Manual therapy is a generic term for various forms of therapy used to treat disorders of the musculoskeletal system. Manual therapy procedures belong to the field of alternative medicine, but are also part of manual medicine, which is performed by many physiotherapists and masseurs.
What is manual therapy?
Manual therapies include osteopathy, chiropractic, craniosacral therapy, ortho-bionomy, atlaslogy, and orthopedic manual therapy (OMT). In the broadest sense, the term manual therapy refers to procedures for the therapy of joints, muscles or nerves. Manual therapy includes both diagnostic and treatment techniques. Manual therapies include osteopathy, chiropractic, craniosacral therapy, ortho-bionomy, atlaslogy and orthopedic manual therapy (OMT). In the narrower sense, manual therapy is a protected form of treatment of physiotherapy and can be prescribed by the treating physician by means of a prescription for therapeutic products. The additional qualification Manual Therapy for physiotherapists includes a further training with at least 250 teaching hours. Only after completion of this training may the designation manual therapist be used.
Function, effect, and goals
In classical manual therapy by the physiotherapist, a diagnosis of joint mechanics, muscle functions and coordination of movements is first made. Based on the results of the examination, a treatment plan is created. This includes various hand grips and mobilization techniques. These techniques are intended to relieve pain and eliminate dysfunctions of the musculoskeletal system. Part of the treatment techniques is passive, which means that only the therapist mobilizes the muscles and joints of the patient. Another part of the treatment is carried out through exercises in which the patient is actively involved. The goal of classical manual therapy is to enable physiological interaction between muscles, joints and nerves. Chiropractic was developed by the American physician Daniel David Palmer. His goal was to use chiropractic treatment techniques to restore normal mobility to restricted joints. One focus of chiropractic is the treatment of the spine. Special hand grips are used to treat subluxations, meaning displacements, of the vertebral bodies. Chiropractic is based on the assumption that displaced vertebral bodies can trigger a wide variety of symptoms by exerting pressure on the spinal nerves and spinal cord. So-called tractions are used to reduce pressure and relieve joint pressure by pulling joint structures apart. In combination with stretching of the surrounding ligaments and joint capsule, this should result in improved mobility. Stretching and relaxation techniques adapt the muscles to the new range of motion. Like chiropractic, craniosacral therapy originated in the United States. Cranio-sacral therapy is based on the assumption that a certain rhythm, the craniosacral pulsation, can be found within the cerebrospinal fluid. The spinal fluid serves to nourish, protect and move the nervous system. According to craniosacral therapy, the craniosacral rhythm spreads throughout the entire body. If the rhythm is disturbed, this can result in pain, restricted movement, tension and impairment of the immune system. The task of the craniosacral therapist is to sense the rhythm of the craniosacral system and, if the rhythm is disturbed, to correct the rhythm through gentle pulling and pushing movements. Osteopathy was also founded in America. The basic assumption of osteopathy is that the body is capable of regulating and healing itself. However, a prerequisite for this is that all structures in the body are mobile and well supplied. Restrictions in movement hinder the supply of the surrounding tissues and can thus cause disorders. The osteopath therefore examines the patient’s entire body to find any restrictions in the mobility of tissues, muscles and joints. If he finds such restrictions, he can solve them with various techniques. Ortho-Bionomy is a manual therapy based on physiotherapy, osteopathy and the meridian teachings of traditional Chinese medicine.Ortho-Bionomy also focuses on the self-regulation of the body and sees itself as a salutogenetic procedure. Salutogenetic procedures serve more to maintain health and prevent disease than to treat disease. Naprapathy is a procedure from Sweden that may only be performed by trained Doctors of Naprapathy or Doctors of Naprapathic Medicine. The theory of Naprapathy is that scar tissue in muscles, connective tissues and ligaments caused by injuries and toxic deposits affects the nerves, blood and lymph vessels, causing physical discomfort. Through special manual stretching techniques, naprapathy aims to restore the damaged tissue so that blood and lymph can flow freely again, and also to ensure proper nerve impulse transmission.
Risks, side effects and dangers
The effectiveness of manual therapy procedures is controversial among physicians. Some scientists even consider chiropractic and manual therapy procedures to be harmful. Before any manual therapy, damage to the spine from lesions, accidents, or bone metastases should first be ruled out. Diagnostic imaging procedures may need to be used. In particular, improper treatments in the cervical spine pose a risk of damage to the blood vessels in the neck. If arteriosclerotic deposits are present in these vessels, they can be loosened, especially by jerky manual techniques in the cervical spine, and reach the brain. There, the loosened arteriosclerotic components can trigger a stroke, for example. However, with gentler procedures such as craniosacral therapy or osteopathy, the risk of stroke is vanishingly small. Caution should be exercised with manual therapy when conditions such as osteoporosis, cancer, fresh heart attack, bone fractures or febrile infections are present. If uncertain, consult with the treating physician.
