Manual Therapy Techniques: Theory and Evidence (02:16)

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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.

Strain-Counterstrain (02:48)

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.

Evidence (01:51)

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