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Manual Therapy : Procedures, Side effects, Recovery time, Costs and alternatives

What is the treatment? How is the treatment done? Who is eligible for the treatment? (When is the treatment done?) Who is not eligible for the treatment? Are there any side effect? What are the post-treatment guidelines? How long doesit take to recover? What is the price of the treatment in India? Are the results of the treatment permanent? What are the alternatives to the treatment?

What is the treatment?

Manual therapy can also be referred to as manipulative therapy. This therapy is a form of physical ‎treatment that is essentially used by the physical therapist for treating the problems associated ‎with disability and pain. This physical treatment is generally used in conjunction with several ‎traditional techniques of physical therapy. Instead of using any machine or device the therapist ‎would use their hands for exerting pressure on the tissues of the muscles and joints. The basic ‎objective of manual therapy is to reduce the pain and improve the range of motion by relaxing the ‎stiff joints and tense muscles. Manual therapy is mostly used in patients who are suffering from ‎musculoskeletal disorders. In such conditions, the use of manual therapy restores the mobility of ‎the stiff joints. Manual therapy may particularly prove to be very helpful in treating the condition ‎of back pain in the patients. This therapy can be used for treating back pain arising from either ‎soft tissue injury or joint problem like sacroiliac joint dysfunction

The manual therapy techniques are inclusive of the following types of movement

  • Mobilization/manipulation: in this type of movement the therapist makes of movements that are ‎measured based on speed variance, distance, and force for pushing, pulling and placing the joints ‎and bones into a specific position.‎
  • Soft tissue work: in this type of movement a therapist applies the pressure on the soft tissues of ‎the patient’s body by massaging the tissues.‎ In the case of athletes, the use of manual therapy has become very normal. They usually ‎incorporate manual therapy both in their training and recovery after their performance. Some of ‎the advantages of using manual therapy are
  • Improved range of motion: in patients whose ability to move is getting diminished use to joint ‎stiffness or any joint disorder then manual therapy is very useful in restoring the motion.‎
  • Enhance the performance of the athletes: the overall performance of the athletes improves if ‎manual therapy is correctly used in combination with exercise and training. ‎
  • Reduced pain: manual therapy proves its effectiveness by reducing the pain in the beginning and ‎then gradually completely eliminates the pain.‎ Manual therapy is used for the treatment of several disorders. A doctor may prescribe manual ‎therapy if he/she may feel that undergoing manual therapy can be beneficial for the patient.‎

How is the treatment done?

Before starting treatment with manual therapy the practitioner of the therapy would examine the ‎condition of the affected area. This assessment would be done to gauge what kind of technique ‎would be best suited for the treatment along with risks that would be involved while using these ‎techniques. Based on the condition of the patient any of the manual therapy techniques can be ‎used for treatment

Strain-Counterstrain: this type of technique is used when a patient develops painful tender points ‎due to a postural and structural problem stemming from the abnormality of the neuromuscular ‎reflexes. In this technique, the therapist asks the patient to be in a position in which the patient is ‎most comfortable and then after a 90 second time gap the therapist induces asymptomatic strain ‎through mild stretching. Gradually the patient comes out of this position. The usual tension ‎which the patient would experience after this process indicates that healing has started. ‎

Joint mobilization: in this technique the joints that are stiff get loosened up by applying improved ‎amplitude and slow velocity movement at the affected site in a manner in which a patient can ‎never move their joints by themselves.‎ High velocity and low amplitude thrusting: this technique finds its use in the patients who are ‎suffering from the restricted gliding motion of the joints. This technique is an aggressive ‎technique in comparison to other techniques of manual therapy. If this technique is used correctly ‎then a patient may experience reduced muscle tone and improved mobility.‎

Muscle energy technique: these are a set of techniques which are designed by a therapist for ‎improving the mobility of the joint and lengthening the shortened muscles. In this technique, the ‎practitioner applies controlled counterforce in a specific direction from a specific position against ‎a voluntary contraction of the muscles of the patient. This process is repeated based on the ‎tolerance level of the patient.‎

Soft tissue mobilization: the basic objective of this technique is breakdown the myofascial ‎adhesions (fibrous muscle tissue) like scar tissue and relax the tension in the muscles. This ‎method usually finds application around the muscles encircling the spine. In this technique, the ‎practitioner applies deep pressure and the patient has to undergo rhythmic stretching. The ‎practitioner may use traction force on the affected area for restoring the normal texture of the ‎tissues.‎

Who is eligible for the treatment? (When is the treatment done?)

A patient is considered eligible for the treatment using manual therapy if he/she is showcasing the ‎following conditions

  • A patient experiencing twitching or burning sensation in their muscles.‎
  • The pain in the joints and muscles is recurrent in nature.‎
  • A patient is suffering from the neck spasm.‎
  • A patient experiencing severe shoulder pain.‎
  • A patient may be advised manual therapy for knee pain, ankle pain, shoulder pain, ‎thoracic spine pain, and hip pain.‎
  • A patient suffering from the condition of fibromyalgia is often prescribed treatment using ‎manual therapy.‎

Who is not eligible for the treatment?

It is a doctor who decides which patient is eligible for treatment using manual therapy. In some ‎minor condition of pain and inflammation, the patient may heal by using muscle relaxant ‎medicines. A patient is not considered eligible for treatment if he/she is not exhibiting any of the ‎conditions described above which make a patient eligible for treatment. Besides these, a medical ‎history of the patient helps the doctor in deciding whether a patient is eligible for treatment or ‎not. For instance, patients that have undergone cardiac surgery in which any foreign object has ‎been placed like a pacemaker, and stents then such candidates are not eligible for treatment using ‎manual therapy. ‎

Are there any side effect?

Side effects are an integral part of any treatment which is received by a patient. The side effects ‎are exhibited if a patient undergoes treatment through oral medicine, or injectable, or surgical ‎procedure. The possibility of occurrence of the side effect varies in every patient. Some patient ‎might experience minor side effects while others may experience any major side effect. The ‎minor side effect usually goes away after some time. In case a patient experiences any major side ‎effect the doctor must be informed immediately. It is hard to imagine side effects of the ‎treatment using manual therapy where no medicine or surgical procedure is required but the ‎reality is there are some side effects that are associated with the use of this therapy.

The side ‎effects of manual therapy are

  • Severe pain: when undergoing treatment using this therapy the patient may experience a ‎severe pain which may reduce the motivation level of the patient undergoing this ‎treatment.‎
  • Swelling: a patient may experience swelling in the affected area after the starting of the ‎treatment.‎
  • A patient may experience increased fatigue after a session of manual therapy.‎ In case any of these side effects persists or there any other health issues arising during or after treatment, it is advised to kindly consult the health specialist immediately.

    What are the post-treatment guidelines?

    The post-treatment guidelines are a set of rules that are defined by the doctor after the ‎completion of treatment. The post-treatment guidelines play a very decisive role in restricting the ‎reoccurrence of a disease in a patient. The doctor advises the patient to strictly follow the post-‎treatment guidelines as it helps the patient in recovery after the treatment. Few of the post-‎treatment guidelines which must be followed by the patient after manual therapy are

    • The stretching and exercises must not be stopped abruptly after the completion of the ‎treatment.‎
    • Some form of exercises must be done by the patient to prevent the reoccurrence of the ‎medical condition.‎
    • Repetitive motions must not be performed by the patients.‎
    • Right posture must be maintained by the patient.‎
    • If any discomfort is experienced by a patient then the doctor must be informed promptly.

    How long doesit take to recover?

    The recovery of the patient after manual therapy treatment is based on the condition for which ‎the patient is undergoing treatment. Another factor which has an effect on the recovery time of ‎the patient is the techniques which are used by the manual therapy practitioner. In usual cases of ‎muscle spasm, it may take a couple of weeks to recover while in severe cases like fibromyalgia ‎and musculoskeletal disorders a patient may take longer to show improvement. ‎

    What is the price of the treatment in India?

    The cost of treatment using manual therapy in India depends upon the location and experience of ‎the manual therapy practitioner. In small cities, the average cost of manual therapy treatment ‎ranges in between 300 to 600 rupees per session depending upon the experience of the therapist. ‎In metro cities, the cost of manual therapy ranges between 1000 to 1500 rupees per session as per ‎the experience of manual therapy practitioner.‎

    Are the results of the treatment permanent?

    In some cases, the result of manual therapy treatment can be considered permanent. However, if ‎proper care is not taken by the patient then he/she may be required to undergo manual therapy ‎treatment again in the future as the condition for which the treatment was sought earlier may ‎reoccur. ‎

    What are the alternatives to the treatment?

    Apart from the manual therapy treatment, a patient may also opt for other alternative treatment ‎like heat therapy treatment. In some cases, a patient might prefer taking pain medications like ‎non-steroidal anti-inflammatory drugs for relief. ‎

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