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.
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.
1From 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.
Several MT approaches or techniques have evolved over the years. By their nature, many of these techniques have not been developed with the same scientific rigor as fields such as anatomy and physiology, and much of their use is based on clinical outcomes, rather than evidence-based proof. However, an absence of evidence does not always mean that there is evidence of absence (of effect), and there is always the risk of rejecting therapeutic approaches that are valid.
Of the approaches commonly applied, the Cyriax,
8and osteopathic techniques
Table 10-1) originated from physicians, whereas the Maitland,
Table 10-2) were derived by physical therapists.
Table 10-1 Manual Therapy Approach—Physician Generated |Favorite Table|Download (.pdf)
Table 10-1 Manual Therapy Approach—Physician Generated
Cyriax (Orthopaedic Medicine) Assertions
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
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 ...