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Main Clinic: Heritage Courtyard • 54 Oakway Center • Eugene, OR 97401 • 541-687-7005 | Downtown Satellite:1410 Oak Street, Suite 100 • Eugene, OR 97401 • 541-345-2064
A clinical approach utilizing skilled, specific hands-on techniques,
including but not limited to manipulation/mobilization,
used by the physical therapist to diagnose and treat soft
tissues and joint structures for the purpose of modulating
pain; increasing range of motion (ROM); reducing or eliminating
soft tissue inflammation; inducing relaxation; improving
contractile and non-contractile tissue repair, extensibility,
and/or stability; facilitating movement; and improving function.1,2 (Definition from American
Academy of Orthopedic Manual Physical Therapy (AAOMPT) and American Physical Therapy
WHEN IS MANUAL THERAPY USED?
Research coming out of Australia has demonstrated significantly better
outcomes for patients who have a "multi-modal approach."
This means when manual therapy is used in conjunction with
other forms of therapy, such as exercise, proprioception
training, etc., compared to manual therapy used alone. 6
Type of Manual Therapy we provide:
MOBILIZATION / MANIPULATION
The AAOMPT, APTA, and IFOMT (International
Federation of Orthopedic Manual Therapy)
define this as "a manual therapy technique
comprised of a continuum of skilled passive movements to
joints and/or related soft tissues that are applied at varying
speeds and amplitudes, including a small amplitude/high
velocity therapeutic movement."7
It is described
as "the attempt at restoration
of full, painless joint function by rhythmic, repetitive,
passive movements within the patient's tolerance and within
the voluntary and accessory range, and graded according
to examination findings."1
may affect a whole vertebral region or may be localized
to a single segment. Manipulation is associated with a high
velocity, low amplitude therapeutic movement. 1,2
MUSCLE ENERGY TECHNIQUE (MET)
Originally developed by Fred L. Mitchell, Sr., D.O., FAAO and T. J.
Ruddy, D.O., this technique is defined as a "direct
manipulative procedure that uses a voluntary contraction
of the patient's muscles against a distinctly controlled
counterforce from a precise position and in a specific direction.
This is considered an active technique, as opposed to a
passive technique where only the clinician does the work.
In contrast to joint mobilization, this technique engages
the joint restriction barrier but does not stress it. MET
may also be used to lengthen shortened muscles, reduce localized
edema, and mobilize restricted joints."3
Originally developed by Lawrence Jones, D.O., FAAO, this technique
is defined as "a passive positional procedure that
places the body in a position of greatest comfort, thereby
relieving pain by reduction and arrest of inappropriate
proprioceptor activity that maintains somatic dysfunction."5
This technique is uniquely different from other manual techniques
as it is considered an indirect technique as positioning
occurs opposite the restricted barrier and is thus very
comfortable for the patient, even in the acute stage.
SOFT TISSUE MOBILIZATION (STM) / MYOFASCIAL RELEASE (MFR)
STM: restoration of med/lat muscle play, breaking fascial restrictions
between muscles and decreasing hypertonus that is associated
with muscle tightness. Specific directional manual force
is used in the direction of fascial restriction. Functional
STM combines active lengthening of the muscle tissue with
manual work at the same time.
MFR: similar to STM, but a larger area of tissue is targeted
as opposed to very localized primary restrictions.
Research in the Netherlands has demonstrated cadaver dissection analysis
of fascia to contain actin and myosin. If this research
has validity, one could speculate fascia to be a contractile
tissue instead of inert, connective tissue as previously
- American Academy of Orthopaedic Manual Physical Therapists. www.aaompt.org
Orthopaedic Manual Therapy: Description of Advanced Clinical Practice. 1999 pp: 29
- American Physical Therapy Association. www.apta.org
- Donatelli R, Wooden MJ. Orthopaedic Physical Therapy.
Churchill Livingstone, NY. 1989 pp: 360, 463
- Greives Grieve's Modern Manual Therapy. Harcourt Publishers Ltd. 1994
- Kusunose RS, Wendorf R, Jones L. Strain and Counterstrain Syllabus.
Jones Institute, Encinitas, CA. 1990 pp: 1
- Jull G, Trott P, Potter H, Zito G, Niere K, Emberson J, Marschner I, Richardson C.
A randomised control trial of physiotherapy management of cervicogenic headache.
2002 SPINE 27: 1835-1843.
- Olson KA. IFOMT 2004: Building Bridges.
2004 ARTICULATIONS (Official Publication of AAOMPT) 10 (2) pp: 1,3, 21
- Hinz B, Gabbiani G Fibrosis: recent advances in myofibroblast biology and new therapeutic perspectives.
F1000 Biology Reports 2010, 2:78
(Giulietti, rev. 12/2011)
MANUAL THERAPY LINKS
Manual Therapy Research, University of Sydney: Evidence Database Search Engine
North American Institute of Orthopaedic Manual Therapy (NAIOMT)
American Academy of Orthopedic Manual Physical Therapists
International PNF Association
Institute of Physical Art
Jim Meadows, PT, FCAMT. MCPA