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Manual Therapy Diagnostics

Healthcare Research August 19, 2018

Manual Therapy Diagnostics

Hands-on Assessment for Health and Vitality

A headache might feel like a bone bruise of the temporal bone to an Integrative Manual Therapy practitioner. That same headache can look like an energy disturbance in the tissue to a Reiki master. The headache might smell pungent to an acupuncturist.

So, which is the “real” headache? The pain, the blood flow, the bone, the energy, the smell are all just manifestations of structures and processes in the body. To each individual their perception of this manifestation is what is “real”. That is what they can work with to shift the uncomfortable symptoms and improve health.

Myofascial mapping, developed by Sharon W. Giammatteo, PT, PhD, is an assessment tool used by Integrative Manual Therapy practitioners to get an image on paper of what is contributing to the symptoms a client is experiencing. It involves the client lying clothed on a comfortable table, as the practitioner palpates, feels the surface of their body first on the front then on the back of the person.

The practitioner is feeling for several things. One, the quality of the tissue. Is it too dense, too spongy or swollen, too hot, too cold or too hard? Two, are there areas of redness, paleness, or sweat on the palms or feet. Three, they are palpating the rhythm of the connective tissue, a circadian rhythm that gives an indication of the health of the deeper tissues. Just as one can feel the effects of the heart beat far from the heart (at the wrist, for example), a skilled therapist can feel the effects of connective tissue dysfunction with their hands on the surface of the body.

Manual Therapists will also consider the range of motion or how well the joint and tissues move. They can press on a joint and feel the response or lack of response of the bones, cartilage, muscles and even whether there is enough space for the joint and muscles to move freely. This makes it easy to locate areas that don’t move as well as the surrounding tissue. These are considered to be contributors to the pain and symptoms.

The location of the tissue that is not moving the way it should, or is too hot or there is too much muscle tension or swelling can also be important. There are certain points that are considered reflex points and when they are different from the surrounding tissue it can indicate specific things.

If there is myofascial mapping over the liver but not the head, that could indicate that toxicity from the liver is contributing to the headache. If several acupuncture points along the heart meridian are more dense than they should be, it can indicate that the circulatory system is contributing to the headache.

If there is swelling and tenderness over the Chapman Reflexes, it indicates that a disturbance of the lymphatic system is contributing to the headache. Chapman Reflex points are found along the spine and the middle of the chest, they are points developed by an American Osteopath, Frank Chapman.

In 1993, Inamura, et al. in Environmental Medicine noted, the role of sympathetic (fight or flight part of the nervous system) nerve outflow to the muscles in the generation of one-minute waves in body fluid volume. A power spectral analysis of muscle sympathetic nerve activity (MSNA) was performed in an upright standing position simultaneously with the measurements of body circumference, venous pressure at the dorsum pedis veins at the ankle, intrathoracic fluid volume, soleus (muscle in the calf) EMG, and calf fluid volume.

They found that several things changed during the one-minute oscillation:

  1. an increase in calf fluid volume;
  2. a decrease in intrathoracic fluid volume;
  3. an increase in venous pressure at the dorsum pedis veins;
  4. an increase in the soleus EMG activation;
  5. an activation of muscle sympathetic nerve activity;
  6. a decrease in calf fluid volume; and
  7. an increase in intrathoracic fluid volume.

It is concluded that sympathetic nerve activity as well as cardiovascular variables have a cyclic rhythm with a duration of one minute to maintain hemodynamic homeostasis in humans in an upright standing position.

These, are the kinds of things a manual therapist pays attention to, assesses and palpates with the goal of balancing out any disturbance. Each practitioner will use their own method of assessing the problem listening to the client’s history and symptoms, observing the way they move, talk and even smell.

They will note the quality of the tissue and palpate for subtle changes. The shifts in the tissue indicate where there are bone bruises, circulation and lymphatic dysfunctions. The skill with which they assess and gather information and then put it together to come up with a plan of care, will determine the effectiveness of the treatment, the reduction of symptoms and recovery of health.

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