Manual Therapy

The treatment of the musculoskeletal system diseases is an urgent task for modern medicine. Thus, sedentary lifestyle, developed in the process of work, incorrect motor stereotype, and the violation of posture are among the main causes of the emergence and growth of the number of patients with osteochondrosis of the spine, arthrosis, scoliosis, and other degenerative-dystrophic diseases. Over recent years, the increase of the diseases of the musculoskeletal system has caused the emergence of manual therapies in the world medical practice. Therefore, there is a need to define what manual therapy is, identify its various techniques, required education and scope of practice as well as show an example of a successful treatment with manual therapy

Definition

Manual therapy is a scientific direction and field of medical practice that implies a complex system of manual medical methods, aimed at restoring physiological statics, dynamics and biomechanics of the spine as a single organ. They also aim at the rehabilitation treatment of patients with painful manifestations of osteochondrosis and the musculoskeletal system in general, including internal organs. Manual therapy is a hand-operated effect on the spine, joints, and muscles in order to relieve pain and other neurological manifestations of the diseases of the musculoskeletal system. In Latin, the term means hands-on recovery/treatment. Manual medicine includes diagnostic and proper therapeutic methods, based on knowledge in neurology, orthopedics, and neurophysiology. Manual healing gains popularity at the expense of a quick pain reliever effect. Since the second half of the 19^th century, manual influence on the spine has developed in the teachings of chiropractors and osteopaths. In the United States, chiropractics is the main treatment for spinal pathologies, accompanied by acute pain (International Chiropractors Association, 2016). Some patients consider manual therapy a terrible method of treatment. However, procedures, conducted by experienced specialists, are quite reliable and effective. Moreover, in modern manual therapy, the so-called solid methods are not actually used. In addition, manual therapists choose a program of personal therapy for each patient, depending on their diagnosis, concomitant conditions, and age. Patient should receive these procedures several times a week at intervals of a couple of days. If the patient holds sessions every day, this can cause discomfort in the spine and joints or even pain.

Techniques

The techniques of manual influence are quite varied. The essence of the method is the use of the entire system of receptions, performed by a manual therapist with the help of hands. Thus, McGlone, Cerritelli, Walker, and Esteves (2017) note that due to the individually chosen algorithm of treatment and experience, the doctor can effectively treat any parts of the spinal column and joints with the help of their hands and eliminate violations in the muscular system and ligaments that develop in many neurological conditions and the diseases of internal organs. In simple words, manual therapy is a therapeutic massage (McGlone et al., 2017). In addition, this type of massage has significant differences in comparison with the traditional or classical one because it is directed at muscles and soft tissues in most cases. With manual therapy, the effect is felt in the bones and cartilage and is more severe in character.

A manual therapist applies a different, milder technique called osteopathy. A distinctive feature of any method of treatment with manual therapy is selectivity and focus on a strictly defined zone (American Association of Colleges of Osteopathic Medicine, n.d.). Like other medical specialties, manual therapy has a certain anatomical substrate for specific diagnostics and therapy. This substrate is primarily the joints of the spine, limbs, intervertebral discs, muscles, and nerves. Manual therapy is more effective regardless of the level of the lesion if it starts from the neck. Then, the doctor can go to other departments. The result of the impact on the lumbar spine is the improvement of posture, the disappearance of curvature of the spine and lameness. Osteopaths exclude shock equipment. If manual therapists sometimes still resort to it, they techniques without detaching from the blocked joints, using the movements of the chest during breathing. This plays an important role in the manipulation, especially on the chest. Manual therapy is the synthesis of scientific knowledge in the field of anatomy, physiology, orthopedics, neurology, and human biomechanics.

A chiropractic is another kind of manual therapist who alleviates pain by removing the blockade (pinching) of the vascular and nerve plexus in order to relieve muscle tension or to restore the mobility of joints and vertebrae. Not with any pain in the field of the spine, the patient can conduct the procedure of manual influence. Chiropractic methods are contraindicated in such pathologies as oncology, infections of the musculoskeletal system (tuberculosis, osteomyelitis, acute rheumatism), severe hypertension, fresh fractures of the joints and spine. Furthermore, individuals with the acute pathologies of the gastrointestinal tract or respiratory organs, stroke, heart attacks, bleedings, heavy intoxication, and alcohol poisoning cannot use chiropractic. Serious complications include tears and muscle bonds, the reduction of hernia, the displacement and fractures of the vertebrae, the formation of hypermobility of the spine, and ischemic stroke.

Manual therapy is a complex of manipulations that have different goals. Segmental massage, as a sort of manual technique, is the maximum relaxation and the warming up of muscles without the use of creams and oils. This therapy has a significant effect on the reflex zones. Due to the extraction of the spine under its own weight (passive mobilization) or using weighing (traction mobilization) functionality is restored. Forced actions might be accompanied by cramps and unpleasant sensations, which presupposes the use of preliminary relaxing preparation. The course of manual therapy is usually 5-10 sessions, with the ability to repeat in six months.

Education

Previously, only orthopedists could help patients with manual therapy. However, nowadays neurologists, traumatologists, and doctors of any specialization can practice its methods. Nevertheless, they must undergo special training courses and receive a certificate of a manual therapist. Levesque and Yeung (2015) indicate that the physician-manual therapist must finish a medical higher educational institution and become a neurologist or traumatologist-orthopedist. The specialty manual therapy implies the preparation of a qualified specialist who will be able to diagnose a disease with the help of a survey and additional studies, for example, X-rays, and only after diagnosing and proceeding to treatment. In the process of acquiring this specialty, students will study such disciplines as anatomy, physiatry, emergency medicine, topographic anatomy, X-ray diagnostics, HIV infection, reflexology, massage, exercise therapy, and so on. Every ordinate undergoes compulsory medical practice, which allows them to apply their knowledge before commencing their work according to their specialty. Thus, after training in the university, a fully qualified manual therapist starts to work. Qualified specialists, who have mastered the residency program, will be able to provide quality medical care to the population.

Case Study

The confirmation of a successful treatment with manual therapy is the history of a patient’s illness. One patient had complaints of pain in the lumbar spine, numbness, and paresis of the left foot. This patient had suffered severe pain for 3 months. The diagnosis is osteochondrosis of the spine with hernias. Further, the patient had addressed the center of manual therapy, where the specialists conducted a functional diagnosis of the muscular system. The examination revealed the strain of the muscles of the lumbar spine and lack of elasticity in the muscles of the lower extremities. Tests on the simulators revealed the weakness of individual muscles and the poor mobility of the joints of the body. The manual therapist used the technique to restore strength and elasticity of the leg muscles as well as to relieve tension in the muscles of the back. Furthermore, the usage of the manual therapy techniques can change the muscles or ligaments, which leads to a rapid alleviation of pain and the removal of tension in the muscles and blocked joints (Voogt, Vries, Meeus, Struyf, Meuffels, & Nijs, 2015). Such a result is achieved owing to the observance of the natural neurophysiological principles (Voogt et al., 2015). The patient received treatment as acupuncture, massage, and physiotherapy. This approach to treatment allowed to restore not only the normal blood flow in the lumbar spine but also sensitivity and tone in the left foot.

Conclusion

Therefore, it is necessary to draw a number of following conclusions. Manual therapy is a scientific direction and area of medical practice that uses medical methods to restore the physiological statics, dynamics, and biomechanics of the spine as a single organ. Methods of manual therapy are applied for the rehabilitation treatment of patients with painful manifestations in the musculoskeletal system. The basis of manual therapy is a strictly dosed local mechanical effect on certain elements of the motor segment in order to restore the normal mobility in it or to adapt it biomechanically to the changed conditions of functioning. Manual therapy consists of three main areas of massage therapy, visceral osteopathy, and chiropractic. In order to work as a manual therapist, a person, who has already graduated from a medical educational establishment, must undergo additional training for the specialization manual therapist. Manual therapy is an effective methodology, and specialists use this program in the combination with therapeutic physical activity, medical treatment, and hardware techniques.

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