Manual therapy, or manipulative therapy, is a physical treatment primarily used by physical therapists, physiotherapists, occupational therapists to treat musculoskeletal pain and disability; it mostly includes kneading and manipulation of muscles,

joint mobilization Joint mobilization is a manual therapy intervention, a type of straight-lined, passive movement of a skeletal joint that addresses arthrokinematic joint motion (joint gliding) rather than osteokinematic joint motion. It is usually aimed at a 'ta ...

and joint manipulation. It is also used by

Rolfer Rolfing () is a form of alternative medicine originally developed by Ida Rolf (1896–1979) as Structural Integration. Rolfing is marketed with unproven claims of various health benefits. It is based on Rolf's ideas about how the human body's " ...

s, massage therapists, athletic trainers, osteopaths, and

physicians A physician (American English), medical practitioner (Commonwealth English), medical doctor, or simply doctor, is a health professional who practices medicine, which is concerned with promoting, maintaining or restoring health through th ...

. A 2011 literature review indicates that placebo is one of likely many potentially relevant mechanisms through which manual therapy improves clinical outcomes related to musculoskeletal pain conditions.

Definitions

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."

Use and method

In Western Europe,

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and

Australasia Australasia is a region that comprises Australia, New Zealand and some neighbouring islands in the Pacific Ocean. The term is used in a number of different contexts, including geopolitically, physiogeographically, philologically, and ecolo ...

, 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 Traditional bone-setting is a type of a folk medicine in which practitioners engaged in joint manipulation. Before the advent of chiropractors, osteopaths and physical therapists, bone-setters were the main providers of this type of treatmen ...

also provide some forms of manual therapy. 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 The United States of America (U.S.A. or USA), commonly known as the United States (U.S. or US) or America, is a country primarily located in North America. It consists of 50 U.S. state, states, a Washington, D.C., federal district, five ma ...

in 2007.

Techniques

* Myofascial therapy targets the muscle and fascial systems, promotes flexibility and mobility of the body's connective tissues. It is said to mobilize adhesions and reduce severity/sensitivity of scarring. A critical analysis finds that the relevance of fascia to therapy doubtful. * Massage may be used as part of a treatment. Proponents claim this may reduce inflammation. Science writer Paul Ingraham notes that there is no evidence to support the claim. * Friction massage is said to increase mobilization of adhesions between fascial layers, muscles, compartments and other soft tissues. They are thought to create an inflammatory response and instigate focus to injured areas. A 2002 systematic review found that no additional benefit was incurred from the inclusion of deep tissue friction massage in a therapeutic regimen, although the conclusions were limited by the small sample sizes in available randomized clinical trials. * Soft Tissue Technique is firm, direct pressure to relax hypertonic muscles and stretch tight fascial structures. A 2015 review concluded that the technique is ineffective for lower back pain, and the quality of research testing its effectiveness is poor. * Trigger point techniques claim to address myofascial trigger points, though the explanation of how this works is controversial.

Stretching

From the main article's effectiveness section: * Apart from before running, stretching does not appear to reduce risk of injury during exercise. * Some evidence shows that pre-exercise stretching may increase range of movement. * The

Mayo Clinic The Mayo Clinic () is a nonprofit American academic medical center focused on integrated health care, education, and research. It employs over 4,500 physicians and scientists, along with another 58,400 administrative and allied health staff, ...

advises against bouncing, and to hold for thirty seconds. They suggest warming up before stretching or stretching post-exercise.

Taping

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.

Styles of manual therapy

There are many different styles of manual therapy. It is a fundamental feature of ayurvedic medicine,

traditional Chinese medicine Traditional Chinese medicine (TCM) is an alternative medicine, alternative medical practice drawn from traditional medicine in China. It has been described as "fraught with pseudoscience", with the majority of its treatments having no logica ...

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. * Acupressure * Anma * Bobath concept * Bodywork (alternative medicine) *

Bone setting Traditional bone-setting is a type of a folk medicine in which practitioners engaged in joint manipulation. Before the advent of chiropractors, osteopaths and physical therapists, bone-setters were the main providers of this type of treatment. T ...

* Bowen Technique *

Chiropractic Chiropractic is a form of alternative medicine concerned with the diagnosis, treatment and prevention of mechanical disorders of the musculoskeletal system, especially of the spine. It has esoteric origins and is based on several pseudoscien ...

Cranio-sacral therapy Craniosacral therapy (CST) or cranial osteopathy is a form of alternative therapy that uses gentle touch to palpate the synarthrodial joints of the cranium. CST is a pseudoscience and its practice has been characterized as quackery. It is bas ...

Dorn method The Dorn method is a form of manual, holistic alternative therapy used to correct misalignments in the spinal column and other joints. During a treatment, the practitioner palpates the patient's spine. If any 'unbalanced' areas are found, possible ...

* Joint manipulation *

Joint mobilization Joint mobilization is a manual therapy intervention, a type of straight-lined, passive movement of a skeletal joint that addresses arthrokinematic joint motion (joint gliding) rather than osteokinematic joint motion. It is usually aimed at a 'ta ...

Spinal manipulation Spinal manipulation is an intervention performed on spinal articulations, synovial joints, which is asserted to be therapeutic. These articulations in the spine that are amenable to spinal manipulative therapy include the z-joints, the atlanto ...

Spinal mobilization Spinal mobilization is a type of passive movement of a spinal segment or region. It is usually performed with the aim of achieving a therapeutic effect. Spinal mobilization has been described as "a gentle, often oscillatory, passive movement ap ...

* Massage therapy * Manual lymphatic drainage * Medical acupuncture * Muscle energy techniques *

Myofascial release Myofascial release (MFR, self-myofascial release) is an alternative medicine therapy claimed to be useful for treating skeletal muscle immobility and pain by relaxing contracted muscles, improving blood and lymphatic circulation, and stimulati ...

(MFR) *

Myotherapy Myotherapy is a form of muscle therapy which focuses on the assessment, treatment and rehabilitation of musculoskeletal pain and associated pathologies. The term myotherapy was originally coined by Bonnie Prudden to describe a specific type of ...

* Naprapathy * Osteopathic manipulative medicine * Osteopathy *

Physiotherapy Physical therapy (PT), also known as physiotherapy, is one of the allied health professions. It is provided by physical therapists who promote, maintain, or restore health through physical examination, diagnosis, management, prognosis, patient ...

Polarity therapy Randolph Stone (February 26, 1890 – December 9, 1981) was an Austrian-American chiropractor, osteopath and naturopath who founded polarity therapy, a technique of alternative medicine. He had an interest in philosophy and religions, and encou ...

* Postural Integration * Rolfing * Shiatsu * Siddha Medicine * Structural Integration * Traction * Tui na * Zero Balancing

References

External links

American Academy of Orthopaedic Manual Physical Therapists

American Organization for Bodywork Therapies of Asia

Manual Therapy Foundation of India

International Federation of Orthopaedic Manipulative Therapists
{{Authority control Orthopedic surgical procedures Concepts in alternative medicine

Definitions

Use and method

Techniques

Stretching

Taping

Styles of manual therapy

See also

References

Further reading

Journals

Books

External links