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Content type: Research 20 January Content type: Research 12 January Most recent articles RSS View all articles. Content type: Review 6 March Content type: Case report 12 January Content type: Debate 10 August Content type: Debate 18 May Most accessed articles RSS View all articles. Important message to authors Chiropractic and Manual Therapies CMT aims to publish studies with definitive research questions that are relevant to our chiropractic and manual therapy clinical communities.
Perle A new paradigm for musculoskeletal pain care: moving beyond structural impairments Edited by Prof Julie Fritz, Prof Alice Kongsted Click here to explore all articles collections. In Review Chiropractic and Manual Therapies has launched In Review, a new option that provides authors with on-demand information on the status of their manuscript, enables them to share their work with funders and their research community, and allows their colleagues to comment and collaborate - all whilst their manuscript is under review.
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If you are dealing with an injury, book an appointment with one of our therapists so they can help you return to what you love doing. Previous Next. View Larger Image. What is Manual Therapy? Therapist will use different pressures and depths to act on the soft tissue Manual traction : providing a distraction force on a joint to allow for decompression or gapping to occur in the joint space Joint mobilizations : specific passive movements working directly on the movement at joint surfaces through different velocities and amplitudes Instrument assisted soft tissue mobilization IASTM : use of specific tools to eliminate soft tissue and myofascial restrictions Trigger point release : trigger points are palpable nodules that create taut bands in the muscle.
Effectiveness of Manual Therapy There is a lot of controversy about the effectiveness of manual therapy in the literature. Myofascial trigger points MTPs are focal areas of tenderness within a muscle belly which usually respond to a referred pain at the distance of the point. Neural mobilisation is the mobilisation and gliding of the nerves.
JP Barral. More therapies. What our patients say. Effective Pilates…. Need help? Want to get in touch? We will be happy to answer your questions. Contact us now. This limitation can cause discomfort, pain, and an alteration in function, posture, and movement.
Manual physical therapy involves restoring mobility to stiff joints and reducing muscle tension in order to return the patient to more natural movement without pain. Thus, manual physical therapy may provide back pain relief both for patients with chronic back pain involving joint problems, such as sacroiliac joint dysfunction , and acute back pain from soft tissue injuries such as a back muscle strain or a pulled back ligament.
Although extensive clinical studies have yet to be performed on all areas of manual therapy, limited clinical data and patient reports support the assertion that manual physical therapy can be effective in relieving back pain for certain patients. As a group, manual physical therapy techniques are aimed at relaxing tense back muscles and restricted joints in order to decrease back pain and increase flexibility.
Clinical anecdotes and innumerable patient stories support the effectiveness of MT in treating a great variety of musculoskeletal conditions. MT is cost effective in comparison to other commonly provided interventions [ 7 ] and is rarely associated with serious complications [ 8 ]. In fact, MT has a similar risk profile for adverse events as exercise and a smaller risk profile than most medications [ 9 ].
MT is also a commonly sought treatment, and its use in USA has been fairly stable from to ; for example, in the most recent survey 8. In addition, our work and that of others, suggests that patients with pain have both high expectations for benefit from MT. Studies have been performed in several different musculoskeletal disorders; for example, low back pain [ 10 ], shoulder pain [ 11 ] and cervical pain [ 12 ].
These studies of MT have mainly focused on providing direct evidence supporting its clinical effects [ 13 ] with the primary outcome being reduction in both pain at rest and pain with activity. Thus, the most studied aspects of MT suggest a change in the sensory discriminate domain of the pain experience; that is, MT produces a reduction in pain intensity and unpleasantness in the pain experience and ultimately improved clinical outcomes.
But how does this occur? The mechanisms underpinning clinical outcomes associated with MT are not yet well established to date. Understanding the mechanisms of action is essential prior to identifying and selecting appropriate patients to receive MT; that is, those who will respond favorably. The identification of mechanisms of action would likely also provide greater acceptance of MT techniques and more appropriate use of MT by healthcare providers [ 14 ].
In this paper, we consider mediating and moderating factors that influence the outcomes from MT. These are summarized in Figure 1. Mediating factors are those aspects of an intervention that are a component of the mechanism through which the intervention impacts the outcome.
As such treatment effect mediators are measured during treatment to determine if changes in the mediating variable in question impact a particular outcome. Once identified, mediating variables are capable of providing additional information related to the process and potential mechanisms by which an intervention may be effective or ineffective [ 15 ]. In addition, treatment aimed at influencing a mediating variable assuming it can be modified through direct treatment may be used to improve the effectiveness of other interventions e.
The mediating mechanisms of MT likely combine biomechanical and neurophysiological effects [ 16 ]. The mechanical stimulus provided by the MT and the series of neurophysiological effects initiated, in conjunction with the context or manner in which it is provided, are responsible for the clinical outcomes observed.
Historically many MT approaches have been based on an identification of biomechanical dysfunction and interventions applied using biomechanical principles to correct the noted dysfunction.
Accordingly, evaluation techniques are used to determine the tissue dysfunction responsible for the patient's pain according to these approaches. The subsequent selection of technique usually depends on the therapist's previous training or own preferences and overall conception of practice [ 17 ]. The implication behind this kind of approach is that the success of the MT depends on the correction of biomechanical abnormalities detected during clinical examination in accordance with theoretical biomechanical constructs.
Additionally, specific conceptual models explain the mechanism of action of MT in biomechanical terms. However, as we report below, many of these conceptual biomechanical theories have not been supported empirically.
It is very true that in humans MT is capable of causing movement of or stresses within the structures to which it is applied. These movements have been quantified for treatments targeting the joint [ 21 ] muscle or nerve [ 22 ]. In the studies of joint-biased techniques considerable motion and force are imparted on tissues [ 23 ]. During manipulation a high velocity, small amplitude technique targeting a joint of the spine, for example, these forces range from to N and approximately 6 mm of posterior to anterior translation of the vertebral segment occurs [ 24 ].
During techniques purported to primarily target the neurovascular structures there may be as much as 16 mm of excursion in the median nerve during some techniques [ 22 ]. Structural changes in tissues are also reported after select interventions.
For example, report increased fluid uptake in the intervertebral disc is associated with clinical pain relief after joint-biased interventions to the lumbar spine [ 25 ] and, in a feline model, changes in spinal stiffness were dependent upon the specific location of a joint biased MT intervention provided to the spine [ 26 ].
Techniques that primarily target muscles and other soft tissues, such as massage, use mechanical pressure. This pressure is hypothesized to increase tissue extensibility with resulting increases in joint motion. Pressure to the tissues might also help to increase blood flow [ 27 ]. Few studies have examined changes in human connective tissues after muscle and connective tissue-biased techniques.
However, several limitations to using biomechanical effects as the sole explanation for mechanisms of effective pain relief have been reported. The reliability of some biomechanical assessments e. Positional changes reported after joint-biased techniques do not last beyond the intervention [ 21 , 29 ]. For example, spinal mobilization of the third lumbar vertebrae causes segmental effects at the first lumbar vertebrae [ 31 ] and effects of spinal manipulation may occur 14 cm away from the site of the application.
The forces used by practitioners also vary considerably with a systematic review of these studies indicating poor to moderate interpractitioner application of force intraclass correlation [ICC]: This is coupled with the findings that the use of MT to randomly chosen areas other than the area of dysfunction [ 33 , 34 ], render similar results as interventions targeting specific dysfunction.
❿Manual therapy - Wikipedia. Manual therapies
Neural mobilisation is the mobilisation and gliding of the nerves. JP Barral. More therapies. What our patients say. Effective Pilates…. Need help? Want to get in touch? We will be happy to answer your questions. Contact us now. News and Events. Thus, manual physical therapy may provide back pain relief both for patients with chronic back pain involving joint problems, such as sacroiliac joint dysfunction , and acute back pain from soft tissue injuries such as a back muscle strain or a pulled back ligament.
Although extensive clinical studies have yet to be performed on all areas of manual therapy, limited clinical data and patient reports support the assertion that manual physical therapy can be effective in relieving back pain for certain patients.
As a group, manual physical therapy techniques are aimed at relaxing tense back muscles and restricted joints in order to decrease back pain and increase flexibility.
In general, manual physical therapy techniques employ the following types of movement:. The following page covers the specific manual physical therapy techniques that are designed to alleviate low back pain related to muscle spasm, muscle tension, and joint problems. Similarly, diagnostic tests need to be refined or abandoned in the light of new evidence. Our journal will continue to publish sound science on these and other related topics to help inform clinical practice.
Clinical decision making is all about presenting the best choices to patients. High-quality, patient-oriented evidence serves as the foundation of this important process. However, there are many areas within the discipline of rehabilitation where our knowledge and practices are suboptimal. It will be the role of research to fill these gaps in knowledge and inform our future practices. Research provides us an opportunity to be systematically curious.
In my opinion it is a responsibility for all health professions to ask questions that challenge our thinking and continue to explore and explain how things work and why, and what can we do better to meet the needs of the patients and communities we serve. All health care professions need to describe their practice, challenge the things they believe work, and test new ideas and innovations.
Chiropractors and related health care providers need access to high quality research addressing such aspects of relevance to their clinical practice. As Associate Editor, I am happy to help facilitating the publication of evidence within this field and to guide researchers from a relatively young field of research in this process.
Continuous health care quality improvement inspires us to constantly ask patient-centred questions; measure and interpret health information; share and implement our findings; and remain open to change and evolution as a modern health care profession.
Editing the journal gives me an opportunity to help our profession expand our knowledge base in a way that is open to the world to see - I was actually investigating starting an open access journal with BioMed Central because I see access to the literature as one of the limitations to the use of evidence based practice in our profession. Citation Impact 1. A treatment effect modifier is a factor that results in a greater treatment effect in one group compared with another and is best identified through randomized controlled trials.
Identification of treatment effect moderators provides information about which patients and under which conditions a particular treatment is most effective [ 15 ]. The mechanisms of action underpinning these moderating factors are similar and overlap supraspinal regions mediating MT pain relief. Synergistic effects through these common pathways may underlie individual variations in the magnitude of clinical response.
The mechanical stimulus and resultant neurophysiological effects are modified by nonspecific factors such as expectation of the patient [ 58 , 59 ], equipoise of the practitioner [ 60 , 61 ], placebo effects [ 62 ], contextual factors such as the setting and therapeutic alliance between provider and patient [ 63 ].
All of these factors can be decisive in treatment outcomes. These effects are patient-dependent, therapist-dependent, mediated by the context of the intervention and obviously by the clinical condition and are an integral to all complex interventions such as MT to the extent they may be considered constituent parts of the treatment approach rather than a separate entity [ 3 ].
These effects are not unique to MT but discussion of them is pertinent to understanding the effects of MT on the pain experience. Patient-related issues include patient expectations, especially if they have had previous positive experiences with the treatment received. The patient's expectations on a given kind of manual intervention may be more decisive in the therapeutic result than the actual manual intervention applied [ 59 ].
Therefore, it is essential to consider the patient's expectations and preferences when choosing the patient's MT treatment. The effectiveness of MT maybe enhanced when, based on the evidence of the effectiveness of that treatment, patient expectation is increased in view of the possibility of a positive response to treatment.
Alternatively, outcomes may worsen based on the interaction of patient and therapist. Findings from single arm studies provide conflicting results for relationships between pre-intervention psychological factors and short-term clinical outcomes following MT joint based techniques [ 64—66 ].
Findings from randomized clinical trials also provide conflicting results for this relationship. For example, Lopez-Lopez et al. A secondary analysis of the UK BEAM dataset [ 67 ] did not however find any statistical interactions when evaluating for similar relationships with pre-intervention back pain beliefs and treatment response. A previous review study indicated some evidence that spinal manipulation improved psychological outcomes compared with verbal interventions [ 68 ].
In that study, the authors provided a unique perspective on the influence that psychological factors may have on a patient's pain experience and the difficulty in evaluating treatment effectiveness associated with MT interventions.
As we come to understand more regarding the factors that produce clinical benefit from specific MT interventions the likelihood of improved clinical measures increases.
Identifying underlying mechanisms by which MT relieves pain treatment mediators will improve the clinical effectiveness of this approach by determining the clinical presentation of individuals likely to benefit from the established mechanisms and will increase both acceptability and utilization by patients and healthcare providers.
In addition, if we can identify other mediators that are capable of being addressed through direct treatment e. The recognition of patient and therapist characteristics that modify treatment outcomes will also improve the application and implementation of MT approaches to the management of the pain experience by determining the psychological profile of individuals likely to benefit from these interventions and the best context in which to provide these interventions Figure 1.
MT is an effective treatment contributing to the recovery of functional capabilities, but it should be included within a multimodal approach targeting the functional recovery of the patient.
Current evidence is suggesting that a multimodal approach, including MT, exercise and education, seems to provide better outcomes than MT alone. A genuine multimodal approach should include not only physical management but a consideration of the psychological and psychosocial aspects of the patient's unique pain experience.
As we continue to uncover more about the management of pain conditions using MT, especially chronic pain, it becomes more noticeable that they appear to resemble a mosaic of phenotypes that may be further influenced by genetic factors related to peripheral and central neural plasticity e. Moving forward, investigations will continue to uncover biomarkers that underlie the complex pathophysiology of pain conditions and the transition of acute to chronic pain states.
As healthcare moves toward mechanism-based personalized treatments, it will become ever more important to understand the extent to which MT influences these underlying mechanisms. In addition, studies of MT must link the many immediate changes in neurophysiological function e. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.
No writing assistance was utilized in the production of this manuscript. Pain Manag. Author information Copyright and License information Disclaimer. Abstract Manual therapy MT is a passive, skilled movement applied by clinicians that directly or indirectly targets a variety of anatomical structures or systems, which is utilized with the intent to create beneficial changes in some aspect of the patient pain experience.
Practice points. Background Manual therapies MTs are centuries old and practiced by many professions worldwide. Techniques are generally classified as joint, muscle and connective tissue, or neurovascular-biased techniques based on the primary tissue focus of the technique.
Mediating factors for effectiveness of MT Biomechanical:. Moderating factors for effectiveness of MT Patient and provider expectation, therapeutic alliance, and context of the intervention heavily influence the clinical outcomes of MT. Psychological factors e. Future directions Additional work is needed to link immediate changes in neurophysiological measures with clinical outcomes. The pain experience The International Association for the Study of Pain defines pain as "…unpleasant sensory and emotional experience that is associated with actual or potential tissue damage or described in such terms.
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Read Edit View history. More Read Edit View history. Physical treatment used to treat musculoskeletal pain and disability. See also: Bodywork alternative medicine. The neutrality of this article is disputed. Relevant discussion may be found on the talk page. Please do not remove this message until conditions to do so are met. April Learn how and when to remove this template message.
When appropriate, our clinicians will use appropriate manual therapy techniques to help manage your condition and improve your function. If you are dealing with an injury, book an appointment with one of our therapists so they can help you return to what you love doing. Previous Next. View Larger Image. What is Manual Therapy? Therapist will use different pressures and depths to act on the soft tissue Manual traction : providing a distraction force on a joint to allow for decompression or gapping to occur in the joint space Joint mobilizations : specific passive movements working directly on the movement at joint surfaces through different velocities and amplitudes Instrument assisted soft tissue mobilization IASTM : use of specific tools to eliminate soft tissue and myofascial restrictions Trigger point release : trigger points are palpable nodules that create taut bands in the muscle.
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