Manual therapy (manipulative therapy)

Manual therapy, also called manipulative therapy, involves physically stimulating injured, sore, or stiff parts of the body to prompt muscle relaxation and healing. It is primarily targeted at soft tissue groups and joints, but it is also used for spinal manipulation/mobilization. Manual therapy is used to increase the range of motion of a joint or muscle group, reduce pain, and may improve the neuromuscular function and coordination in affected soft tissues. Health care professionals such as physical therapists and occupational therapists typically perform manual therapy on patients.

Background

Muscles are the parts of the body that make movement possible. The skeletal muscles typically account for approximately 30 to 40 percent of an adult human body’s weight, depending on factors such as age, sex, and physical fitness. The body has three distinct varieties of muscles: smooth, cardiac, and skeletal. Smooth muscles are found in the lining of blood vessels and various organs. They are responsible for the movement of most organs, including the small intestine and the bladder. Cardiac muscle is found in the heart. It is responsible for the heart’s characteristic beating, causing blood to pump throughout the body. Skeletal muscles are attached to various bones throughout the body. Unlike smooth muscles and cardiac muscles, skeletal muscles are consciously controlled. Willing a skeletal muscle to move causes it to contract, pulling on bones and causing them to move.

Tough, stretchy fibers called tendons attach skeletal muscles to bones. If a muscle becomes detached from the bone, it can no longer cause that part of the body to move. If tendons become strained, torn, or overstretched, this results in a loss of strength and control in the relevant body part. Tendons attach to the muscle fibers at one end of the muscle. The muscle fibers are organized into thick bands bound together by perimysium (a connective tissue layer surrounding muscle fiber bundles). The entire muscle is then bound in a light pink fibrous coating called the fascia.

Joints are the areas where two bones meet. In most cases, these are flexible enough to allow the bones to move independently. Six primary types of synovial joints are found in the human body: hinge, pivot, condyloid (ellipsoidal), saddle, plane (gliding) and ball-and-socket joints. Hinge joints allow bending and straightening movements, like that of a door hinge. Pivot joints allow rotational movement. Ellipsoidal joints found in the wrist and ball-and-socket joints of the shoulder allow many degrees of movement.

Joints contain many sensitive, delicate parts. Ligaments are tough bands of connective tissue that connect different bones. They limit the joint’s movement and improve its stability. Cartilage coats the ends of the bones, reducing friction and stopping the ends of the bones from wearing. Bursae, specialized fluid-filled sacs, help cushion joints from impacts. If any of these are damaged, a joint can quickly lose its function.

Overview

Physical therapy is a way to treat injuries through exercise and physical manipulation of the body, rather than surgery or medication. It is useful for healing sports-related injuries, retraining the body to move in a normal manner, and healing or correcting a variety of muscular and skeletal problems. Commonly prescribed types of physical therapy include heat treatments, weight lifting, cardiovascular exercise, and manual therapy.

Manual therapy involves physically manipulating muscles, soft tissue, and joints to promote healing, reduce inflammation, restore range of motion, improve response time, and reduce pain associated with the injured or damaged body part. Manual therapy has two primary motions: manipulations and mobilizations. Manipulation involves a single high-velocity, low-amplitude motion, while mobilization involves continuous passive movement applied to a particular area.

Manual therapy techniques can be used to treat a range of neuromuscular and skeletal problems. For example, some patients who are prescribed manual therapy may suffer from abnormal neuromuscular reflexes that cause muscles to constrict on their own. This creates stiff, tense, and painful locations on the patient’s body. Therapists often employ a technique called strain-counterstrain to retrain the malfunctioning muscles. When using this process, small amounts of tension are applied to a problem muscle, pushing and pulling it in a variety of directions for short periods. After these brief periods of stress, the therapist instructs the patient to return to their most comfortable position, resting the muscle.

To combat other types of muscle tension, therapists may utilize soft tissue mobilization. When using this tactic, they alternately apply deep pressure and gentle stretching. When used routinely, soft tissue mobilization loosens healthy muscles. It also breaks up stiff, hard scar tissue that may form after an injury.

When a joint is injured or stiffened, which can occur when the joint’s skeletal structure or ligaments are damaged, the therapist utilizes joint mobilization techniques. These techniques loosen the muscles surrounding the joint, which reduces muscle spasms and slowly increases mobility. They involve applying controlled, gentle movements within or at the limit of a joint’s normal range of motion to improve mobility and reduce pain. The process is generally well tolerated, though some patients may experience mild discomfort depending on the condition being treated. When repeated on a regular basis, joint mobilization techniques gradually increase the joint’s range of motion to a healthy level. Joint mobilization techniques may be used concurrently with muscle energy techniques, which are designed to lengthen injured or shortened muscles. During muscle energy techniques, therapists instruct patients to contract their muscles while the injured limb is braced against a stiff object. They are then instructed to rest before repeating the procedure. The repeated strain stretches the muscle, gradually lengthening and strengthening it.

Once a joint’s mobility has been extended to a healthy range, the therapist may utilize high-velocity, low-amplitude thrusting to make the joint’s operation a smoother process. In this context, high velocity means that the motion is fast, and low amplitude means that the motion is small. The therapist moves the joint to a point close to the end of its range of motion and then quickly moves the joint to the end of its range. They then repeat that step, conditioning the joint to move more smoothly at higher speeds.

Bibliography

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