Transcript Manual therapies1

Manual therapies
Alexander technique
Alexander technique
• “Every man, woman and child holds the
possibility of physical perfection; it rests
with each of us to attain it by personal
understanding and effort. “
• FM Alexander
Definition
• The Alexander technique is an educational and
therapeutic method of encouraging an individual
to expend a minimum of effort to achieve the
maximum efficient use of muscles and
movement with the aim of relieving pain and
improving posture and overall health.
• Put more simply, it is a practical method for
finding out what habits of body use a person has
and how best he or she can promote the most
beneficial actions and prevent the most harmful
actions.
Theory
• 1. End gaining and the means whereby:
Alexander used the term ‘end gaining’ to
describe the tendency to follow some course
of action almost automatically without first
thinking through one’s intended actions
carefully. He called the opposite process of
waiting, thinking and assessing the most
appropriate activity the ‘means whereby’.
Theory
• 2. Faculty sensory appreciation: with this
term Alexander acknowledged the presence
of habits of proprioception or feeling
underlying habitual actions. This can result in
a feeling of uneasiness during the correction
of a long-standing incorrect posture because
it represents a change from what has been
regarded as normal behaviour in the past.
Theory
• 3. Inhibition: the third idea is linked to the second.
It represents a natural self-control of unwanted and
inappropriate reactions without any sense of
suppressing spontaneity. When Alexander
discovered a way of integrating these concepts he
found the solution to his problems. By recognising
the strength of his old habits and the
inappropriateness of end gaining, he was forced to
consider the ‘means whereby’ he could secure the
necessary improvements in posture. To do this he
had to overcome the faulty sensory perception of
how his body should be. This he did by inhibiting
his end-gaining behaviour.
Practice
• The technique involves a process of
psychophysical re-education that engages both
mind and body.
• This learning process is best achieved through a
series of one-to-one lessons with a qualified
teacher who, using very gentle non-manipulative
touch, gives the pupil the necessary new
experiences.
• Modern practitioners recommend up to an hour
to enable changes to be made.
Practice
• In group classes the emphasis is more on
experiment and observation.
• Pupils are also encouraged to observe the
thought processes and tensions associated with
their activities in daily life.
• As the principles are assimilated, the pupil
begins to develop the tools necessary to make
his or her own discoveries and can continue to
learn independently.
• Alexander technique may not be effective for
everyone. Most teachers consider that 20–40
lessons are required.
Feldenkreis method
Feldenkreis method
• A technique similar to the Alexander
technique has been developed by Moshe
Feldenkrais (1904–1984) in Israel over a
40-year period.
• The Feldenkreis method (FM) is viewed as
an educational system for the
development of self-awareness, which
relies on the body as the learning
instrument.
Feldenkreis method
• It deals with the question of how to enable the
individual to reorganise and recall forgotten
movement patterns.
• Unlike other complementary and alternative
manual and touch modalities, FM is not aimed at
curing or healing a client but rather at bringing
about a change in his or her awareness, selfimage and attitude towards the self, and taking
responsibility for his or her wellbeing.
Bowen technique
Bowen technique
• The Bowen technique involves a gentle, rolling
motion, with very light touches. The practitioner
stimulates sets of points, often with pauses
between sets.
• Bowen therapy was pioneered by Tom Bowen of
Victoria, Australia (1916–82) in the 1950s. It has
been suggested that the Bowen technique may
introduce specific harmonic frequencies to the
body systems.
Bowen technique
• The Bowen technique is not a form of massage,
although it does claim to release areas of builtup stress in the muscles, and clients usually
experience profound relaxation after a session.
• A typical session takes place over 30–45
minutes, with occasional 2- to 5-minute breaks
during the session to allow the body to respond
to the treatment.
• The Bowen technique has been used to treat
back pain, neck pain, frozen shoulder, tennis
elbow, repetitive strain injury and other
musculoskeletal disorders.
Chiropractic
Chiropractic
• Chiropractic is gaining in popularity and in
the USA its practitioners are third in
number to physicians and dentists.
• The discipline is the most popular example
of complementary and alternative
medicine (CAM) in the country, with as
many as one in three patients with lower
back pain being treated in this way.
Definition
• Chiropractic (chieri, meaning hand, and
praktikos, meaning performed) is a
complementary discipline that focuses on
the spine as being integrally involved in
maintaining health, providing primacy to
the nervous system as the primary
coordination for function and thus health in
the body.
Definition
• Maintenance of optimal neurophysical
balance in the body is accomplished by
correcting structural or biomechanical
abnormalities or disrelationships through
the use of manipulation and adjustment.
• Chiropractors specialise in the diagnosis,
treatment and prevention of biomechanical
disorders of the musculoskeletal system,
particularly those involving the spine and
their effects on the nervous system.
History
• Although manipulation dates back to
ancient times, its popularity in modern
times is attributed to Daniel David Palmer
(1845–1913), a selfeducated scientist from
Iowa.
• He founded that the nervous system was
the ultimate control mechanism of the
body and that even minor misalignments
of the spine, which he termed
subluxations, could significantly impact on
a person’s health.
History
• In the closing years of the 19th century, Palmer
produced his theory of musculoskeletal effects on the
central nervous system and developed the first
manipulative techniques to relieve them.
• Palmer is reputed to have opened his own school in
the 1890s; some texts quote 1895 and others 3 years
later.
• The profession celebrated its centenary in 1995 so the
earlier date would seem to be the more appropriate!
• Daniel’s son, Bartlett Joshua (1882–1961), promoted
chiropractic enthusiastically, helped by a number of his
father’s contemporaries and his own students.
Theory. There are four aspects of
chiropractic philosophy:
• 1. The importance of the nervous system:
31 different pairs of spinal nerves travel
through openings in the vertebrae to and from
the brain. If one of the vertebrae is partly
displaced from its correct position, it can
cause an impingement and pressure, or
irritate the surrounding nerves. As a result,
essential nerve messages are distorted,
causing damage to the surrounding tissues.
Theory. There are four aspects of
chiropractic philosophy:
• 2. The body’s inherent ability to heal itself:
this is embodied in the phrase vis medicatrix
naturae.
• 3. The effect of subluxation or joint
dysfunction: such abnormalities are believed
to interfere with the ability of the
neuromuscular system to act in an optimal
fashion, in turn contributing to the presence of
disease.
• 4. The identification and treatment of
subluxations.
Practice
Examination
• As spinal manipulation
is of such importance
to the chiropractor,
examination of this
area of the body is of
particular
interest,
following
an
initial
history-taking.
The acronym PARTS (steps of
examination):
• Pain: pain and tenderness are identified using
observation, palpation and percussion.
• Asymmetry: this may be identified by palpation,
radiograph analysis or observation of gait.
• Range of motion: this includes assessment of
different types of motion, including stability of joints
using palpation and radiographs.
• Tissue characteristics: these include tone, texture
and temperature abnormalities; a range of diagnostic
techniques may be employed.
• Special procedures: EMG, ultrasonography and
kinesiology may be considered to augment information
obtained from previous tests.
Treatment
• Procedures used during chiropractic
treatment may include gentle massage,
ultrasonic treatment and adjustment.
Treatment
• The chiropractic adjustment (often also
called manipulation) to joints in the spine
or extraspinal regions entails placement of
the practitioner’s hands on appropriate
contact points.
• This is followed by positioning of the joint,
during which the patient may feel tension
of the muscles and ligaments; a popping
sound may occur.
Treatment
• A short sharp thrust may then be
delivered. Chiropractors use different parts
of the hand to direct the thrust, depending
on the joint being adjusted, e.g. the middle
or base of the index finger may be used to
adjust the neck whereas an area of the
wrist bone may be used to adjust the
lumbar spine. In cases of injury an indirect
thrust may be used.
Treatment
• The joint to be manipulated may be gently
stretched over a pad or wedge-shaped
block until realignment is accomplished.
• A typical course of treatment for
uncomplicated cases may involve six
sessions over a 2- to 3-week period.
Massage
Massage
• Although remedial massage
has its own methods and
procedures, at its simplest it
may be considered as being
the age-old response to a
painful stimulus, i.e. rubbing
the bit that hurts!
• It is used in physical
therapy, sports medicine,
nursing, and as an adjunct
to chiropractic, osteopathy
and naturopathy.
The aims of massage are to:
• relieve pain and reduce swelling
• relax the muscles
• encourage the healing process after strain
and sprain injuries.
Contrary to popular opinion, it cannot
prevent loss of muscle strength or reduce
fat deposits.
Definition
• Massage is the systematic manipulation of body
tissues, performed primarily (but not
exclusively) with the hands for therapeutic
effect on the nervous and muscular systems,
and on systemic circulation.
• The primary characteristics of massage are
touch and movement.
• It may be performed in association with another
therapy or alone.
History
• Massage is reputed to have been used more
than 3000 years ago by the Chinese.
• Later, the Greek physician Hippocrates used
friction in the treatment of sprains and
dislocations, and kneading to treat constipation.
History
• Early in the nineteenth century, Per Henrik Ling
(1776–1839) of Stockholm devised a system of
massage to treat ailments involving joints and
muscles. Ling believed that vigorous massage
could bring about healing by improving the
circulation of the blood and lymph. In the past
20–30 years complementary therapists have
adapted Swedish massage so as to place
greater emphasis on the psychological and
spiritual aspects of the treatment.
• The benefits of massage are now described
more in terms such as ‘calmness’ or
‘wholeness’ than of loosening stiff joints or
improving blood flow.
History
• In contrast to the vigorous and standardised
treatment recommended by Ling, current
massage techniques are more gentle, calming,
flowing and intuitive. Ling’s Swedish system
was popular at European spa towns in the
nineteenth century, when it was used in
conjunction with hydrotherapy. It was taken to
the USA in 1854 by Dr George Taylor and his
brother Dr Charles Taylor.
• Others later extended the treatment to relieve
deformities of arthritis and to re-educate
muscles after paralysis.
Theory
• Massage involves two main components:
touch and pressure.
• Attaining a balance between the two is an
important skill.
Practice
• The most commonly used therapeutic
massage is known as Swedish massage,
although many other variants exist,
including deep-tissue massage (used to
release chronic patterns of muscular
tension), sports massage (similar to both
Swedish and deep-tissue massage) and
acupressure.
Practice
• Craniosacral massage is designed to deal with
cranial and spinal imbalance. Treatment often
involves several different procedures and may
last between 15 and 90 min. It starts with the
case history, although this is usually relatively
short compared with other complementary
therapies. The patient is ideally treated
unclothed on a specially designed massage
couch. This normally incorporates soft but firm
padding and a hole for the face.
A variety of strokes are used:
• Effleurage is a deep stroking movement in
the direction of the venous flow that
relaxes muscles, improves circulation to
the small surface blood vessels and is
thought to increase the flow of blood
towards the heart.
• Pétrissage is a compression procedure
that includes kneading, squeezing and
friction; it is useful in stretching scar tissue,
muscles and tendons so that movement is
easier.
A variety of strokes are used:
• Friction or rubbing is carried out with a slow
elliptical or circular movement to increase
blood flow and muscle movement.
• Tapotement or percussion uses the sides of
the hands to strike the surface of the skin in
rapid succession to improve circulation.
• Vibration or shaking is used on the
extremities and is said to lower muscle
tone.
A variety of strokes are used:
• Massage practitioners who treat sports
injuries and musculoskeletal disorders
may incorporate techniques derived from
physiotherapy, osteopathy and
chiropractic. These include deep
massage, passive and active stretching,
and muscle energy techniques (in which
the patient moves against resistance from
the practitioner).
Massage of the joints
• Stiff and swollen joints can be cured by massage
combined with mechanical movements.
• Massage is, however, not recommended in serious
inflammatory cases of the joints and in tubercular
joints.
• Sprains and bruises can be cured by massage.
• In these cases, affected parts should first be bathed
with hot water for 15–30 min.
• Next the massage should be done for a few minutes.
• Gentle stroking and kneading are recommended on
and around the injured tissues.
• Fractures can also be treated through massage.
Massaging the nerves
• Massage benefits many nerve problems. In
cases of acute inflammation of the nerves,
massage should be done carefully.
• Light and gentle stroking is recommended.
• Deep pressure should not be used on swollen
nerves because it will increase the
inflammation.
• All that is needed is a gentle tapotement or
beating of the nerve.
Abdominal massage
• This form of massage is beneficial in
constipation.
• It stimulates peristalsis of the small
intestines, tones up the muscles of the
abdomen walls, and mechanically
eliminates the contents of both the large
and the small intestines.
Chest massage
• Chest massage is helpful in many ways.
• It strengthens the chest muscles, increases
circulation and tones up the nervous system
of the chest, heart and lungs.
• It is especially recommended in weakness of
the lungs, palpitation and organic heart
disorders.
• Bust and mammary glands can be developed
by proper massage.
Massage of the back
• The purpose of massage of the back is to
stimulate the nerves and circulation for
treating backache and rheumatic afflictions
of the back muscles, and for soothing the
nervous system.
• The patient is made to lie down with the
arms at the sides.
Massage of the throat
• This helps to overcome headache, sore
throat and catarrh of the throat.
Anxiety
• There is some good evidence from RCTs
that massage can reduce anxiety in the
short term in psychiatric patients who are
children or adolescents, 83 and in
palliative care.
• In one study of cancer patients suffering
from pain, 60% of the respondents
reported a reduction in pain after a 30minute massage.
Anxiety
• Massage has been beneficial in intensive
care after cardiac surgery, although some
concerns about its effect on critically ill
patients have been expressed.
• Long-term elderly hospital patients are
reported to have responded to massage
with a reduction in anxiety, tension and
heart rate.
Premenstrual syndrome
• Massage therapy may be an effective
long-term aid for pain reduction and water
retention, and a short-term aid for
decreasing anxiety and improving mood
for women with premenstrual dysphoric
disorder.
Low back pain
• An RCT with four parts sought to compare the
effectiveness of massage therapy with other
interventions for the treatment of low back pain.
• The massage provided a benefit to patients in
excess of the other interventions.
• AIDS There is some evidence that massage
may improve the immune function and quality of
life of AIDS patients.
Massage for children
• A critical review of the use of massage
therapy in children concluded that there
was insufficient evidence to support its use
without qualification.
• None the less it is used in both neonates
and older children with a variety of medical
conditions.
Massage for children
• Benefits include improved mood (less
crying and salivation), increased sleep and
reduced pain in children with juvenile
rheumatoid arthritis.
• Supporters believe that massage has a
positive effect on behaviour, concentration
and children’s respect for each other.
Osteopathy (osteopathic
manipulative medicine)
• The name ‘osteopathy’ stems from the
Latin words osteon and pathos, which
translates to ‘suffering of the bone’.
• This name has caused con-fusion in the
sense that it makes people believe that an
osteopath treats only conditions of the
bones.
Osteopathy (osteopathic
manipulative medicine)
Osteopathy (osteopathic
manipulative medicine)
• However, the name was chosen because
its founder, Dr Andrew Still, recognised
that a well-balanced, properly functioning
body relies on both the muscular and the
skeletal systems of an individual being
healthy and well.
• The World Health Organization recognises
the osteopathic concept of somatic
dysfunction as being scientifically proven.
Definition
• Osteopathy is a medical discipline that is based
primarily on the manual diagnosis and treatment
of impaired function resulting from loss of
movement.
• Its philosophy has an emphasis on internal
relationships of structure and function, with an
appreciation of the body’s ability to heal itself.
• It uses a wide range of techniques to treat
musculoskeletal problems and other functional
disorders of the body.
History
• Osteopathy was developed in the USA in
the 1870s by an American frontier doctor,
Andrew Taylor Still (1828–1917).
• Still used his extensive knowledge of
anatomy and physiology to develop a
method to diagnose and treat the body
through palpation and manipulation.
• He founded the American School of
Osteopathy at Kirksville, Missouri in 1892.
Theory
• The philosophy of osteopathic medicine is
based on the idea that the human body
constitutes an ecologically and biologically
unified whole.
• Body systems are united through the
neuroendocrine and circulatory systems.
Theory
• In the study of health and disease,
therefore, no single part of the body can
be considered autonomous.
• Osteopaths believe that the problems of
health and the treatment of disease can be
rationally considered only through the
study of the whole person in relation to
both internal and external environments.
The following key principles are
involved:
• The body comprises interrelated organs
and systems, and functions as a whole
unit; disease results from an imbalance in
overall health.
• The body has an ability to heal itself and
may be assisted in this function by the
practitioner; disease represents a
breakdown in this capability.
The following key principles are
involved:
• The body is much more than the sum of its
individual parts; nothing exists in isolation
and the totality must be considered, e.g.
dysfunction in the musculoskeletal system
frequently contributes to pain, poor
circulation and changes in function leading
to constipation, headache, fatigue.
• Treatment is based on the three basic
principles of body unity, selfregulation and
the interrelationship of structure and
function, as stated above.
Practice
• Osteopathic treatment is purely and
solely based on manual techniques,
which are used to adjust and correct
mechanical problems in the whole body.
• The osteopath does not prescribe any
medicines, nor does he or she use any
invasive techniques (injections, surgery,
etc.), although in the USA the scope of
treatment may be wider than this.
• Diagnostic techniques are as for
chiropractic and may include radiology.
• The aim is not to treat the illness itself
but to stimulate the patient’s natural
healing processes.
There are four phases to
treatment:
• 1. Detection of changes in muscles and tissues
(by palpation)
• 2. Observation of any body asymmetry (e.g. leg
length), posture and respiratory function
• 3. Testing of mobility and sensitivity
• 4. Application of treatment.
• Usually, a patient will be asked to be passive
during this phase. However, at times there are
some techniques for which the patient must
actively participate in the movements.
Examples of the direct and indirect
techniques employed by osteopaths:
• Counterstrain techniques achieve release of restriction
by placing the affected joint or muscle in a position of
comfort, while applying a counter-stretch to the
antagonists of the tight muscles.
• Functional techniques involve gentle mobilisation of
joints so that barriers to normal movement are
identified until a way is found through the restriction.
• Osteopathic manipulations are carried out using
minimum force levels in order to maximise safety and
minimise patient discomfort; manipulation is not the
mainstay of most osteopathic treatments.
• A treatment session lasts approximately half an hour.
Craniosacral techniques
are very gentle release techniques particularly
suited to young children and physically frail
individuals;
this therapy was evolved by the Swiss practitioner
William Garner Sutherland (1873–1954) and
depends on the suggestion that cranial sutures
have the ability to move slightly and their
manipulation is thought to improve the
circulation of cerebrospinal fluid, which in turn
may relieve certain local symptoms.
Visceral techniques
are used in the management of conditions
affecting internal organs and involve
gentle and rhythmical stretching of the
visceral areas.
Apart from low back pain, other conditions
treated by osteopathy are similar to those
addressed by chiropractors and include
neck and shoulder pain, sports injuries,
repetitive strain disorders and headache.
Visceral techniques
In addition, practitioners also treat arthritis;
although they cannot affect disease
pathology or progression, they claim to be
able to treat secondary symptoms such as
pain from associated muscle spasm.
Cranial osteopathy has a particular
reputation for treating children with
conditions such as infantile colic, constant
crying and behavioural problems.
Reflexology
Reflexology
• The word ‘reflexology’ comprises ‘reflex’, in this
case meaning one part reflecting another part,
and ‘ology’, meaning study of.
• Put together, we get the study of how one part
reflects another.
• However, the discipline involves much more
than simply a study of parts.
• Reflexology is the most popular complementary
discipline in Denmark.
Definition
• Reflexology may be defined as ‘the
scientific theory that maps out the reflexes
on the feet and hands to all the organs
and the rest of the body’.
• It involves the application of pressure to
reflex areas of the hands or feet to
produce specific effects in other parts of
the body.
Reflexology map; each of the
shaded areas represents different
areas of the body or organs.
History
• A pictograph in the tomb of Ankhmahar, a
physician of particularly high esteem,
discovered at Saqqara in 1979, revealed
that the ancient Egyptians were aware of
the benefits of foot and hand reflexology.
• The pictograph, dating back to around
2500 BC, shows a therapist working on a
patient’s foot and a second therapist
working on another patient’s hand.
History
• Reflexology is also said to have been
practised in Chinese and North American
Indian cultures.
• Willam Fitzgerald (1872–1942), observed
that applying pressure to specific areas of
hands and feet caused an anaesthetising
effect on other areas of the body and was
useful in the treat-ment of pain.
• He divided the body into five longitudinal
zones on each side of the body.
History
• These terminated in the toes and fingers.
Fitzgerald suggested that a direct link
existed between the areas and organs
within each of the zones.
• This idea was developed by Eunice
Ingham (1879–1974), who charted reflex
areas in the foot that appeared to
correspond to areas of the entire body.
refinements.
Theory
• It is suggested that, when the reflexes are
stimulated, the body’s natural electric
energy works along the nervous system
and meridian lines to clear any blockages
on those lines and in the corresponding
zones.
• A treatment seems to break up deposits
(felt as gritty areas under the skin) that may
interfere with the natural flow of the body’s
energy.
Practice
Practice
• Reflexologists do not seek to diagnose medical
conditions, nor do they prescribe medicines,
although the topical use of oils or herbal
preparations is often recommended.
• Dietary advice may also be given. Most
reflexologists work on the feet, although the hands
may also be involved.
• A treatment session lasts around 40 min.
Practitioners usually advise their patients that the
effects of a treatment may last up to a week.
Practice
•
•
•
•
The need for further treatment will vary
according to the severity of the condition
and the patient. The following benefits are
possible:
Improved urination
Improved digestion
Heightened sense of energy
Reduction in pain.
Rolfing
• When the body gets working appropriately
the force of gravity can flow through then,
spontaneously, the body heals itself.
• Dr Ida P Rolf
Rolfing
Definition
• Rolfing is a comprehensive system of hands-on,
connective tissue manipulation and movement
education that releases stress patterns in the
human organism.
• As with other similar techniques (e.g.
Feldenkrais), rolfing seeks to organise and
integrate the body in relation to gravity by
manipulating the soft tissues or by correcting
inappropriate patterns of movement.
• The final goal is that the client can move and
function with greater freedom, and effortlessly
maintain a more upright posture.
History
• Rolfing is the creation of Dr Ida Rolf, a biochemist
and physiologist who established the Rolf Institute
for Structural Integration in 1970.
• She believed that, for optimum health, the body
must be in alignment with gravity: any deviation
from the norm requires extra energy for movement
and imposes unnecessary strain on the muscles.
• She contended that, as the muscles work to
compensate for failing efficiency over the passing
years, the fascia surrounding them tend to bunch
up and harden, creating even more strain.
• Ultimately, she said, the cumulative stress can
interfere with normal breathing and impair
circulation, digestion and the nervous system.
Theory
• The deep massage techniques
employed in rolfing seek to
loosen and relax the fascia –
the membranes that surround
the muscles.
• Rolfers believe that the fascia
toughen and thicken over time,
subtly contorting the body and
throwing it out of healthy
alignment.
Practice
• To break up knots in the fascia and ‘reset’
the muscles, rolfers apply slow, sliding
pressure with their knuckles, thumbs,
fingers, elbows and knees.
• The treatments are not mild and relaxing –
indeed, they can cause a degree of pain.
• However, practitioners view this temporary
discomfort as a sign that the treatment is
achieving the changes necessary to bring
the body back into proper alignment.
Practice
• During each session, the rolfer will
concentrate on a different set of muscles,
starting with those nearest the surface and
moving on to those deep within the body.
• To maximise the benefits of treatment, the
therapist may also teach selfhelp exercises
known as movement integration.
• Sessions usually last 60–90 min.
• The basic sequence of rolfing consists of 10
sessions through which a new structural
order and a more efficient movement
pattern are developed.
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