| Part of a series on |
| Alternative medicine |
|---|
 |
Manual therapy, or manipulative therapy, is a treatment primarily used by physical therapists, occupational therapists, and massage therapists to treat musculoskeletal pain and disability. It mostly includes kneading and manipulation of muscles, joint mobilization and joint manipulation. It is also used by Rolfers, athletic trainers, osteopaths, and physicians.
Irvin Korr, J. S. Denslow and colleagues did the original body of research on manual therapy. Korr described it as the "Application of an accurately determined and specifically directed manual force to the body, in order to improve mobility in areas that are restricted; in joints, in connective tissues or in skeletal muscles."
According to the Orthopaedic Manual Physical Therapy Description of Advanced Specialty Practice manual therapy is defined as a clinical approach utilizing specific hands-on techniques, including but not limited to manipulation/mobilization, used by the physical therapist to diagnose and treat soft tissues and joint structures for the purpose of modulating pain; increasing range of motion (ROM); reducing or eliminating soft tissue inflammation; inducing relaxation; improving contractile and non-contractile tissue repair, extensibility, and/or stability; facilitating movement; and improving function.
A consensus study of US chiropractors defined manual therapy (generally known as the "chiropractic adjustment" in the profession) as "Procedures by which the hands directly contact the body to treat the articulations and/or soft tissues."
Massage and spinal manipulation are said to be the most widely used and earliest manual interventions. The earliest historical reference to manipulative therapy as a practice was in Europe dating back to 400 BCE. Historically, the origin of manipulation can be traced to many parts of the world where it was used for a variety of musculoskeletal conditions. It was proposed that Spinal Manipulation was widely used across the world and was very prominent in the early interventions of manual therapy. Spinal Manipulation was said to be used in places like Indonesia by the Balinese, Hawaii by the Lomi-Lomi, in different areas of Japan, China, and India, in Central Asia by the shamans, in Mexico by sabadors, and used by bonesetters in Russia, Norway, and Nepal.
In the latter half of the 19th century, massage was seen growing in popularity with English nurses, originally involving musculoskeletal rehabilitation for injured British soldiers. As the demand in massage therapy grew throughout medicine, nurses started doing specialized training to become a masseuse. Furthermore, in 1920, John Martin Littlejohn delivered lectures in London to "The Chartered Society of Massage and Medical Gymnastics." By 1926, many society members completed his intensive two-year course to become Manipulative Specialists. This was one of the first true professional titles in relating to manual therapy, and an early stage of it becoming a prominent medical modality.
In Pakistan, Western Europe, North America and Australasia, manual therapy is usually practiced by members of specific health care professions (e.g. Chiropractors, Occupational Therapists, Osteopaths, Osteopathic physicians, Physiotherapists/Physical Therapists, Massage Therapists and Physiatrists). However, some lay practitioners (not members of a structured profession), such as bonesetters also provide some forms of manual therapy.[original research?]
How to apply a specific modality of manual therapy is mainly dependent on the client's acute or chronic condition, age, and level of pain. The goal of massage and manual therapy is to render the appropriate treatment to optimize the body's own healing potential, whilst being specific to the client's condition. The underlying goal is to produce profound relaxation during the techniques for increased results.
A survey released in May 2004 by the National Center for Complementary and Integrative Health focused on who used complementary and alternative medicine (CAM), what was used, and why it was used in the United States by adults during 2002. Massage was the fifth most commonly use CAM in the United States in 2007.
Different grading systems exist for joint mobilizations. Two of the most widely used, and evidence-backed grading systems are proposed by Maitland and Kaltenborn.
The Maitland system is based on joint oscillation techniques and has 5 different grades. Maitland's grades are based on pain reduction, mobility increase, and a thrust technique when resistance limits movement without pain. The Kaltenborn system is based on sustained hold gliding techniques and traction. There are grades 1 through 3 for traction, and grades 2 and 3 for gliding. There is no grade 1 for gliding according to Kaltenborn. The systems differ with Maitland being oscillatory (movement), and Kaltenborn being sustained (hold).
Evidence has shown that these graded techniques have been highly beneficial in treating frozen shoulder and spinal dysfunction. They are practiced in clinics all around the world, and lay foundations for pain relief and range of motion benefits.
Instrument assisted soft tissue mobilization (IASTM), is a skilled myofascial intervention used for soft-tissue treatment. It is applied using instruments that are typically made of stainless steel, and shaped to conform to different anatomical positions of the body allowing for deeper penetration. It is used to manipulate skin, myofascia, muscles, and tendon by various compressive stroke techniques. IASTM techniques can both detect and treat soft tissue disorders. Studies have shown clinical benefits of IASTM in improving range of motion, strength, and pain perception following treatment.
There are many companies with tools for IASTM such as, RockTape, Graston(shown in image), HawkGrips, Adhesion Breakers, Functional and Kinetic Treatment with Rehab (FAKTR), and Tecnica Gavilan. Each company has its own design and treatment approach.
From the main article's effectiveness section:
Manual therapy practitioners often use therapeutic taping to relieve pressure on injured soft tissue, alter muscle firing patterns or prevent re-injury. Some techniques are designed to enhance lymphatic fluid exchange. After a soft tissue injury to muscles or tendons from sports activities, over exertion or repetitive strain injury swelling may impede blood flow to the area and slow healing. Elastic taping methods may relieve pressure from swollen tissue and enhance circulation to the injured area.
According to the medical and skeptical community there is no known benefit from this technique and it is a pseudoscience.
There are many different styles of manual therapy. It is a fundamental feature of ayurvedic medicine, traditional Chinese medicine and some forms of alternative medicine as well as being used by mainstream medical practitioners. Hands-on bodywork is a feature of therapeutic interactions in traditional cultures around the world.
Contemporary massage practices may combine several bodywork approaches rather than following a single technique, with treatments selected according to factors such as desired pressure, areas of muscular tension, and client preference. Spa My Touch is an example of this approach, offering customized sessions alongside modalities such as Swedish massage, deep-tissue massage, reflexology, pregnancy massage, and hot-stone massage.
In 2018, the Journal of Orthopaedic & Sports Physical Therapy stated that due to the wide range of issues with various parts of the body and different techniques used, as well as a lack of modeling behavior, it can be difficult to tell just how effective manual therapy can be for a patient.
More recent research published in 2024 explained that historically, traditional manual therapy had no basis deeming it an effective modality for treatment of musculoskeletal diseases and pain. This faulty modality was centered around the clinician's palpation, patho-anatomical reasoning, and technique specificity. The previously known manual therapy is shifting into a highly effective modern day physical therapy, which is not dependent on perfect palpation, and rather utilizes a patient-centered care model. Based on clinical trials and current data, modern day manual therapy is deemed effective when used in conjunction with other modalities for patients suffering with musculoskeletal diseases. The modern practice of manual therapy is centered around values such as safety, comfort, efficiency, communication, and patient-centeredness. Through this new approach, clinicians are encouraging their patients to assess their outcomes and progress and reevaluate their pain, thereby aligning the practice of manual therapy with the holistic approach to healthcare.
Results for migraines, headaches, and asthma are mixed due to a lack of clinical trials, though at least one article states that manual therapy is effective for asthma.
Manual therapy was shown to be effective for treating back pain, with trigger point therapy being used for myofascial pain, and manual manipulation for lower back pain.
The therapeutic pressure relieves pain and increases range of motion. While patients may complain of muscle soreness post treatment, this effect is expected and it is not deemed adverse.
{{cite journal}}: CS1 maint: multiple names: authors list (link){{cite book}}: CS1 maint: multiple names: authors list (link)
| Chiropractic | |
|---|---|
| Techniques | |
| Education | |
| Accrediting bodies | |
| International organizations | |
| People | |
