CM-IMAM 313-week 8- Manipulative Practices.pdf

Complementary Medicine (CM) IMAM 313 week 8: Manipulative and Body-Based practices (physical therapies) By Dr. Saud Alsanad Chiropractic General principles & Developments Chiropractic is a manual therapy involving manipulation of the neuromuscular system with a focus on the spine to achieve norm...

Complementary Medicine (CM) IMAM 313 week 8: Manipulative and Body-Based practices (physical therapies) By Dr. Saud Alsanad Chiropractic General principles & Developments Chiropractic is a manual therapy involving manipulation of the neuromuscular system with a focus on the spine to achieve normal function. Chiropractic employs a technique of spinal manipulation based upon theory that problems associated with vertebral alignment may result in neural, muscular or sensory disorders. Realignment of the spine aims to restore normal movement through manipulation. Thus, the principle of chiropractic is that the spine is the central to the maintenance of health. It does not directly treat the disease; instead, it corrects the ‘spine-related’ cause of the illness. General principles & Developments ✔ ✔ ✔ ✔ Chiropractic originated from Daniel Palmer (1842-1913) who manipulated the neck of a work colleague and alleged cured his colleague’s deafness. Palmer asserted that minor “subluxations” (misalignment of the spine) could impact upon a person’s health. Palmer then developed a theory of musculoskeletal effects upon the central nervous system; this is based upon four premises: The body’s inherent ability to heal itself. Centrality of the nervous system: 31 pairs of spinal nerves pass through opening in the vertebrae. If vertebrae are misaligned, this will cause pressure and inflammation, subsequently distort neural impulses and result in damage to surrounding tissue. Subluxation and joint misalignment interfere with optimal functioning of the neuromuscular system. Identification and treatment through manipulation of subluxations. Diagnosis Thorough assessment of the spinal column is essential prior to any form of manipulation, using criteria summarized in the acronym (PARTS): ✔ Pain: assessment of pain through percussion, observation, palpation. ✔ Asymmetry: assessed using palpation, ,radiography and observation. ✔ Range of motion: assessment of various types and range of motion. ✔ Tissue characteristics: color, tone, temperature, observation of swelling or abnormality. ✔ Special procedures: ultrasound and other diagnostic procedures. Treatment Adjustment occurs through manual manipulation using parts of the hand and fingers. Direct and/or indirect pressure or thrust may be used. On average, patients should expect to need 4-6 sessions of chiropractic to feel the benefit. According to the literature, indications for chiropractic include: ✔ Relief of low back pain. ✔ Management of neck pain. ✔ Relief of neck back pain. ✔ Migraine. ✔ Neck dysfunction. However, research chiropractic efficacy remain inconclusive. Safety considerations Generally, chiropractic is considered safe if it is performed appropriately: ✔ Should only be performed by qualified and skilled practitioner. ✔ Should be avoided with bone cancer or other spinal disease patients. ✔ It is not suitable in severe osteoporosis and arthritis, inflammatory disease, traumatic injuries, or if patients is on anticoagulation medication. Education and Licensure of Practitioners In the UK: ✔ All chiropractors in the UK must be registered by law with the General Chiropractic Council (GCC) and meet these requirements: A degree in chiropractic (recognized by GCC). No health issues that may prevent safe treatment. Valid indemnity insurance. A commitment to maintain their skills and knowledge. ✔ Chiropractors registered with the GCC sign up to the GCC’s Code. This outlines minimum standards that are required to practise safely in the UK. ✔ There are national guidelines on the treatment of low back pain noting that chiropractic manipulation is recommended as a symptomatic treatment for acute uncomplicated low back pain. ✔ Chiropractic and osteopathy are the only two complementary therapies regulated by statute. “GCC” Education and Licensure of Practitioners In the US: ✔ To practice in the United States, chiropractors must earn a Doctor of Chiropractic (D.C.) degree, pass the National Board of Chiropractic Examiners exam, and have a state license. All states require practicing chiropractors to take continuing education classes. ✔ To enroll in a D.C. program in the United States, which typically takes 4 years to complete, students must have had at least 3 years of undergraduate education. ✔ Institutions that award the D.C. degree are accredited by the Council on Chiropractic Education, which is recognized as an accrediting agency by the U.S. Secretary of Education. In 2017, there were 15 accredited D.C. programs on 18 campuses. ✔ Chiropractic education includes classes in basic sciences, such as anatomy and physiology, and supervised clinical experience in which students learn skills such as spinal assessment, adjustment techniques, and making diagnoses. ✔ Some chiropractors complete postgraduate education in specialized fields, such as orthopedics or pediatrics. “NCCIH” Osteopathy General Principles & Developments Osteopathy is a discrete clinical discipline involving mechanical, functional and postural treatment of the structure of the body and its relationship with problems affecting the neuromusculoskeletal system. Osteopathy emerged as a system of manual medicine in 1874 and the approach is still based upon the original three principles: I. The body contains an inherent ability to combat disease and maintain health; II. The structure and function of the body are interrelated; III. The body is more than the sum of its parts: ✔ Thus, dysfunction in the musculoskeletal system may contribute to other organ dysfunction such as constipation or headache. ✔ If the structure of the body is sound, the body is more able to maintain health and recover from illness. General Principles & Developments Osteopathy is perceived as a well-established therapy, underpinned by extensive clinical training (4-5 years), which is central to the ability to make differential diagnosis, in order to distinguish appropriate manual care. Associated therapies to the osteopathy include spinal manipulation, chiropractic, craniosacral therapy and posture-based therapies. Diagnosis A detailed patient history is taken, including mode of onset, extent, duration and severity of current or previous episodes. This may be categorized into congenital, developmental, traumatic, degenerative or pathological. Determination of pathological or psychological issues is also considered when assessing dysfunction. Examination consists of palpation to determine changes in tissue and muscle and observation of the body for posture and respiration, mobility and sensitivity. Passive palpatory examination is regarded as one of the hallmarks of osteopathy from which a segmental analysis is developed. X-rays may also be taken for further structural information. Treatment A treatment session usually lasts approximately 30 minutes, with 6-12 treatments constituting a full course. Osteopaths do not treat conditions per se, prescribe medications or use invasive techniques such as injections. Osteopaths work with their hands, using a wide variety of manual techniques including soft tissue stretching, passive movements to improve joint flexibility or high-velocity thrust techniques to improve mobility and joint movement (the double click). Progress is monitored over subsequent treatments and therapy is perceived as a collaboration between therapist and client. Treatment Despite research osteopathy efficacy remain inconclusive, it has good evidence for the following indications: ✔ Low back pain ✔ Neck and shoulder pain. ✔ Arthritis. ✔ Headache. ✔ The General Osteopath Council (GOC) reported up to 40% improvement in symptoms of chronic fatigue syndrome following osteopath treatment. ✔ Craniosacral therapy: for certain conditions, particularly in babies and young children, craniosacral massage may be used. This involves gentle release techniques based upon the premise that cranial sutures have the ability to move very slightly. This manipulation is thought to enhance the circulation of cerebrospinal fluid, so relieving symptoms such as infantile colic, insomnia, irritability or certain behavioral problems. This should only be carried out by experienced and qualified therapies. Safety considerations Should only be performed by qualified and skilled practitioner. ✔ Should be avoided in: • Osteoporosis. • Active bone disorders. • Brittle bone disease. • Spinal trauma. • Stroke. • Direct treatment over infected areas. Reflexology General Principles & Development Reflexology employs varying degrees of pressure, commonly to the hands and feet, to promote health and well-being. There is evidence to suggest that the therapeutic use of hand and feet pressure for pain relief and a range of symptoms existed in China and India over 5000 years. Reflexology is based on the premise that the internal organs of the body are ‘mapped out’ on the surface of the hands, feet and ears. Treatment of internal organs is said to occur through gentle pressure to specific area of the hands or feet, causing a therapeutic effect via ‘reflexes or zones’ that run throughout the body, terminating in the hands and feet. It has been suggested that when pressure is applied to reflexes, the natural energy flow of the body (Qi) is stimulated so that blockages, sometimes felt as gritty deposits under the skin, are dispersed, promoting harmonious energy flow around the body. More recent developments of reflexology are commonly attributed to William Fitzgerald who was an ENT specialist at the end of the 19th century. He claimed that each zone manifested externally in the hands and feet so that gentle pressure on specific zones could produce a therapeutic response elsewhere in the body. General Principles & Development However, the concept of reflexology remains unexplained since there is no known neurophysiological basis for connections between the hands, feet and internal organs. The concept of channels of energy flowing around the body is not unique to reflexology and can also be found in acupuncture and shiatsu. Similar approaches to reflexology include massage, shiatsu, reiki zone therapy, metamorphic technique. Diagnosis & Treatment A full history is usually taken by the practitioner. The patient may be sitting with feet elevated on a chair, or lying down. Hand or foot therapy usually follows a particular procedures, depending upon the style of reflexology employed. Each ‘zone’ will usually be treated systematically, employing direct pressure or massage. Painful or ‘gritty’ areas are identified and light to strong pressure applied. Oils may be used as lubricants to facilitate therapy. Treatment usually lasts between 30 and 45 minutes, and patients are encouraged to drink plenty of water following a session and to rest for a short while following treatment. Diagnosis & Treatment There appears to be a common consensus that foot and hand massage are efficacious in facilitating relaxation and thus provide some relief for stress-related symptoms. At present there are few published RCTs to support claims. Some evidence also support the benefits of reflexology for: Anxiety. Migraine. Premenstrual symptoms. Safety considerations Reflexology is generally very safe. However, some contraindications include: ✔ Specific foot conditions such as gout, open foot ulcers, peripheral vascular disease. ✔ Direct treatment over bony or soft tissue injury. ✔ No clinical diagnosis should be made with reflexology. ✔ Care should be taken when treating diabetic patients as foot injuries may be less well recognized in this client group. Shiatsu General principles Shiatsu is also referred to as ‘acupressure’ and uses pressure points, as in acupuncture but without use of needles. The term ‘shiatsu’ literally means ‘finger pressure’ in Japanese but in reality the therapy is performed with the use of pressure from fingers, hands, elbows, knees and feet, along Qi energy pathways known as meridian lines. It is therefore popular with patients who are terrified of needles or for whom they are contraindicated (bleeding disorders). General principles The modern form of shiatsu was introduced to the West approximately 40 years ago. In comparison with acupuncture, the most significant differences occur in the use of direct pressure rather than the insertion of needles into the body, the use of some aspects of massage and working with patient’s breathing patterns in order to gently extend or flex the body where appropriate. Diagnosis & Treatment Visual, facial, tongue and ‘hara’ diagnosis (gentle abdominal palpation) is performed. A detailed personal history will also be obtained. Unlike massage, shiatsu is conducted with the patient wearing, ideally, loose cotton clothing. Therapy occurs with the patient initially lying down and then gently being moved according to the treatment required. A recent particularly widespread application of shiatsu is the use of elasticated wristbands which have a ‘button’ attached to produce pressure at the relevant point. These are used to treat travel sickness and morning sickness of pregnancy. Diagnosis & Treatment According to the literature, indications for shiatsu include: ✔ General healthcare and to promote relaxation. ✔ Fatigue and anxiety. ✔ Motion sickness. ✔ Menstrual cramps. ✔ Tension-related disorders such as headache. ✔ Nausea and vomiting. Safety considerations Contraindications to shiatsu include: ✔ Direct pressure on painful areas. ✔ Osteoporosis. ✔ Burns. ✔ Bruises. ✔ Skin infections.