Manual and Manipulative Therapy

Joint mobilization refers to techniques that are used to treat joint dysfunction such as stiffness, reversible joint hypomobility, or pain.  These are graded according to the amount of force applied and movement that occurs at the joint and can vary from small oscillations to treat pain and muscle spasms to larger manipulative thrusts that move a joint beyond its physiological range of motion.
Orthopaedic manual therapy, which includes mobilization, can be defined as a systematic method of evaluating and treating dysfunctions of the neuromusculoskeletal system in order to relieve pain, increase or decrease mobility, and in general normalize function.  Mobilization and manipulation is one of the oldest forms of physical therapy mentioned in ancient medical records.. Hippocrates (460-380 BC)  in his book Corpus Hippocrates, listed methods of treatment that are comparable to mobilization techniques used today. During the renaissance, Ambrose Pare, a well known physician, described in detail how to treat a dislocation by manipulation. Different philosophies of thought govern how we use mobilization and manipulation techniques today.

Cyriax, a British orthopaedist, believes that almost all spinal pain arises from a disruption of discs, which can be reduced by manipulation and traction. He is an enthusiastic proponent of the use of manipulation by physical therapists because of their training and expertise in understanding the musculoskeletal system.  Maitland. a physical therapist from Australia has developed a system of dealing with a client's signs and symptoms through treatment with graded oscillations, and Kaltenborn, a Norwegian physical therapist, has developed a system of mobilization utilizing  arthrokinematic principles to treat musculoskeletal dysfunctions. Kaltenborn and other members of a Scandinavian group of physical therapists categorize spinal dysfunctions into two main disorders: disc degeneration and facet dysfunction. Treatment is determined by loss of mobility and the presence of pain. Mobilizations are used with minimum force in the direction of the limitation in order to normalize the movement of the joint.

Mobilization is only one part of the management of a client with a neuromusculoskeletal dysfunction. There is at the therapist's disposal a multitude of approaches which can be used to develop individualized treatment programs. Therapy will also include appropriate range of motion, strengthening, and functional techniques. The proper incorporation of all procedures is needed for effective treatment of musculoskeletal problems.