Manual Therapy: Massages and Physiotheraphy

Lisel Morfi 

Is very common now a day when you a person that is really tired or had a long day saying “I need a massage “or some type of manual therapy. I have tried this at home using different oils to help with back pain or just to relax my muscle, but do I really know What is manual therapy? Manual therapy is defined as “any kind of manual mobilization or manipulation, with or without the addition of exercises” (Braun & Hanchard, 2010, p. 63).

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Physical therapists (PT) usually use this intervention to treat musculoskeletal pain, physical disabilities, manual lymph drainage among others. It is also used as a relaxation technique to reduce stress and tension accumulated during a hard-working day (Choi, Hwangbo, Park, & Lee, 2014). Normally the PT uses its hand to produce movements in the target area to provide therapeutic effects.

Therapy techniques

Although the hands are the major tool for manual therapy, there are many different techniques that are used to target each specific area. After being assessed by a physician to rule out any complication that can be cause by the therapy, the PT can decide what technique will be more efficient depending in the current complain. One of the most common technique is soft tissue mobilization. This method is used to treat soft tissue injuries such as strains and sprains, contusions, tendonitis among other by promoting flexibility and mobility of the body’s connective tissues. The PT using this technique, will first localize the area of most tension, and then provide traction force in that area until the texture in back to normal releasing pain and discomfort. Sometimes more than one section is need it to archive the ultimate results. Research backup that this technique provides its main therapeutic benefits through relaxing tense muscles, minimizing scar tissue, among others (Coughlin, 2002).

Another technique is joint mobilization. Join mobilization is effective in treating joint pain, joint stiffness, and other musculoskeletal problems.  In this procedure, the PT uses range of motion in the joint that is restrictive. The results that can be obtain are reduction of pain, loosen up the restriction and increasing the range of motion in the treated area (Choi et al., 2014). This very common used in hospital when client is in bed for a period of long time to prevent joint stiffness.

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  Certification, scope of practice, and treatment claims

To be able to archive manual therapy certification there are many advanced programs are “one-to-two-years in duration that provide extensive hands-on and didactic training and rigorous competency testing. Graduates earn the credential, Certified Orthopaedic Manual Therapist (COMT)” (Therapy, S. P. (2017). A high school diploma is need to apply for this certification. Most of the time PT decide to add this certification to their curriculum to use in combination with other therapies. The scope of practice varies depending on the certification. Manual therapy scope falls in the of joints (joint mobilization/ manipulation) and soft tissues (soft tissue mobilization/specific localized massage) but if you have other certification like massage therapists, physiotherapists, occupational therapists you scope may be extended, however specific state requirements may “restrict the practitioner’s scope of practice to certain areas of the body” (Coughlin, 2002, p. 87).

As far as treatment claim, it is clear that most manual treatment practitioner hold the position that with human hands and the correct interventions could be utilized to analyze and treat different diseases and musculoskeletal issues. Unlike other professionals like chiropractic and osteopathic therapists they believe that they need a deep assessment to know and understand the underlying cause (Olson, 2016).

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Case study

This case study is about a 54-year-old male that was referred by the physician due to neck and shoulder pain with no medical diagnostic. He explains that the pain was provoked by reaching overhead or prolonged side-lying. Pain rate is 3/10 and only resting lessened it. “He also reported intermittent tingling in the neck and arms with no attributed cause” (Gillete, nd). After an overall assessment, he diagnosed with a biomechanical fault caused by a stiff sternoclavicular joint (SCJ) causing impairments of pain and reduced range of motion in the shoulder and neck.  They decided that manual therapy was perfect for his condition. The therapy goals consist of pain-free neck and shoulder movements.

Treatment include mobilization of the left clavicle posteriorly to improve clavicle rotation during shoulder flexion. This resulted in improved pain-free ROM. “Additionally, myofacial release of the left subscapularis was performed, which resulted in his ability to reach overhead pain-free” “To improve his neck ROM, the therapist also did a right atlanto-occipital side bend into flexion, myofascial release of lateral cervical musculature, and bilateral cervical rotation with resistance to retrain his cervical rotators to use the new range. After treatment, the joint had increased range and decreased pain” (Gillete, n.d).

Overall result the client pain decreased and limitation of the neck and shoulder improved. A better result could have been archive if the client didn’t miss three appointment.  During a follow-up three months after, he returned to work, and had no pain or limitations with upper-extremity movements (Gillete, n.d).

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References

Braun, C., & Hanchard, N.C.A. (2010). Manual therapy and exercise for impingement-related shoulder pain. Physical Therapy Reviews, 15, 62-83. doi: 10.1179/174328810X12786297204675

Choi, J., Hwangbo, G., Park, J., & Lee, S. (2014). The effects of manual therapy using joint mobilization and flexion-distractions techniques on chronic low back pain and disc heights. Journal of Physical Therapy Science, 26, 1259-1262. doi: 10.1598/JPES.26.1259

Coughlin, P. (2002). Principles and practice of manual therapeutics. Philadelphia, Pennsylvania: Elsevier Science.

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Gillete, D. (nd). Manual Therapy and Exercise Intervention in the Treatment of Shoulder and Neck Pain in a Patient with Mental Health Comorbidities: A Case Report – Physiopedia, universal access to physiotherapy knowledge. Physio-pedia.com. Retrieved 18 February 2017, from http://www.physio-pedia.com/Manual_Therapy_and_Exercise_Intervention_in_the_Treatment_of_Shoulder_and_Neck_Pain_in_a_P

Olson, K.A. (2016). Manual physical therapy of the spine (2nd ed.). St. Louis, Missouri: Elsevier.

Therapy, S. P. (2017). Manual Therapy certification. Retrieved February 18, 2017, from http://www.selectphysicaltherapy.com/clinicians/manual-therapy-certification/

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