Manual Therapy: What About It?

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Manual Therapy: What About It?

By: Tony Farina

 

What is it?

The American Physical Therapy Association (APTA) defines manual therapy as skilled passive movements to a joint or surrounding soft tissues applied at varying speeds and amplitudes, including a high-velocity low amplitude movement. Manual therapy is often applied to address a diverse range of impairments, including but not limited to; tissue extensibility, the range of motion, modulating pain, mobilizing/manipulating joint structures, and reducing edema. A simple Google search can illustrate the many ways that manual therapy can be implemented. Techniques such as mobilization/manipulation, soft tissue mobilization, active release technique (ART), instrument assisted soft tissue mobilization (IASTM), muscle energy techniques (MET) are just a few of the many options available to provide manual therapy.

What does it do?

Manual therapy has been demonstrated throughout the literature to be effective in treating a variety of conditions such as low back pain, neck pain, and hip pathology. The benefits of manual therapy can be improved when performed in conjunction with appropriate therapeutic exercise. There are four primary effects proposed that help to explain the benefits of manual therapy; psychological, biomechanical, neurophysiological, chemical.

Psychological – This can refer to a placebo effect that is associated with a therapeutic touch. For some individuals, just providing manual therapy is associated with pain relief or as beneficial. In some circumstances, there may also be a cavitation or “pop” to the joint structure which again, is sometimes associated with a beneficial effect.

Biomechanical – These effects were originally proposed to be beneficial in the way of stretching muscles, ligaments, joints, and the accompanying joint capsules. In addition, these effects were proposed to stretch and snap micro-adhesions that had formed within the structures and allow for realignment of collagen fibers, restoring its natural ability to glide and elongate. However, an article published in 2008 noted that there is likely a combination of effects occurring rather than strictly a biomechanical effect. They demonstrated that the choice of manual therapy technique applied was not specific, nor was the force or site in which the technique was applied. Lastly, they stated that although there may be multiple mechanisms in play with manual therapy, a mechanical force is necessary to initiate a chain of neurophysiological responses.

Neurophysiological – This can refer to the effect that manual therapy can have on the peripheral and central nervous system and how it relates to pain. Manual therapy can be beneficial in modulating pain by activating various mechanoreceptors within the body which may assist in obstructing the brain’s ability to perceive pain.

Chemical – Chemical effects of manual therapy are also associated with modulating pain. When a tissue or structure is damaged, it begins to release inflammatory hormones as part of the natural healing process. These hormones, such as substance P, can lower an individual’s pain threshold. Meaning that it requires less of a stimulus to produce pain. It is proposed that manual therapy can help alleviate some of the pain symptoms by providing a mechanical force to the area which would in turn “wash out” the inflammatory hormones responsible for initiating the pain response.

Thank you for checking out today’s post. Next up we will begin to look at how we can formulate a thought process for the implementation of manual therapy techniques. As always, please feel free to leave some comments below or reach out and contact me via the contact page. Until next time!

References:

Guide to Physical Therapist Practice 3.0. Alexandria, VA: American Physical Therapy Association; 2014.

DeLitto A, George S, Van Dillen L, et al. Low back pain: clinical practice guidelines linked to the international classification of functioning, disability, and health from the orthopedic sections of the american physical therapy association. J Orthop Sports Phys Ther. 2012;42(4):1-57

Childs J, Cleland J, Elliot J, et al. Neck pain: clinical practice guidelines linked to the international classification of functioning, disability, and health from the orthopedic sections of the american physical therapy association. J Orthop Sports Phys Ther. 2008;38(9):1-34

Cibulka M, White D, Woehrle J, et al. Hip pain and mobility deficits – hip osteoarthritis: clinical practice guidelines linked to the international classification of functioning, disability, and health from the orthopedic section of the american physical therapy association. J Orthop Sports Phys Ther. 2009;39(4):1-25

Bialosky JE, Bishop MD, Price DD, Robinson ME, George SZ. The mechanisms of manual therapy in the treatment of musculoskeletal pain: A comprehensive model. Manual Therapy. 2009 Oct;14(5):531–8.

Lederman E, Cramer GD, Donatelli R, Willard FH. The science and practice of manual therapy: Physiology Neurology and psychology. 2nd ed. United Kingdom: Elsevier/Churchill Livingstone; 2005 Mar 9. ISBN: 9780443074325.

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