MANIPULATION
Medically, manipulation is defined as “the act, process, or an in- stance of manipulating especially a body part by manual exami- nation and treatment; especially, adjustment of faulty structural
relationships by manual means (as in the reduction of fractures or dislocations or the breaking down of adhesions) [28] .” Classification of manipulative techniques is shown in Figure 7.
Figure 7: Manipulation Techniques
Massage Massage stimulates the touch sensory receptors, blocking the pain signal at the pain gate. Massage consists of methods such as stroking, kneading, and friction. Stroking Stroking can be performed either with one hand or both hands. It starts with a firm contact and ends with a smooth liftoff of the hands. Usually, it is applied proximal to distal. It gives a sedat- ing effect to tight muscles, so the muscles relax. Slow strokes are more sedative, while fast strokes are more stimulating. Kneading Kneading moves the skin and the underlying soft tissues in a cir- cular motion. It can be performed using the palmar side of the whole hand, heel of the hand, palm, all fingers, one/two fingers, Myofascial release (MFR) During an injury, myofascia tends to tighten and adhere to the adjacent muscle. This affects the functionality of the muscle, leading to joint restrictions. Also, myofascial restrictions trigger severe pain. Release of these restrictions is called myofascial re- lease (MFR). Release of myofascia breaks down the scar tissue in between the muscle and the fascia and relaxes the underlying muscle. People suffering from back pain, headaches, fibromyal- gia, muscle injuries, and sciatica can be successfully treated with MFR [29] . Joint manipulation The International Federation of Orthopaedic Manipulative Physi- cal Therapists (IFOMPT) has defined joint manipulation as “a pas - sive, high velocity, low amplitude thrust applied to a joint complex within its anatomical limit with the intent to restore optimal mo - tion, function, and/or to reduce pain [30] .” The definition implies that manipulation can increase the passive range of motion of the joint, and can simultaneously reduce the pain. Pilates Pilates is a technique introduced by Joseph H. Pilates in the be- ginning of the 20th century. Pilates controls muscle movement consciously to gain balance, strength, and correct posture. This technique primarily focuses on the core of human body, which is denoted by the abdominals, back musculature, and glutei . Main - taining a strong core helps preserve the normal curvatures of the spine. Deviation of the proper alignment of the vertebral column and the pelvis may result in poor posture, which can cause back pain. Thus, Pilates can be considered a gold standard in prevent- ing back pain.
thumb, and elbow. If the force given by one hand is not suffi- cient, it can be reinforced by the other hand (called superimposed kneading ). Adhesions formed in the subcutaneous soft tissues are broken down by kneading, leading to pain relief. Friction In friction, deep manipulation is applied over a specific structure by thumbs or fingers. The adhesions formed in the deeper soft tis- sues are deformed by this technique. There are two types of fric- tion: circular and transverse. Circular friction is used for adhesions in the ligaments and myofascial junctions, whereas transverse fric- tion is used for adhesions in the muscles, myofascial junctions, tendons, and ligaments. When performing transverse friction, the tendons must be stretched and the muscles must be relaxed. People who have acute rheumatoid arthritis, osteoporosis, malig- nancies, and healing fractures should not undergo MFR. It is possi- ble to have MFR during pregnancy with special precautions to avoid the abdominal area. Self-MFR is quite common in the sports world. Affected myofas- cial can be self-treated with the aid of a foam roll or a ball placed under the particular area. With the pressure of bodyweight ex- erted over the foam roll, the adhesions are broken down. There are two types of joint manipulation: peripheral joint manipu- lation and spinal manipulation (chiropractic). Contraindications to this technique include healing fractures, dislocations, malignan- cies, spinal deformities, and spinal cord compressive disorders. Joint manipulation has to be done by an experienced chiroprac- tor, physiotherapist, osteopath, or occupational therapist. Pilates techniques integrate both physical and psychological components. There are eight principles of Pilates, including [31] : 1. Concentration : Concentrating on the correct movement pat- tern is required in Pilates. Each muscle performing the tech- nique has to be consciously moved. 2. Breathing : Pilates focuses on breathing in the movement pat- tern. During Pilates sessions, breathing flows into a slow and deep rhythm. The participant must maintain a relaxed neck and shoulder musculature to facilitate normal breathing.
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