Manual therapy describes treatment techniques in which therapists use their hands to apply varying amounts of pressure, stretching, or mobilization to tissues depending on each patient's needs. These techniques are frequently incorporated into a comprehensive treatment program designed by the therapist to correct problems occurring in joints, muscles and connective tissues. Manual therapy provides:
- Alignment of Structures
- Range of Motion/Joint Function
- Strength and Flexibility
- Muscle Tightness or Spasm
Mobilization generally refers to the movement of tissues to "free them" from tightness, spasm, or scar tissue adhesions. Accomplished through techniques such as spot massage over the area of dysfunction, mobilization promotes tissue relaxation, improved circulation (which helps decrease local edema or swelling, and removes the waste products of inflammation), and provides pain relief.
Based on your initial physical or occupational therapy evaluation, the need for Manual therapy will be determined. It is our belief that the hands on approach often helps facilitate a faster and stronger recovery. There are many different techniques in Manual therapy. Based on their characteristics, these techniques can be grouped into broad categories as follows.
Soft Tissue Mobilization (STM)
This type of mobilization utilizes rather gentle movements (massage) of the soft tissues that have restricted range of motion. Restricted range often occurs after an injury when fascia, muscles, and ligaments tighten. Treatments are usually spot specific massage to the area of injury (rather than generalized massage). This may be the first rehab intervention applied following acute injury to help stimulate initial mobility.
The Myofascial Release technique addresses the fascia--the thick covering over muscles--to restore its elasticity or flexibility of movement so the muscles are not "bound" and stiff. Therapeutic massage/mobilization assists with muscle relaxation, pain management, decreasing swelling, and used in conjunction with manual techniques, modalities, and therapeutic exercises improve rehab potential.
Deep Tissue Mobilization (DTM)
Deep tissue mobilization focuses on the deeper layers of muscle tissue. To reach these deeper levels, the therapist applies greater pressure. DTM is used to release chronic muscle tension through slower strokes and deep finger pressure or friction over the contracted muscle tissues, applied across the grain of the muscle, tendons, and fascia. Deep tissue massage also helps to break up and eliminate scar tissue. DTM may cause some soreness during or right after the massage. However, if the massage is done correctly, you should feel better than ever within a day or two.
A technique known as strain-counterstrain can be used when trigger (tender) points in muscle tissue cause pain and/or restrict movement. A muscle experiencing a false, on-going sense of being under strain is "reset" by mildly straining its counterpart--its antagonist--in order to place the malfunctioning muscle in its shortest position, thereby relieving the inappropriate strain reflex.
Joint and Spinal Mobilization
Tight muscles, stiff ligaments, or structural problems in the joints themselves may cause decreased movement. If pain is associated with this decreased movement, loosening up the structure that causes the restriction can often relieve the pain.
Joint mobilization consists of small passive movements, usually applied as a series of gentle stretches in a smooth, rhythmic fashion to the individual joints. It involves moving the joints in such a way that a small movement of the actual bone surfaces takes place. As a result, joint mobility is restored. In addition, certain stretching and strengthening exercises are performed to prevent the pain from returning.
Muscle Energy Technique (MET)
Muscle energy technique relieves muscle spasms, which lead to spinal/pelvic joint misalignment, decreased range of motion, and pain. The affected muscle is positioned. The patient then uses the muscle to resist force applied by the therapist. As the patient slowly relaxes the muscle, the therapist slowly applies a stretch in transition. These isometric contractions and stretches help mobilize the soft tissues and relieve spasm and pain. MET can be applied safely to almost any joint in the body. Many athletes use MET as a preventive measure to guard against future muscle and joint injury. However, it's mainly used by individuals who have a limited range of motion due to back pain, neck and shoulder pain, scoliosis (curvature of the spine), sciatica, asymmetrical legs, hips or arms, or to treat chronic muscle pain, stiffness or injury.
Proprioceptive Neuromuscular Facilitation (PNF)
PNF is often used as an advanced form of rehabilitative therapy to improve the flexibility, strength, and range of motion of a damaged or stiff muscle. It is also used to treat lower back, neck and shoulder pain associated with poor posture or injury. The correction of poor posture, movement patterns, and muscular imbalances also leads to improved health, increased stability, and decreased risk of re-injury.
This technique is designed to re-educate the motor unit stretch reflex - taking advantage of a nervous system reflex to help relax the muscle to rehabilitate it after injury. A typical session of PNF therapy consists of a series of muscle contractions followed by periods of muscle relaxation. The therapist stretches the affected muscle to the point of tension, then holding that position, the patient contracts the muscle against static resistance applied by the therapist. The patient relaxes the contraction, and immediately the therapist carefully pushes the stretch beyond its normal range of motion. Movements are often performed on diagonal planes from start to finish.
Although PNF was originally developed for physical rehabilitation, the fitness community and athletes of all levels have adopted it. PNF helps to improve muscle strength, increase endurance and improve coordination. A comprehensive program, including appropriate exercises, will help maintain the gains in strength and flexibility achieved by PNF.