Manual therapy aim to restore function on the structural, functional, activity and participation levels. Normal mobility in the joints is central to manual therapy. Therefore there have been a number of methods developed to examine mobility in the joints of the extremities (the joints of the arms and legs) and in the spinal column, as well as treatment techniques that promote normal, active movement. Guidelines have been developed for examination in the field of manual therapy.

Diagnosis

The reasons behind musculoskeletal complaints can be simple or complicated. This is reflected in the practical use of manual therapy. The manual therapist’s evaluation of the patients includes biological, psychological and social circumstances. The process of diagnosis starts with a thorough anamnesis (examination of medical history).

The anamnesis offers important information in order to arrive at a concise diagnosis. It also gives other information which makes it possible to evaluate the possibility of a more serious, underlying disease being the reason behind the complaint, or whether there are factors that increase the risk of chronic . Particular to the manual therapist’s anamnesis is charting the injury mechanisms and strains that may have triggered the complaint. Conditions surrounding function at work and leisure activities also have a bearing.

The clinical examination expands on information from the anamnesis and aims to prove/disprove suspicion of possible patho anatomical lesions (damage to or morbidity of the tissue), as well as charting the musculoskeletal system’s function.

The clinical examination consists of inspection, general test of function, active, passive and isometric muscle testing, neurological tests, nerve stretch tests, and other tests such as pain provocation tests, stability tests, tests to reveal circulatory failure in, or the entrapment of, nervous/other tissue, sensory-motor testing and palpation. There are further test dealing especially with joint function in the joints of the extremities, spine and pelvis.

The manual therapist will choose measures of treatment based on the examinations and form a tissue diagnosis (i.e. cruciate ligament injury of the knee), which gives a function diagnosis (i.e. instability of knee). In combination these provide the foundation for a plan of action. The treatment aims to restore painlessness and good function locally (in the knee) and generally (walking, running, etc.).  Based on the injury’s nature and scale, the manual therapist will inform the patient of the expected time of recovery (prognosis), and, in cooperation with the patient, s/he will commence a conservative plan of treatment (meaning treatment without surgical procedures) or refer to surgery and rehabilitation. The treatment is based on knowledge of the tissue’s (i.e. the cruciate ligament’s) healing process. In many cases one will start with a conservative form of treatment and refer to surgery if it proves ineffective.

In many conditions, i.e. acute lower back pain, it can be difficult to reach a definitive tissue diagnosis (pathologic lesion). In 85% of the cases, it will not be possible to provide a diagnosis with a firm anchoring in a pathologic lesion. In these cases the manual therapist only has a function diagnosis and a pain centre at which to direct treatment. In cases such as these, it is advisable with a course of test treatments followed by a new evaluation of function and pain. It can be advisable to base the treatment on a perceived tissue diagnosis and re-evaluate this should the course of treatment prove ineffective. The manual therapist will commence the course of treatment and set out short- and long-term goals of what one can expect to achieve through following it. If the treatment is not expected to yield results, the need for further examination, interdisciplinary cooperation and referral to other health care professionals will be evaluated.

In the manual therapists’ examination the emphasis is on sub-grouping what are usually labelled ‘unspecific conditions’. The treatment is unique in that often the manual techniques are combined with training. Rehabilitation following an injury is an important part of the manual therapist’s practice.

Treatment

The main aim of manual therapy is to normalize function in the musculoskeletal system, possibly helping patients to master a disability or pain.

- Methods included in the treatments offered by manual therapists: Manual methods of treatment etc.

- Pain reducing treatment

1. -Mobilization and manipulation (see videos of manipulation), immobilization (use of corsets, neck brace, splint, taping), extracorporeal shock wave therapy, and trigger points treatment.
   

Soft tissue treatments

1. •Massage: classical, connective tissue massage, cross-friction.
   

2. •Muscle relaxing techniques based on specific reflexes: grip-release relaxation.
   

3. •Specific stretches to conserve flexibility in muscle- and connective tissue.
   

Joint mobilization

Joint mobilization treatment includes passive mobilization which comprises of specific movements in a joint, either mechanical or manual. In addition, manipulation is used in connection with joint treatment. This comprises of a manual mobilization of a joint given a quick impulse and will often lead to the release of a ‘clicking’ sound in the joint. You can read more about manipulation here.

Neural mobilization

Neural mobilization treatment is a passive immobilization of the spinal cord with membranes, nerve root, -stem, and peripheral nerves.

Counseling

The manual therapist’s focus is on providing the patient with defusing information that instils a sense of security, as well as offering advice on how to prevent a relapse. It is a goal to increase the patient’s ability to be self-reliant.

The manual therapist provides

1. •An explanation of your complaint and a prognosis for recovery.
   

2. •Advice related to rest, work and leisure activities.
   

3. •Analysis of your work situation and ergonomic advice.
   

4. •Referral to other relevant health-care personnel.
   

Purposeful rehabilitation

What is specific for manual therapists is that they, in addition to the manual methods of treatment, can provide purposeful treatment which aims to rehabilitate the patient’s disability. This combination of treatments has proved to yield especially satisfactory results in patients with back- and neck complaints.

Control of movement – stabilizing can involve external support, i.e. splints, braces or taping, and active stabilizing treatment comprising of sensory-motor training, stabilizing exercises and exercising neuromuscular control.

Daily function – training involves, among other things, exercises that promote muscle strength, endurance and coordination.