Healthy Life: (3) Manipulative Therapy (441)

Healthy Life: (3) Manipulative Therapy

蘇鎮邦 (Christopher So)：
舒整物理治療師 (Manipulative Physiotherapist) 人類工程師 (Ergonomist)

Most of these articles are focused on middle age people when they start their degenerative cycle. However, many principles are useful for people of all ages. Many people go to the ‘gym’ for convenience. They concentrate on building up muscle strength, weight loss or cardiovascular exercises. However, the commonest problems for middle age people are lower back or lumbar spine pain, upper back or thoracic spine pain, neck or cervical spine pain, particularly for those involved in sedentary desk work in front of computers. Other common problems are caused by weekend gardening or house maintenance works e.g. shoulder, elbow and knee pain. The main cause of these degenerative joint problems is the lack of proper treatments after minor injuries. This leads to pain and stiffness or decreased joint mobility. Gym work rarely deals with joint mobility. However, most of our daily activities require only 30% of the joint mobility. It is when we do vigorous sports which demand 100% of our joint function that we realize that we have problems.

Manipulative or manual therapy is a postgraduate course in physiotherapy. It deals specifically with the normal function and mobility of all joints. The Manipulative Therapy Association was a former special group within the Australian Physiotherapy Association. Now it is called the Musculoskeletal Association. It was the first association to have a mandatory continual education program. Each member was audited to ensure they had upgraded their professional knowledge by completing seminars and courses with an aggregate of 500 points within a 4 year period. Now, the Australian Physiotherapy Association has taken over the responsibility for every member.

Manipulative therapy focuses on manual therapy in applying biomechanical and anatomical means for correcting any mechanical problems in joints and muscles. Traction is an automated mechanical means of mobilisation and is very beneficial for sciatica and radiculopathy i.e. referred leg and arm pain caused by compression on the spinal nerves in the lower back and neck respectively. The most common injuries are Repetitive Strain Injuries or Occupational Overuse Syndrome, Sports Injuries and Postural Problems. I also use adjunct therapy such as Ultrasound, Interferential, laser therapy.

Why is manipulative therapy an effective treatment for joint problem? The reason is that the tests also can be used as a treatment technique. In this way, during the treatment process the manipulative physiotherapist can detect any change or improvement in the joint tissues e.g. stiffness or mobility. The advantage of this approach is that after every technique the manipulative physiotherapist will reassess each particular test to confirm any change or improvement. This is very logical and scientific. Most of the time, there is clear clinical reasoning and explanation of each technique and the appropriateness for each joint condition. Each technique is graded from 1 -5. Grade 1-4 are gradual progressive mobilisation techniques while grade 5 is quick sudden thrust which usually will produce a clicking or popping sound. The purpose is to release any nerves or painful tissue from compression and to restore normal functioning of the joint. It aims to correct the cause of the joint problem rather than provide symptomatic relief. The adjunct therapy aims to reduce symptoms which act as barriers to the speed of recovery thus is helpful in many instances.

The last but not the least, is exercise therapy. The exercises must be appropriate in selection and amount for individual cases which differ to any form of class exercises. They must be reviewed by the manipulative therapist in follow-up sessions to ensure that patient does it correctly. My clinical experience is that no matter how simple the exercise, many patients do it incorrectly. As I stated in the home page, the more exercises you do, the less you see me. The less you do the more you see me. The choice is yours!