Wednesday, February 11, 2009

Manual Therapy: We can call this Western "Tui Na"

When was the last time you suffered from a really bad back pain or neck pain?

I know a lot of patients who would visit a Chinese Sinseh for "Tui Na" (Manipulation and massage) whenever they suffer a back pain and then also come to the clinic for some painkillers and muscle relaxants.

"Tui Na" is a very effective way to release muscle spasms and re-align bones and joints which might be out of place due to pain and inflamation. However, finding a good practitioner is critical because a lot of harm can be done if the practitioner is inexperienced.

In modern medicine, we have a branch of physiotherapy that specializes in manual therapy which essentially does "Tui Na" but with a scientific understanding of the anatomy and physiology of the causes of backpain. Not every physiotherapist does manual therapy because these therapists have to go through a few more years of post graduate training in order to earn their Masters degree. In Australia, where I trained in medicine, manual therapy is a very well established practice. In Singapore, it is still in the developmental stage but there are more and more physiotherapists who are being trained to do manual therapy.

Our clinic has started referring such cases of back and neck pains to Core Concepts, a group of physiotherapists who specialise in manual therapy and sports injuries. I have asked Sylvia Ho, one of the senior physiotherapists to contribute the following article about Manual Therapy so that you are aware about this the next time you have a "pain in the neck".

What's Manual Therapy?

Article by Sylvia Ho

Manual Therapy is an area of manual medicine treating musculoskeletal conditions; conditions related to the muscles, bones, joints, connective tissues such as tendons and ligaments, spinal discs and the nervous system that enables them to all work together. Manual therapy covers a broad range of techniques and perhaps easiest to define as an approach not based on the use of electrical and/or electronic devices such as traction machines, TEN, EMG and shortwave diathermy machines.

As with most other areas of specialties, there are two broad areas of manual therapy – the techniques and the critical diagnostic analysis.

Manual Techniques

First, there are the techniques. These can range of myofascial trigger point release of tight muscles, spinal manipulation or mobilization to release tight joints, neuromuscular retraining correct the muscle activation pattern, sports taping to provide support to joints to something more basic like deep tissue massage. Manual therapy is not technique specific but rather includes a very broad range of technique to enable proper musculoskeletal functioning. This area is the most visible area and perhaps most familiar to the general public.

Critical Diagnostic Analysis

It is the second area that manual therapy comes into its own – critical diagnostic analysis. Determining what is the immediate cause of the pain is often straight forward such as a muscle strain in the back or a nerve impingement in the lumbar spine. Treatment in such cases using TENS machine on the area of pain or traction is simple and can be effective to address the immediate pain. But these treatments usually have no lasting effect as they do not address the 2nd or higher level causes of pain. It is like driving a car with a leaking radiator. The car overheats when there is no water in the radiator. Filling up the radiator solves the immediate overheating problem. But if the leak continues, the radiator will soon empty again and cause the engine to overheat.

So a manual therapist must probe further, “Why is the muscle strained?” Because of the musculoskeletal system in the human body are all interconnected, answers can sometimes be found rather far away from the pain site and not immediately intuitive. Here is an interesting case study of found at our online journal (MCR) – Mal-Aligned Rib .

Manual therapists usually work with a team of massage therapists and sports rehabilitation trainers to assist with the manual treatment and exercise rehabilitation once the root cause of the problem is diagnosed.

About Sylvia Ho

Sylvia graduated from the University of Sydney, Australia with a Bachelor of Applied Science (physiotherapy) in 1995 and subsequently obtained her Master in physiotherapy, specialising in manipulative therapy from University of Melbourne, Australia. Her current interests are in treating back and neck pain and improving sports performance through sport specific exercises. She is actively involved in educational talks to organisations such as JP Morgan, Ministry of Finance, clubs and fitness centres and is also a specialist advisor to MyHealthScanner, the region's first on-line real-time health screening tool for 27 major conditions.

You can visit Core Concepts website here
She is a regular contributer to Musculoskeletal Consumer Review

1 comment:

Anonymous said...

Dear Doctor Leslie,

Actually most, if not all, physiotherapists do learn and engage the use of manual therapy in their treatment, regardless of their specialisation. For example, if you have a stroke patient who is unable to bend the ankle joint due to swelling, gliding (part of manual therapy) of the tarsal bone can then be performed.
The branch of post-graduate specialisation which you were referring to is actually Manipulation, which I guess is a more complicated form of manual therapy.

By the way, I really enjoy reading the ieatishootipost blog. Do keep up the good work!