WHAT IS MANUAL THERAPY? IS IT ALL ABOUT OUR HANDS?
3 more mins to read……
Last weeks I’ve read on social media some strange statements about manual therapy. Like “passive therapy is old fashioned”, “it helps only the teachers & organisations”, “it doesn’t fit for chronic pain patients” or “it’s all about beliefs and far from evidence based medicine / therapy”. At least what we’re teaching on IMTA courses, it’s completely the opposite to the cited statements.
Passive Mobilisations for joints only?
Yes, we’re teaching passive mobilisations. For all peripheral joints as well as for all parts of the spine. Some people believe, that a joint technique is exclusively mobilising the joint. Let’s say we move the hip joint in flexion or flexion / adduction. It’s clearly a movement for the hip joint. But of course it’s also moving the joint capsule, the surrounding ligaments, the muscles which are passing the joint. And also the nerves are involved. Don’t forget the fascias, they are not excluded in our techniques, neither during the examination nor during the treatment. Do we stretching muscles? During flexion / adduction, may combined with medial rotation, we’re stretching the glut max. With the shoulder quadrant we clearly stretch the pec major muscle.
Passive techniques for soft tissues
As I mentioned above, many (if not all) of our so called joint mobilisations are targeting also the muscles. Nevertheless, if the clinical reasoning process shows that the problem is dominantly the muscle, we will treat the muscle itself. E.g. with trigger point techniques. Although it’s very rare, that the muscle is developing his problem on it’s own. The literature is overwhelming, that a muscle dysfunction is very often the effect of a changed arthrogenic input. Later on this year I will post a blog about “Arthrogenic myogenic inhibition (AMI)”.
I can’t remember, that I had a patient who left my clinic without any exercises. Many, many reasons to give exercises. Not only for strengthening, stretching, better endurance or coordination, but also for making the patient independently from the therapist, reinforcing the self confidence of the patient, giving him a chance to get control over his pain, strengthening his passive structures (form follows function).
If the preferred sports activity or the job of the patient is a contributing factor of the patient’s problem, we have to advice the patient to learn may be a better, more harmless moving pattern. Sometimes easy things like a better position of the screen on the desk could solve the problem.
Explaining the problem to the patient could have a great effect. Avoiding catastrophising, reducing fear, motivation to move, trusting their own bodies again, giving the patient the conviction that I believe his pain and suffering and and and. In Germany, patients expect to being treated by my hands, and so I do. 99,5% of these patients I would say, are happy after I give them a good explanation to go along with the hands-on. The few patients who are complaining about explanations have no real problems IMO.
Although it’s called “Manual Therapy”, we are treating our patients not only passively. Although some techniques are called “joint techniques”, it’s not possible to treat a joint isolated! Muscles, nerves, fascias etc are always involved.
Enjoy your freedom to choose the clinical decision to treat the patient as effective as possible.