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 Manual therapy





Manual therapy (manual medicine) is a branch of medicine that deals with the study and treatment of functional (reversible) disorders of the locomotor system. It is often mistakenly identified with chiropractic, which in contrast to the manual therapy is not based on any sources of medical knowledge. Manual therapy belongs to physiotherapy and is supported with scientific research. In literal translation manual therapy means treatment with hands (Lat. manus- hand). According to the definition prepared by the International Federation of Orthopaedic Manipulative Physical Therapists (IFOMPT) manual therapy is a specialised area of physiotherapy for the management of neuro-musculo-skeletal conditions, based on clinical reasoning, using highly specific treatment approaches, including manual techniques and therapeutic exercises" which are adjusted to the individual needs of the patient. Manual therapy restores a proper performance of complex motor, stature and breathing activities. It is often mistakenly associated with chiropractic and with unspecified cracks in the spine, the bases for which can be traced back to the folk wisdom. However, manual therapy is a medical field, the efficacy and safety of which are backed by scientific research. It is based on the principles of biomechanics, specialist anatomical and neurophysiological knowledge as well as clinical, deductive reasoning. Manual therapy is applied in a variety of the medical fields, including neurology, orthopedics, rheumatology and rehabilitation.


The history of manual therapy dates back to the ancient times. The first mention of the treatment of spine-related symptoms appeared as early as in 3000 BC in Asia Minor and Egypt. Manipulation techniques with hands and legs were already described by the father of the European medicine -  Hippocrates. He called manual therapy a cornerstone of medicine and considered it as important as pharmacology and surgery. There are many illustrations and reliefs showing the application of such techniques as manipulation and traction in those days. Hippocrates also emphasized the importance of knowledge of spine-related problems, as many disorders in the human body were associated with the spine. Manual therapy survived for many years in an unchanged form. First major schools in which one could be educated in this profession were established as late as in the nineteenth century.


The first stage of manual therapy is a detailed interview and a thorough examination of the patient, including viewing, palpation, muscle tests, evaluation of the mobility and play of the joints, as well as additional tests, such as. X-rays, to determine the nature of the problem. Through specialized tests the therapist is able to assess whether a particular discomfort is caused by an excessively tight muscle, a joint changed by a disease or a nerve compression. Depending on the tissue which is responsible for the patient's problems, one applies relevant manual techniques, which constitutes another part of the therapy - treatment. The techniques and methods vary and include muscle stretching, postisometric muscle relaxation, traction (distraction of one articular surfaces perpendicular to the other), quick release of blocked joints (manipulation with an occasional characteristic "click"), and mobilization. The most well-known methods of manual therapy include: the Kaltenborn-Evjenth concept, the Mulligan method, the Ackerman method and the Holistic Manual Therapy by A. Rakowski. One needs broad knowledge and experience to properly implement the above methods.


The essence of manual therapy procedures is to relieve pain. Therefore, the aim pursued by those working according to this method is to understand and eliminate the causes of pain and to restore thereby the normal function of the joints and normalize the muscle tone. This can be achieved thanks to the reflexive effects of manual therapy. The principle of reflex consists in the impingement on the sensory receptors located in the area of ​​pain or in the place of the source of pain, and they trigger further reaction. For example, impingement on the skin can trigger a response in the muscles,  in the motor segment or in internal organs.


Manual therapy has many applications. It must be remembered that one treats only such disorders that do not arise from organic changes, i.e. disorders during which the construction of a given structure is destroyed. Manual therapy treats ailments resulting from functional (reversible) disorders. It deals both with spinal pain and pain syndromes originating from the spine, as well as with overload nad mechanical damage to soft tissue (muscles, joints, ligaments) and peripheral joints (knees, hips, shoulder, etc.). Indications for manual therapy include: intervertebral disc disease, neuralgic pain, limb numbness, headaches and muscle tension. There are also contraindications to manual therapy. These include advanced osteoporosis, blood clotting problems, severe pain preventing examination of the patient, pain associated with cancer or an acute inflammatory process, serious disorders of internal organs and pregnancy.

In conclusion, manual therapy, when applied by qualified doctors or physiotherapists, is a highly effective method of diagnosis and treatment of disorders of the musculoskeletal system. If this is done according to the indications and contraindications, it is a painless and safe method of working with the patient.


Indications for manual therapy:


  •  pain radiating towards the extremities connected with irritation and compression of the nerve roots
  •  pain originating from excessively tense muscles
  •  pain caused by degenerative disease of the intervertebral discs
  •  pain in the course of disc disease (damage, protruded / herniated intervertebral disc)
  •  stiffness caused by contraction or blocking of intervertebral and sacroiliac joints
  •  spine-related headaches, dizziness
  •  asymmetrical posture


Peripheral joints:

  •  pain caused by muscle, attachment and tendon injuries
  •  conditions after injuries and after orthopedic procedures within the bones, joints, ligaments and muscles
  •  pain caused by arthrosis
  •  preparation for elective surgery and rehabilitation after treatment
  •   joint stiffness caused by immobilization or degeneration
  •  Increased / decreased tone of soft tissues that change the posture and overload other tissues


Contraindications to manual therapy:


  •  unbearable pain (no possibility to perform the examination)
  •  osteoporosis
  •  blood clotting problems
  •  skin lesions
  •  severe internal medicine disorders
  •  lack of cooperation on the patient's side



  •  acute inflammatory process
  •  cancer
  •  injuries, fractures, sprains in the phase of immobilization
  •  capsular- articular instability
  •  pathologies of the vertebrobasilar artery
  •  ligamentous laxity of the cervical spine
  •  symptoms of spinal cord compression
  •  progressive muscle paralysis
  •  pregnancy


Complications after manual therapy

There are no complications when one follows the indications / contraindications, although in the case of manual treatment techniques the patient may experience:

  •  severe pain from the already damaged tissue caused by a premature therapy
  •  increased tenderness of tissues pressured or pulled during the mobilization of the joints
  •  periodic dizziness and nausea in the case of a previously undiagnosed vertebrobasilar insufficiency


Failure to observe the contraindications to the manual therapy may occasionally result in muscle or ligament injury, muscle paralysis and, in extreme cases, in death.

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