Physical therapists are the logical practitioners to assume the responsibility for manual therapy treatments. They work closely with physicians who are capable of ruling out serious pathology. Techniques involved have indications, contraindications and precautions, which your physical therapist will assess in collaboration with your physician, past medical history and extensive physical therapy evaluation.
After an extensive evaluation of your condition, your physical therapist will decide what types of therapeutic treatments are appropriate for you. Some types of manual therapy that may be used, depending on your diagnosis, are traction, myofascial release, joint mobilization and neural flossing.
Traction can be done manually or mechanically. Mechanical spinal traction involves using an electronic traction unit that pulls on the cervical or lumbar spine segments to provide a prolonged longitudinal separation of the spinal segments. Alternatively, a physical therapist can perform traction manually, to provide a more gentle pull. The main purpose of traction is to reduce signs and symptoms of cervical or lumbar spinal compression. Traction gently stretches facet joint capsules, allows increased space for spinal nerve roots, elongates posterior muscle tissues to decrease muscle guarding and improves blood supply to the posterior soft tissues and the intervertebral discs. Traction decreases the intradiscal pressure, which may reduce the bulging of the nuclear material of the disc.
Myofascial Release and trigger point therapy are techniques used by physical therapists to treat muscle spasms, myofascial pain, muscle tightness, trigger points and tender points. Any muscle in the human body can develop trigger points and cause referred pain to local areas or other areas of the body. For example, trigger points in the trapezius muscles of the shoulder can produce pain in the temples, above the ear and over the eye. Trigger points can also cause symptoms of ringing in the ears, loss of balance, dizziness, urinary frequency, buckling of the knees, eye tearing, abnormal sweating, numbness and tingling in various parts of the body and muscle weakness. Trigger points form after sudden trauma or injury or due to mechanical stresses, emotional factors and stresses, nutritional factors, sleep problems and poor posture and muscle weakness. If trigger points are left untreated, the myofibrils are stretched thin and may break, leaving permanent damage.
Joint mobilization is a form of passive movement performed by a physical therapist to restore joint play, component motion and range of motion. The procedure is relatively pain free. Joint mobilizations may be applied to joints of the body to increase mobility, and your therapist will decide if it is necessary to decrease pain and improve function.
Muscle Energy is a form of manual treatment that uses active muscle contraction at different intensities to reposition musculosketal dysfunction into alignment. Muscle energy techniques may be used to decrease pain, stretch tight muscles and fascia, decrease muscle tonus, improve local circulation, strengthen weak muscles and mobilize joint restrictions. This method utilizes muscle contractions by the patient, followed by relaxation and stretch of an antagonist muscle. It is a mobilization technique using muscle facilitations and inhibitions that your therapist may use to correct your musculoskeletal alignment. Moderate to maximal contractions are used to stretch muscles and fascia. Minimal to moderate contractions are used for joint mobilizations.
Neural tissue mobilization or neural flossing are methods that can be applied by your physical therapist when symptoms or signs indicate pain is arising from a nerve root or nerve branches. Manual techniques and exercises are used to help, typically, symptoms of numbness, tingling and “pins and needles” sensations in the arms and legs.