Manual Therapy Techniques: Theory and Evidence (02:16)
Dr. Regis Turocy will look at a broad range of manual therapy skills, their intended function, and their pitfalls. He discusses the importance of touch in the healing process; see a visual representation of the somatosensory cortex.
Manual Therapy (02:57)
Manual therapy is used to alter pain, joint motion, and adaptively shortened tissue. Dr. Turocy provides a brief history of 20th century system developments, including an ongoing neurobiological revolution. Approaches are tissue specific; technique variety can be a problem.
Manual Therapy Challenges (02:44)
There is little agreement about which technique is best. Decisions are based on training, biases, and deductive reasoning. Outcome measures and efficacy are unknown. Variables include: joint knowledge, symptoms, patient and provider position, hand placement, specificity and force direction.
Soft Tissue Techniques: Transverse Friction Massage (01:31)
Transverse friction massage increases connective tissue extensibility and treats inflammatory scar tissue. Challenges include: the amount of tension, area treated, tissue position, technique amplitude and duration, and post treatment.
Augmented Soft Tissue Mobilization (01:14)
ASTM uses hand held devices to assist with mobilization of disorganized connective tissue. It creates microvascular trauma, capillary hemorrhage, and localized inflammatory response, and stimulates a healing cascade. Challenges are similar to those of transverse friction massage.
Myofascial Release (03:03)
The technique is based on the belief that trauma causes a loss of physiological adaptive capabilities and pulls the body out of alignment; it also draws upon holistic theory. Challenges include: relying on perceived patient tissue feedback, measuring pressure, and palpation skills.
The indirect technique treats somatic dysfunction and uses passive body positioning to achieve comfort. Challenges include finding tender points, palpation skills, degree of pressure, post-treatment regime, and speed of recovery.
Joint Mobilization (00:51)
Dr. Turocy outlines a broad spectrum of techniques producing neurophysiological, nutritional, and mechanical effects.
Muscle Energy (02:12)
The joint mobilization technique moves restricted muscle-joint complex. The theory is that pain and impairment "scar" the neuromuscular system, disrupting harmony and body rhythm. Challenges include: palpation skills, diagnostic techniques, training, motion barriers, treatment position, and using the agonist or antagonist muscle.
Kaltenborn (Norwegian Approach) (02:31)
Following a concave-convex rule, the technique uses traction and accessory movements to reduce pain and increase mobility. Pressure is classified in three grades, which are hard to measure. Other challenges include: hand placement, technique, patient and practitioner position, and strength and duration.
Maitland (Australian Approach) (01:41)
The technique employs five grades of oscillatory mobilization to restore normal joint function; it is difficult to quantify touch amplitudes. Further challenges include: technique, methodology, hand placement, and positioning.
Neurodynamic Mobilization (02:49)
According to neurodynamic mobilization theory, nervous tissue is a form of connective tissue; injury inhibits nerve traction forces from even distribution. Recommendations are to treat anatomical restrictions surrounding neural structures. Challenges include: neural tension testing, technique, and stretching nerves prematurely.
Dr. Turocy reviews Sackett's levels of evidence. Evidence quality is low; there is no evidence from systematic reviews; and the patient-practitioner relationship plays a major role in outcomes.
What do We do Now? (02:05)
Dr. Turocy calls for higher level quality research. He urges healthcare professionals to touch patients, enroll in continuing education courses, and constantly question techniques.
On the Horizon (06:04)
Dr. Turocy outlines the Total Motion Release technique developed by Tom Dalonzo-Baker and Primal Reflex Release Therapy (PRRT) developed by John Iams. PRRT theorizes that reflexes create chronic musculoskeletal dysfunction. Treatment down-regulates the nervous system and reduces pain.
Credits: Manual Therapy Techniques: Theory Underlying the Techniques and the Evidence to Support (00:27)
Credits: Manual Therapy Techniques: Theory Underlying the Techniques and the Evidence to Support
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