MR techniques are one of the latest therapeutic methods in manual medicine. They focus on working with the myofascial system. These techniques improve internal mobility of soft tissues, especially the fascia. Living tissue has an internal ability to move, resulting from rhythmic changes in muscle tone and internal body rhythms (spasms of blood vessels, bowel movements, breathing, muscle spasms, eyeball movements, etc.). The activation of forces in MR techniques takes place directly and indirectly. They are both internal and external. Internal forces are associated with the physiological movements of living tissue mentioned above. The external forces are related to the delivery of mechanical energy by the therapist through pressure, traction, twisting, stretching which adequately affect the soft tissue, changing its biomechanical properties and inducing reflex movement. They are linked by the main goal of manual medicine, which is to achieve a symmetrical, painless range of movement of the musculoskeletal system.
This method was developed in the 1960s by Jones, the osteopath, who observed that placing the joint in the position of maximum release and maintaining this position for 20-120 seconds results in a radical improvement in the range of joint movement and reduction of its pain. Jones believes that placing the joint in the direction where muscle tension is reduced causes the release of hypertonic muscles as a result of reduced nociceptive stimulation and thus changes the activity of muscle spindle receptors and improves the blood supply of ischemic and hypertonic muscles. The therapist searches for the most sensitive point and, by controlling it with his finger, he puts the patient’s body in a position so that the point disappears or decreases to 2 points (in a subjective pain scale from 0 to 10) and maintains this position for 90 seconds.
Trigger point therapy is a technique that uses different forms of pressure and movement in sensitive regions of muscle tissue. The aim of the therapy is to free oneself from pain and improve the disturbed movement patterns. The trigger points are sensitive areas in the muscles with increased tension, which are painful under pressure and cause radiating pain and other symptoms in regions of the body distant from the irritation site.During the physiotherapeutic examination an individual patient’s problem is assessed. Our therapists work on specific elements related to this problem later. But what can be done to make the effects of the therapy last very long? How to strengthen the results of the therapy? And finally, how to prevent the recurrence of problems? The answer to all these questions is self-therapy. Self-therapy is an individually tailored exercise that is easy to do at home and is mainly based on the method of post isometric relaxation (PIR) but it also involves various positions stretching individual muscles or entire anatomical bands. Self-therapy together with postural education forms an important factor supplementing the treatment process and ensuring its long-term results. Therefore, therapeutic success also depends to some extent on the level of patient motivation.
Fascial Manipulation was developed by Italian physiotherapist Luigi Stecco, who for 40 years of clinical practice and profound study of human anatomy and physiology developed an extremely effective and coherent therapeutic system. The author noted that certain places in the body show great tactile pain if the consistency of tissues in this region is altered and the restoration of proper slip between these tissues (manipulation) causes reactions in distant regions of the body. It took many years to develop a map of those points which (and there is nothing strange about that) mostly coincide with acupuncture points. He called these points the Coordination Centres (CC) and Merger Centres (CF). Stecco came to the conclusion that these special places lie on the tension line of the fascial system which is a “transmission band” for the propagation of mechanical compensation and pain radiation in our body. The method therefore takes into account a holistic approach to the body, treating its individual segments as individual links in the tissue chain whose continuity is provided by the fascia. The selection of points for manipulation is made according to specific rules – based on motor and palpation verification. A detailed history is an extremely important element that guarantees effective therapy. Another aspect that underlines the uniqueness of this concept is its extraordinary therapeutic effectiveness, which in just a few visits allows to solve many problems of patients, treated in a classical manner for years.
Manual Therapy (OMT) deals with: diagnosis and treatment of structural disorders of the locomotor system (joints, muscles, nerves). Due to the extensive differential examination scheme, the physiotherapist is able to find the abnormal structures, confirm the degree of their damage and analyse the mechanisms of the appearance of ailments basing on a detailed history taken and performed examination. Thus, the therapist formulates a hypothesis of a structural disorder in the patient. The cause of the ailment often lies in the disproportion between the ability of the tissue to absorb the load and its actual load. The treatment consists in abolishing this disproportion and restoring physiological “symbiosis” between joints, muscles and nervous structures. The following techniques are used as treatment: joint mobilization, neuromobilization of nerve structures, treatment of soft tissues (i.e. muscles, ligaments, tendons), as well as medical functional training with training devices adapted to patients’ problems.
The overriding goal of the McKenzie method is to restore the full function of the disturbed structures and thus protect the patient from the next occurrence of the pain problem. After a proper education of the patient, this method allows to deal with the pain individually. The author of the method has developed a program of therapeutic management, in which, in addition to the techniques performed by the therapist, the patient’s own movement, exercises and self-therapy performed at home are important. The exercises mostly involve low and recumbent positions. Active movements are repeated many times in different planes but in a strictly defined direction that does not cause pain. Great importance is attached to recommendations that protect the spine against further injuries and overloading. McKenzie places great emphasis on prevention.