Manual Therapy: Difference between revisions
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== Description == | == Description == | ||
Manual therapy has a long history within the profession of physical therapy and physical therapists have greatly contributed to the current diversity in manual therapy approaches and techniques. Mechanical explanations were historically used to explain the mechanisms by which manual therapy interventions worked, new research reveals intricate neurophysiologic mechanisms are also at play and the beneficial psychological effects of providing hands-on examination and intervention should not be ignored.<ref>Huijbregts PA. [https://www.sciencedirect.com/topics/medicine-and-dentistry/manual-therapy Manual therapy.] InPain Procedures in Clinical Practice 2011 Jan 1 (pp. 573-596). Hanley & Belfus. Available from: https://www.sciencedirect.com/topics/medicine-and-dentistry/manual-therapy (last accessed 21.9.2019)</ref> | [[File:Matos Manuever.jpg|right|frameless]]Manual therapy has a long history within the profession of physical therapy and physical therapists have greatly contributed to the current diversity in manual therapy approaches and techniques. Mechanical explanations were historically used to explain the mechanisms by which manual therapy interventions worked, new research reveals intricate neurophysiologic mechanisms are also at play and the beneficial psychological effects of providing hands-on examination and intervention should not be ignored.<ref>Huijbregts PA. [https://www.sciencedirect.com/topics/medicine-and-dentistry/manual-therapy Manual therapy.] InPain Procedures in Clinical Practice 2011 Jan 1 (pp. 573-596). Hanley & Belfus. Available from: https://www.sciencedirect.com/topics/medicine-and-dentistry/manual-therapy (last accessed 21.9.2019)</ref> | ||
The International Federation of Orthopaedic Manipulative Physical Therapists ([http://www.ifompt.com/ IFOMPT]) defines manual therapy techniques as: "Skilled hand movements intended to produce any or all of the following effects: improve tissue extensibility; increase range of motion of the joint complex; mobilize or manipulate soft tissues and joints; induce relaxation; change muscle function; modulate pain; and reduce soft tissue swelling, inflammation or movement restriction." | The International Federation of Orthopaedic Manipulative Physical Therapists ([http://www.ifompt.com/ IFOMPT]) defines manual therapy techniques as: "Skilled hand movements intended to produce any or all of the following effects: improve tissue extensibility; increase range of motion of the joint complex; mobilize or manipulate soft tissues and joints; induce relaxation; change muscle function; modulate pain; and reduce soft tissue swelling, inflammation or movement restriction." | ||
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{{#ev:youtube|https://www.youtube.com/watch?v=X6q5i0L89-M&app=desktop|width}}<ref>Antonio Sanson What is Manual Therapy | Do PTA's Give Massage? Available from: https://www.youtube.com/watch?v=X6q5i0L89-M&app=desktop (last accessed 21.9.2019)</ref> | {{#ev:youtube|https://www.youtube.com/watch?v=X6q5i0L89-M&app=desktop|width}}<ref>Antonio Sanson What is Manual Therapy | Do PTA's Give Massage? Available from: https://www.youtube.com/watch?v=X6q5i0L89-M&app=desktop (last accessed 21.9.2019)</ref> | ||
== Three Paradigms for Manual Therapy Therapeutic Effects == | |||
# Physiological: positive placebo response | # Physiological: positive placebo response | ||
# Biomechanical and Physical: facilitates repair and tissue modelling | # Biomechanical and Physical: facilitates repair and tissue modelling | ||
# Psychological: pain relief via- stimulates gating mechanism; muscle inhibition; reduction of nocioceptive activity; reduced intraarticular or periarticular pressure<ref>MAJ Guy R Majkowski PT, DSc, OCS, FAAOMPT, Norman W GillIII PT, DSC, Cert MPT, OCS, FAAOMPT, [[Physical Therapy Modalities]] The Sports Medicine Resource Manual, 2008 Available from: https://www.sciencedirect.com/topics/nursing-and-health-professions/physiotherapy (last accessed 21.9.2019)</ref> | # Psychological: pain relief via- stimulates gating mechanism; muscle inhibition; reduction of nocioceptive activity; reduced intraarticular or periarticular pressure<ref>MAJ Guy R Majkowski PT, DSc, OCS, FAAOMPT, Norman W GillIII PT, DSC, Cert MPT, OCS, FAAOMPT, [[Physical Therapy Modalities]] The Sports Medicine Resource Manual, 2008 Available from: https://www.sciencedirect.com/topics/nursing-and-health-professions/physiotherapy (last accessed 21.9.2019)</ref> | ||
=== Techniques | === Techniques Include === | ||
[[File:Massage image.jpg|right|frameless]] | [[File:Massage image.jpg|right|frameless]] | ||
* [[Traction for Neck Pain CPR|Traction]] | |||
* [[Massage]] | |||
* [[Trigger Points|Trigger Point Therapy]] | |||
* [[Active Release Techniques]] | |||
[[ | |||
[[ | |||
* Assisted Active [[Range of Motion]] (AAROM) | |||
* Passive [[Range of Motion]] | |||
* [[Manual lymph drainage|Lymph Drainage]] | |||
* [[Stretching|Stretches]] (muscle, neural tissue, joints, fascia) | |||
* [[Instrument Assisted Soft Tissue Mobilization]] | |||
* '''Joint Manipulation''': A passive, high velocity, low amplitude thrust applied to a joint complex within its anatomical limit* with the intent to restore optimal motion, function, and/ or to reduce pain.<ref name="Mintken">Mintken PE, et al. A Model for Standardizing Manipulation Terminology in Physical Therapy Practice. J Orthop Sports Phys Ther 2008;38(3):A1-A6.</ref> | |||
* '''Joint Mobilisation: '''A manual therapy technique comprising a continuum of skilled passive movements to the joint complex that are applied at varying speeds and amplitudes, that may include a small-amplitude/ high velocity therapeutic movement (manipulation) with the intent to restore optimal motion, function, and/ or to reduce pain.<ref name="Mintken" /> | |||
NB The terms "'''Thrust Manipulation'''" and "'''Non-Thrust Manipulation'''" have been used in the literature. "Thrust Manipulation" is used to describe interventions described as Manipulation by IFOMPT, and "Non-Thrust Manipulation" would be synonymous with the term Mobilization as proposed by IFOMPT. | NB The terms "'''Thrust Manipulation'''" and "'''Non-Thrust Manipulation'''" have been used in the literature. "Thrust Manipulation" is used to describe interventions described as Manipulation by IFOMPT, and "Non-Thrust Manipulation" would be synonymous with the term Mobilization as proposed by IFOMPT. | ||
== Guide to Grading of Mobilisations/Manipulations == | |||
Maitland Joint Mobilization Grading Scale: | Maitland Joint Mobilization Grading Scale: | ||
[[File:Central Posteroanterior (PA) Mobilisation Technique.jpg|right|frameless]] | [[File:Central Posteroanterior (PA) Mobilisation Technique.jpg|right|frameless]] | ||
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'''Grade III - '''Large amplitude rhythmic oscillating mobilization to point of limitation in range of movement | '''Grade III - '''Large amplitude rhythmic oscillating mobilization to point of limitation in range of movement | ||
'''Grade IV - '''Small amplitude rhythmic oscillating mobilization at | '''Grade IV - '''Small amplitude rhythmic oscillating mobilization at end of available range of movement | ||
'''Grade V (Thrust Manipulation) - '''Small amplitude, quick thrust at | '''Grade V (Thrust Manipulation) - '''Small amplitude, quick thrust at end of available range of movement | ||
Kaltenborn Traction Grading Scale: | Kaltenborn Traction Grading Scale: | ||
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'''Grade III -''' Stretching of soft tissue surrounding joint | '''Grade III -''' Stretching of soft tissue surrounding joint | ||
== Additional Viewing == | |||
This 28 minute video gives a good overview of the hands on/off debate and suggestions of when to use manual therapy.{{#ev:youtube|https://www.youtube.com/watch?v=g36vqjx5N-Q&app=desktop|width}}<ref>The Canadian Physio Student MANUAL THERAPY IN PHYSIOTHERAPY PRACTICE WITH JESSE AWENUS Available from: https://www.youtube.com/watch?v=g36vqjx5N-Q&app=desktop (last accessed 21.9.2019)</ref> | This 28 minute video gives a good overview of the hands on/off debate and suggestions of when to use manual therapy.{{#ev:youtube|https://www.youtube.com/watch?v=g36vqjx5N-Q&app=desktop|width}}<ref>The Canadian Physio Student MANUAL THERAPY IN PHYSIOTHERAPY PRACTICE WITH JESSE AWENUS Available from: https://www.youtube.com/watch?v=g36vqjx5N-Q&app=desktop (last accessed 21.9.2019)</ref> | ||
== Conclusion == | |||
[[File:Physio works for primary care.png|right|frameless]] | [[File:Physio works for primary care.png|right|frameless]] | ||
Manual physical therapy is a specialised form of physical therapy delivered with the hands as opposed to a device or machine. It has an important place in Physiotherapy and when used appropriately by practitioners is a very effective set of tools literally at our fingertips. | Manual physical therapy is a specialised form of physical therapy delivered with the hands as opposed to a device or machine. It has an important place in Physiotherapy and when used appropriately by practitioners is a very effective set of tools literally at our fingertips. | ||
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== Resources (Mobilization and Manipulation Techniques) == | == Resources (Mobilization and Manipulation Techniques) == | ||
* [[Elbow Mobilizations|Elbow Mobilizations]] | |||
* [[Wrist/Hand Mobilizations|Wrist/Hand Mobilizations]] | |||
* [[Hip Mobilizations|Hip Mobilizations]] | |||
* [[Knee Mobilizations|Knee Mobilizations]] | |||
* [[Ankle and Foot Mobilisations|Ankle and Foot Mobilisations]] | |||
* [[Spinal Manipulation|Spinal_Manipulation]] | |||
* [[Manual Techniques for the Shoulder|Shoulder Mobilizations and Manipulation]] | |||
* [[Manual techniques for the cervicothoracic spine|Cervicothoracic Manipulation]] | |||
== References == | == References == | ||
Revision as of 17:45, 31 October 2019
Original Editor - Finn Gerstell
Top Contributors - Finn Gerstell, Jess Bell, Admin, Kim Jackson, Lucinda hampton, Dana Tew, Samuel Winter, Carin Hunter, Rachael Lowe, Elaine Lonnemann, David Drinkard, Hanz Tao, Mande Jooste, Matt Huey, WikiSysop, Shaimaa Eldib, Scott Buxton, Kai A. Sigel and Rucha Gadgil
Description[edit | edit source]
Manual therapy has a long history within the profession of physical therapy and physical therapists have greatly contributed to the current diversity in manual therapy approaches and techniques. Mechanical explanations were historically used to explain the mechanisms by which manual therapy interventions worked, new research reveals intricate neurophysiologic mechanisms are also at play and the beneficial psychological effects of providing hands-on examination and intervention should not be ignored.[1]
The International Federation of Orthopaedic Manipulative Physical Therapists (IFOMPT) defines manual therapy techniques as: "Skilled hand movements intended to produce any or all of the following effects: improve tissue extensibility; increase range of motion of the joint complex; mobilize or manipulate soft tissues and joints; induce relaxation; change muscle function; modulate pain; and reduce soft tissue swelling, inflammation or movement restriction."
According the the American Academy of Orthopaedic Manual Physical Therapists (AAOMPT) Description of Advanced Specialty Practice (DASP), orthopaedic manual physical therapy (OMPT) is defined as: any “hands-on” treatment provided by the physical therapist.
Treatment may include moving joints in specific directions and at different speeds to regain movement (joint mobilization and manipulation), muscle stretching, passive movements of the affected body part, or having the patient move the body part against the therapist’s resistance to improve muscle activation and timing. Selected specific soft tissue techniques may also be used to improve the mobility and function of tissue and muscles."
Three Paradigms for Manual Therapy Therapeutic Effects[edit | edit source]
- Physiological: positive placebo response
- Biomechanical and Physical: facilitates repair and tissue modelling
- Psychological: pain relief via- stimulates gating mechanism; muscle inhibition; reduction of nocioceptive activity; reduced intraarticular or periarticular pressure[3]
Techniques Include[edit | edit source]
- Assisted Active Range of Motion (AAROM)
- Passive Range of Motion
- Lymph Drainage
- Stretches (muscle, neural tissue, joints, fascia)
- Instrument Assisted Soft Tissue Mobilization
- Joint Manipulation: A passive, high velocity, low amplitude thrust applied to a joint complex within its anatomical limit* with the intent to restore optimal motion, function, and/ or to reduce pain.[4]
- Joint Mobilisation: A manual therapy technique comprising a continuum of skilled passive movements to the joint complex that are applied at varying speeds and amplitudes, that may include a small-amplitude/ high velocity therapeutic movement (manipulation) with the intent to restore optimal motion, function, and/ or to reduce pain.[4]
NB The terms "Thrust Manipulation" and "Non-Thrust Manipulation" have been used in the literature. "Thrust Manipulation" is used to describe interventions described as Manipulation by IFOMPT, and "Non-Thrust Manipulation" would be synonymous with the term Mobilization as proposed by IFOMPT.
Guide to Grading of Mobilisations/Manipulations[edit | edit source]
Maitland Joint Mobilization Grading Scale:
_Mobilisation_Technique.jpg)
Grade I - Small amplitude rhythmic oscillating mobilization in early range of movement
Grade II - Large amplitude rhythmic oscillating mobilization in midrange of movement
Grade III - Large amplitude rhythmic oscillating mobilization to point of limitation in range of movement
Grade IV - Small amplitude rhythmic oscillating mobilization at end of available range of movement
Grade V (Thrust Manipulation) - Small amplitude, quick thrust at end of available range of movement
Kaltenborn Traction Grading Scale:
Grade I - Neutralises joint pressure without separation of joint surfaces
Grade II - Separates articulating surfaces, taking up slack or eliminating play within joint capsule
Grade III - Stretching of soft tissue surrounding joint
Additional Viewing[edit | edit source]
This 28 minute video gives a good overview of the hands on/off debate and suggestions of when to use manual therapy.
Conclusion[edit | edit source]
Manual physical therapy is a specialised form of physical therapy delivered with the hands as opposed to a device or machine. It has an important place in Physiotherapy and when used appropriately by practitioners is a very effective set of tools literally at our fingertips.
Resources (Mobilization and Manipulation Techniques)[edit | edit source]
- Elbow Mobilizations
- Wrist/Hand Mobilizations
- Hip Mobilizations
- Knee Mobilizations
- Ankle and Foot Mobilisations
- Spinal_Manipulation
- Shoulder Mobilizations and Manipulation
- Cervicothoracic Manipulation
References[edit | edit source]
- ↑ Huijbregts PA. Manual therapy. InPain Procedures in Clinical Practice 2011 Jan 1 (pp. 573-596). Hanley & Belfus. Available from: https://www.sciencedirect.com/topics/medicine-and-dentistry/manual-therapy (last accessed 21.9.2019)
- ↑ Antonio Sanson What is Manual Therapy | Do PTA's Give Massage? Available from: https://www.youtube.com/watch?v=X6q5i0L89-M&app=desktop (last accessed 21.9.2019)
- ↑ MAJ Guy R Majkowski PT, DSc, OCS, FAAOMPT, Norman W GillIII PT, DSC, Cert MPT, OCS, FAAOMPT, Physical Therapy Modalities The Sports Medicine Resource Manual, 2008 Available from: https://www.sciencedirect.com/topics/nursing-and-health-professions/physiotherapy (last accessed 21.9.2019)
- ↑ 4.0 4.1 Mintken PE, et al. A Model for Standardizing Manipulation Terminology in Physical Therapy Practice. J Orthop Sports Phys Ther 2008;38(3):A1-A6.
- ↑ The Canadian Physio Student MANUAL THERAPY IN PHYSIOTHERAPY PRACTICE WITH JESSE AWENUS Available from: https://www.youtube.com/watch?v=g36vqjx5N-Q&app=desktop (last accessed 21.9.2019)
