Manual Therapy

Manual therapy is a specialization within physical therapy. The training, which now increasingly incorporates higher standards at the student level, is further developed in courses, following the four year degree courses in physical therapy.

The manual therapist provides comprehensive, conservative management for the spinal and peripheral joint pain of musculoskeletal dysfunction. The manual therapist works within the medical team, providing a specialist service, following referral by a physician.

Under the guidance of Cyriax, Grieve, Kaltenborn, Maitland, Marsman, Mennell, Paris, Van der Bijl and others, manual therapists have now developed a new systematic treatment approach. This approach has remained nondoctrinal, based upon careful analysis establishing dysfunction of the vertebral segment (or peripheral joint) with consequential changes in the neuromusculoskeletal structures.

Appropriate physical therapy techniques are used to normalize the function that may include various massage techniques, proprioceptive neuromuscular facilitation, rhythmical and sustained traction, passive maintenance movements, various electrotherapeutic modalities, ergonomic analysis, specific exercise techniques for strengthening, flexibility and stabilization.

How I use Manual Therapy

The method of manual therapy I use in my practice is that according to Mr. Marsman of the Netherlands. It is a gentle "egg shell" form of manipulation/mobilization that induces increased mobility, while the structures are moved within, or at, the limit of their range. This is in direct opposition to the "sudden thrust" techniques, in which there is a forcing of movement beyond the limit of the range. The gentle approach will at all times allow the patient to resist the manipulation/mobilization if it should become too painful; whereas the suddenness of the forceful manipulation prevents any control by the patient.

The practical approach to the use of manual therapy is to relate treatment to the patient's signs and symptoms. In most cases a series of treatments is indicated, whose duration is dependant of the chronicity of the condition.

I would like to emphasize that manual therapy, though a significant part in the overall treatment of functional and degenerative disorders affecting the spine, joints and muscles, should be seen in the context of a larger framework of treatment. Each practitioner makes use of his or her own, specialized training, so as to present to the patient a treatment plan that is the combination of all the practioners skills, including those of psychology and manual therapy.

The guideline of good medical practice then becomes "Primum nil nocere" - "Do no harm".