Manual Therapy

Strictly speaking manual therapy is any treatment that is carried out with the hands; this would include massage, joint and spine mobilization and manipulation, exercise when guided by the therapists such as with certain neurotherapy techniques, stretching by the person doing the treatment, craniosacral therapy and pretty much anything else you can think of that is therapeutic and is done with the hands directly. It would not include any of the electrotherapies even if they are directed with the hands such as ultrasound and vibrators. But in most health care professions, the generally accepted use of manual therapy is reserved for joint and spine mobilization and manipulation. The term “Manual Therapy” with uppercase first letters is almost exclusively used by physiotherapists while other professionals prefer the various other terms including adjustment and chiropractic adjustment.

Both mobilization and manipulation is used to reduce pain and muscle tone and to increase range of motion. These techniques are used by physiotherapists (in the USA physical therapists), chiropractors, osteopaths, massage therapists, naturopaths and countless other groups.

Mobilization

This is where a limb or a spinal segment is rhythmically oscillated at some point in the available range of motion but there is no sudden or forceful manoeuvre or cracking unless it occurs incidentally.  The techniques can be used in the early part of the range when there is severe pain or towards or at the end of the range when the pain is less severe as an attempt to stretch tight tissues to increase range of motion.

These are the techniques typically taught to student physiotherapists at Canadian schools as their introduction to Manual Therapy as they are considered easier to learn and use (although that is not the case, they just seem easier at first glance but gaining mastery is extremely difficult). I think it is fair to say that physiotherapists are the group that uses these techniques most on everything from extremely severe through moderate pain and for the stiff non-painful joint that is over-stressing other tissues.

Manipulation

These techniques are usually associated with the Chiropractic profession and for good reason. For most, but not all, chiropractors this is their bread and butter technique, but it is not exclusively theirs. Osteopaths and physiotherapists use these techniques extensively. These are for the most part short range, fast techniques that often result in a joint noise (crack, pop, grinding etc) that is carried out at the end of the joints range. While the popular image is that of cracking the spine, the techniques can be used very effectively in the limb joints.

Comparing mobilization and manipulation it seems from research that manipulation is more efficient than is mobilization for non-severe pain, that is it will achieve recovery faster than will mobilization. It will take fewer sessions but there is a bit of a higher risk associated with manipulation than is believed to be present during mobilization particularly in the spine. So manipulation requires an additional layer of education in assessment and technique to determine the need for manipulative techniques and also to identify anything that may increase the risk of using these techniques and of course to carry out the manipulation. This education is mainly carried out by the Canadian Physiotherapy Association’s Orthopedic Division, one or two university’s postgraduate programs and increasingly by Swodeam Institute which is owned and operated by Jim Meadows, the owner of Creekside Physiotherapy, which teaches Manual Adjustments Therapy Airdrie and particularly spinal and peripheral manipulation across Canada and the USA. In Alberta programs teaching physiotherapists spinal manipulation have to satisfy the College of Physical Therapists of Alberta, with standards of instruction and examination to make their graduates eligible for registration as a spinal manipulative therapist, Swodeam Institute is one of these programs. At a higher level the Canadian Academy of Orthopedic Manual Physical Therapy (CAMPT), standards organization of the International Federation of Orthopedic Manual Therapy, award Fellowships for those physiotherapists who have completed instruction and examination with accredited programs (see this site’s blog on regulation of manual therapy in Canada). The designation FCAMPT allows the public and physicians to identify such therapists. Jim Meadows, FCAMPT has held that designation or its predecessor for about 30 years.

At Creekside Physiotherapy in Airdie, both mobilization and manipulation are used routinely to improve pain and movement and invariably they are followed with an exercise program that is designed for your specific movement difficulties after a thorough examination and electrotherapy to help the pain and stimulate the small stabilizing core muscles.

Conditions Treated

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If your therapist feels that physiotherapy will not help you she or he will tell you that and suggest alternative paths for you take as soon as possible.

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Treatments

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Treatments will be changed appropriately as your condition improves and if we are unable to help you we will tell you that as soon as we know.

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