Types of manual therapy. The whole truth about manual therapy of the spine: what it is, techniques and techniques, indications and contraindications, reviews, photos

Myofascial release is aimed at working with muscle tension formed due to injuries, stress, spinal curvature, and physical inactivity. Using applied kinesiology, a specialist helps restore the ability to move correctly, without creating muscle and joint stress. Lymphatic drainage helps improve metabolism, enrich tissues with oxygen, relieve fatigue and pain. The main reasons for treatment are hernia, scoliosis, osteochondrosis.

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Principles of treatment for hernia

Treatment of the disease begins with an initial appointment, at which the doctor examines the patient. Based on the information received, a treatment program and recommendations are developed. Compliance with the rules of nutrition, sleep and rest, and physical activity allows you to consolidate the effect of treatment. The developed treatment algorithm can be adjusted as improvements occur.

The initial stage includes traction, which helps relieve pain. After this, massage and physical therapy are prescribed to strengthen the muscle corset. Other techniques are used to restore the functioning of intervertebral discs.

People with obesity and poor posture are recommended to take a special course physical exercise and acupuncture. A diet is prescribed. The use of manual therapy methods for a hernia is not effective without working to correct posture and reduce body weight. Pharamacupuncture is a method that consists of introducing special medications into active points. It is used as an alternative to acupuncture. The presence of some diseases does not allow the disease to be treated using manual therapy methods. Among them are sequestered hernias and myelopathy.

Features of work with scoliosis

Before prescribing procedures, the doctor assesses the patient’s age, etiopathogenetic, morphological features based on an examination by an orthopedist, neurologist, or radiologist. A prerequisite is diagnostics that determine the motor function of muscles and joints.

The operating technique has the following features:

• soft techniques are used;
• the impact is aimed exclusively at the area of ​​curvature;
• corrective movements are carried out in the direction of the deformation area;
• the possibility of excessive mobility of the spine is minimized due to the weakness of the “connecting” structures.

The gentle technique is considered the most effective in treating scoliosis, especially in children. When working with children, it is recommended to work only with the muscles, avoiding pressure on the vertebrae.

Some experts suggest treating scoliosis with manual techniques, directing the joints to the physiologically correct position.

Work on the body with scoliosis is designed to tone the weak muscle corset, restore the mobility of the vertebrae, increase the strength of the bones, and eliminate functional type blocks.

Therapy for osteochondrosis

Treatment with manual therapy methods for osteochondrosis of the cervical spine is aimed at reducing unpleasant symptoms and removing the blockade. Returning joint mobility. The main method of work is segmented massage.

Parts of the spine are associated with a diseased organ or nerve. Warming and relaxing techniques help reduce discomfort.

To unlock the joints of the thoracic region and neck, mobilization techniques are used: stretching techniques, traction. Active power techniques help restore mobility: everting the elbow and shoulder joints, bringing the shoulder blades together, lifting by the armpits and shaking. This stage is the most painful.

Contraindications for manual therapy are:

• oncological diseases;
• infections;
• heart pathologies;
• cracks and fractures;
• acute period of polyarthritis;
• disc myelopathy;
• lordosis, kyphosis, scoliosis;
• mental disorders, diseases of the nervous system.

Mobilization is used both independently and as a warming technique. Manipulation is carried out directly by blows, pressing, or indirectly, using flexion, extension, and twisting. A characteristic crunch indicates that the joint is in place. It is important that the specialist has the appropriate qualifications and is well versed in the methods.

How does an appointment with a specialist work?

The first visit is limited to examination and consultation. The doctor checks the degree of joint mobility, muscle tension, and the presence of pain in the ligaments.

After the examination, the patient is sent for an MRI or X-ray to check for hernias and other pathologies. It is recommended to visit a reflexologist, vertebrologist, or neurologist if you have diseases of the corresponding profile. If necessary, the person undergoes a vascular examination. Then a treatment program is drawn up.

To conduct manual therapy.

The problem of contraindications to manual treatment is to some extent artificial. Obviously, in addition to the patient’s condition, expanding or narrowing the list of contraindications directly depends on the qualifications of the doctor, the correct selection of the methods used and the appropriate diagnostic capabilities of the attending physician. Treatment should always be carried out taking into account the physical or mental condition of the patient. Currently, with the development of “soft tissue” manual therapy techniques, the number of absolute contraindications may be reduced to two<в первоисточнике до "трех" [см. ссылку выше]>: patient's mental state And local tissue destruction. Potentially traumatic methods of influencing moving elements can be replaced with potentially less traumatic ones, for example, post-isometric relaxation, functional techniques, lymphatic drainage techniques, work on associated parts of the body, etc. Currently, each doctor himself must decide which methods of manual therapy and for which conditions he can use, guided by his experience, knowledge and qualifications, as well as deontological and ethical principles. However, you should always remember that if a chiropractor underestimates the severity of his patient’s condition and does not identify existing contraindications in a timely manner, then performing manual therapy can cause great harm to the patient.

An absolute contraindication is the absence of any diagnosis., even any reasonable plausible working hypothesis. There is too much temptation to treat without a treatment plan, and therefore without a possible sequence of techniques. The patient's body is so ready to gratefully accept manual therapy treatment that there is a temptation to perform it immediately and only then diagnose it. For the most part, the results are also good, until an undiagnosed pathology or congenital anatomical defect occurs. Diagnostics is an absolute prerequisite for each therapy, and its absence is a major contraindication.

Often doctors are faced with situations in which there are no direct or obvious contraindications, but an experienced doctor intuitively feels that such a patient should not be treated. The doctor should always listen to this opinion of his intuition.

Contraindications to manual therapy(recommendations from the Center for Manual Therapy of the Russian Ministry of Health).

Absolute: Tumors, infectious and acute and subacute inflammatory processes in joints, spine, brain and spinal cord. Fresh injuries of the spine and joints, fresh fractures up to 6 months ago, condition after fresh surgical interventions on the spine, fragments of a sequestered disc herniation, focal spinal symptoms, spondylolysis, severe spondylolisthesis, grade 3 - 4 osteoporosis, Klippel-Feil disease, acute disorders of the brain and cardiac circulation, history of heart attack, acute diseases of internal organs, mental illness.

Relative: Severe developmental anomalies (nonfusion of the vertebral arches, assimilation, anomalies of tropism, sacralization, lumbarization, concrescence). Tuberculosis of the vertebral bodies. Cervical ribs III - IV degree. Fixing Forestier hyperostosis. Pathological tortuosity of the carotid and vertebral arteries. Anomalies of the head joints<примечание laesus de liro: сустав "затылочная кость - позвонок СI" и "сустав Крювелье: СI - СII">. Saddle hyperplasia of the atlas. Arnold-Chiari malformation II - III degree. Severe somatic diseases.

This list of pathologies is significantly narrowed in comparison with the previously proposed contraindications described in the specialized literature and, of course, does not cover the entire range of difficulties that a chiropractor may encounter.

Sitel A.B. describes some differential diagnostic signs that should alert the doctor regarding neoplasms: 1 . Discrepancy between subjective and objective clinical symptoms; 2 . The presence of a vegetalgic component that cannot be controlled by medication and physical methods; 3 . In the presence of a vegetalgic component, the bilateral nature of the irradiation of pain, sensitivity disorders, paresis lower limbs; 4 . Combination of a pronounced vegetalgic component with paresis of the proximal or distal parts of the lower limb.

Difficulties and complications of manual therapy.

Any type of medical care (therapy, surgery, etc.) can lead to an objective or subjective deterioration of the condition. This is especially true for such an individual treatment method as manual therapy, especially if the capabilities of manual therapy are overestimated and there are unjustified expectations of healing in all cases. The reasons for such deterioration may be both incorrect diagnostic or therapeutic influence of the doctor, and inadequate perception of such influence by the patient. A doctor performing certain therapeutic and diagnostic procedures must be prepared for such complications. Even the most qualified chiropractor has examples of unsuccessful treatment. The most “offensive” examples of such treatment arise in the case of inappropriate behavior of the patient in response to even the most correct treatment. It is extremely difficult during the initial examination to identify the imbalance and inadequacy of the patient’s behavior, before which the doctor remains completely unprotected. It is the troublesome and scandalous nature of such cases that is an obstacle widespread method of manual therapy in large medical institutions in the territory of the former Soviet Union, where there is insufficiently regulated legislation on the relationship between the patient and medical institutions, and explains the tendency towards gentle and strictly documented implementation of techniques by Western specialists.

When discussing the possibility of complications after manipulation, especially in the cervical spine, the possibility of serious damage as a result of this treatment method is constantly emphasized. Although you need to imagine that if you compare the number of manipulations performed daily with the mortality rate, then the danger is extremely small. With careful use and continuous monitoring of the patient's symptoms and manifestations, the risk of serious damage becomes almost impossible, especially considering that manual therapy is not used by competent doctors in patients with serious pathologies. However, the doctor must carefully weigh the risk of not only a possible complication, but also carefully weigh the consequences of such a complication, both for the patient and for himself.

In addition to the underlying disease, any patient may also have a mechanical disorder of the movement apparatus. As long as the purpose of the technique is to eliminate a mechanical disorder, and it is performed with sufficient caution, many contraindications can be considered relative. The main reason for dividing manual therapy techniques into different categories and modalities in a variety of modifications is to avoid the need to use potentially dangerous techniques, for example, on an elderly patient. In such cases, the use of soft techniques is acceptable. Therefore, in the case of relative contraindications, it would be more accurate to talk about the problem the right choice manual techniques. Thus, in conditions that absolutely do not allow for rotation with counter-holding, one can find techniques that alleviate the patient’s suffering, for example, light traction, post-isometric relaxation, etc. Manual therapy should always adapt to the structure of the body, taking into account age and tissue condition, which is determined during a general preliminary examination.

For example, bladder and bowel dysfunction or loss of sensation in the perineum will also be signs indicating a contraindication. Signs of spinal cord damage are also contraindications to any form of active manipulation. Performing a very gentle mobilization would be a fairly safe method, but it is unlikely to be of much use. Traction techniques will also be quite safe and, although they are used from time to time, it is quite difficult to see their positive effect on the change in spinal symptoms, but if the use of these techniques does not bring success, then it is not worth taking active measures.

Iatrogenic complications mainly occur due to inaccurate examination, assessment of the pathological process and the use of inadequate techniques in a particular situation. Under-examination of the patient leads to incorrect diagnosis, which in turn leads to incorrect treatment. Some chiropractors often do not have the diagnostic skills necessary to prescribe manipulation. It must be remembered that the patient’s coming to the doctor does not necessarily mean that manual therapy should be performed. First of all, the arrival of a patient means determining the indications for manual therapy in general and establishing a preliminary diagnosis, which must be confirmed by various diagnostic methods, including hardware ones, such as radiographic, ultrasound, laboratory, etc. This assessment is completed both before the first session and before each session.

Other possible reason complications- lack of skill as a doctor. A physician with excellent diagnostic ability to identify and treat the affected segment, but with insufficient general clinical and general diagnostic training, is as great a threat to safe manual therapy as unskilled manipulators. At the same time, many cases of complications, including fatal ones, were described, when the lack of skill and experience was replaced by brute force.

Applying manipulation without any formal training is probably one of the biggest challenges of manual therapy.. Reading a textbook or attending short introductory courses does not make even a good doctor a chiropractor. The absence of at least some controlled skills in performing a technique should be a contraindication for treatment. According to Ivanichev G.A. the set of standard treatment techniques available to an amateur and applied to any clinical situation is doomed to complications, sometimes very serious.

The third cause of iatrogenic complications is insufficient interprofessional consultation. If the doctor does not sufficiently know the diagnostic criteria for establishing contraindications for treatment or wants to “insure himself” in the event of a possible complication, if there is the slightest doubt about the diagnosis, it is better to consult a related specialist. Self-confidence caused by high qualifications in the field of manual therapy, to the detriment of general clinical training, sooner or later leads to complications due to a “missed” disease or due to an undiagnosed congenital pathology. In order to know that treatment, for example, while taking steroids or blood thinning drugs, can lead to complications, you need to know that there are side effects from taking these drugs in the form of osteoporosis or bleeding. In order to prevent complications from performing manual therapy against the background of a particular disease, you must at least know that such a disease exists at all, as well as know the clinical manifestations, general diagnostics, or what specialty doctor can confirm or refute the diagnosis of such a disease. Below is an analysis of some possible complications, which, however, do not cover the entire range of possible difficulties that arise during treatment.

Excessive, insufficient or technically inadequate treatment. At certain stages of the disease (for example, exacerbation of spinal osteochondrosis), changes in the motor stereotype are adaptive, compensatory in nature. Under these conditions, thoughtless – “from the coccyx to the back of the head” elimination of functional “blockades” without appropriate manual diagnostics will only delay the rate of recovery. Carrying out manipulation in unaffected motor segments of the biokinematic chain contributes to the emergence of new dysfunctional lesions, as well as the removal of protective myofixation, which leads to a pathological motor stereotype, hypermobility and relapses of blocking. Violation of technical execution or tactical application of techniques can lead to both traumatic injury and insufficient effectiveness of therapeutic measures. Excessive force when performing techniques can lead to traumatic complications, and insufficient force can lead to a lack of effect. It should be noted that forced or excessive efforts to overcome pain reactions at the time of performing techniques are the most common mistakes when performing manipulative treatment.

Acute period. Direct influence in the acute period is not always desirable, since in these cases additional damage to the ligaments, displacement of the moving parts of the joint, an increase in circulatory disorders in the form of increased congestion, etc. are possible, inevitable during manual therapy. In addition, in such cases, local sanogenetic rigidities are usually mobilized. However, treatment of associated motor segments, the so-called, can have a good effect. key areas of the spine, visceral and cranial manual therapy.

Disc offset. Complications that arise during manipulation or mobilization of the spine include severe neurological disorders caused by sequestration of a disc herniation and displacement of the nucleus pulposus into the spinal canal with the development of compression and vascular complications (paralysis, myeloischemic changes, central hemodynamic disorders after treatment in the neck, etc. .). Such manifestations quite often can be directly related to treatment in the area of ​​an existing disc herniation due to an increase in its size. Therefore, the worsening dynamics of symptoms should always be noted and the possibility of sudden decompensation due to an increase in the size of the hernia should always be taken into account, especially with rotational techniques of manual therapy.

Instability and spondylolisthesis. Intensification or appearance of instability, or even spondylolisthesis, after manual therapy, especially with frequent repetition of manipulations on one segment or with incorrect technical execution of the technique with the absence of pretension and exposure of adjacent segments using occlusion (in this case, manipulation on the blocked segment occurs successfully, but traumatic blocking of adjacent segments). It should be noted once again that manual therapy is aimed at increasing the range of mobility, primarily of hypomobile structures. Incorrectly performed specific manipulation or nonspecific manipulation without an accurate diagnosis of range of motion can lead to pathological hypermobility. An increase in pathological mobility leads to increased disc protrusion and compression of neurovascular formations by bone structures of hypermobile moving elements. Such artificially induced hypermobility is subsequently extremely difficult to treat. !!! --> Displacement of a vertebra by more than one third of the vertebral body is a contraindication for manual therapy, since in this case the pathological mobility in the motor segment of the spine sharply increases and the possibility of compression of the spinal cord. The diagnosis of spondlolisthesis is valid only after functional radiography. In case of spondylolisthesis or instability, an effect that increases the range of motion is certainly contraindicated due to the aggravation of the patient's condition, but this does not prevent the impact from being carried out at adjacent hypomobile levels, of course, when using techniques that do not cause movement at the level of spondylolisthesis.

Spondylosis, assimilation, concrescence, etc.. Manual therapy of excessive stiffness created by spondylosis, fixation ligamentosis, concretion, and spondylosis can lead to injury or fracture of the ossified ligaments with subsequent instability and disability, especially after manual therapy of the cervical spine. Such rigidities are relative contraindications in the absence of narrowness of the spinal canal caused by such lesions due to their compensatory-adaptive nature. To alleviate the patient's complaints, work is used on related areas of the body. Directly at the site of the lesion, only treatment of the soft tissues located above the lesion can be used without the use of stretching methods (good results can be obtained by using functional techniques, in particular the “local listening” technique).

Complications of soft tissue techniques. Complications can occur not only when performing manipulative treatment, but also when treating with soft tissue techniques. For example, with a forced stretching force of the fascia, which is stretched in this case not in the place of greatest compaction, but at the junction of the transition between the normal and shortened section (i.e., in the place of least resistance), stretching of an overstretched ligament (which can also cause pain) or excessive and frequent stretching of shortened ligaments with further relaxation of the ligamentous apparatus and iatrogenic hypermobility, increasing the pace of rhythmic execution of the technique, which, on the contrary, leads to an even greater reflex shortening of the myofascio-ligamentous structures, etc.

Marginal growths (osteophytes). Caution is necessary in the presence of marginal bone growths on the posterior and posterolateral surfaces of the vertebral bodies, especially in the cervical spine, against the background of existing instability, as well as against the background of narrowing of the spinal canal due to possible injury to the surrounding neurovascular structures. !!! --> Some authors indicate that manual therapy is contraindicated, even if the radiograph reveals only marginal bone growths and there is no instability in the segments. According to Sitela A.B, osteophytes in the cervical spine, directed posteriorly, can injure the root in the intervertebral foramen, and in the lateral direction - the vertebral artery. It was found that the presence of osteophytes with a length of more than 1.5 mm in the lateral direction in the cervical spine can cause compression and even rupture of the vertebral artery during manual diagnostics and therapy. Even if you try to perform them with such an osteophyte, a deterioration in the condition may occur in the form of dizziness, headache, nystagmus, the appearance or increase of numbness in the hands, back of the head, and face. If the vertebral artery is damaged in such cases, the functional stage of vertebral artery syndrome may turn into an organic one. At the lumbar level, osteophytes are less important, since the root is more often threatened by disc protrusion itself or its loss. There is a possibility of an osteophyte fracture either as a result of household overexertion or injury, or as a consequence of rough manipulation performed by a doctor.

Osteoporosis, fractures. Vertebral fractures occur as a result of manual therapy for osteochondrosis in patients with systemic or local osteoporosis of the spinal column of various etiologies, for example, against the background of cancer or hormonal spondylodystrophy, etc. Osteoporosis becomes apparent on radiographs when approximately 40% of the bone structure is lost. When performing manipulations on the spine, fractures of pathologically altered vertebrae are possible. It is not uncommon for bone fractures to occur simply due to rough execution of the technique. !!! --> At the same time, treatment without prior x-ray examination may lead to mobilization or manipulation treatment at the site of the pathological fracture. This cause of pain may well occur in older women or after traumatic falls.

Vascular disorders. Complications can occur with difficult-to-diagnose anomalies of the vascular system in the vertebrobasilar system, the Adamkiewicz and Deproge-Gotteron artery system, or with their injury during treatment, especially with incorrect manipulation. To prevent such complications, it is always necessary to perform tests to establish a minimal deficit of blood flow in the vertebral vessels or rotation tests to establish a disorder of spinal blood flow, the mechanism of their occurrence and the subsequent choice of treatment. It should be taken into account that therapeutic techniques should not imitate postures when performing provocative tests that reveal blood flow deficiency.

Chondrogenesis disorders. Congenital disorders of chondrogenesis of the spine and large joints exclude a forced increase in mobility. Only indirect and soft tissue techniques are acceptable.

Complications associated with the selection of patients for treatment without taking into account somatic pathology and general clinical manifestations. You should always remember about diseases of the internal organs that can cause viscerovertebral syndromes in the form of blocking the motion segment. In this case, treatment, especially manipulative treatment, can lead to trauma to the structures of the motor segment, exacerbation of a somatic disease, or, more often, to a relapse of blocking. Excessive re-treatment in this case is guaranteed to lead to hypermobility. Of particular importance in such cases is the pathology of the central and peripheral nervous system, as well as the anatomical and constitutional features of the musculoskeletal system as a whole. As a rule, such complications arise as a result of an insufficiently complete and thorough examination, but, what is even more annoying, often as a result of increased self-esteem of both the doctor himself and the treatment methods he uses. !!! --> You should not rush to perform manual therapy for cardialgia; in such cases, preliminary electrocardiography is necessary. Carrying out manual therapy against the background of severe coronary heart disease or heart attack can lead to irreversible consequences and even death. Techniques with potential tissue trauma such as manipulation or ischemic compression (acupressure) should not be performed in case of changes in the blood coagulation system (increase or decrease), diseases of the lungs and blood vessels, as this can cause vascular thrombosis and corresponding severe complications. Manipulations in patients receiving treatment with anticoagulants (danger of hemorrhages), steroid drugs (danger of bone loss, osteoporosis), muscle relaxants (inability to form protective myofixation after treatment and restore impaired postural and motor balance), etc. – are used with extreme caution and low-injury. If the patient is prone to high blood pressure, heart attacks, arrhythmias, after recent operations, with artificial joints, etc. a gradual increase in the degree of mobilization is required, as well as its duration, which will allow the patient to become familiar with and adapt to unusual feeling and physiological changes, thereby reducing some of the risk of treatment. There are quite a lot of similar “traps” among the patient’s “ordinary” diseases.

Pregnancy. It is believed that pregnancy beyond 12 weeks is a contraindication for manual therapy. However, according to Maitland G.D., 1970, pregnancy creates mechanical and technical difficulties, but there are no absolute obstacles to manipulation. Such a statement may be true, however!!! --> even an accidental coincidence or straining of the patient, which may cause the water to break or stimulate the uterus, leads to absolute discredit of both the chiropractor and the entire method as a whole. Such treatment can only be performed in a specialized treatment department.

Age . Age itself is not a contraindication to manual therapy. However, extreme age limits require both increased caution when performing techniques and a thorough assessment of the patient's condition before treatment. Accordingly, the treatment of senile tissues that are compacted and affected by the degenerative-dystrophic process does not tolerate harsh treatment that can lead to their injury (rupture, fracture, etc.), in addition, concomitant therapeutic pathology (cerebrovascular accident, hypertension, damage to the cardiovascular system, etc.) significantly complicates treatment. According to Sitela A.B., with age, patients gradually increase tonic tension of the scalene muscles, upper portions of the trapezius muscles, muscles that lift the scapulae, sternocleidomastoid muscles, pectoralis minor and major muscles, weakness of the lateral serratus muscles, lower phasic portions of the trapezius muscles, appears. deep neck flexors. As a result, the neck and shoulders shift forward with increasing thoracic kyphosis. The sagittal and vertical dimensions of the chest increase, which leads to difficulty breathing and disruption of its central regulation, mainly due to the scalene and pectoral muscles. At the same time, tonic tension occurs in the iliopsoas muscles, the lumbar part of the erector spinae muscles, the tensor fascia lata muscles, semitendinosus and semimembranosus muscles, and weakness of the abdominal muscles, gluteus maximus and gluteus medius. The pelvic-costal gap decreases and the flexion position of the hip joints develops. The patient acquires a characteristic posture - the “Voltaire” pose. !!! --> An attempt to correct such a compensated posture, which makes the patient more resistant to the clinical manifestations of the disease, especially the use of dorsoventral mobilization at the top of the kyphotic deformity of the thoracic spine (kyphosis of the thoracic spine is often associated with the progression of osteoporosis), which leads to a decompensated exacerbation. !!! --> Therefore, in old age, the so-called techniques are mainly used. "soft" manual therapy. Joint manual therapy is used with caution; manual therapy alternates every other day with other methods of physical influence (massage, physiotherapy). Before, during and after manual therapy, the patient's condition is monitored. !!! --> In old age, it is better not to perform manual therapy at all, since the patient’s condition is “overloaded” with general somatic pathology. The very journey to the doctor at this age is already a burden that can lead to a sharp deterioration in the patient’s condition, not to mention possible reactions to treatment.

Contraindication to manipulation. General contraindications to manipulation treatment should be clarified again: signs of involvement of more than two adjacent segments or nerve roots in the lumbar region, elastic sensation at the end of joint movement and protective joint spasm, inability of the patient to relax. In all these cases, direct tissue damage is possible. Any signs of diseases of the spinal cord or cauda equina or their compression should be treated as an absolute contraindication for manipulation. This applies even to such mild symptoms as moderate bilateral paresthesia of the legs (Maitland G.D., 1970).

Consolidation of the MT effect. Complications of manual therapy in the form of relapse of blocking a motor segment or a violation of the motor stereotype can be caused by insufficient measures to consolidate the effect of manual therapy in the form of strengthening fixation of the affected motor segment, therapeutic and general physical training, optimization of household and work skills, a healthy lifestyle, timely and appropriate treatment diseases (including somatic or inflammatory) causing blocking of the motor segment, etc.

Complications that appear during treatment. Of course, one should pay attention to the patient's pain or resistance as a warning sign. If such signs occur, then the symptoms and diagnosis must be interpreted in a new way. This means that manual therapy should never be performed with pain or against blocking resistance. In this case, either the course of action or the indication for treatment is wrong. !!! --> In the few cases where manipulation was the cause of a violation, it was the doctor’s work against the clear resistance of the patient. The patient's tissue always knows best what is good for it, and we must listen to this. The less experience the doctor has, the more he should pay attention to pain or resistance as an absolute contraindication. !!! --> With more experience, some of the absolute contraindications can be considered relative.

Patient-related complications. Even if all the rules for selection for treatment are followed and safe and appropriate methods of therapy are used, there is always a patient factor that cannot be taken into account. For example, to an unusual change in sensations during and after treatment, the psyche and body of even a relatively healthy patient may react with a heart or vascular attack due to changes in hemodynamics, sudden straining at the time of manipulation. The patient may display unusual behavior due to psycho-emotional stress, for example, quickly jump up after treatment, contrary to the doctor’s recommendations, immediately after treatment and pain reduction, go to training, to the market, “run up” to transport, against the background of increased after treatment of range of motion: carelessly sitting down or standing up abruptly, etc. According to Maitland G.D., !!! --> if the patient, for some reason, is unable to follow the recommendations prescribed by the chiropractor to limit physical activity, maintain correct posture, etc., then it is better to refuse treatment, since the lack of a positive result may discredit the specialist. !!! --> Particular attention should be paid to contraindications associated with the patient’s neuroticism. Such patients are not able to relax during treatment and research, and are not able to fully follow the doctor’s instructions. Subsequently, they tend to conflict with the doctor and cause serious trouble to the attending physician. Examples of patients in whom treatment is prone to complications: patients with a psychological lack of tolerance to pain or discomfort, with emotional instability, with neuroticism focused on a disease of the musculoskeletal system, patients who have recently been treated by other doctors, litigious patients, psychological or emotional incompatibility between doctor and patient.

MT addiction. A change in sensations, the appearance of comfort, relief and general relaxation after a manual therapy session can form a behavioral dominant, which encourages the patient to seek an appointment without special need and solve their problems. psychological problems with the help of a chiropractor, with a certain degree of persistence. Manual therapy can never replace psychotherapeutic care or psychological assistance. In any patient one can find certain deviations from the hypothetical “norm”, and if desired, one can always find an “object” for the doctor’s efforts. However !!! --> Frequent and prolonged sessions ultimately lead to hypermobility with frequent relapses of the pain syndrome and the patient’s physical dependence on this type of medical care. It can also be said that the doctor’s integrity is demonstrated at the beginning and end of a course of manual therapy. The pursuit of a “long ruble”, as a rule, ends badly for the patient and the doctor.”

Manual for doctors “Manual therapy” A. B. Sitel; M. "Rus" "Publishing Center", 1998.

Absolute contraindications to the use of manual therapy are as follows::

1 . Tumors of the spine, spinal cord, brain, joints, limbs, internal organs.
2 . Specific and nonspecific infectious processes in the spine and joints (tuberculous spondylitis, osteomyelitis, active rheumatism).
3 . Acute and subacute inflammatory diseases of the joints.
4 . Acute and subacute inflammatory diseases of the spinal cord and its membranes.
5 . Fresh traumatic injuries of the spine and joints.
6 . Condition after spinal surgery.
7 . Ankylosing spondylitis.
8 . Fragments of sequestered disc herniation (as a result of trauma).
9 . Disc myelopathy.
10 . Any factors that cause a sharp relaxation of blood vessels with an avalanche-like increase in the permeability of the vascular wall and, as a consequence, leading to the possibility of hemorrhagic permeation of the brain (infections, alcohol intoxication, increased blood pressure above 180 mm Hg).
11 . Acute diseases of the gastrointestinal tract, chest organs, acute disorders of cerebral and coronary circulation (stroke, heart attack, bleeding, acute inflammation, infections, etc.).

Relative contraindications include the following nosological forms and conditions:

1 . Vertebrogenic syndromes of spinal osteochondrosis in the acute stage.
2 . Instability of the vertebral segments, stage III. (spondylolisthesis more than 1/3 to the underlying vertebra, spondylolysis spondylolisthesis).
3 . Severe developmental anomalies (nonfusion of the vertebral arches, sacralization, lumbolization).
4 . Forestier's disease (fixing ligamentosis).
5 . Consolidated spinal fractures and traumatic injuries of intervertebral discs until callus formation (on average 6 months).
6 . Arthrosis III - IV degrees.
7 . Congenital developmental anomalies.
8 . Intercurrent diseases.
9 . Pregnancy over 12 weeks.
10 . Old age over 65 years (osteoporosis of bones).

When selecting patients for manual therapy, it is necessary, first of all, to rely on the clinical manifestations of the disease, clearly collect medical history data, especially about previous injuries (including perinatal), and take into account concomitant diseases. But the main criterion for the successful use of manual therapy is X-ray data and MRI.

Manual therapy (or manual medicine) is one of the areas of alternative medicine that deals with the treatment and diagnosis of spinal diseases.

The first mentions of manual practices date back to the beginning of the 18th century: in those days, chiropractors were called chiropractors (this term is still used among the people today). Today, a chiropractor is a specialist who has higher education in the specialty “Orthopedics” or “Neurology” and a license to engage in this type of activity.

Chiropractor - doctor with higher education

Treatment by a chiropractor allows you to correct spinal pathologies in the initial stages, improve the functioning of internal organs, increase the body's resistance to pathogens and get rid of chronic headaches and migraines. Despite the fairly stable positive results of using manual methods in patients with chronic back diseases, not everyone can use this method of alternative treatment due to big list contraindications.

Manual medicine is a complex of various techniques in which the doctor acts on the affected segments of the spine using his hands. If you visually evaluate the work of a chiropractor, you can say that this is an ordinary back massage, but this is absolutely not the case. During the massage, the specialist works on soft tissues (musculo-ligamentous apparatus), and his main task is to restore normal microcirculation and muscle tone. Unlike a massage therapist, a chiropractor works not only on paravertebral (paravertebral) muscles, but also on deeply located organs: bones, joints, tendons, osteochondral joints and internal organs.

The method is based not only on a direct stimulating effect on the soft tissues surrounding the spine, but also on the bone structures that make up the central part of the human axial skeleton. With the correct implementation of various techniques, it is possible to achieve normalization of the anatomical location of the vertebrae when they are displaced and eliminate muscle spasms that occur when the muscle fiber is injured by vertebral osteophytes (bone growths).

If you want to learn in more detail, as well as consider the causes, symptoms and treatment methods, you can read an article about this on our portal.

Are manual medicine and osteopathy the same thing?

Osteopathy is a branch of alternative medicine, which is based on the theory of the inextricable connection between the functioning of internal organs and bone-anatomical structures, the basis of which is the human spine. Despite the fact that chiropractors are often called osteopaths or chiropractors, both directions cannot be designated by a single term, since osteopathy in its classical sense is part of manual medicine.

A certified osteopath can help solve the following problems:

• increasing the adaptability of the human body and organism to environmental conditions and its manifestations, including various injuries (the idea of ​​self-healing);
• normalization of the hematopoietic and circulatory system;
• harmonious restoration of the nervous system;
• increasing the physiological mobility of the body.

In osteopathy, increasing physiological mobility means not only the work of joints, muscles and bones, but also the frequency and strength of respiratory movements, as well as the pulsation of blood vessels.

What diseases does a chiropractor treat?

Chiropractors treat pathologies of the musculoskeletal system, the central segment of which is the spine. The spine consists of vertebrae that are connected to each other in a vertical sequence using fibrocartilaginous formations. These formations are called intervertebral discs. They act as a shock absorber and “dampen” axial and impact loads on the spine, preventing premature deformation and abrasion of the surface of neighboring vertebrae.

When the functions of the intervertebral discs are disrupted, spinal deformation occurs (primarily due to a decrease in the height of the vertebral bodies and their displacement).

Using various manual techniques, the doctor can realign displaced vertebrae, as well as reduce bulging gelatinous pulp due to herniated intervertebral discs. The jelly-like core fills the disc space with a cavity, and when it is displaced between the vertebrae, hernias and protrusions are formed, which are a consequence and complication of osteochondrosis.

In addition to osteochondrosis, indications for contacting a manual medicine specialist may include:

• intervertebral hernias and protrusions;
• chronic headaches due to cervical osteochondrosis and old traumatic brain injuries;
• chronic pain syndrome in the lumbar region (lumbodynia);

  

• neurological disorders associated with compression of spinal nerve endings;
• pathologies of paravertebral muscles (myositis, myalgia);
• diseases of bones and joints (spondylolisthesis, arthrosis deformans, spondyloarthritis);

  

• stenosis of the central spinal canal;
• injuries to the bones and pelvic organs after pregnancy and childbirth in women;
• radicular syndrome (radiculopathy).

  

A consultation with a chiropractor may also be indicated for diseases of internal organs, the functioning of which depends on the condition of the spine.

What pathologies of internal organs does a chiropractor treat?

Pay attention! In some cases, taking a course of manual medicine is recommended for people with metabolic disorders and obesity, as well as patients prone to neuroses and depressive disorders.

Effect of treatment

Manual medicine methods are often prescribed to patients with osteochondrosis, radiculitis, intervertebral hernias and other spinal pathologies as part of complex therapy during the recovery stage (after relief of acute symptoms and inflammation). Manual therapy as an effective method of recovery and rehabilitation of patients with diseases of the musculoskeletal system is recommended by about 80% of specialists, based on fairly high rates of positive outcome in patients in this group.

After completing a full course of manual therapy, patients with spinal diseases can achieve the following therapeutic and clinically significant results:

• elimination of headaches and chronic dizziness;
• normalization of blood pressure (in the absence of disorders of the heart and blood vessels, especially in the stage of decompensation);

  

• relief of myofascial pain syndrome, as well as vertebrogenic pain that occurs against the background of compression of nerve bundles and injury to the muscle fiber by bone vertebral growths;
• relief of attacks of thoracalgia (shooting pain in the chest);

  

• restoration of respiratory function;
• improvement of digestive processes, elimination of constipation;
• increased mobility of the spine.

  

Most patients note that after treatment their back pain disappeared, sleep and appetite normalized, headaches decreased, and their mood improved. Almost 40% of patients with osteochondrosis and intervertebral hernias note a significant decrease in the intensity of pain when walking, as well as a decrease in morning stiffness in muscles and joints, which is also characteristic of osteoarthritis.

Impact techniques

Despite the fact that a chiropractor treats only with the help of his hands and his own touch, there are various methods of influencing the human spine, each of which gives a specific therapeutic result.

If you want to learn more about the technology of spinal alignment, you can read an article about it on our portal.

Manual techniques in the treatment of spinal diseases

Spinal mobilization and manipulation can be used both simultaneously (the first step will always be spinal mobilization) or separately from each other, depending on the indications and the degree of degeneration of the various spinal structures.

How is the reception going?

Full treatment with a chiropractor usually begins with the second visit. At the initial appointment, the doctor will collect a detailed medical history, conduct a manual (physical) examination and palpation of the spine to identify painful and trigger points, possible displacement of the vertebrae and other deformities of bones and joints.

Starting from the second appointment, a direct therapeutic effect is carried out, which always begins with relaxation and ends with mobilization or manipulation (or a combination of both). The duration of the session is usually from 20 to 45-50 minutes, and no more than 2 sessions are prescribed per week, since the muscles need time to recover and adapt to the new position. To assess the dynamics of the therapy, it is necessary to undergo at least 3 sessions. The maximum possible result is usually achieved after 5-7 procedures.

Video – Manual therapy session

Important! For patients leading a sedentary lifestyle, with severe hypodynamic disorders and weak muscle strength, the doctor may recommend wearing a special corset or for several weeks to reduce discomfort after therapy and quick recovery muscle fiber.

Why is preliminary diagnosis necessary?

Before starting treatment, a manual medicine specialist will definitely ask the patient for the results of a magnetic resonance scan, ultrasound or radiography. This is necessary for an objective assessment of the functional state of the spine and identification of possible contraindications that the patient may not be aware of.

Before starting treatment, the patient must undergo diagnostics and provide the results to the chiropractor

For the same purpose, a blood test is carried out before sessions in order to promptly identify signs of infectious, inflammatory or tumor processes in which manual therapy is contraindicated.

Pay attention! Patients who are at risk for intervertebral hernias and protrusions (these are mainly patients with chronic osteochondrosis) should have this done before going to a chiropractor, since X-ray examination is ineffective for this pathology.

Efficiency in osteochondrosis

Patients with this diagnosis should understand that manual medicine is effective only in the early stages of osteochondrosis (up to degree 3).

The main techniques that chiropractors use in treating patients in this group:

• removing functional blockade from the joints of the spine;
• spinal traction (traction therapy) and stretching of paravertebral muscles;
• returning the anatomically correct position to the vertebrae (in case of osteochondrosis complicated by spondylolisthesis).

The therapeutic effect is determined by the elimination of muscle spasm, the release of pinched nerve endings and the normalization of blood circulation in the vessels of the spine and paravertebral muscles.

Contraindications and restrictions

Manual therapy refers to methods of active influence on the spine, so such procedures have many contraindications. These include:

• infectious diseases (including spinal infections);
• inflammatory processes in the spine and surrounding tissues in the acute stage;
• pathologies accompanied by a decrease in bone mass density (osteoporosis, bone metastases);
• cancerous formations (regardless of location);
• fresh injuries of the musculoskeletal system;
• malignant hypertension.

Is it possible to undergo treatment during pregnancy?

Despite the fact that some experts talk about the possibility of treatment during pregnancy, representatives of traditional medicine recommend abandoning manual therapy during pregnancy and breastfeeding. Women with chronic osteochondrosis and other diseases of the spine should know that incorrect manipulations on this musculoskeletal segment during pregnancy can cause miscarriage (regardless of gestational age).

Manual therapy during menstruation

Menstruation is not a direct contraindication for manual therapy sessions, but it is better to refuse treatment until the end of your period. Manual exposure can lead not only to increased menstrual pain, but also to more abundant and prolonged discharge (menorrhagia).

Video - Manual therapy of the cervical spine

Manual therapy is a fairly effective method of treating the spine and many internal organs, such as the reproductive system or respiratory tract. When choosing a chiropractor, you need to be interested not only in reviews of a particular specialist, but also in whether he has a diploma, certificate and license. Treatment by a non-professional can cause displacement and fracture of vertebrae, rupture of ligaments, muscle injury and other serious complications, so this issue must be approached very responsibly.

According to statistics, the popularity of therapeutic massage today is increasingly growing, and it is gradually becoming almost the most popular means of alternative medicine. Any back and neck massage, regardless of technique, can bring both benefit and harm. Therefore, before doing the procedure, read the contraindications. If you have any doubts, it is better to consult a specialist. And detailed information about massage techniques, contraindications and benefits of procedures can be obtained

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Manual therapy has been around since time immemorial. In ancient times, people noticed that by performing certain actions, one could more easily endure pain from injuries or bruises received while hunting. It also allowed for a faster recovery. For example, pain at the site of a bruise was relieved by cold running river water. And a broken leg healed faster if it was tied to a straight stick.

The history of manual therapy

Elements of traditional medicine techniques that have survived to this day are the following:

Dressings;

Herbal decoctions;

Use of cold and heat.

Over time, knowledge of the anatomy of the human body, accumulated over many generations, turned into one of the branches of medicine - surgery. A separate direction in its early stages was bone-setting. Hippocrates also developed a very interesting method to heal the spine. The patient's stretched legs and arms were fixed, and then they walked on his back.

In the 18th-19th centuries. The functions of chiropractors began to be partially performed by bathhouse attendants. As a rule, these were people with remarkable strength, which allowed them to stretch the joints of visitors and perform a massage procedure, which consisted of targeted punches to certain parts of the body.

Rural healers were also involved in bone-setting. Their technique included massage, percussive movements and stretching. Various spells against illnesses were popular.

Somewhat later, all the experience accumulated by traditional healers was systematized, studied, somewhat supplemented and transformed into the following sections of medicine:

Herbal, balneo- and psychotherapy;

Manual therapy itself by the end of the 19th century. consisted of two main directions. These included chiropractic and osteopathy. The working methods of specialists representing these movements were different. While the former performed manipulations using crude percussion techniques, the latter were, as a rule, theorists.

Meaning of the term

Manual therapy in modern world performs a number of functions. This direction studies the movement of body parts; explores the sources of pathologies arising in the locomotor system.

Manual therapy is a fairly effective means used to treat ailments of the musculoskeletal system. The impact of the method under consideration will be repeatedly enhanced in the case of parallel use of reflexology, herbal medicine, and physiotherapy. The main thing that specialists in this area work with is the spine.

The essence of the technique

Manual therapy is a whole system that includes manual techniques. The main purpose of its effect on the patient is to eliminate those pathological changes that have arisen in the ligamentous, bone, and muscular apparatus.

Manual therapy restores the anatomically correct position of the vertebrae and intervertebral discs. This is not an easy task. Unsuccessful restoration of the position of displaced vertebrae can cause pinching of blood vessels. This leads to venous stagnation and negatively affects the functioning of many organs. To correct this situation, manual therapy techniques are also used.

Manual pressure on painful areas allows you to move the surfaces of the joints away from each other and restore blood circulation. Chiropractors work on specific areas of the spine in doses. This allows you to restore normal mobility to the musculoskeletal system. It is very effective to combine manual therapy with homeopathy. However, it is worth consulting with a specialist in advance on this issue.

Contraindications

Manual therapy sessions are prohibited for the following problems:

Infectious diseases that affect the joints and spine;

Tumors;

Hypertension;

Recent injuries to the limbs and spine.

In what other cases is manual therapy not performed? Contraindications apply to patients who have prolapsed intervertebral disc herniations. This technique is prohibited in case of malformations of the skull. This limitation also applies to the same pathology of the spine.

When is manual therapy still prohibited? Contraindications apply to those patients whose condition is assessed as extremely serious. Moreover, its cause can be not only the above infectious diseases, but also neurotic or mental disorders. Manual therapy sessions are prohibited for somatic diseases, as well as in complex treatment with anticoagulants. Manual therapy of the musculoskeletal system is not recommended for elderly patients. You should not undergo manual therapy sessions for any pathologies of the joints and spinal cord.

Postisometric relaxation

Spinal manipulation can be performed using a variety of manual techniques. One of them is post-isometric relaxation. It is noteworthy that this technique has no contraindications. Its essence lies in alternate tension and relaxation of muscles.

Manual therapy of the spine, performed using post-isometric relaxation, stretches muscles, eliminates swelling, and relieves pain. This technique is simple and safe to use. The patient, after completing a short training course, is able to repeat its basic elements at home.

Causes and stages of osteochondrosis

This disease causes degenerative changes in the intervertebral discs and adjacent vertebral bodies. In pathology, there are four stages. The first of them is difficult to diagnose. The patient receives only general complaints. Main symptoms of this state are malaise and discomfort of an unspecified nature. At the second stage, when intervertebral connections are disrupted, pain occurs. Compression of blood and lymphatic vessels occurs. The third stage is characterized by rupture of the fibrous rings and the appearance of a hernia. Visual curvature of the spine appears.

At the last stage of osteochondrosis, displacement and compaction of the vertebrae occurs. The result of this process is the formation of pathological bone growths. This is fraught with a decrease in motor functions and impaired mobility of the entire spinal column. The disease process, as it develops, leads a person to disability. The above is typical for all types of osteochondrosis (cervical and thoracic, lumbar and sacral).

Treatment of osteochondrosis using manual therapy

The spine is the main organ to which ligaments, muscles, blood vessels that feed them, and nerves are attached. His health is extremely important for a person’s normal well-being.

Manual therapy of the spine involves specially designed techniques, which include the following components:

Mobilization;

Immobilization;

Manipulation;

Correction of functional relationships, etc.

All these manual influences are aimed at solving the problem of eliminating the pathobiomechanical phenomena of osteochondrosis. What is manual therapy for such patients? This is an opportunity to restore mobility and activity of the musculoskeletal system. However, it is worth keeping in mind that this technique does not eliminate the factors contributing to the appearance and development of osteochondrosis.

How does manual therapy affect the patient’s condition? Feedback from experts confirms the fact that the use of this technique does not solve initial problems with the spine. Yes, the pain after the session will go away quite quickly, but the progression of the disease will remain.

The greatest effectiveness of manual therapy can be felt in the early stages of osteochondrosis. But when further development pathology, when displacement of the vertebrae has already occurred, this method is strictly contraindicated.

Features of the event

Before starting any relaxation technique, it is necessary to cure the underlying disease. For this purpose, medications and physiotherapy are used. Manual therapy for osteochondrosis will be most effective if the tense muscles are warmed and stretched using slow movements before the session begins.

Treatment of spinal hernia

To conduct a manual therapy session, the patient must undergo a CT scan or MRI. As a result of these studies, the location of the hernia formation will be determined, in the area of ​​which the chiropractor will work.

If the disease is in an acute stage, manual techniques should be carried out smoothly, gently, without any physical effort or sudden movements. With such an intervertebral hernia, traction (stretching the spinal column) is often used. The patient is in a sitting or lying position. In case of a hernia, a spinal corset or a Shants collar worn around the neck can help.

After the acute period is left behind, traction mobilization, post-isometric muscle relaxation, and traction (manual or hardware) are used. Such manipulations eliminate the symptoms of spinal hernia, pain, and, in addition, prevent relapses of the pathology.

Cervical spine treatment

This area of ​​the spine is subject to serious stress. This is why osteochondrosis often occurs in the cervical spine.

What is manual therapy for patients with this diagnosis? This is an opportunity to reduce or completely remove pain, as well as restore the range of motor function of the spine or shoulder joints. In addition, manual manipulation is performed to relieve symptoms of nerve compression, which are expressed by tinnitus and headaches.

The maximum effect when performing manual therapy occurs after two sessions. For maximum results, you should visit the doctor seven to ten times.

Manual therapy is a unifying medical term for mechanical action, where the hands are the main tool of treatment. Manual massage is considered the most advanced form of contact interaction. The basis of the therapeutic and diagnostic methodology of an alternative (non-traditional) method of treatment is osteopathy, which the chiropractor considers as the root cause of the painful relationship between the structural and anatomical systems of life. In this article, we will define what manual therapy is from the point of view of contact interaction with the musculoskeletal system, what are the advantages, what are the indications and the main contraindications to manual therapy, we will consider the main methods and techniques of manual therapy.

The current basics of manual technique combine:

• An idea of ​​the treatment of the spinal column as the main osteo-articular formation of the supporting system, its ligamentous-muscular and vertebral elements: intervertebral discs, articular segments, vascular and nerve plexuses.
• An idea of ​​post-isometric relaxation of the muscles of various parts of the vertebral motor segments in osteochondrosis, hernial protrusion of pulpous contents in the spinal body, deforming spondyloarthrosis, displacement and/or compression pinching of the meniscoids, and the like.
• The concept of the work of anatomical vital organs.
• Development of diagnostic methods and special techniques for performing manual therapy using natural passes to displace the mobile regional part.

Thus, it becomes obvious that manual therapy methods contribute to the pathobiomechanical elimination of musculoskeletal disorders and their pain symptoms. In other words, manual massage does not significantly affect degenerative activity and dystrophy of the spinal-motor parts of the musculoskeletal system. However, craniosacral and osteopathic gymnastics, performed by a chiropractor or massage therapist, has an extremely positive effect on the healthy functionality of the main organ of the nervous system and musculoskeletal vertebral areas, and also significantly helps in relaxing all its muscular-ligamentous plexuses.

What is a function block (FB)

A functional block of the spinal motion department means a reversible restriction of intra-articular mobility of connective tissue elements relative to each other, which means their violation of periarticular reflex myofixation. The reversibility of the functional block is ensured by the action of passive mobilization movements, traction impulse, as well as various types of relaxation actions (manual massage, post-isometric muscle relaxation, autorelaxation). The most common cause-and-effect factors for the appearance of a functional block are:

• Trophic muscle failure due to prolonged immobilization.
• Dynamic overload (sudden jerks and the like).
• Static overload.
• Nociceptive reflex effect in diseases of the spinal system.
• Inertial overstrain of the musculoskeletal segment.

When assessing a limited block, the manualist determines its direction. The opposite of FB is articular hypermobility of the vertebral segments. The difference lies in the enhanced anterolateral, ventrodorsal and dorsoventral displacement of the spinal motor segments. Such differences in excess mobility increase the ability to reversible a certain amount of movement during manual techniques for mobilizing the articular segments of the spine. The manual therapist selects manual exercises based on the pathogenesis and type of biomechanical functional disorder. General requirements for the use of therapy techniques include:

• An indicator of clinical and radiological examination, excluding the main contraindications to manual therapy.
• Determination of the type of pathobiomechanical functional disorder.

Correct assessment of the situation and accurate determination of the differential approach to an alternative method of influence helps the doctor establish positive compatibility with the patient, which makes the chiropractor psychologically contactable.

Manual action: classification of techniques

To eliminate pain and other manifestations of clinical symptoms, the manualist selects the appropriate mechanical effect:

1. Segmental relaxing manual massage. For 3–5 minutes, the manual therapist gently strokes and kneads the spasming muscles to provide them with a warming effect. As a result of this action, muscle tension is significantly reduced, the osteoarticular segment becomes more sensitive and flexible to stretching. The patient's response is a decrease or complete disappearance of pain, dizziness disappears, the body becomes more obedient, while the head becomes heavier and makes one feel sleepy. This reaction of the body indicates the high professionalism of the therapist.
2. Segmental mobilization, that is, ensuring painless restoration of the FB or spasmodic shortening of the muscle segment through passively repeated leisurely movements within the limits of the joint physiological volume.

At the same time, mobilization requires certain conditions:

• Stable fixation of the above or below located parts of the body; these conditions are especially strictly met when manual therapy of the neck is performed.
• Providing complete muscle relaxation.
• Any manual technique must be performed during the exhalation phase.
• The manualist ensures the direction of smooth and soft movements along the longitudinal axis of mutual gliding and mutual removal of articular surfaces.
• Mobilization is carried out until there is a slight sensation of pain and the appearance of slight resistance in the joint, after which the articular segment returns to its original position.
• Patient and consistent mobilization sometimes completely replaces manipulation.

So, after establishing the pathogenetic and clinical condition, as well as a detailed neurological examination of the patient, a therapeutic tactic of mechanical action is developed and the question of the appropriateness of treatment is decided.

Pros and cons

Currently, it is becoming fashionable to impose various methods of alternative medicine. Street pillars are full of advertisements for reliable healing with osteopathy, craniopathy and/or visceral manual medicine methods. It is very difficult to understand this terminology, how they differ from each other, whether these methods of treatment are good or whether they will have a bad effect on human health, and whether it is worth paying attention to this at all. Often, home-grown medical experts insist that manual therapy during pregnancy is the only way to eliminate pain in the musculoskeletal system of the spine, and also recommend such alternative ways treatment for young children.

What are the features and differences between osteopathy and manual therapy?

Osteopathy finds out the causes of diseases and provides a gentle therapeutic effect on muscle structures, which is acceptable even for infants. Classical manual therapy is the identification of pain symptoms, identifying the consequences of their occurrence and methods of mechanical action. Craniosacral manual therapy is dosed manipulation of the cranial bones by the hands of a chiropractor.

Indications for therapy

The therapeutic effect of mechanical intervention in the spinal motion segment must be determined by certain conditions or indications for manual therapy. There are two types of such therapeutic and restorative prevention - absolute and relative indications and contraindications.
Absolute:

• Diseases of the osteoarticular organization of the spine associated with a degenerative disorder leading to the development of functional blocks of the PDS - osteochondrosis, deforming spondyloarthrosis, and so on.
• Discogenic reflex disorders at the level of the cervical (cervicalgia), thoracic (thoracalgia) and lumbar (lumbodynia) vertebrae, expressed by a certain degree of local pain.
• Diseases of spondylogenic pathology with irritative-reflex muscular-dystonic disorder.
• Irritative-vegetative-trophic osteoarticular disorders - coxarthrosis, arthrosis of the iliosacral segment, glenohumeral periarthrosis, and so on.
• Acroparesthesia, pseudoarteritis, thermal paresthesia, restless legs syndrome, that is, all those clinical manifestations that relate to irritative-reflex-vascular syndromes of spondylogenic pathology.
• Diseases of the osteoarticular segments that cause myofascial pain in trigger zones.

Relative:

• The severity of pain exceeding the third degree.
• Spondylogenic symptoms of radicular syndrome with paresis, hyporeflexia, etc.
• Spondylogenic syndromes with pronounced neurodystrophic disorders.
• Sympathetic syndromes with pronounced posterior cervical spondylogenic characteristics.
• Symptoms of dysfunction of the functional block of the spinal motion segment with visceral reflex muscle and/or pain syndrome.

Methodological contraindications

Mechanical impact may be limited by absolute and relative criteria, which provide certain harm from manual therapy.
Absolute signs:

• Presence of malignancy in the segmental part of the proposed procedure.
• The presence of acute infectious lesions.
• Severe spinal instability.
• Inflammatory disorders in the spinal cord.
• Disruption of the main blood supply.
• Spinal injury or arterial thrombus.

Relative characteristics include:

• Unstable psycho-emotional state of the patient.
• Stage of decompensation of clinical pathologies of internal organs.

Resume

Attention! All manipulations should be carried out only by a highly qualified specialist with a state diploma and confirming medical state certificates of special training as a neurologist, orthopedist or traumatologist.

Rough or unprofessional movement of the hands can provoke complications: fracture of the cervical or other vertebrae, rupture of the ligamentous apparatus, disruption of the main blood circulation.