Term Paper: Manual Therapy

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Manual therapy is regarded as one of the traditional methods of treatments in the field of medicine and includes all types of message, mobilization, manipulation and traction. (Geffen, 2003) Etymologically manual implies the work performed with the use of hands. Houglum applies the concept 'manual therapy' to mean the application of hands-on techniques to assess, treat and enhance the position of neuromusculoskeletal conditions. During the past several years the profession of athletic training has been revolutionized with introduction of varied technologically advanced modalities considered more effective than human hands. Denegar, however viewed that enormous power rests in the hands of athletic trainer as a tool of evaluation and treatment. (Holt, 2004)

As understood earlier, manual therapy techniques apply hands on approaches such as massage, manipulation and mobilization techniques. The massaging incorporates stroking, friction, and kneading of muscles and soft tissues. The stroking massage is applied in reducing edema and generates relaxation of muscle, while friction and kneading massage on the other hand break down intramuscular adhesions and prepare the muscles and soft tissues for the purpose of stretching. Its effectiveness in alleviating edema, stiffness and pain particularly in myofascial trigger points is quite evidential. Mobilization incorporates techniques in that a trained physical or occupational therapist applies a manual approach to deal with tissues along with muscles and fascia. The myofascial release is considered as a manual approach of soft tissue mobilization that concentrates on the fascial component that evidentially generates pain and dysfunction. Manipulation involves a skilled, passive movement of a spinal segment, generally within and occasionally exceeding its active range of motion. Several medical professionals along with osteopathic physicians, chiroparactors and primary care physicians apply spinal manipulation but vary in rationale and techniques applied. (Physical Rehabilitation in Managing Pain)

The advantages of manual therapy include declining levels in oedema and spasm and enhanced flexibility and a serried of joint motion along with the psychological impacts. (Geffen, 2003) As Denegar points out the manual therapy mostly includes massage, strain-counterstrain, joint mobilization, myofascial release and muscle energy. Each of such activity has its own application as a modality even though there is a high magnitude of mutual benefits inherent in them. The athletic trainers use such manual therapy on injured athletes with the primary aim of returning athletes to enable them exert their full potentiality and participate in competition recognizing its therapeutic advantages. More particularly the therapeutic modalities of manual therapy techniques entail benefits in terms of forward end of the treatment-rehabilitation dimension particularly to relieve pain and restore the normal level of motion. Its use as a rehabilitation technique stems from the goal of restoring strength and muscular strength. The therapeutic modalities and rehabilitation activities cannot be taken in isolation to achieve the desired results. The advantages of massage are recognized in terms of circulatory, metabolic, neuromuscular, connective tissue and analgesic effects. (Holt, 2004)

Besides the mechanical and physiological benefits of massage, as Prentice observed, it has exerts some psychological responses. Myofascial release involves a more tender form of hands-on therapy than some forms of message or trigger point therapy, targeting at decreased pain and increasing muscle flexibility by realigning fascia and the muscle that it is linked to a normal situation. Indirect myofascial release declines gamma gain, which enables muscles and tendons to extend even further. Eliminating stress from muscles by means of comfortable repositioning, output to gamma efferent nerves declines. Direct myofascial release gently extends tight fascia, permitting fascia and muscles to relax and in the manner improving the stretch capability and range of motion. The method of strain counterstrain is resorted to for addressing the relief of pain. The objective is to restore the effected segment in the status of minimum pain, then slowly transferring the segment to neutral position thereby seeking to relax tender points which are deep within tendons, ligaments, muscles, or fascia. (Holt, 2004)

The effectiveness of the strain counter strain depends upon the stretch reflex since the release of overstretched tender points is relaxed and pain is minimized. The benefit of the strain-counterstrain is thus seen as an establishment of more suitable activity thus both alleviating the pain and enabling greater level of motion. Another manual therapy is joint mobilization. Tenderly, moving motion regulated joints through a particular portion of the range, joint receptors can be modified to enable an enhanced pain free range of motion. Moreover, the low-velocity passive movements of joint mobilization enhance stimulation of the large diameter afferent fibers thereby alleviating pain. The passive movement of an affected joint gives rise to the beneficial effects in terms of declining the splinting by the athlete, and the pain-spasm cycle can be reduced, giving rise to restoration of the maximum length of the muscles.

The muscle energy is another form of manual therapy. This involves active contraction of affected muscles by the athletes which is set against a counterforce. Application of concentric, isometric and eccentric contraction is seen in the efforts of restoring muscle and joint function. The technique of muscle energy is mostly applied in the treatment of lower back problems. The basic advantages of the muscle energy are the provision of stretch in hypertonic muscles and fascia, improving of weak muscle and enhanced mobilization in the restricted joints. Hence the two basic advantages of modality application, minimizing pain and enhancement in range of motion, are directly dealt through the use of muscle energy as a therapeutic method. The manual therapies are widely used in later stages of rehabilitation. However, as modalities they are mostly used to alleviate pain and enhance range of motion in injured tissues. The therapies generally are applied along with other modalities like TENS or other non-mechanical techniques but are mostly used by themselves in the initial stages of rehabilitation injuries. (Holt, 2004)

The correction of biomechanical imperfections is clinically significant even if it is not sure whether it directly influences tendon recovery. The variation in the amount and/or speed of foot pronation is regarded as the most useful interference. The regulation of foot mechanics in athletics is best possible with modified, rigid orthotic prescription. Regular message during rehabilitation is considered advantageous to help muscle recovery in the process of strengthening. Inadequate response to the load management and exercise by athletes reduces the effectiveness of rehabilitation. Such athletes seem to recover partially and return to abusive loads prematurely only to ensure recurrence of pain. (Beeton, 2003)

The manual therapy along with mobilization and manipulation; physiotherapy; and pain relief medications are normally administered to alleviate neck pain. A study appeared in the April 26, 2003 issue of the British Medical Journal made a comparison with the efficacy and cost effectiveness of such forms of care and revealed that manual therapy is regarded as more effective. (Devitt, 2003) The study conducted by researchers on 183 patients being administered with different types of manual therapy, traditional physical therapy and medical care from a general practitioner. The study revealed that there were considerable improvements over time in those that administered with manual therapy, in comparison to other two groups. As per the statistics the 68% of patient in the group administered with manual therapy could recover in the seventh week. In respect of physical therapy and medical care group it is only 51% and 36% respectively. The study concluded that manual therapy is faster and less expensive in reducing neck pain than more conventional types of physical therapy and medical care from a general practitioner. (BMJ: Manual therapy beats out traditional treatment)

Similarly a study has been conducted in Netherlands taking the sample of 183 patients with non-specific neck pain and administering them with manual therapy, exercise therapy, or continued care from a general practitioner. Observation was made on its impact with reference to physical dysfunction, pain intensity and disability. After six weeks the rates of success were about 68.3% for manual therapy, 50.8% for exercise therapy and 35.9% for that of continued care confirming the fact that manual therapy scored persistently better than the other two interventions on most of the outcome measures. (Manual therapy best for necks)

Several studies have been made to probe into the influence of manual therapy on chronic low back pain with reference to pain, function and sick leave. But the out come of such studies have however found to be self contradictory. A particular study took a sample of 49 patients having chronic low back pain or raducular pain having been sick-listed for about more than eight months but less than six months. They were grouped under two categories - 27 patients were applied manual therapy and the rest 22 with exercise therapy. About 16 numbers of various treatments were applied over the span of two months. Subsequently, the researchers observed and recorded the pain gravity, disability in functioning, general health conditions and return for work, immediately after the elapse of 4 weeks, 6 months and 12 months of the treatment period. (Aure; Hoel Nilsen; Vasseljen, 2003)

Even though considerable improvements were being found in both the categories the group administered with manual therapy… [END OF PREVIEW]

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