Manual Therapy

Original Editor - Finn Gerstell

Top Contributors - Finn Gerstell, Dana Tew, Rachael Lowe, David Drinkard and Hanz Tao  

Description

According the the American Academy of Orthopaedic Manual Physical Therapists (AAOMPT) Description of Advanced Specialty Practice (DASP), orthopaedic manual physical therapy (OMPT) is defined as: "OMPT is any “hands-on” treatment provided by the physical therapist. Treatment may include moving joints in specific directions and at different speeds to regain movement (joint mobilization and manipulation), muscle stretching, passive movements of the affected body part, or having the patient move the body part against the therapist’s resistance to improve muscle activation and timing. Selected specific soft tissue techniques may also be used to improve the mobility and function of tissue and muscles."

The International Federation of Orthopaedic Manipulative Physical Therapists (IFOMPT) defines manual therapy techniques as: "Skilled hand movements intended to produce any or all of the following effects: improve tissue extensibility; increase range of motion of the joint complex; mobilize or manipulate soft tissues and joints; induce relaxation; change muscle function; modulate pain; and reduce soft tissue swelling, inflammation or movement restriction."

Terminology

(The International Federation of Orthopaedic Manipulative Physical Therapists (IFOMPT) has offered the following definitions:)

Manipulation: A passive, high velocity, low amplitude thrust applied to a joint complex within its anatomical limit* with the intent to restore optimal motion, function, and/ or to reduce pain.

Mobilization: A manual therapy technique comprising a continuum of skilled passive movements to the joint complex that are applied at varying speeds and amplitudes, that may include a small-amplitude/ high velocity therapeutic movement (manipulation) with the intent to restore optimal motion, function, and/ or to reduce pain. 

The terms "Thrust Manipulation" and "Non-Thrust Manipulation" have been used in the literature.  "Thrust Manipulation" is used to describe interventions described as Manipulation by IFOMPT, and "Non-Thrust Manipulation" would be synonymous with the term Mobilization as proposed by IFOMPT.  

The American Academy of Orthopaedic Manual Physical Therapists (AAOMPT) has proposed the following framework for describing manipulative interventions[1]:

Grading Scales

Maitland Joint Mobilization Grading Scale:

[2]

Grade I - Small amplitude rhythmic oscillating mobilization in early range of movement

Grade II - Large amplitude rhythmic oscillating mobilization in midrange of movement

Grade III - Large amplitude rhythmic oscillating mobilization to point of limitation in range of movement

Grade IV - Small amplitude rhythmic oscillating mobilization at endrange of movement

Grade V (Thrust Manipulation) - Small amplitude, quick thrust at endrange of movement

Kaltenborn Traction Grading Scale:

Grade I - Neutralizes joint pressure without separation of joint surfaces

Grade II - Separates articulating surfaces, taking up slack or eliminating play within joint capsule

Grade III - Stretching of soft tissue surrounding joint

Resources (Mobilization and Manipulation Techniques)

Elbow Mobilizations

Wrist/Hand Mobilizations

Hip Mobilizations

Knee Mobilizations

Ankle and Foot Mobilisations

Spinal_Manipulation

Shoulder Mobilizations and  Manipulation

Cervicothoracic Manipulation

References

  1. Mintken PE, et al. A Model for Standardizing Manipulation Terminology in Physical Therapy Practice. J Orthop Sports Phys Ther 2008;38(3):A1-A6.
  2. Physiotutors. Maitland Mobilization Grades. Available from: https://www.youtube.com/watch?v=G_QI7bVrHN0