Manual Physiotherapy

WHAT DO YOU NEED TO KNOW ABOUT IT?

Physiotherapy is a branch of alternative medicine, in which, different types of musculoskeletal conditions are treated by the application of certain therapies. The scope of musculoskeletal conditions ranges from stiff neck, backaches, sciatica, knee injury, headaches, shoulder pain, etc. Now, when we say manual therapy, it primarily involves the application of a set of skilled hands, that are trained and used to evaluate a patient’s body thoroughly to know subtle muscle spasms or injuries that may be causing discomfort to an individual. 

The pain is relieved by the methods of massages, stretches, lymph drainage, and much more. These practices not only bring in a sense of relaxation to the individual as these involve a lot of kneading on the muscles of the body, but the practitioner also gets to the root cause of the pain and tries to alleviate the pain by a set of practiced and tested techniques.

Who can perform manual physiotherapy?

Manual physiotherapy can be performed by massage therapists, chiropractors, or osteopaths. An In-depth introspection about the scope of Manual Physiotherapy.

Before we delve deep into the types of techniques or methods involved in Manual physiotherapy, we need to first understand its scope. We will hover around certain physical conditions to understand their probable causes. From a superficial perspective, we will not be able to gauge as to what are the physical conditions that call for Manual Physiotherapy. 

CHRONIC HEADACHES

Chronic headaches can be caused by many factors like sinusitis, migraines, tension headaches, head injury, jaw disorders, or neck problems.

Sinusitis: It is caused by inflammation of the tissues in the sinus cavities, that are responsible for pushing mucus down the throat onto the digestive system. When the mucus that is filled by germs, dust, and dirt particles is not drained out, it causes headaches around the temple region especially, facial pressure, a feeling of heaviness in the head, or neck pain.

Migraine: A migraine is characterized by a throbbing pain that affects one half of the head, and is worsened by light, noise, or stress. Migraine may also cause nausea or vomiting and sensitivity to certain types of smells. A migraine is said to be caused by genetic or environmental factors. Stress is supposed to be one of the biggest triggers of a migraine headache.

• Tension headaches: Tension headaches can be explained as a dull pain that continues to affect a person, and causing tightness in the parts of the head. They are different from migraines. The physiotherapist prescribes muscle relaxation techniques for the same. Nonetheless, it is also caused by stress. 
• Jaw disorders: Jaw disorders can be termed as pain in the jaws that extend to other parts of the face. Many times, the temporomandibular joint disorder causes jaw pains. Many conditions affect the jaws resulting in temporomandibular joint disorders, a few of which are as follows: stress, lack of sleep, teeth grinding and clenching, neuropathic pain, a dislocated jaw, etc. 
• Neck Problems: Neck problems can arise out of many reasons, a few being post-surgical neck pain, muscle spasm, disc pathology, etc. It can also result from stress or over-thinking mostly due to the feeling and accumulation of negative emotions like guilt, anger, or ego. So, a few kinds of neck pains result from psychosomatic conditions that can be treated holistically and by manual intervention or therapy. 
• Shoulder Pain: Shoulder pain is usually an extension of neck and headaches. Common categories of shoulder pain are frozen shoulder/adhesive capsulitis, post-surgical, and stress-oriented pain. Frozen shoulder is a condition in which there are problems in the shoulder joint that results in stiffness of the shoulder and thereby reduces the mobility of a person. 
• Ankle pain: This can be as a result of ankle arthritis, post-surgical pain, sprains, etc. The ankle is one of the most vital parts of the body responsible for the movement of the legs and maintaining poise and balance and the gait of the human body. In the presence of pain in the ankles, the movement of the body can become restricted.
•  The above, are a few of the common types of Musculoskeletal conditions resulting in discomfort in the human body. In the subsequent segment let us see how physical therapy or manual physiotherapy can help in relieving a person of these kinds of pains. Of course, there are various techniques involved, pertaining to the various types of pains or traumas.

 MANUAL PHYSIOTHERAPY TECHNIQUES

Manual physiotherapy techniques can be broadly classified into two categories: Soft Tissue Techniques, Joint Techniques 

1. Soft Tissue Techniques: Under the broad umbrella of Soft Tissue Techniques, come massage, manual lymph drainage, Myofascial release, Soft tissue mobilization, etc.
2. Joint Techniques: Under the Joint techniques come joint manipulation, traction, mulligan techniques, etc. Soft Tissue techniques will elaborate on a few types of therapies that come under soft tissue techniques and see which Musculoskeletal conditions they can help with.
3. Massage: Massage is nothing but kneading and manipulating the muscles and soft tissues to improve circulation around the area. A qualified masseur massages the target areas to improve circulation around the soft tissues. Massage also reduces neuromuscular excitability. So, the response to pain gets lowered, this directly also lowers stress in an individual. Helpful for knee pain, ankle pain or neck, and shoulder pain.
4. Manual lymph drainage: By the use of certain movements of the fingers and pressure applied on local points, this technique helps in the drainage of cellular waste through a fluid called lymph, into the digestive system. The wastage is then filtered in the liver and removed. So, in an ideal case of sinusitis, when there is a swelling of the walls of the sinus, manual lymph drainage helps in relieving the pressure around the sinus cavities. 
5. Myofascial release: This is done to release the adhered muscles and fascia by applying compression or tension in different directions of the body. Now, fascia is a sheet of connective tissue. It separates the muscles from other organs. When fascia becomes too stiff or loses stiffness it causes pain and hence this technique comes to help. Back, neck and shoulder pain can be reduced by using the myofascial release technique.
6.  Soft tissue mobilization: In this, the physiotherapist applies rhythmic pushing on the restricted tissue or does a friction massage. 

There are two interesting methods that come under this and those are perpendicular mobilization and parallel mobilization. 

In perpendicular mobilization, the pressure is applied to the painful area in a perpendicular direction, and in parallel mobilization, the pressure is applied along the muscle seam.

Joint Techniques 

• Joint Manipulation: When we say manipulation, it means indulging in passive movements of the joints (with the help of a manual physiotherapist and gradually by self-practice). These passive movements help in the restoration of the optimal motion and function of the joints. The movements are done in varying levels of speeds and amplitudes. Gradually the joint that had pain around it restores its mobility and hence the normalcy is achieved. 
• Traction: When there is a case of spinal injury or fracture, traction is applied. It consists of a set of mechanisms by which pressure on the spine is relieved and the bones are straightened. Broadly skeletal traction or skin traction is used. Traction is done using various tools like weight application, insertion of pins, harness, and halters. 
• Mulligan techniques: In this technique, a “repositioning” of the joint is done by the physiotherapist manually, and this helps the patient to move further once the pain is reduced.” It has a long-lasting effect”.The above techniques help in the restoration and movement of the joints and muscles effectively albeit done under an able physiotherapist. 

There are many more techniques available too, but the above are the most used ones to cure Musculoskeletal conditions. Apart from the above techniques, two other methods are employed namely: 

• Stretching: Stretching exercises help in the reduction of any injury when one performs exercises. It is also known as warming or the exercises are known as warm-up exercises. It also helps in increasing the range of the person’s movement. These exercises are a way to let the body prepare for more strenuous movements during running or brisk walking.
•  Taping: To get relief from pressure or from the pain of an injury, by the use of therapeutic taping. This kind of elastic therapeutic tape helps in increasing circulation to the injured area by relieving pressure from the surrounding tissues that are swollen. The tape is gradually removed after a few days when the manual physiotherapist feels that the joint has regained its mobility or the muscle has got repaired from its tenderness. 

DURATION OF TREATMENT: 

                                                  The duration of the above-mentioned treatments depends on the condition of the patient. The diagnosis is done on the first day by the manual physiotherapist. The therapist who is a certified one evaluates the condition and recommends the techniques used for the therapy. This may or may not be accompanied by certain oral medication, usually, an ongoing oral medication is prescribed by the doctor, comprising of vitamins and minerals that aid the functioning of the joints and the muscles. Usually, physiotherapy sessions are scheduled on a daily basis for a few days continuously. Let us say a throbbing back pain that has increased over the years due to negligence and wrong posture may take 3 weeks of physiotherapy. The frequency of therapy is gradually decreased so that the body normally gets into its usual functioning even without the manual therapies. Sometimes a combination of therapies is involved so two factors are targeted: mobility and inflammation. 

AFTERCARE IN THE FORM OF EXERCISES

• Once the physiotherapy sessions are over, the physiotherapist recommends a set of home care techniques and exercises.
•  These techniques and methods help the patient to completely cure the pain or Musculoskeletal conditions. 
• The recommended set of exercises (passive ones used in Joint Manipulation) should be practiced by an individual for at least 3 months after the physiotherapy sessions are over. 

This also brings in a lifestyle change so that these activities form a part of an individual’s lifestyle as such. Posture correction also plays an important part here. Many times, it is observed that an incorrect posture of an individual that he or she got accustomed to over the years is the root cause of the arising pain. Though the pain is relieved by manual physiotherapy sessions, if one goes and continues to assume the incorrect postures, one is likely viable to get that condition back after some time. We are supposed to sit and stand in an upright position, slouching, keeping the legs in an uncomfortable position for long, excessive usage of mobiles, incorrect position of laptop and mouse while working, incorrect method of sleeping, the use of an uncomfortable mattress and also sometimes incorrect footwear, resulting in all these complicated conditions of the muscles and the joints. 

                                                 Hence maintaining a correct posture solves most of the issues of the body. Almost every manual physiotherapist advises regular walking and mindful breathing as part of the recovery process. Hence the patient should also get involved in a regular physical regime that includes all of the above physiotherapy practices along with a 30-minute brisk walking.

HOW DIET PLAYS A VITAL ROLE: After the manual physiotherapy sessions are over the patients are encouraged to have a balanced diet that does not involve the consumption of excessive calories in the form of junk food. A diet must contain an equal proportion of protein, carbohydrates, minerals, fats, and vitamins, to aid the normal functioning of the joints. A person who is battling weight-related issues is encouraged to lose weight not by crash diets but a well-balanced diet and over a period of time. This might be a very common point, but it is an extended part of the therapy.

CONCLUSION: Manual physiotherapy is thus an inevitable part of therapy used by millions of people around the world. It just emphasizes the magic of physical touch in the process of relief from pains and injuries.