Manual therapy can be termed as all the techniques administered passively by trained practitioners to move/mobilize/manipulate joints and soft tissues for therapeutic purposes, especially pain management and treatments (Carnes, Mars, Mullinger, Froud, & Underwood, 2010). As such, the manual therapist endeavour to restore normal movement of joints and tissues. The establishment of tissue/joint movement restrictions is done and the reasons sought before the treatment is started (Physical Therapy, 2016).
Manual therapy intervention is done through various effects, including mechanical, neurophysiological, biochemical, and psychological. These interventions can be applied to any patient presenting joint and tissue pain or restricted/abnormal mobility. Precautions should be considered in instances where the patient is sick, there are hypermobile joints, and joint replacements (Physical Therapy, 2016).
Manual Therapy Techniques and What are They Treat
Numerous manual therapy interventions can be adopted in treating various disorders of the human body that result from tissue and joint malfunctioning. For instance, there are techniques such as exclusive supervised exercise, supervised exercise accompanied with glenohumeral mobilization, and the Mulligan concept of mobilization with movement (MWM) (Yang, Chang, Chen, Wang, & Lin, 2007; Kachingwe, Phillips, Sletten, & Plunkett, 2008).
The mulligan concept of mobilization with movement is a manual therapy technique adopted in treating tissue and joint problems that result in organ dysfunctions. Administering MWM to a patient is geared to restoring immediate and sustained organ mobility and treating joint pain (Kachingwe, Phillips, Sletten, & Plunkett, 2008). The clinician applies an accessory mobilization to the affected joint. Meanwhile the patient should attempt making active movements as the physician applies the treatment. Continuous and regular monitoring of the patient is recommended during administration of MWM to deter recreation of pain. In cases where pain is felt, the physician should check for treatment alternatives to ensure that movements are not associated with pain. Effective administering of the MWM technique results in pain treatment and mobility restoration (Kachingwe, Phillips, Sletten, & Plunkett, 2008).
A second technique that can be adopted in tissue and joint pain and organ immobility treatment is the End-Range mobilization (ERM). The administering of the End-Range manual therapy technique is intended to make restoration of normal joint functioning and to allow the stretching of contracted periarticular structures (Yang, Chang, Chen, Wang, & Lin, 2007). The sessions are started by thorough examination of patients. A qualified practitioner does the examination on the patient to check on end-range position and the end-feel of the affected joint (Yang, Chang, Chen, Wang, & Lin, 2007). Subsequently, the physician/therapist places their hand near the affected joint. The humerus is gradually positioned in a way that optimal range of movement in different direction is obtained. The exercise is done repeatedly (10-15 times) and intensively varying the plane and degree of rotation (Yang, Chang, Chen, Wang, & Lin, 2007).
It is of paramount importance to note that some techniques are more effective than others are in treating specific tissue/muscle pain/immobility. For instance, Yang et al. (2007) established that ERM and MWM registered higher efficacy than MRM in increasing mobility in patients with FSS while MWM was more effective in correcting scapuohumeral rhythm than ERM. Nevertheless, manual therapy techniques can be adopted in treating almost all joints and tissues pain. As such, all joints can be manipulated and treated using manual therapy. Some of the common problems that can be treated using manual therapy include pain and immobility in shoulder, elbow, wrist, hand, and muscle spasms (Physical Therapy, 2016).
Education, Scope of Practice, and Different Manual Therapy Practitioners
Education requirements are some of the key issues related to manual therapy. Manual therapy training commences with the entry-level professional programs that have specification on manual therapy courses that are preceded by post-professional programs (Huijbregts, 2007). Some of the most common post-professional programs include education seminars, specialist board certification, post-graduate, and mentorships. It is worth noting that entry procedures and requirements are provided both nationally and internationally and by different institutions of learning (Huijbregts, 2007).
Scope of practice for manual therapist defines and stipulates what the therapist do upon certification and licence issuance. As such, qualified practitioners practice in safe and effective procedure observing laws and regulations. It is worth noting that regional regulations and laws highly influence the scope of practice of manual therapists (Huijbregts, 2007). As such, the scope of practices may vary from one state to another or from one country to another. Nevertheless, a consensus may be obtained when the role and limitations of the therapists are harmonized. The key role of manual therapists, however, is treating of disorders in human beings through manipulation of tissue or joints. This role defines what is expected of a manual therapist in various states, countries, or regions (Huijbregts, 2007).
Some of the common well known fields in manual therapy include chiropractors, osteopaths/osteopathic experts, physiotherapist, and massage therapist among other specialists (Huijbregts, 2007).
A Case Study Report of a Successful Treatment with Manual Therapy
The manual therapy treatment involved a 47-year-old female patient who complained of a deep intermittent pain in her left buttock (Riley, 2011). According to the patient, the pain the pain was significantly sharp, rating it 9 out of ten on the NPS scale. Moreover, the pain would occasionally increase in severity and during these increases, she would experience additional deep pain down the post-lateral aspect of her left leg above the knee (Riley, 2011). The occasional deep pain above the knee would lead to what she termed as collapsing of the leg and, therefore, she asserted that the pain would be rated 10 out of 10 on the NPS scale. Nevertheless, numbness, weakness, cord and related symptoms were absent (Riley, 2011)
The management process involved positioning of the patient with the L5/S1 intervertebral joint in mid position and rotation mobilization, gentle massages. Counselling on favourable prognosis and the need for right attitude (Riley, 2011).
In the consecutive consultation, which was done on the following day, significant reduction in pain was noted and the patient felt much better. According to the patient, the rating of the pain had greatly improved to 6 out of 10 on the NPS scale. Lumbar flexions resulted in her finger reaching approximately 10 centimetre above her patella. It was also noted that her neurological signs had no observable change. Some of the procedures done during the first visit, such as rotational mobilization and massage were repeated. More treatments sessions that involved massage, rotation mobilization were done within seven days and gradual positive outcomes were recorded (Riley, 2011). More counselling and instructions were given, especially on recruiting her Transversus Abdominus muscle. The positive progress and improved neurological signs ruled out the need for referral to a neurosurgeon (Riley, 2011).
Approximately 45 days later, a review was done and the pain was gone. The patient would comfortably carry out her chores and would execute her receptionist duties effectively. Notably, application of pressure on the previously painful body parts revealed that she was pain free and the treatment was considered successful (Riley, 2011).
References
Carnes, D., Mars, T. S., Mullinger, B., Froud, R., & Underwood, M. (2010). Adverse Events and Manual Therapy: A systematic review. Manual Therapy, 15(2010), 355-363.
Huijbregts, P. A. (2007). Chiropractic Legal Challenges to the Physical Therapy Scope of Practice: Anybody Else Taking the Ethical High Ground? Journal of Manipulative Therapy, 15(2), 69-80.
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. The Journal of Manual & Manipulative Therapy, 16(4), 238–247.
Physical Therapy. (2016). The Evidence-Based Practice of Joint Manipulation/Manual Therapy. Web.
Riley, J.-A. (2011). Manual therapy treatment of lumbar radiculopathy: A single case report. SA Journal of Phisiotherapy, 67(3), 41-45.
Yang, J.-l., Chang, C.-w., Chen, S.-y., Wang, S.-F., & Lin, J.-j. (2007). Mobilization Techniques in Subjects With Frozen Shoulder Syndrome: Randomized Multiple-Treatment Trial. American Physical Therapy Association, 87(10),.