Who bears the costs (PKV/GKV)
As with physiotherapy, the costs of manual therapy are covered by the respective health insurance company. The costs of manual therapy are minimally higher than those of physiotherapy. A prescription has a total value of about 110 Euros, depending on the guideline value of the health insurance company, of which the health insurance company itself covers the costs.
However, the patient must pay a personal contribution. He refers to a flat rate of 10 Euro for the prescription and 10% share of the total prescription fee. With private patients the costs depend on the respective practice. Each practice has its own costs for the treatment, but these are usually between 22 and 26 euros.
How long does an MT last?
The duration of manual therapy depends on the timing in the practice. Different practices work in a 15 minute to 30 minute rhythm for a single treatment. According to the remuneration agreement, a treatment duration of 15-25 minutes is specified.
The less time available, the less can be achieved in one session. Some practices that have a shorter treatment time schedule more time for the first treatment in order to prepare a detailed report. But in the end, this is time that is not paid for and so not every practice wants to offer this.
What further training does an MT have?
Advanced training in manual therapy can be conducted at various institutes in Germany. The duration of the entire advanced training lasts between 2 and 3 years. After each year there is an intermediate examination, which must be passed in order to obtain the certificate as a manual therapist.
The examination after the year includes only the topics worked on during the year. The weekends are structured according to specific topics and usually begin with theory and discussion of findings, followed by mobilizations and manipulations.The body sections hip, knee, foot, pelvis and lumbar spine should be performed in the training before the upper extremity, because especially in the cervical spine a good sensitivity should be present. Up to 6 courses are held per year and usually run from Friday to Sunday.
Costs can be about 250 Euro per weekend and the exam has to be paid extra. Costs and dates vary from institute to institute. The fact is, the costs are usually paid by the therapist alone.
Few receive support from the employer. In addition, he takes a day off for every Friday of the training. Anamnesis After the therapist has clarified the contraindications for a cervical spine treatment, he begins with the anamnesis.
Here it is important when the pain occurs, i.e. during which movement, during the course of the day, after exertion, after training, after sleeping, etc. In addition, the patient should indicate the exact location of the pain, i.e. at the upper cervicals, in the course of the cervical spine or even further to the shoulders or upper back. If there are movement restrictions in the rotation, lateral inclination, flexion or extension of the cervical spine, if the restrictions are the same on one side or both sides, radiating pain into the arms, these are all questions of anamnesis.
Examination The therapist then tests passive mobility and feels along the cervical vertebrae to determine whether any malpositions can be felt. In addition, hardening of the short neck muscles caused by incorrect loading can be detected. By releasing muscle tensions using soft tissue techniques, such as massage grips or releasing the trigger points, mobility is improved.
Exercises In addition to direct techniques, stretching techniques can also help to improve the muscle structure. Here the therapist places the head in a lateral inclination, rotates it to the opposite side and presses the shoulder of the opposite side down. If the movement restrictions cannot be completely resolved, the blockage should be carefully mobilized.
It should be known in which direction the vertebra is blocked and, above all, how the biomechanics of the cervical spine function. Accordingly, the vertebra can be mobilized. If the mobilization does not help either, manipulation can be performed, but this requires extreme caution and accuracy.
If the therapist-patient relationship is not right, i.e. the patient cannot let go, no manipulation should be performed. If these blockages occur frequently, the patient should perform specific exercises to strengthen the short neck muscles and try to keep the surrounding muscles loose and relaxed. This is best done by circular movements of the shoulder joints, stretching exercises and warmth to stimulate the blood circulation.
This article might also be of interest to you:
- Cervical spine mobilization exercises
- What is the best way to stretch the cervical spine?
- What is the best way to relax the cervical spine?
For manual therapy of the temporomandibular joint, the indications for treatment must be clarified at the beginning. Patients are usually referred by their dentist because they suffer from grinding and biting of teeth at night. The patient does not necessarily notice this himself, but it is often noticed by a partner.
Patients wake up in the morning with severe pressure in the jaw, headache or neck pain. During the examination the dentist detects increased abrasion on the teeth. Usually the patient also notices a general restriction of movement in the jaw, so that biting directly from a crunchy apple is hardly possible.
In addition, there may be pain in the area of the cheeks, temples or eyes, earache, headache or general shoulder and neck pain. One of the most common causes of jaw problems is stress and the difficulty in dealing with stress. When everyday life becomes too much and you don’t really notice it, stress is often dealt with at night.
Then it comes to the crunching or biting and the resulting neck pain. Other causes can be a general malposition of the jaw, which is caused by an accident or orthodontic treatment. This leads to increased wear and tear of the discus and joint capsule and accordingly to restricted movement.
General malpositions or poor posture of the spine, often when working at a desk, can also be a cause. In manual therapy, the jaws are then checked for mobility after the patient’s medical history and malpositions are detected.The therapist feels the temporomandibular joint inside the mouth and tries to mobilize it if movement is restricted. In addition, the therapist checks the muscle tension of the outer chewing muscles.
He finds this in the cheek area and can test the sensitivity to pain with a pressure test. By releasing trigger points or massages, the tone can be regulated. The patient also receives exercises for self-mobilization.
He should form circles or write eights with the lower jaw. This stimulates the blood circulation and helps to improve mobility. The dentist can create a bite splint, which the patient should wear at night to prevent grinding.
The article Stress – Are you also affected? might be of interest to you. For manual therapy of the shoulder, the general anamnesis is valid at the beginning, just as for the cervical and jaw.
The active examination in all directions of shoulder movement, the assessment of the shoulder blade and the shoulder joint during movement, give an indication of the extent of the functional disorder. A passive motion examination is then performed, during which a distinction can be made between a joint or muscle problem. If there is a joint problem, the shoulder can be mobilized.
Simple passive or assistive movements are essential, but more the sliding techniques of manual therapy. This involves the biomechanics of the joint. When the arm is lifted laterally or anteriorly, the head of humerus rolls normally in the corresponding direction up to 90°, from this point it slides in the joint surface of the acromion in the opposite direction to increase the movement.
Due to a narrowing in this area or wear, the head of humerus can no longer slide. The therapist can thus use certain grips to mobilize the head in the right direction. The traction also works.
In this case the head is pulled out of the socket by the traction over the arm. This stimulates the metabolic process and the blood circulation, so that sediments can be removed. Depending on which structures are involved in restricting movement, the shoulder blade and the acromioclavicular joint should also be mobilized.
If there is muscular imbalance instead of a joint problem, it is important to know which muscles are involved. In most cases, pain in the area of the rotator cuff is caused by prolonged wear and tear. This pain can be irritated by transverse friction so that a new wound can heal and vision can be regenerated.
Often the trapezius, which forms the shoulder and neck muscles, is also affected because it is hypertensive. The shoulder is pulled up permanently and this leads to a shortening, which causes further problems in the shoulder. By detonating this musculature, the complaints can be relieved. In most cases, a longer-term treatment is necessary.
