In recent years, manual therapy has gained prominence in physiotherapy contexts due to its role in the management of painful and disabling conditions such as neck and back pain (Paanalahti et al., 2016). The present paper aims at creating a deeper understanding and awareness of manual therapy by defining the concept, discussing some of the most used physical therapy techniques, analyzing the education, scope of practice and treatment claims guiding different manual therapy practitioners, and presenting a case study that demonstrates successful treatment with manual therapy.
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Manual therapy is defined as “any kind of manual mobilization or manipulation, with or without the addition of exercises” (Braun & Hanchard, 2010, p. 63). The manual therapy intervention is often used by physical therapists to treat musculoskeletal pain and disability using skilled, hands-on techniques such as massaging, manual lymph drainage, soft tissue mobilization or manipulation, as well as myofascial release (Choi, Hwangbo, Park, & Lee, 2014). On most occasions, manual therapy uses the sense of touch and passive movement techniques such as skilful handling with the hands to provide a therapeutic effect that is used in the treatment of various conditions by restoring motion to the joints of the body (Olson, 2016).
Manual Therapy Techniques
One of the most used techniques in manual therapy is soft tissue mobilization, which basically aims to achieve the manifold aims of breaking up inelastic or fibrous muscle tissue such as scar tissue from a back injury, moving tissue fluids, and relaxing muscle tension by applying deep pressure to the musculature around the spine and facilitating rhythmic stretching of the affected area (Olson, 2016). A therapist using this technique to will first localize the area of greatest tissue restriction using the layer-by-layer evaluation procedure, before attempting to mobilize the noted restrictions by placing a traction force on the tight area to restore normal texture to the tissue and minimize associated pain. Research is consistent that the soft tissue mobilization technique provides its main therapeutic benefits through relaxing tense muscles, minimizing scar tissue, stretching fascia, as well as lengthening fascia (Coughlin, 2002).
Joint mobilization is yet another manual therapy technique that is used by therapists in many practice settings. Available literature demonstrates that this manual therapy technique is often used to loosen up the restricted joint and enhance its range of motion by providing slow velocity and augmenting amplitude movement directly into the barrier of a joint with the view to achieving a therapeutic effect that decreases pain and increases joint mobility (Choi et al., 2014). Other procedures such as gentle joint mobilizations, mobility exercises, minimal energy techniques and traction/distraction techniques could be used by an experienced therapist to reduce joint pain and increase joint mobility using the joint mobilization principles that normally aim at achieving a normal range of pain-free joint motion. It is important to note that the joint mobilization technique is distinct from the joint manipulation technique since it does not involve high-velocity thrusting to generate the therapeutic effect.
The two manual therapy techniques discussed in this section are used to treat different etiologies of complications and disease. For example, soft tissue mobilization is used to treat soft tissue injuries such as strains and sprains, contusions, tendonitis, bursitis and stress injuries by promoting flexibility and mobility of the body’s connective tissues. The joint mobilization technique, on the other hand, is effective in treating joint pain, joint stiffness, low chronic back pain, and damaged spinal nerves (Choi et al., 2014; Olson, 2016).
Education, Scope of Practice, and Treatment Claims
Since most manual therapy practitioners are engaged in assessing and diagnosing movement dysfunctions as well as treating a person’s injury itself, it is important to have a 3-year Doctor of Physical Therapy (DPT) degree or a Bachelor’s degree with specializations in human anatomy, physiology, biology, biomechanics, orthopedics, chemistry or physics. Most manual therapy practitioners are also expected to pass a certification examination and gain clinical experience in their areas of specialization to develop adequate understanding of how to apply evidence-based practices to address various problems and conditions. Manipulation and mobilization are within the scope of practice of manual therapy practitioners such as massage therapists, physiotherapists, occupational therapists, chiropractors and osteopaths, though specific State licenses and requirements may “restrict the practitioner’s scope of practice to certain areas of the body” (Coughlin, 2002, p. 87). As such, it is of immense importance for manual therapy practitioners to understand the legal limits of their scope of practice to avoid costly lawsuits and other problems in the practice environment.
In terms of treatment claims, it is evident that most manual therapy practitioners hold the position that human hands and the right kind of skill mix could be used to diagnose and treat various illnesses and musculoskeletal problems. However, unlike chiropractic and osteopathic therapists, orthopedic professionals and physiotherapists are required to undertake a comprehensive assessment of the patient with the view to understanding the dynamics behind the problem (Olson, 2016). Additionally, although most manual therapy practitioners believe that treatment can occur through moving joints in specific directions and at diverse speeds to regain movement and functionality, they normally use different techniques and processes to remove movement restrictions and assist patients move better (Coughlin, 2002).
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Case Study on Manual Therapy
The case selected revolves around a 45-year old F-5 pilot, who had sought nonpharmacological and noninvasive therapy from a branch heath clinic due to chronic low back pain. It is important to note that “low back pain (LBP) is pain localized to the lower back, within the lumbar spinal region associated with the vertebral column or surrounding musculature” (Andicochea, Fulkerson, Taylor, & Portouw, 2015, p. 1132). His severity of pain was rated as an 8 on the numeric analogue scale, though he was not on actual distress. The medical tests and other physical assessments done on the patient were significant for chronic low back pain.
The patient was exposed to three days of manual treatment, which proceeded as follows: on the first treatment day, the patient was exposed to osteopathic manipulative treatment (OMT) that was directed to his hamstrings with the view to enhancing flexibility by improving direct muscle energy. The therapists also used indirect, counterstain techniques and lateral-medial pressure to correct the sacrum and other underlying muscles. On the second day, the “treatment focused around correction of the sacral rotation on a right axis and spastic gluteal muscle” (Andicochea et al., 2015, p. 1133). Additional manual therapy techniques such as stretching and effleurage were employed to treat other underlying muscles, resulting in a substantial pain reduction by up to 80 percent. On the third day, “stretching and effleurage were done to lower back paraspinal muscles and lower extremity quadriceps and hamstring muscle groups with the goal of reinforcing previously successful treatments” (Andicochea et al., 2015, p. 1133). Overall, this case scenario rightly demonstrates that the use of manual therapy in the form of the three OMT interventions targeted at the sacrum, lumbar, and pelvis areas was effective in treating chronic low back pain.
This paper has discussed some of the most important aspects of manual therapy. Overall, the paper has created a deeper understanding and awareness of manual therapy by providing useful insights on its definition, types, and scope of practice and treatment claims. The elucidation contained in the case study shows that the manual therapy approach can be used to address contemporary problems affecting individuals.
Andicochea, C.T., Fulkerson, J., Taylor, B.M., & Portouw, S.J. (2015). Manual therapy for chronic low back pain in an F-5 pilot. Military Medicine, 180, 1132-1135. Web.
Braun, C., & Hanchard, N.C.A. (2010). Manual therapy and exercise for impingement-related shoulder pain. Physical Therapy Reviews, 15, 62-83. Web.
Choi, J., Hwangbo, G., Park, J., & Lee, S. (2014). The effects of manual therapy using joint mobilization and flexion-distractions techniques on chronic low back pain and disc heights. Journal of Physical Therapy Science, 26, 1259-1262. Web.
Coughlin, P. (2002). Principles and practice of manual therapeutics. Philadelphia, Pennsylvania: Elsevier Science.
Olson, K.A. (2016). Manual physical therapy of the spine (2nd ed.). St. Louis, Missouri: Elsevier.
Paanalahti, K., Holm, L.W., Nordin, M., Hoijer, J., Lyander, J., Asker, M., & Skillgate, E. (2016). Three combinations of manual therapy techniques within nephropathy in the treatment of neck and/or back pain: A randomized controlled trial. BMC Musculoskeletal Disorders, 17(1), 1-10. Web.