This is part 1 of a 2 part blog post.  I like to keep my blog posts a shorter length as, personally, I find it difficult to read a lot in one sitting, especially at a computer screen.  Manual therapy is part of what makes New Leaf Physiotherapy different, getting our hands to touch our clients and feel how they move.

As for the pictures in this post, I always try to give credit to the website in which I found them.  In this post I took some pictures from achieves, I have from some of the teaching I do.  I have had some of these photos for 5+ years and got them from other physiotherapists who got them from other physiotherapists.  Enjoy!

 

manual_therapy2Back when I was a student going to Physiotherapy school, I read many different textbooks, articles, posts on the internet about manual therapy.  Things seemed to be quite positive about the results of manual therapy with clients.  I wanted to learn more about this “manual therapy”.  So teaching assistants and professors would talk about how much better ‘manual therapy’ made this client or that client feel.  It sounded good but I did not know what it was.  In fact, there are many different ways to define “manual therapy”.  I like to keep it simple.  So to me, manual therapy is technique that is performed by a therapist on a client using their hands. 

Notice that I did not say physiotherapist or physical therapist.  There are a large number of manual therapy techniques out there.  For example, massage therapists perform manual therapy every time they massage a client.  Their hands working on the tissues, the skin, fascia and muscles to name a few, are being manually manipulated by their hands.  The thought is to decrease the muscle tension on the sore spot and let it heal.  

logo of the Orthopaedic Division of the CPA

logo of the Orthopaedic Division of the CPA

However, this is a physiotherapy blog, so I am going to write about physiotherapy manual therapy techniques.  More specifically, the friction, soft tissue mobilization, mobilization and manips (manipulation).  Although I am writing about only these techniques, there are many, MANY more techniques.  For example, ART (active release techniques), fascial manipulation, cranial/sacral techniques are all different forms of manual therapy.  

 

Fingers crossed friction technique

Fingers crossed friction technique

What is a friction?  A friction is a specific technique used when you want to target a very specific area.  The target is usually one spot or along a tendon or ligament.  The basic technique for performing a friction is using your second finger, pointer finger, while it is re-enforced by the third or middle finger. These fingers push down onto the sore spot and generally move perpendicular to the orientation of the fibre you are frictioning.  One extremely important aspect of frictioning, is that the therapist’s fingers do not slide over the skin.  The fingers stay in contact with the same patch of skin.  If the therapist moves and slides their fingers over the skin, within a couple of minutes, the therapist and the client would both have blisters!  

Ankle friction

Ankle friction

What kind of conditions can frictions be used for?  Most different types of tendonitis’ (acute or chronic), muscle strains (acute or chronic) and ligament sprains (acute or chronic).  

What is the goal of using a friction technique?  The goal could be to; prevent scar adhesion, cause analgesia(pain relief), increase blood flow to a specific spot,

More importantly, there are times when you do not want your therapist to use a friction on your injury.  Some examples are skin breakdown over the area to be treated, neuritis (inflammation of a nerve), long term corticosteroid use or calcification of soft tissues to name a few.  

 

Soft tissue mobilization (STM) of the neck

Soft tissue mobilization (STM) of the neck

Soft tissue mobilization (STM) is another type of manual therapy.  It can include massage but there are other techniques included as well.  Other techniques could be, for example, skin rolling, simply picking up a fold of skin and ‘rolling’ it up the spine or away from the spine.  One technique, I learned along the way and I do not know where is simply feeling around the tender area and feeling for ‘pebbles’ in the muscle.  They feel like tight bulges in the muscles and they are quite tender.  They can also go by the name of trigger points.  The technique involves rubbing the trigger point with my fingertips, generally perpendicular to the direction of the muscle fibers.  I think about prying those tiny muscle fibers apart.  The ‘pebble’ in my fingertips slowly get smaller and smaller.  The pebble simply vanishes.  One way I explain it to clients, is to think of a sugar

Sugar cubes, taken from: https://render.otoy.com/forum/viewtopic.php?f=6&t=44804

Sugar cubes, taken from: https://render.otoy.com/forum/viewtopic.php?f=6&t=44804

cube and you have a eye dropper filled with hot water.  You slowly drop the hot water on the sugar cube and you can slowly see it melt away.  That is what the muscle knot/ trigger point in my fingers feels like it is doing.  While performing this technique, I have noticed something else happens.  When the muscle is initially grabbed, the client’s say that the pain is quite intense, almost sharp.  Rubbing the tight spot, unfortunately does not make the pain any easier to take.  However, within 30-60 seconds, the trigger point seems to shrink, much like the sugar cube getting drops of hot water.  Once the change in muscle tone is detected, my clients say something like ‘it just let go’

STM of the shoulder Taken from: http://www.ace-pt.org/wp-content/uploads/2013/07/manual-therapy-shoulder-massage.jpg

STM of the shoulder
Taken from: http://www.ace-pt.org/wp-content/uploads/2013/07/manual-therapy-shoulder-massage.jpg

or ‘the pain is much more of an ache now, not as intense’.  That change signals to me that the muscle has initiated a reflex to decrease the tension on itself.  A lot of my client’s get this technique on a regular basis.  The client’s that do their exercises typically get this technique less.  Why?  Possible, they are starting to recruit their muscles while the trigger point is not present or minimally present.  This muscle recruitment will bring more nerve impulses and blood flood to the muscle as well as contracting and relaxing of the muscle.  I do not know which part of it helps the most but it seems to work really, really well.

 

 

The above two techniques are generally used on soft tissue, i.e. muscles, ligaments…  In the next blog post we will look at two techniques are done on joints of the human body, where two bones meet.  They are mobilizations and manipulations.  Stay tuned!