Manipulation , Traction, and Massage
QU YUN
MD.
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Manipulation
Manipulation History
Therapeutic manipulation has been practiced in almost all countries of the world since at least the time of Hippocrates (460? 377? BC).
Recent times have seen rapid growth of manipulation and manual therapy and an increase in its public use.
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Manipulation History
Most of the 90 million annual manipulations performed in the US
back and neck pain.
Manipulation eliminate pain secondary to  biomechanics.
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Definition of manipulation
IFOMM definition :
The use of hands in the patients management process using instructions and maneuvers to maintain maximal, painless movement of the musculoskeletal system in

postural balance.
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Most common types of manipulation involve passive mechanical forces applied to specific vertebral segments, regions, or other joint segments of the

musculoskeletal system with a primary goal of restoration of diminished ROM.
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Effects of manipulation
Improving motion.
Facilitating mobility.
Minimizing pain.
Increase of physical activity.
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Disorder treatment of Manipulation
Joint dysfunction
Change in tissue texture
Asymmetry of structural
Segmental motion testing
Acute or chronic cervical pain
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Manipulation
    In the American literature manipulation encompasses mobilization techniques that utilize thrusting (high velocity, low amplitude, or impulse) forces as

well as many other non thrusting procedures .
    (Table 21 1，Page 82.)
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Classification of Manual Medicine Techniques
many different types of manual treatments.
They can be classified as soft tissue procedures,articulatory procedures, and specific joint mobilizations.
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Classification of Manipulation
    The direction force
    Direct methods.
    Indirect methods.
    Combined methods.
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Classification of Manipulation
    The type of activating treatment force involved may be extrinsic or intrinsic.
    Extrinsic.
    Intrinsic.
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Classification of Manipulation
    Manual medicine techniques can also be classified by the patient contribution.
    Active.
    Passive.
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Classification of Manipulation
    The effects treatments :
    1.Postural structural;
    2.Neurological;
    3.Respiratory circulatory;
    4.Bioenegy;
    5.Psychosocial.
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Specific Types of Manual Medicine Techniques
Mobilization with impulse
Articulatory technique;
Muscle energy(ME) technique;
Strain and counterstrain(CS);
Myofascial release;
Craniosacral therapy;
Soft tissue techniques.
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Classification of manipulation 1
Counterstrain
Developed by Jones.
Counterstrain treatment involves placing a joint or body part into position of maximal ease or comfort, thereby relaxing ligamentous and myofascial soft

tissue.
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Classification of manipulation 2
Functional techniques
Functional techniques counterstrain
the position
The most relaxed position balanced state.
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Classification of manipulation 3
Muscle energy
a direct nonthrusting technique
US isometrics
Europe mobilization
neuromuscular facilitation.
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Classification of manipulation 4
Soft tissue technique
stretch of skin, muscle, and fascia to increase motion.
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Classification of manipulation 5
Myofascial release
Myofascial release techniques are directed at vertebral, segmental, or generalized hypomobility.
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Classification of manipulation 6
Craniosacral therapy
based upon primary respiratory mechanism.
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Classification of manipulation 7
Mobilization technique
See page 101 for detail
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Contraindication & side effect of manipulation
Only for somatic dysfunction
Each type of technique has its own contraindications.
Such as page 84R4
side effect discomfort lasting approximately 6 72 hours.
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TRACTION
Concept:
Traction is the technique in which a pulling force is used to stretch soft tissues and to separate joint surfaces or one fragments.
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Goal of spinal traction
Pain relief
Functional improvement
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Factor of traction
Force types: applying a force of sufficient magnitude; duration in the proper direction
Force directions: equal; opposing
Force areas: localized to a specific area
Main areas: cervical spine; lumbar spinal
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History of traction
Soft tissue or skin traction burn contractures
Skeletal traction fracture in the limbs
Spinal traction lumber disc lesions; neck pain
     1950s Cyriax, MD.
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Treatment of traction
Currently, traction is used in fractures, lumber or cervical disc lesions.
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In physiatric practice, use of traction often is limited to the cervical or lumbar spine with the goal of relieving pain.
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Various methods of traction
Manually
Motorized equipment or mechanized force
(Inversion techniques,Overhead harness.)
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Types of traction
Continuous traction (20 40h +)
Sustained traction (20 60 min ++)
Intermittent traction  (force change cycle, 15 25 min +++)
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Areas of traction
Cervical spine (Page 94)
Lumbar spinal (Page 94 95)
Limbs fractures
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Why traction can work?
Trauma, a degenerative process, compression from disc
Irritation or compression of nerve roots
Pain secondary to nerve root compression (Sciatica)
Traction
Elongation.
Reduction of disc pressure
Vacuum, Relaxation of muscle spasm, Freeing of adherent nerve roots
Relief pain                    (p90R4, p93R2)
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Contraindications to traction
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(1) ligamentous instability,
(2) osteomyelitis,
(3) discitis,
(4) primary or metastatic tumor,
(5) spinal cord tumor,
(6) severe osteoporosis,
(7) clinical signs of myelopathy,
(8) severe anxiety,
(9) untreated hypertension.
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Massage
Definition of Massage
Graham, in 1884, defined massage as “ A group of dures which are usually done with the hands, such as friction, kneading, rolling and percussion of the

external tissues of the body in a variety of ways, either with a curative, palliative or hygienic object in view.”
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Definition of Massage
Or : Massage is a therapeutic manipulation of the soft tissues of the body with the goal of achieving normalization of those tissues.
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History
Several thousand years.
Common ancient roots as manipulation.
Each modality represents treatment for pain sought by a steadily increasing number of people.
(Page 96)
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History
The cultural context of medicine.
Both Eastern and Western.
In China, 2700 BC
In India, 1500 BC
Greek, Roman, followed
Hippocrates (460? 377? BC)
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History
In the US
approximately $2 4 billion annually
to massage therapists
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History
The American reasons:
Relief of pain
Relaxation
Conditioning
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Basic massage effects
Massage can have mechanical, neurological, psychological, and reflexive effects.
reduce pain or adhesions
promote sedation
mobilize fluids
increase muscular relaxation
relief of discomfort
muscle hypertonicity
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Basic massage effects
Massage easily can be a preliminary treatment to manipulation; however, it clearly targets the health of soft tissues.
But manipulation targets joint segments.
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Types of massage  p98L3
Active Release Techniques (ART)
Acupressure
Alexander Technique
Aquatic Massage Therapy
Aromatherapy
Bowen Technique
Cranio Sacral Therapy
Deep Connective Tissue Massage
Deep Muscle Therapy
Esalen Tissue Work
Feldenkrais
Integrative Manual Therapy
La Stone Therapy
Lomi Lomi
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Western massage
Western massage is the most common type of massage practiced in the western today.
Soft tissue manual therapy
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Spirit of Western massage
use hands to apply mechanical forces to the skeletal muscles and skin
superficial or deeper tissues
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Types of massage  p98L3
Swedish system
(Western massage)
Effleurage
Petrissage
Friction 
Tapotement 
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Effleurage
Gliding over the skin
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Superficial or deep.
Relaxation
Confidence
Diagnose muscle spasm and tightness
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Distal                      proximal
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different effects
     　　slow for relaxation
　　　Rapid for stimulation
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Petrissage
Compressed between the hands or fingers and thumb
deep
release of soft tissues
reactive blood flow
neuroreflexive response to flow
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Tapotement
Repetitive compressive hit
Superficial or deep
Stimulatory
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Friction
shearing stresses are created at tissue interfaces below the skin
Deep
Prevent or slow adhesions of scar tissue.
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Eastern massage (TCM)
Eastern massage systems have been an integral part of the cultures
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Systems for evaluation, diagnosis, and treatment generally are not grounded in conventional Western neurophysiology.
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Eastern massage (TCM)
12 traditional Chinese meridians (channels) the energy or life force, or Chi, circulates.
Shiatsu Japanese system based on Traditional Chinese Meridian theory
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Eastern massage (TCM)
Acupressure channels
massage forces to the same points
disease can be cured by localized finger pressure.
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Reflexology and auriculotherapy
These systems of massage share the meridian concept
                                 with
                        YIN and YANG.
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Tui Na
Tui Na The traditional Chinese therapy uses the same classical medical theory as Acupuncture.
Tui Na, ‘push’ and ‘grasp’
Practiced and developed for over 4000 years.
Balance Qi, affects the body, mind and spirit.
Jing (Essence)
Qi (Vital Energy)
Shen (Mind and Spirit)
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goals
sedation
Reducing adhesions
Mobilizing fluids
Muscular relaxion
Vascular changes
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Effects of massage
relaxation
Mobilization of intertissue fluids
Reduction or modification of edema
Increase of local blood flow
Decrease of muscle soreness and stiffness
Decreases of muscle tone.
Moderation of pain
Facilitation of relaxation
Prevention or elimination of adhesions
Express improvements in mood, body image, self esteem, and perceived levels of anxiety.
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Contraindications for massage
Absolute contraindications:
(1) New open wound.
(2) Acute infection.
(3) Bleeding.
(4)etc.
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Principles
1 Comfortable,relaxed and not too clod.
2 The therapist must be comfortable and not change the position frequently.
3 The therapist should have clean hands,short nails,no areas of broken skin.
4 The lubricant should be used.
5 The control of the power accored by the patient.
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Prepare for group 2
Next Week.
Choice one disease
Write down the Rehabilitation plan on P40 + evaluation
Microsoft Word, 4 pages and print with A4 paper, Times New Roman Font 16, 1.5 interline, 2.5cm board
Prepare for 5 minutes oral presentation (next lecture)
Hand in one hard copy
10% score in total scores
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Rehabilitation plan requist

1.summary statement: depend on the group disease, include the history of disease.
2.evaluation: at last 4 methods.
2.rehabilitation problem: only list functional deficits.
3.medical problem: the disease name.
4.management plan: only use physical therapy. to list the therapy methods that can treat those functional deficits.
5.goals: depend on the functional deficits, what you want to improve?

 

Good Luck.

End

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