Monday, February 9, 2009

Discussion of Mechanisms Of Maual Therapy

Mechanisms of Manual Therapy:

This article is taken from an article in Manual Therapy by Joel Bialosky and associates from the University of Florida. The article provides a framework of manual therapy that has yet to be previously defined to this degree.

How manual therapy works is more controversial than the procedures. Convictions differ considerably about proposed mechanisms for manual therapy among the clinicians, teachers & peers. However,in generic terms, now a days it is believed that the identification and correction of biomechanical faults within the musculoskeletal system leads to the clinically found effects. The peer reviewed literatures are proving us insights into what really happens when manual therapy is done. However with emerging evidences, it is gradually becoming clearer that manual techniques are more than correcting upslips and stretching joint capsules etc. Bialosky et al has proposed five potential mechanisms reponsible for manual therapy.
Mechanical Stimuli: Our hands are capable of inducing temporary mechanical changes within connective tissue, but the lasting effects are still uncertain. We have seen positive effects from our manual techniques and assumed a mechanical response to our mechanical technique, but it may not be that simple.

Neurophysiological Mechanism: There is clearly an interaction between the peripheral and central nervous systems during manual therapy. Hypoalgesia and changes in sympathetic activity following joint mobilization technique have been consistently documented in recent literature. Notably the changes in pain threshold and sympathetic activity often occur distant to the site of the manual technique. Something within the patient is clearly interested in what we do!

Peripheral Mechanism: Local tissue injury sets off a cascade of events both near and far within the body. Manual therapy has been recently shown to reduce inflammatory chemicals such as cytokines and substance P along with increasing systemic opioid release. The "good feelings" associated with manual therapy have often been attributed to correction of mechanical faults, but peripheral mechanisms may provide a more reasonable description the therapeutic effect.

Spinal Mechanisms: Renown pain physiotherapist David Butler refers to the spinal cord as an amplifier for sensory modalities. Manual interventions have been recently implicated in modifying both afferent and efferent activity within the spinal column. The bottom line is that the spinal column isn't simply a conduit, but an active participant in determining the effects of manual care.
Supraspinal Mechanisms: Admit it. There have been times where we've thought privately that a condition or response to treatment was "all in the patient's head". Turns out there may be more truth to this statement than we'd previously imagined. Recent animal and human studies implicate specific regions of the brain in mediating the pain experience. Moreover psychosocial factors such as patient expectation and placebo are very likely to affect the outcome of our manual intervention.

1 comment:

  1. I agree with everything you said in this post. In fact, I couldn't agree more. I'd go a bit further, to say that probably any beneficial effects of anything we do manually have less to do with "what" we do, and more about "how" our own non-conscious nervous system has interacted with that of our patient, and what it in turn managed to "learn" or "exploit" as a result of the kinesthetic encounter on behalf of its "organism."

    Diane (Neurotonics blog)


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