Chapter 10: Manual Techniques

CHAPTER OBJECTIVES

At the completion of this chapter, the reader will be able to:

1. Give definitions for commonly used biomechanical terms used in manual therapy (MT).

2. List the criteria that are important for the correct application of a manual technique.

3. Summarize the various types of MT.

4. Describe the importance of knowing the shapes of the various articular surfaces and how that determines the direction of applying a technique.

5. Apply the knowledge of the various MT techniques in the planning of a comprehensive rehabilitation program.

6. Recognize the manifestations of abnormal tissue and develop strategies using manual techniques to treat these abnormalities.

7. Categorize the various effects of MT on the soft tissues.

8. Make an accurate judgment when recommending an MT technique to improve joint or muscle function.

OVERVIEW

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 approximately 15,000 years. 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 interventions are the preferred treatment for healthcare professionals from various disciplines and patients with musculoskeletal pain conditions. Indeed, MT has become such an important component of orthopaedic and neurologic interventions that many considered it an area of specialization within physical therapy, despite that systematic reviews only find small to modest effect sizes or fail to recommend these interventions. Much of the appeal for MT is its personalizing of treatment.

The approaches commonly applied, the Cyriax,¹ Mennell,² and osteopathic techniques³ (Table 10-1), originated from physicians, whereas physical therapists derived the Maitland,^4,5 Kaltenborn,⁶ and McKenzie and May⁷ approaches (Table 10-2).

Within these major philosophies, several subsets have also emerged, including myofascial release (MFR), positional release techniques, neurodynamic mobilization techniques (see Chapter 11), manually resisted exercise, proprioceptive neuromuscular facilitation (PNF), joint mobilization, and high-velocity thrust (manipulation) techniques.

While drug effects are often attributed to a specific and well-defined active ingredient, the mechanisms underlying complex interventions, such as those used for MT, are multifaceted and comprise specific and nonspecific factors related to the intervention, the patient, the provider, and the environment in which the intervention is provided.⁸ MT techniques have traditionally been used to produce several therapeutic alterations in pain and soft-tissue extensibility by applying specific external forces to decrease pain and improve motion quality in an area with restriction.⁹ Some of these therapeutic alterations may be neurophysiologic and are therefore difficult to assess clinically. Unfortunately, the therapeutic efficacy of many MT techniques remains undetermined. Thus, many of these techniques have not been developed with the same scientific rigor as anatomy and physiology, and much of their use is based on clinical results rather than evidence-based proof. There are numerous ...