Manual therapy consists of a variety of hands-on intervention techniques. These include mobilisations of soft tissue, joints and neural tissue. In some cases, joint manipulations can be utilised. Overall, manual therapy is a highly effective treatment method that can provide excellent pain relief, improve range of movement and improving physical functioning.
Soft Tissue Mobilisation (including Massage)
Physiotherapists use various techniques to have an effect on soft tissue (including muscles, ligaments, tendons, connective tissue/fascia). Deep tissue massage, frictioning, myofascial releases and trigger point therapy are techniques employed by our therapists to improve the extensibility, elasticity and tone of soft tissues, promote the formation of “good” scar tissue, enhance circulation and encourage fluid drainage. Soft tissue mobilisation techniques can be applied at different depths, depending on which tissues are being targeted and, obviously, patient tolerance. Physiotherapists can use their hands, forearms and elbows to alter the strength of the massage.
The mobilisation techniques most commonly used by our physiotherapists are derived from Maitland and Mulligan teachings. Varying degrees of passive, mechanical pressure is directed at a particular joint, encouraging a specific movement in a specific direction. The gentle movement aims to improve joint mechanics and/or correct joint positional faults. It also stimulates mechanoreceptors, which helps to reduce pain. Because of their knowledge of joint kinematics, physiotherapists are able to facilitate small movement gains at implicated joints which then can lead to significant improvements in the overall range of movement of that body segment.
Joint manipulation is characteristically associated with the production of an audible ‘clicking’ or ‘popping’ sound. This sound is believed to be the result of a phenomenon known as cavitation occurring within the synovial fluid of the joint (the rapid release of trapped gases in a high pressure environment, similar to uncorking champagne bottle).
Maitland has classified a manipulation as a joint manoeuvre of high velocity and low amplitude. This rapid and forceful end-of-range movement is complex and is associated with a degree of risk, especially when it involves the spine. Hence, this technique is only performed by experienced and qualified physiotherapists who are required to perform a pre-screening of the client to ensure safe, effective and appropriate application of technique. The technique involved should always be explained to the patient and all risks outlined clearly. The patient’s informed, written consent must always gained before administering this technique.