Clarification on Osteopathic Manual Techniques - Osteopathic Mobilization

Clarification on Osteopathic Manual Techniques - Osteopathic Mobilization

Manual therapy, or manipulative therapy, is a physical treatment primarily used by massage therapists, physiotherapists, occupational therapists, chiropractors, osteopaths, and osteopathic physicians to treat musculoskeletal pain and disability; it most commonly includes kneading and manipulation of muscles, joint mobilization and joint manipulation.^[

The three most notable forms of manual therapy are manipulation, mobilization and massage. Manipulation is the artful introduction of a rapid rotational, shear or distraction force into an articulation. Manipulation is often associated with an audible popping sound caused by the instantaneous breakdown of gas bubbles that form during joint cavitation. Mobilization is a slower, more controlled process of articular and soft-tissue (myofascial) stretching intended to improve bio-mechanical elasticity. Massage is typically the repetitive rubbing, stripping or kneading of myofascial tissues to principally improve interstitial fluid dynamics.

The differentiation between a manipulation and mobilization from a regulatory perspective is that a mobilization can be stopped at any point should the recipient decide to forgo the remainder of the procedure. On the other hand, a manipulation cannot be stopped by the practitioner once initiated.

Manual therapy can be defined differently (according to the profession describing it for legal purposes) to state what is permitted within a practitioners scope of practice. Within the physical therapy profession, manual therapy is defined as a clinical approach utilizing skilled, specific hands-on techniques, including but not limited to manipulation/mobilization, used by the physical therapist to diagnose and treat soft tissues and joint structures for the purpose of modulating pain; increasing range of motion (ROM); reducing or eliminating soft tissue inflammation; inducing relaxation; improving contractile and non-contractile tissue repair, extensibility, and/or stability; facilitating movement; and improving function.

Joint mobilization is a manual therapy intervention, a type of passive movement of a skeletal joint. It is usually aimed at a 'target' synovial joint with the aim of achieving a therapeutic effect. When applied to the spine, it is known as spinal mobilization. These techniques are often used by chiropractors, osteopaths, occupational therapists, and physical therapists.

Joint manipulation is a type of passive movement of a skeletal joint. It is usually aimed at one or more 'target' synovial joints with the aim of achieving a therapeutic effect.

Manipulation is known by several other names. Historically, general practitioners and orthopaedic surgeons have used the term "manipulation". Chiropractors refer to manipulation of a spinal joint as an 'adjustment'. Following the labelling system developed by Geoffery Maitland, manipulation is synonymous with Grade V mobilization, a term commonly used by physical therapists. Because of its distinct biomechanics (see section below), the term high velocity low amplitude (HVLA) thrust is often used interchangeably with manipulation.

Joint manipulation is characteristically associated with the production of an audible 'clicking' or 'popping' sound. This sound is believed to be the result of a phenomenon known as cavitation occurring within the synovial fluid of the joint. When a manipulation is performed, the applied force separates the articular surfaces of a fully encapsulated synovial joint. This deforms the joint capsule and intra-articular tissues, which in turn creates a reduction in pressure within the joint cavity. In this low pressure environment, some of the gases that are dissolved in the synovial fluid (which are naturally found in all bodily fluids) leave solution creating a bubble or cavity, which rapidly collapses upon itself, resulting in a 'clicking' sound. The contents of this gas bubble are thought to be mainly carbon dioxide. The effects of this process will remain for a period of time termed the 'refractory period', which can range from a few minutes to more than an hour, while it is slowly reabsorbed back into the synovial fluid. There is some evidence that ligament laxity around the target joint is associated with an increased probability of cavitation.