Manual Therapy

Pain, discomfort, loss of strength and even more serious cases – such as fractures or ligament injuries – can be treated with manual therapy. In addition to acting in prevention, the therapeutic technique is also used in the treatment and maintenance of musculoskeletal health.

Defined by traumatic-orthopedic physiotherapy as a subspecialty, the manual therapy meets by another denomination in other countries. Outside Brazil, it meets the translated version of “manipulative orthopedic physiotherapy”. The modality uses manual resources for management of neuromusculoskeletal clinical conditions, contemplating joints, muscles, fascia and peripheral nervous system.

“The manual therapeutic resources allow the physiotherapist to evaluate and feel better the movements and quality of them, as well as better palpation of musculoskeletal tissues,” explains physiotherapist Francisco de Araujo, master in Rehabilitation Sciences at the Federal University of Health Sciences of Porto Alegre.

The approach is viewed positively by most patients, who feel more comfortable with manual techniques. The non-mandatory nature of drug therapy also contributes to this. However, it is worth remembering that the manual method should not be used as a priority in more advanced stages of rehabilitation.

Evolution and research

The physiotherapeutic diagnosis is made in stages and differs from the common medical analysis, usually linked to structural changes or lesions – such as disc herniation or meniscus injury. But it is the function (or the loss of it) that ends up weighing down at the time of evaluation.

“I can have ten patients with the same medical diagnosis and each of them presents a different clinical picture, with different disabilities,” notes Araujo.

In the first stage of the diagnosis, an anamnesis is performed, so that the physiotherapist can gather information about the patient and write down his complaints. Then, the professional begins a series of tests to identify the source of the discomfort.

Combining biological, psychological and social issues with adequate clinical reasoning, the physiotherapist performs the most appropriate diagnosis for each case.

From this sum of information, and considering the patient’s preferences and expectations, he determines which procedures and techniques will be most appropriate for each tissue. In many cases, manual therapy is the best alternative.

Next, check out an interview with Francisco de Araujo:

We know that physiotherapy procedures contribute to the prevention, cure and recovery of musculoskeletal disorders. Could you tell us a little more about what it is, how it works and, above all, what is the importance of physiotherapy for these types of treatment? What differs the use of these physiotherapeutic resources from the others?

Within the specialty of traumatic-orthopedic physiotherapy, a subspecialty is called manipulative orthopedic physiotherapy. This is the internationally recognized term, although here in Brazil it is often called manual therapy.

This is because the term manipulative may imply that it is only the use of techniques called manipulation – which is not correct. This subspecialty, therefore, addresses several manual resources (not only manipulation) both for the evaluation and treatment of different clinical neuromusculoskeletal conditions. These resources can be addressed to the joints, muscles, fascia and even the peripheral nervous system.

Manual therapeutic resources allow the physiotherapist to evaluate and better feel their movements and quality, as well as the palpation of musculoskeletal tissues. The information is an important part of the evaluation process.

Moreover, the contact with the patient is fundamental in the therapeutic alliance, because many times they feel more secure and comfortable. These techniques present positive effects, called mechanics, and neurophysiological effects, such as analgesia without the need to take medication.

However, they are more important at an early stage of treatment, and should not be a priority in advanced stages of rehabilitation – since the patient needs to become independent as soon as possible. Thus, exercises performed autonomously and exercises that the patient can do at home are fundamental to the success of treatment.

To whom is traumatic-orthopedic physiotherapy intended and where can it be applied?

To any patient who presents any neuromusculoskeletal condition. They are patients who need from the rehabilitation of important traumas – fractures, surgeries or ligament injuries – to simpler conditions – pain, discomfort, loss of strength or of range of motion articulation.

Traumato-orthopedic physiotherapy operates in hospitals, health posts, outpatient clinics, clinics, offices and sports clubs, in addition to companies (ergonomic area) and research centers. It acts both in the prevention, evaluation and treatment of these conditions.

For the physiotherapist to define which procedures will be used at the time of treatment, how is the diagnosis of the patient made?

Firstly, the physiotherapeutic diagnosis is different from the medical diagnosis. The medical diagnosis is usually linked to some alteration or structural lesion (for example, disc herniation, ligament rupture, meniscus lesion, etc.).

For the physiotherapist, this information is also important, but more than that, it is the function (or loss of function) of the patient that matters to us. Ten people with the same medical diagnosis can present ten different clinical pictures and ten different disabilities.

Thus, the physiotherapeutic diagnosis is made in stages. Through the anamnesis, the physiotherapist collects important information about the patient and his/her complaints. Then, he performs a series of tests that help him try to identify the cause (or structure) responsible for the problem.

It is up to the physiotherapist to understand how this condition affects the patient’s specific function and quality of life. This sum of information, combining biological (injured tissues or not), psychological and social issues, with adequate clinical reasoning, will allow a proper diagnosis.

From then on, based on available scientific evidence, clinical experience and patient preferences and expectations, the physiotherapist determines the most appropriate procedures. In many cases, but not all, manual therapy resources are a good approach.

What would those resources be? Could you talk a little more about them?

There are, therefore, manual therapy techniques applied to joints called joint mobilizations and also joint manipulations. So are myofascial mobilization or release techniques (addressed to muscles and fascia). Finally, the techniques of mobilization or sliding of the nerves.

From the physiotherapeutic diagnosis, the adequate clinical reasoning, and based on scientific evidence, the physiotherapist chooses which technique (and for which tissue) should be chosen. Each one of them has different effects, but in general they have the objective of reestablishing the normal function of this tissue and consequently reestablishing the normal function of the patient.