Manual therapy, or manipulative therapy, is a treatment primarily used by physical therapists, occupational therapists, and massage therapists to treat musculoskeletal pain and disability. It mostly includes kneading and manipulation of muscles, joint mobilization and joint manipulation. It is also used by Rolfers, athletic trainers, osteopaths, and physicians.
Definitions Irvin Korr, J. S. Denslow and colleagues did the original body of research on manual therapy. Korr described it as the "Application of an accurately determined and specifically directed manual force to the body, in order to improve mobility in areas that are restricted; in joints, in connective tissues or in skeletal muscles." According to the Orthopaedic Manual Physical Therapy Description of Advanced Specialty Practice manual therapy is defined as a clinical approach utilizing specific hands-on techniques, including but not limited to manipulation/mobilization, used by the physical therapist to diagnose and treat soft tissues and joint structures 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. A consensus study of US chiropractors defined manual therapy (generally known as the "chiropractic adjustment" in the profession) as "Procedures by which the hands directly contact the body to treat the articulations and/or soft tissues."
Origin and History Massage and spinal manipulation are said to be the most widely used and earliest manual interventions. The earliest historical reference to manipulative therapy as a practice was in Europe dating back to 400 BCE. Historically, the origin of manipulation can be traced to many parts of the world where it was used for a variety of musculoskeletal conditions. It was proposed that Spinal Manipulation was widely used across the world and was very prominent in the early interventions of manual therapy. Spinal Manipulation was said to be used in places like Indonesia by the Balinese, Hawaii by the Lomi-Lomi, in different areas of Japan, China, and India, in Central Asia by the shamans, in Mexico by sabadors, and used by bonesetters in Russia, Norway, and Nepal. In the latter half of the 19th century, massage was seen growing in popularity with English nurses, originally involving musculoskeletal rehabilitation for injured British soldiers. As the demand in massage therapy grew throughout medicine, nurses started doing specialized training to become a masseuse. Furthermore, in 1920, John Martin Littlejohn delivered lectures in London to "The Chartered Society of Massage and Medical Gymnastics." By 1926, many society members completed his intensive two-year course to become Manipulative Specialists. This was one of the first true professional titles in relating to manual therapy, and an early stage of it becoming a prominent medical modality.
Notable Names/Pioneers Andrew Taylor Still Daniel David Palmer James Henry Cyriax Freddy Kaltenborn Geoff Maitland Robin McKenzie Hippocrates Bonesetters Mary Mcmillan Per Henrick Ling
Use and method In Pakistan, Western Europe, North America and Australasia, manual therapy is usually practiced by members of specific health care professions (e.g. Chiropractors, Occupational Therapists, Osteopaths, Osteopathic physicians, Physiotherapists/Physical Therapists, Massage Therapists and Physiatrists). However, some lay practitioners (not members of a structured profession), such as bonesetters also provide some forms of manual therapy. How to apply a specific modality of manual therapy is mainly dependent on the client's acute or chronic condition, age, and level of pain. The goal of massage and manual therapy is to render the appropriate treatment to optimize the body's own healing potential, whilst being specific to the client's condition. The underlying goal is to produce profound relaxation during the techniques for increased results. A survey released in May 2004 by the National Center for Complementary and Integrative Health focused on who used complementary and alternative medicine (CAM), what was used, and why it was used in the United States by adults during 2002. Massage was the fifth most commonly use CAM in the United States in 2007.
Techniques Myofascial therapy targets the muscle and fascial systems, promotes flexibility and mobility of the body's connective tissues. It is said to mobilize adhesions and reduce severity/sensitivity of scarring. A critical analysis finds that the relevance of fascia to therapy doubtful. Massage may be used as part of a treatment. Proponents claim this may reduce inflammation. Science writer Paul Ingraham notes that there is no evidence to support the claim. Friction massage is said to increase mobilization of adhesions between fascial layers, muscles, compartments and other soft tissues. They are thought to create an inflammatory response and instigate focus to injured areas. A 2002 systematic review found that no additional benefit was incurred from the inclusion of deep tissue friction massage in a therapeutic regimen, although the conclusions were limited by the small sample sizes in available randomized clinical trials. Soft Tissue Technique is firm, direct pressure to relax hypertonic muscles and stretch tight fascial structures. A 2015 review concluded that the technique is ineffective for lower back pain, and the quality of research testing its effectiveness is poor. Trigger point techniques claim to address myofascial trigger points, though the explanation of how this works is controversial. Myofascial trigger points (MTrPs) are hypersensitive nodules with taut bands of skeletal muscle or fascia. They can produce localized or referred pain.
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