Dr. Moushumi Kuvawala explains–The How, Why and What of Manual Therapy
Physiotherapy (Physical Therapy) is a branch of medical sciences dealing with rehabilitation. This mainly involves the treatment of orthopedic, neurological, and cardio–respiratory conditions. The use of various exercises and electro–therapy equipment (e.g. ultra–sound, short wave diathermy) helps achieve the aims of treatment.
Manual Therapy is a specialized branch of Physiotherapy wherein assessment and treatment of the disorder is carried out manually by the therapist. Various aids like tapes, resistive bands, belts, electrical equipment are used. Manual Therapy mainly aims at treating the neuro–orthopedic component of any condition, thereby helping treat the condition itself. For instance, following a cardiovascular surgery, a patient may have decreased mobility of his ribcage, hence an altered breathing pattern. Treatment with manual therapy would involve mobilizing the thoracic spine and the intercostal joints (joints between ribs) and hence help the excursion of the chest wall to get a better breathing pattern.
In any joint, there are two types of movements–one which can be performed actively, e.g. lifting your arm and movements which occur within the joints but cannot be actively controlled e.g. when the arm is lifted, in the ball socket joint of the shoulder, there are finer gliding–roling movements of the ball in its sockets. These latter movements are called the accessory movements of joints.
A manual therapist not only assesses the active movements, but also these finer accessory movements. If any alteration of these accessory movements is found, it can be treated in a more holistic manner, thereby achieving quicker and longer lasting results. Also, for instance, in knee movements–to bend or straighten, there are gliding accessory movements of the knee–cap (patella) which assist the movement. In many conditions involving the knee–e.g. surgeries, arthritis, sports–injuries, if the normal patellar glide is not maintained, any amount of exercise will not achieve a pain–free and/or stiffness–free knee joint. Our spine as a whole has many movements, but none would have been possible if there was no movement between each spinal segment with its neighbors. A manual therapist achieves this interplay by mobilizing each segment individually and thereby assisting the whole picture. Hence, various conditions of spondylitis, prolapsed discs, nerve impingements have been treated successfully by manual therapists.
Each person having a problem, is specific in his own right. Although a condition is described in a certain manner, as every individual has variations in structure, age, sex, kind of work, postures assumed for activities etc., an individual–specific assessment is needed. Once a diagnosis is reached for a person, individually tailored treatment plans are laid down by the manual therapist. This also involves ergonomics, posture correction, gait analysis, correction of movements in various sporting activities. Once a treatment plan is outlined, the person is treated by the therapist and a maintenance program is given, to be carried out at home. The number of visits required would depend upon the condition being treated, patient compliance, skill knowledge and experience of the therapist. To conclude: A manual therapist has a holistic treatment approach for various conditions thereby adding “Life to years” as opposed to “Years to life”.
