Manual therapy

Abstract

Manual therapy (MT) is a very common practice among primates and its range of uses and the variety of techniques is probably infinite. It has been professionalised for the treatment of a variety of conditions for at least two millennia with texts appearing in China and in the fourth century BC in Greece by Hippocrates, whose applications of it were mainly musculoskeletal.1,2

Manual therapy is considered to be a method of intervening therapeutically that involves the application of movement to the body. This commonly takes the form of movement that is applied to the recipient rather than movement generated by the recipient and thus is termed passive movement. However, forms of guided active movement and isometric muscle contractions are also considered to fall under the umbrella term of manual therapy. Practitioners undertaking MT will use clinical reasoning to determine the parameters, location and objectives of applied movement and will typically label the type of MT used based on the tissue perceived as being targeted. For example, there are numerous texts describing joint mobilizations, muscle techniques, and nerve techniques. Of course, the application of contact to the body with the intention of guiding or evoking motion will influence skin, fascia, neural, vascular, lymphatic, myogenic and arthrogenic tissue, and thus such labels are a little artificial.

This chapter will review the modern use of manual therapy for low back pain under the headings of: history and background, scope and types, evidence and guideline recommendations, mechanisms of action and clinical indications and contraindications.