Manipulative therapy includes massage therapy, mobilization of the joints and stretching of the tissues for providing pain relief.
Massage and other manipulative therapy are aimed at muscle relaxation and improvement in local blood flow.
- Soft tissue technique (massage)
- Passive mobilization of joints
- Passive stretching of soft tissues
- Autostretching of soft tissues
The term massage has been replaced by soft tissue technique and this manipulative therapy involves stroking, kneading picking up, skin rolling etc., of soft tissues (muscles with their fascial sheaths, ligaments, tendons and skin).
It is not known whether benefit is produced by local reflex activity or by mechanical stimulation.
Indications of Manipulative Therapy
- Muscle spasm or tightness
- Scar tissue-adherent and limiting movement
- Post-traumatic oedema
Contraindications of Manipulative Therapy
- Acute inflammation
- Infective skin lesions-eczema
- Recent fractures
Passive Mobilization of Joints
Mobility of joints might get restricted because of degenerative changes, trauma, chronic pain. The restricting factors may be pain, muscle spasm, oedema, fibrous contracture of fascia, ligament or capsule.
Restoration of normal function of joints is very important and passive mobilization helps to restore joint function.
Pain itself may be relieved by restoring normal movements. The relief could be because of direct effect of passive joints movements by the stimulation of mechanoreceptors, which in turn inhibits the transmission of pain impulses from the periphery through the spinal cord to the brain.
Rhythmical passive movements of joints has effects on skin, fascia, muscles, tendons and ligaments. This probably moves fluid through the tissue planes and increase lymphatic and venous drainage. This results in removal of metabolites which act as irritant to the nonciceptive nerve endings in the tissues and pain is reduced.
Treatment of under limiting factors and regaining movement and maintaining it by exercise is often effective in pain relief or reduction.
Contraindications for passive mobilization manipulative therapy
- Inflammatory arthritis with acute flare up
- Instability of joints
- Spinal cord compression
- Vertebrobasilar insufficiency
- Severe pain which is easily provoked
- Local malignancy
Passive stretching of soft tissues
This is a manipulative therapy where soft issues are passively stretch the soft tissue. In soft tissues, after any injury, immediate repair takes place by formation of fibrous tissue (scar). This scar has an inherent property of contracture and tends to bind tissues together. When this scar tissue forms in fascia, muscles and ligaments it limits the function of tissue because of its lower elasticity.
It hurts when the scar tissue is stretched beyond a limit. Early ambulation is essential after injury to ensure that scar tissue is laid down in the correct plane of movement. Despite all these precautions, nerve entrapment happens in scar tissue.
Passive stretching of soft tissues is most often done for frozen shoulder, early osteoarthritis, sprain and other conditions.
Passive stretching is designed to lengthen shortened scar tissue, complement massage and joint mobilization.
Active Stretching of Soft Tissues
This is widely practiced in sports. Before starting of sprint, sports persons perform auto stretching of muscles, ligaments and fascia. Exact benefit is not known. It is supposed to warm up tissues before major activity.
This is supposed to provide flexibility and therefore a greater range of movement. The person takes up the position with the appropriate structure or tissues (hamstrings) on the stretch, feels the tightness and holds for 30-60 seconds; then as the tightness reduced he takes up the slack and hold again.
This is repeated 3-4 times.
The procedure is then applied to the opposite side. This manipulative therapy technique should be performed daily.
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