Manual Therapy is defined as a clinical approach utilizing specific hands-on techniques, including but not limited to manipulation/mobilization, used by the physical therapist to diagnose and treat soft tissues and joint structures for the purpose of modulating pain; increasing range of motion (ROM); reducing or eliminating soft tissue inflammation; inducing relaxation; improving contractile and non-contractile tissue repair, extensibility, and/or stability; facilitating movement; and improving function.
The McKenzie method consists of two components used to treat musculoskeletal conditions: assessment and intervention. The assessment component of the McKenzie method uses repeated movements and/or sustained postures in a single direction to elicit centralisation. In spinal patients centralisation refers to a pattern of pain level response which is characterised by decreased or abolished pain symptoms, experienced sequentially, first to the left and right of the spine (distal symptoms), and ultimately abolished pain symptoms in the spine altogether.
In the last ten years a new approach to joint mobilization has been developed by Brian Mulligan, an expert manual therapist from Auckland New Zealand. What is now referred to as The Mulligan Concept takes joint mobilization in a new and exciting direction. Mulligan treatment techniques have emerged from many years of clinical practise and refinement. Over the years many of these techniques have been clinically proven to be effective with some having recently undergone scientific validation. Mulligan techniques must produce immediate improvements and performed in weight bearing.
(Dr. James Cyriax, an Internist and Orthopaedic Surgeon in England, developed his system of Orthopaedic Medicine in the early 1920's. He proceeded to develop a series of simple objective clinical exams that would effectively diagnose soft tissue musculoskeletal lesions. He coined the term ‘Orthopaedic Medicine”. The basic principles of Orthopaedic Medicine are: 1) Every pain has a source. 2) Treatment must reach the source. 3) Treatment must benefit the source in order to relieve the pain. Most sources of pain in the musculoskeletal system can be localized to a specific tissue. We look carefully in a systematic manner to isolate the cause of pain, and then treat it specifically. A specific diagnosis leads to successful treatment. )
The Maitland Concept of Manipulative Physiotherapy emphasizes a specific way of thinking, continuous evaluation and assessment and the art of manipulative physiotherapy (“know when, how and which techniques to perform, and adapt these to the individual Patient”) and a total commitment to the patient. The application of the Maitland concept can be on the peripheral or spinal joints, both require technical explanation and differ in technical terms and effects, however the main theoretical approach is similar to both
It was developed in the 1960’s by Signe Brunnstrom, an occupational and physical therapist from Sweden. With seven stages, the Brunnstrom Approach breaks down how motor control can be restored throughout the body after suffering a stroke.
The Bobath concept is an approach to neurological rehabilitation that is applied in patient assessment and treatment such as with adults after stroke, or children with cerebral palsy. The goal of applying the Bobath concept is to promote motor learning for efficient motor control in various environments, thereby improving participation and function. This is done through specific patient handling skills to guide patients through initiation and completion of intended tasks. This approach to neurological rehabilitation is multidisciplinary, primarily involving physiotherapists, occupational therapists and speech and language therapists. In the United States, the Bobath concept is also known as 'neuro-developmental treatment' (NDT)
It targets the muscle and fascial systems, promotes flexibility and mobility of the body's connective tissues. It is said to mobilize adhesions and reduce severity/sensitivity of scarring. A critical analysis finds that the relevance of fascia to therapy doubtful.
It is said to increase mobilization of adhesions between fascial layers, muscles, compartments and other soft tissues. They are thought to create an inflammatory response and instigate focus to injured areas. A 2012 systematic review found that no additional benefit was incurred from the inclusion of deep tissue friction massage in a therapeutic regime, although the conclusions were limited by the small sample sizes in available randomized clinical trials.