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Orthopedic Manual Therapy: How it can help in pain relief and rehabilitation

Karen Griffin of STAR Physical Therapy explains the procedures and benefits of Orthopedic Manual Therapy.

Orthopedic Manual TherapyOrthopedic manual therapy has been commonly considered “hands on” assessment and treatment. It allows a trained clinician to assess and treat soft tissue and joint dysfunction. Soft tissue encompasses muscle, tendon, fascia, and nerves. Injuries may include adhesions resulting from direct or indirect trauma, musculotendinous strains, and ligamentous joint sprains. When soft tissue structures or joints are injured, the sequel is one of altered biomechanics, meaning that the joint does not move correctly or the tissue does not perform normally.

Soft tissues normally slide over one another. Manual therapy helps to restore the position and gliding of adjacent tissues with effort of improving pliability of soft tissue and overall joint range of motion. Range of motion is that of active or physiological movements that an individual can perform by oneself (i.e. lifting arm overhead in shoulder flexion motion). However, passive or accessory movements (including gliding, sliding, translation and rotational type movements) cannot normally be performed by oneself but rather are performed by a clinician (i.e. glenohumeral inferior glide joint mobilization of the shoulder).

Another advantage of manual therapy is that of providing pain relief. Gentle progressive oscillatory passive movements can be used to decrease inflammation and relieve mechanical joint pain.

Scientific factors and research help verify the situational change of soft tissue scarring and stimulation of joint mechanoreceptors that decrease pain and inhibit muscular spasm and tone. Scar tissue is weak tissue; therefore, if the healing tissue is not addressed, the injured area can become susceptible to reinjury (i.e. a mild hamstring strain that becomes a chronic hamstring problem with repeated tears to the muscle tissue). As with any musculotendinous strain, the goals are of improving tissue tension, texture, movement and function. Ultimately, the use of manual therapy helps to normalize tissue of an individual in preparation for returning to active exercise and effective passive stretching.

A manual therapist or clinician utilizing manual therapy techniques will typically perform ones that are effective in their hands. Manual therapy techniques include gradual manual joint mobilization, positional soft tissue release techniques, soft tissue mobilization of various therapeutic emphasis,  myofascial techniques, trigger point techniques, assisted instrumentation with manual soft tissue mobilization, and proprioceptive neuromuscular facilitation techniques. “Hands on” facilitates an active rehabilitation, an effective recovery and a return to one’s desired vocation or advocation. Yes, manual therapy is appropriate for most orthopedic maladies, however it is contraindicated in situations of nonstable healing fracture or compromised bone strength, areas of any cancerous tumor, areas of infection or open wounds, and areas of segmental ligamentous instability or laxity.

Manual therapy in combination with progressive functional exercise and activity are generally ideal components of a rehabilitative plan. Specifics and emphasis given is dependent on a patient’s presentation of symptoms and physical limitation. Manual assessment, treatment and reassessment guide the clinician to assist an individual’s return to optimal function.

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