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Manual therapy, or manipulative therapy, is a treatment primarily used by physical therapists,
occupational therapist Occupational therapists (OTs) are health care professionals specializing in occupational therapy and occupational science. OTs and occupational therapy assistants (OTAs) use evidence-based practice, scientific bases and a Holism, holistic perspec ...
s, and massage therapists to treat musculoskeletal pain and disability. It mostly includes kneading and manipulation of muscles, joint mobilization and joint manipulation. It is also used by Rolfers,
athletic trainer An athletic trainer is a certified and licensed health care provider who practices in the field of sports medicine. Athletic training has been recognized by the American Medical Association The American Medical Association (AMA) is an American ...
s, osteopaths, and
physicians A physician, medical practitioner (British English), medical doctor, or simply doctor is a health professional who practices medicine, which is concerned with promoting, maintaining or restoring health through the study, diagnosis, prognosis ...
.


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
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,
Western Europe Western Europe is the western region of Europe. The region's extent varies depending on context. The concept of "the West" appeared in Europe in juxtaposition to "the East" and originally applied to the Western half of the ancient Mediterranean ...
,
North America North America is a continent in the Northern Hemisphere, Northern and Western Hemisphere, Western hemispheres. North America is bordered to the north by the Arctic Ocean, to the east by the Atlantic Ocean, to the southeast by South Ameri ...
and
Australasia Australasia is a subregion of Oceania, comprising Australia, New Zealand (overlapping with Polynesia), and sometimes including New Guinea and surrounding islands (overlapping with Melanesia). The term is used in a number of different context ...
, manual therapy is usually practiced by members of specific health care professions (e.g.
Chiropractor Chiropractic () is a form of alternative medicine concerned with the diagnosis, treatment and prevention of physical disorder, mechanical disorders of the musculoskeletal system, especially of the vertebral column, spine. It is based on sever ...
s, Occupational Therapists, Osteopaths, Osteopathic physicians,
Physiotherapist Physical therapy (PT), also known as physiotherapy, is a healthcare profession, as well as the care provided by physical therapists who promote, maintain, or restore health through patient education, physical intervention, disease preventio ...
s/Physical Therapists, Massage Therapists and Physiatrists). However, some lay practitioners (not members of a structured profession), such as bonesetters also provide some forms of manual therapy. A survey released in May 2004 by the
National Center for Complementary and Integrative Health The National Center for Complementary and Integrative Health (NCCIH) is a United States government agency which explores complementary and alternative medicine (CAM). It was created in 1991 as the Office of Alternative Medicine (OAM), and r ...
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 (USA), also known as the United States (U.S.) or America, is a country primarily located in North America. It is a federal republic of 50 U.S. state, states and a federal capital district, Washington, D.C. The 48 ...
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 Massage is the rubbing or kneading of the body's soft tissues. Massage techniques are commonly applied with hands, fingers, elbows, knees, forearms, feet, or a device. The purpose of massage is generally for the treatment of body stress or pa ...
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 Low back pain or wiktionary:lumbago#Etymology, lumbago is a common musculoskeletal disorders, disorder involving the muscles, nerves, and bones of the back, in between the lower edge of the ribs and the lower fold of the buttocks. Pain can var ...
, 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 Mayo Clinic () is a Nonprofit organization, private American Academic health science centre, academic Medical centers in the United States, medical center focused on integrated health care, healthcare, Mayo Clinic College of Medicine and Science ...
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 A repetitive strain injury (RSI) is an injury to part of the musculoskeletal or nervous system caused by repetitive use, vibrations, compression or long periods in a fixed position. Other common names include repetitive stress injury, repetitiv ...
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 Medicine is the science and Praxis (process), practice of caring for patients, managing the Medical diagnosis, diagnosis, prognosis, Preventive medicine, prevention, therapy, treatment, Palliative care, palliation of their injury or disease, ...
and skeptical community there is no known benefit from this technique and it is a
pseudoscience Pseudoscience consists of statements, beliefs, or practices that claim to be both scientific and factual but are incompatible with the scientific method. Pseudoscience is often characterized by contradictory, exaggerated or unfalsifiable cl ...
.


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. A large share of its claims are pseudoscientific, with the majority of treatments having no robust evidence ...
and some forms of
alternative medicine Alternative medicine refers to practices that aim to achieve the healing effects of conventional medicine, but that typically lack biological plausibility, testability, repeatability, or supporting evidence of effectiveness. Such practices are ...
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 * 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 is based on several pseudoscientific ideas. Many c ...
* Cranio-sacral therapy * Dorn method * Joint manipulation * Joint mobilization *
Sekkotsu or Judo therapy is the traditional Japanese art of Bonesetter, bone-setting. It has been used in many Japanese martial arts and has developed alongside judo into a licensed medical practice somewhat resembling chiropractic in Japan today. A ' is ...
* Spinal manipulation * Spinal mobilization * Massage therapy *
Manual lymphatic drainage Manual lymphatic drainage (MLD) is a type of manual manipulation of the skin, not to be confused with massage, based on the hypothesis that it will encourage the natural drainage of the lymph, which carries waste products away from the tissues bac ...
* Medical acupuncture * Muscle energy techniques * Myofascial release (MFR) * Myotherapy * Naprapathy *
Osteopathic manipulative medicine Osteopathy is a pseudoscientific system of alternative medicine that emphasizes physical manipulation of the body's muscle tissue and bones. In most countries, practitioners of osteopathy are not medically trained and are referred to as osteo ...
*
Osteopathy Osteopathy is a pseudoscientific system of alternative medicine that emphasizes physical manipulation of the body's muscle tissue and bones. In most countries, practitioners of osteopathy are not medically trained and are referred to as osteo ...
*
Physiotherapy Physical therapy (PT), also known as physiotherapy, is a healthcare profession, as well as the care provided by physical therapists who promote, maintain, or restore health through patient education, physical intervention, disease preventio ...
* Postural Integration * Rolfing * Shiatsu * Siddha Medicine * Structural Integration * Traction * Tui na * Zero Balancing


Efficacy

In 2018, the Journal of Orthopaedic & Sports Physical Therapy stated that due to the wide range of issues with various parts of the body and different techniques used, as well as a lack of modeling behavior, it can be difficult to tell just how effective manual therapy can be for a patient. More recent research published in 2024 explained that historically, traditional manual therapy had no basis deeming it an effective modality for treatment of musculoskeletal diseases and pain. This faulty modality was centered around the clinician’s palpation, patho-anatomical reasoning, and technique specificity. The previously known manual therapy is shifting into a highly effective modern day physical therapy, which is not dependent on perfect palpation, and rather utilizes a patient-centered care model. Based on clinical trials and current data, modern day manual therapy is deemed effective when used in conjunction with other modalities for patients suffering with musculoskeletal diseases. The modern practice of manual therapy is centered around values such as safety, comfort, efficiency, communication, and patient-centeredness. Through this new approach, clinicians are encouraging their patient’s to assess their outcomes and progress and reevaluate their pain, thereby aligning the practice of manual therapy with the holistic approach to healthcare. Results for migraines, headaches, and asthma are mixed due to a lack of clinical trials, though at least one article states that manual therapy is effective for asthma. Manual therapy was shown to be effective for treating back pain, with trigger point therapy being used for myofascial pain, and manual manipulation for lower back pain. The therapeutic pressure relieves pain and increases range of motion. While patient’s may complain of muscle soreness post treatment, this effect is expected and it is not deemed adverse.


See also

* Body psychotherapy * McKenzie method *
Osteopathy Osteopathy is a pseudoscientific system of alternative medicine that emphasizes physical manipulation of the body's muscle tissue and bones. In most countries, practitioners of osteopathy are not medically trained and are referred to as osteo ...
*
Physical therapy Physical therapy (PT), also known as physiotherapy, is a healthcare profession, as well as the care provided by physical therapists who promote, maintain, or restore health through patient education, physical intervention, disease preventio ...
*
Qigong Qigong ()) is a system of coordinated body-posture and movement, breathing, and meditation said to be useful for the purposes of health, spirituality, and martial arts training. With roots in Traditional Chinese Medicine, Chinese medicine, Chin ...
* Siddha medicine * Fascial Manipulation


References


Further reading


Journals


The Journal of Manual and Manipulative Therapy
* Journal of Manipulative and Physiological Therapeutics - PubMed acces
found here


Books

* * * * *


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