Manual Therapy

Manual Therapy

 

The gentler and more respectful forms of manual therapy gaining wider acceptance today have a long history. Many of the insights (as well as techniques) started with Osteopathy 150 years ago, through Cranial Osteopathy with William Garner Sutherland to John Upledger's CranioSacral Therapy. Other techniques from osteopathy that shed light on important aspects of manual therapy were Strain Counter-Strain, Muscle Energy Technique, Mechanical Link and Visceral Manipulation. One of the best known came from physical therapy, Myofascial Release. Another significant contribution was developed by Sharon Weiselfish and Tom Giammatteo, both former teachers at the Upledger Institute in Florida. They brought the above six techniques under one banner – Integrative Manual Therapy. They were able to develop the concepts of each system further than the original developers had done, and integrate them into a more holistic system.

All these systems and techniques have three basic aims:

Ø to release restriction in connective tissue,

Ø to improve the everyday working of the body,

Ø to allow the body to heal itself.

Crucial to that end, is the ability to facilitate the flow of information as well as circulation in the Extra-Cellular Matrix (ECM). Every cell depends on the ECM around it for healthy life and function, and it is here that the techniques of manual therapy can most easily be shown to have an effect.

This has led other manual therapists to simplify the whole approach, using key insights that William Sutherland had in the latter stages of his work, and which were not widely publicized. A great deal of recent cell biology and physiology now underpins this approach, and its manual therapy application, Biodynamic Cranial Therapy.

Rather than thinking of the body as a complex organization of separate organs, muscles, bones and blood circulation, we can now see the body as an integrated system. From the smallest cell to the whole person, we're looking at a living matrix.

In this system, the forces and tensions and pressures that cause pain, discomfort and impaired function, can be exactly the signals the therapist needs to provide the system with the correct input for the body to release and heal. The ability to listen to what the body is trying to tell us – and to do only as much as necessary to correct the situation – become the most important skills of the manual therapist.

Manual Therapy releases restriction in connective tissue, to uncover protective mechanisms and heal the underlying issues. Connective tissue is found everywhere in the body – the ECM, the walls of arteries, through tendons, ligaments and fascia to bone. Restrictions are caused by trauma, but also by the body trying to protect an organ or body part. Any symptom tells us that the body has tried to adjust and protect itself as best it can,. Pain happens where pressures and forces and tensions collide - often from those same accommodations. We help the body release those restrictions, uncover the protective mechanisms, and heal whatever the body is protecting.

There's a great definition of pain: The body’s way of telling you, “one of us around here is being a dummy”. By the time any of us have to cope with pain, it's probably limiting other activities of daily life. With all the accommodations the body has made prior to pain, it's a systemic problem, not just local. Tense muscles aren't the problem, they're protecting underlying structures.

Where a structure has become even slightly mis-aligned through use, nerves and arteries will be placed under greater tension, and then muscles, bones and fascia will adapt to protect them. For this reason, approaches that address the whole system are likely to produce the best long-term results.

It's holistic approach that addresses specific problem areas, as well as providing a systemic approach to improve physiological function and promote healing. It thus addresses physical issues like the pain of practice not just to relieve symptoms, but to enhance coordination, ease and fluidity of motion.

One great benefit of this approach is that in order to heal, rehabilitation doesn't have to be painful. In his book    The Lost Art of Healing   Dr Bernard Lown says that the first – or last, depending on point of view – rule of health care is: “When all else fails, listen to the patient.” That's exactly what today's manual therapists are learning to do – with our hands.

By Malcolm Fraser, PT