MANUAL THERAPY

“I dance with both my hands..”

This is an umbrella term that encompasses a lot of techniques! Here are some examples of tools in my tool belt that I may use during a treatment session, but I strongly believe movement is the medicine!

Joint Mobilization

This type of treatment can be applied to the spine, hip, knee, ankle, shoulder, elbow wrist, jaw- literally any synovial joint space! You are relaxed, and I am performing various movements within the joint by changing the direction, pressure and amplitude to improve a specific motion. The change is based on a grading scale, 1 being lighter pressure all the way up to grade 4 being into the end range. Treatment time varies per person, but is usually around 5-10 minutes. Joint mobilization exercises can give immediate feelings of a joint space feeling less stiff and less painful with movement.

Examples of when joint mobilizations techniques may be appropriate:

  • You have trouble reaching behind your back to unclasp your bra because of decreased shoulder range of motion

  • You feel a pinching in the front of your ankle joint when you flex your foot upwards or with running

  • You have trouble performing some of the exercises at barre/pilates/yoga because you lack hip mobility

  • Your neck feels very tight and you are unable to look over your shoulder when driving

  • You have difficulty with bending or twisting in middle or low back region

  • You have pain or are unable to flex or extend your knee fully

Manipulation

More popularly known and also the highest grade, grade 5, is a high velocity thrust within the joint space, also known as an adjustment.

I am trained in performing manipulations to the spine as well as throughout the upper and lower extremities, but use them in my practice for specific cases when I feel appropriate. Manipulations can be very beneficial in helping with decreasing pain, down-regulating the nervous system, and improving joint range of motion. I pair this treatment with strengthening and mobility to follow, to enhance the gains we just made!

Instrument assisted soft tissue massage (IASTM)

A gua sha tool and lotion is used to address the muscles, tendons, or skin that are causing trouble. IASTM evolved from Traditional Chinese Medicine and research has shown that it stimulates mechanoreceptors in the cells to increase fibroblast activity. So, it basically encourages the body to heal itself through its natural mechanisms. 

Mobilization With Movement

With this type of manual therapy, pressure is applied at the joint space while you are instructed in a specific movement pattern that can help the brain make more connections, improve range of motion, and relax the surrounding tissues.


Soft Tissue Massage techniques

Massage techniques include transverse friction, edema, effleurage, petrissage, and rolling. Intentional and specific technique to an area can increase blood flow and help in down-regulating the nervous system.

One of my favorite areas to work on is the suboccipital muscles, which are found right at the base of the skull. This group of muscles can attribute largely to headaches, migraines, vertigo, and cervicogenic dizziness.

Manual Stretching

Some examples include static, dynamic stretching, and Proprioceptive Neuromuscular Facilitation techniques.


Muscle Energy Technique (MET)

With this type of manual therapy, you will be instructed in a gentle isometric contraction of a certain muscle while in a specific position to allow for lengthening of that muscle, reduce pain, and improve joint function. 

Manual Traction

Manual traction is the application of a gentle pull force using the hands around a joint space at an area of compression, commonly at the neck or low back. This can relieve symptoms and help with improving joint mobility, and strengthening exercises commonly follow.  

Passive and Active range of motion

Every joint has a certain degree of functional range that it should be able to move freely in. If range is limited due to prior injury, pain, adhesions, scar tissue, or something like osteoarthritis, I am able to move through the range for you (passively), you may actively do it yourself, or I may assist you through the motion. This can improve range of motion and decrease pain.

Proprioceptive Neuromuscular Technique (PNF)

There are two types of PNF stretching, contract-relax and hold-relax. The stretches focus on moving the muscle towards the end range to trigger the protective reflex which then tells the muscle to relax further. PNF also includes strengthening techniques such as rhythmic stabilization and repeated contraction.