rehabilitation program.
Recognize the manifestations of abnormal tissue and develop strategies using manual techniques to treat these abnormalities.
Categorize the various effects of MT on the soft tissues.
Make an accurate judgment when recommending an MT technique to improve joint or muscle function.
Touch has always been and continues to be a primary healing modality. The first written records of massage go back to Ancient China, and wall paintings in Egypt depict hands-on healing techniques that go back 15,000 years.1 From this early “laying on of hands” evolved many of the techniques used today.
The techniques of MT fall under the umbrella of therapeutic touch. MT has become such an important component of the intervention for orthopaedic and neurologic disorders that it is considered by many as an area of specialization within physical therapy.
Of the approaches commonly applied, the Cyriax,2 Mennell,3 and osteopathic techniques4,5 (Table 10-1) originated from physicians, whereas the Maitland,6,7 Kaltenborn,8 and McKenzie and May9 approaches (Table 10-2) were derived by physical therapists.10–12
TABLE 10-1Manual Therapy Approach—Physician Generated |Favorite Table|Download (.pdf) TABLE 10-1 Manual Therapy Approach—Physician Generated
| ||Cyriax (Orthopaedic Medicine) Assertions ||Mennell Assertions ||Osteopathic Assertions |
|Philosophy ||All pain has an anatomic source and, therefore, all treatment must reach that anatomic source |
If the diagnosis is correct, the treatment will be of benefit to the source
|Dysfunction indicates a serious pathologic process or joint disease |
Loss of normal joint movement or joint play can lead to dysfunction
Joint manipulation can restore normal joint-play movements
|Neuromusculoskeletal system is connected with other systems; therefore, disease processes can be evident in musculoskeletal system |
An abnormality in structure (somatic dysfunction) can lead to abnormal function of related components
Manipulative therapy can restore and maintain normal structure and function relationships
|Key concepts ||Diagnosis of soft-tissue lesions |
Categorization of referred pain
Differentiation between contractile and noncontractile lesions
|Assessment of joint play ||Diagnosis of somatic dysfunction |
Examination focuses on presence of asymmetry, restriction of movement, and palpation of soft-tissue texture changes (i.e., palpation of skin, muscle, and other connective tissue for feeling of thickness, swelling, tightness, or temperature change)
|History ||Observation and history|
Age and occupation
Symptoms (site and spread, onset and duration, and behavior)