Manual Therapy: Definition
Manual therapy (MT) is the “application of accurately directed and selected set of ‘hands-on’ non-invasive physical therapy techniques with minimal equipment” (Ward, 2015, p. 158). It is a major component of physical therapy and can be employed by various practitioners including “orthopaedists, physiotherapists, osteopaths, chiropractors, manipulative therapists, and sports therapists” (Ward, 2015, p. 158). MT may require some active participation of the patient, but typically it is a passively received type of treatment. The term is used to define an extremely wide range of styles and practices. The effects achieved through MT are similarly diverse and include improved tissue and joint range of motion, fluid circulation, tissue repair (including scar tissue), enhanced kinesthetic sense of the patient as well as the alleviation of “tissues, joint, and nerve-related pain and inflammation” (Ward, 2015, p. 161; Starkey, 2013). Apart from that, MT is very likely to have a beneficial impact on the psychological state of the patient (Salvo, 2015).
The primary advantage of MT is its noninvasiveness, but its effects appear limited when compared to invasive therapy (Andicochea, Fulkerson, Taylor, & Portouw, 2015). As a result, MT is often regarded as a complimentary treatment or is complimented by other methods for particular cases. For example, it can be used together with supervised exercise (Kachingwe, Phillips, Sletten, & Plunkett, 2008).
Examples of Manual Therapy Techniques
There are various types (or styles) of MT; for instance, it is easy to distinguish between European massage and Asian bodywork therapy, but both these terms incorporate numerous separate methods and techniques (Starkey, 2013, p. 340; Salvo, 2015, pp. 315-316). Examples of specific techniques that are also often contrasted are the mobilization and manipulation of joints. Mobilization presupposes a treatment with a relatively low speed that allows the movements to be “within the control of the patient” (Ward, 2015, p. 158). As a result, the patient can actively participate in mobilization techniques. The two types of such active participation treatment methods include active assisted movements (for which the patient performs the mobilization actions, and the practitioner guides the joint in the same direction) or resisted ones (for which the practitioner “resists” the movement) (Salvo, 2015). With manipulation, the speed and amplitude of the trusts do not allow the patient to control them; this kind of technique uses the so-called “high-velocity, short- or low-amplitude (HVLT) thrust” (Ward, 2015, p. 158). The mobilization of joints is used to loosen them if they are restricted, which alleviates the pain of restriction; manipulation restores joint motion in a more aggressive manner. Both these types of techniques are used by different MT styles; for example, manipulation is typical for chiropractic and osteopathic practices (Ward, 2015; Starkey, 2013).
Manual Therapy Practitioner
Technically, the specifics of the scope of expertise, practice and treatment claims for different MT practitioners are defined and restricted by the laws of a particular country and state (Huijbregts, 2007). Still, some general aspects can be pointed out.
A practitioner is trained and receives accreditation for a certain type of MT. Specific types of MT, naturally, require specific education. Various therapies based on the usage of electricity, ultrasound, laser, microwaves, injections always require a special certificate. An MT practitioner is not supposed to provide any advice or assistance in non-MT fields of expertise (for example, nutritional counseling or orthopedic disease diagnosis) or fields like surgery, homeopathy, and cosmetology; it is only possible if the therapist is qualified for it. Finally, MT therapists are typically not concerned with genital manipulation (Salvo, 2015).
MT practitioners receive their education through professional programs (that are specific to various practices), and it is typical for them to continue their study in various post-professional courses and training plans. The precise details of this education, as well as accreditation criteria, are also nation-specific; for the US practitioners, for example, the American Physical Therapy Association accreditation process is of importance (Huijbregts, 2007).
Within the particular scope of expertise, the practitioner (a manual therapist) can examine and assess the health state of the patient; collect and document the information about their health history; determine counterindications (if any); create and customize the plan of treatment and provide the necessary consultation; obtain the consent; document the history of treatment; use the techniques the practitioner is qualified for employing together with special equipment the practitioner is qualified for working with; provide recommendations and suggestions within the scope of expertise. If appropriate, it is not prohibited to suggest other health care services and providers (Salvo, 2015).
Successful Manual Therapy: A Case Study
The article by Andicochea et al. (2015) provides a detailed report of a case of a successful MT treatment for chronic low back pain (LBP) that was experienced by a 45-year-old F-5 pilot. The authors point out that this kind of pain is characteristic of the occupation (with various sources stating the incidence rate of up to 83%) and poses a threat to the pilot’s performance (Andicochea et al., 2015, p. 1132). The pilot had a long history of LBP, but three months prior to treatment it reached the level of incidence and acuteness that prevented him from flying. He sought noninvasive therapy and wanted to avoid taking drugs, which made the choice of MT logical. He was diagnosed with “sacral, pelvic, and lumbar dysfunction” (Andicochea et al., 2015, p. 1132). Osteopathic manipulative therapy (OMT) was chosen due to its previously proved effectiveness in similar cases; no counterindications were found. After the treatment, the pilot reported 80% reduction in pain (Andicochea et al., 2015, p. 1133).
References
Andicochea, C., Fulkerson, J., Taylor, B., & Portouw, S. (2015). Manual Therapy for Chronic Low Back Pain in an F-5 Pilot. Military Medicine, 180(10), 1132-1135. Web.
Huijbregts, P. (2007). Chiropractic Legal Challenges to the Physical Therapy Scope of Practice: Anybody Else Taking the Ethical High Ground? Journal of Manual & Manipulative Therapy, 15(2), 69-80. Web.
Kachingwe, A. F., Phillips, B., Sletten, E., & Plunkett, S. W. (2008). Comparison of Manual Therapy Techniques with Therapeutic Exercise in the Treatment of Shoulder Impingement: A Randomized Controlled Pilot Clinical Trial. Journal of Manual & Manipulative Therapy, 16(4), 238-247.
Salvo, S. (2015). Massage Therapy. London, UK: Elsevier Health Sciences.
Starkey, C. (2013). Therapeutic modalities. Philadelphia, PA: F.A. Davis.
Ward, K. (2015). Routledge Handbook of Sports Therapy, Injury Assessment and Rehabilitation. London, UK: Routledge.