Manual Therapy is a term used to describe a clinical approach utilizing skilled, specific ‘hands on’ treatment where joints, muscles ligaments and other soft tissues are mobilized or manipulated by a therapist for the purpose of modulating pain; increasing range of motion (ROM); reducing or eliminating soft tissue inflammation; inducing relaxation; improving contractile and non-contractile tissue repair, extensibility, and/or stability; facilitating movement; and improving function.
In any joint, there are two types of movements–one which can be performed actively, e.g. lifting your arm and movements which occur within the joints but cannot be actively controlled e.g. when the arm is lifted, in the ball socket joint of the shoulder, there are finer gliding–roling movements of the ball in its sockets. These latter movements are called the accessory movements of joints. A manual therapist not only assesses the active movements, but also these finer accessory movements.
Manual Therapy Techniques
Muscle Energy Technique (MET’S) utilizes the energy of ones muscles through very light contractions to release “ catches “, or bio mechanical barriers in Muscles and Joints throughout the body. They are designed to mobilize restricted joints and lengthen shortened muscles.
Myofasical Release is best understood by first describing fascia, a connective tissue that envelopes every muscle, nerve, blood vessel and ligament fiber of the body. Fascia is considered continuous from head to toe and has a propensity to thicken, tighten and restrict in response to inflammation, injury, or mechanical stress. Fascia restrictions limited muscle mobility and function leading to longer tern dysfunction. Myofascial release is the slow progressive multidirectional stretching of the cross fibers to break free the barriers and restrictions. Intense training and experience is required to perform properly and the results of treatment can be dramatic in restoring function and relieving pain.
Strain/Counter Strain is a technique utilizes the body’s nervous system reflexes to release spasm and tension in muscles throughout the body to decrease pain and increased motion. The therapist finds the patient’s position of comfort by asking the patient at what point the tenderness diminishes. The patient is held in this position of comfort for about 90 seconds, during which time asymptomatic strain is induced through mild stretching, and then slowly brought out of this position, allowing the body to reset its muscles to a normal level of tension. This normal tension in the muscles sets the stage for healing.
Cranial Sacral Technique is the least aggressive of manual therapy techniques traditionally used in physical therapy. It involves extremely light touch applied to different areas of the head and spinal tract including the “ tail bone” or the sacrum.
Joint mobilization is the physical stretching or manipulation of a joint’s capsule and/or supporting ligaments in order to restore normal physiologic range of motion. All joint mobilization requires specific hand placement and direction of force to achieve the desired results. Mobilizations are performed up to the end of available joint range, but always within that range. It involves loosening up the restricted joint and increasing its range of motion by providing slow velocity and increasing amplitude movement directly into the barrier of a joint, moving the actual bone surfaces on each other in ways patients cannot move the joint themselves.
Trigger Point Release is a focal technique using direct compressive force combined with controlled muscle contractions to breakup “knots” or small areas of muscle tightness called trigger points.
Soft Tissue Massage is the systematic application of pressure and movement on the soft tissues of the body with the intention of facilitating normal range of movement. The goal of soft tissue mobilization (STM) is to break up inelastic or fibrous muscle tissue (called ‘myofascial adhesions’) such as scar tissue from a back injury, move tissue fluids, and relax muscle tension. This procedure is commonly applied to the musculature surrounding the spine, and consists of rhythmic stretching and deep pressure. The therapist will localize the area of greatest tissue restriction through layer-by-layer assessment. Once identified, these restrictions can be mobilized with a wide variety of techniques. These techniques often involve placing a traction force on the tight area with an attempt to restore normal texture to tissue and reduce associated pain.
Deep Tissue Friction Massage is the application of a massage technique whereby superficial tissues are rubbed against deeper tissues. It is useful in assisting the body’s own healing mechanisms and as such can help to speed up the healing of injured tendons.
Manipulations is a passive joint movement performed with the aim of increasing joint mobility. It incorporates a small amplitude quick thrust movement at the end of the available joint range.
High velocity, low amplitude thrusting is utilized for restoration of joint motion and does not move a joint beyond its anatomical limit. The goal of this procedure is to restore the gliding motion of joints, enabling them to open and close effectively. If utilized properly, increased mobility and a decrease in muscle tone about the joint should be noticed.