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Manual therapy: What is it and how can it help you?

Manual therapy is a very broad topic, covering many different types of treatment, and from many different types of practitioners. Manual therapy can be defined as: “Skilled hand movements intended to produce any or all of the following effects: improve tissue extensibility; increase range of motion of the joint complex; mobilize or manipulate soft tissues and joints; induce relaxation; change muscle function; modulate pain; and reduce soft tissue swelling, inflammation or movement restriction” (International Federation of Orthopaedic Manipulative Physical Therapists).

Initially when practitioners first started using manual therapy to help improve pain after injury, they thought it was strictly having a mechanical effect. This means that the hands on treatment was helping to stretch or loosen tissue and improve tissue repair. However through more research they have also found other important mechanisms that help improve healing and pain relief. One of these is a neuro-physiological effect. Manual therapy helps stimulate the nervous system in a positive way to help inhibit muscle spasm, reduce joint pressure, and stimulate pain gating mechanisms to help reduce painful sensations. The other is through psychological effects. Research has actually shown that hands on therapy on someone during treatment helps improve their response to that treatment. It helps to build practitioner-client rapport as well.

An example of joint arthrokinematic movements

As mentioned previously, there are several different types of manual therapies. One very common practice is something called mobilizations. Mobilizations work to improve joint mobility by aiding in what is called joint arthrokinematic movement. These are movements that occur within your joints that you don’t directly control. For example, in order for a knee to straighten, the bottom bone (tibia), must slide forwards and roll forwards at the same time on the top bone (femur) (see figure). A skilled manual therapist can work on either the slide or the roll (or both) to help improve the ability of the knee to extend. A mobilization is done at an intensity where at any point the client could stop the movement by contracting their muscles. This decreases the risk of complications as the client can actively stop the treatment if there is some discomfort or pain. An alternative of a mobilization is a manipulation, or high velocity thrust. These are done very rapidly and cannot be stopped by a client if they choose to. Many of you may have experienced this at chiropractors or physiotherapists during your treatments. Often manipulations create a “popping” sound in the joint being “cracked”. This popping is essentially a release of gas pressure from the joint that can help with mobility and pain relief in the joint. Manipulations have a higher level of risk, and a similar effect to mobilizations, though in some cases do provide greater pain relief. One common risk for both mobilizations and manipulations is a short term increase in soreness after the treatment. Occasionally there can be a more significant increase in pain, lasting longer than just the short term, and is usually an indication that this type of manual therapy will not be effective.

Another very common form of manual therapy is soft tissue release, or massage. Even this can be broken down into different type of therapy such as active release, trigger point release, myofascial release, cross friction massage, Swedish massage, and effleurage. I won’t go into detail about all of these, but the common theme is using hands on, manual therapy treatment, to relax muscles, improve blood flow, stimulate the nervous system, and help modulate pain.

If you have any other questions, or think that manual therapy may be beneficial for you, please do not hesitate to call us at 905-240-9355!

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