Manual medicine - technique of the soft tissues - mobilization and manipulation

Officially the term „manual medicine was being used since 1965, when the La Fédération International de Medicin Manuel society was established in London. People nowadays use term „myoskeletal medicine”, alternatively „myofascial techniques”. It is about using manual (hand) techniques for treatment purposes - mobilization, manipulation, work with soft tissues (fascia - muscle sheaths, muscles, tendons…).

HISTORY OF THE MANUAL MEDICINE

The founder of manual medicine in Czech Republic was prof. Karel Lewit, who was after the world war two working in a prestigious neurological clinic of dr. Henner in the Kateřinská street in Prague. He was part of a research and treatment of the herniated intervertebral disc. Prof. Lewit was thinking logically when he imagined the mechanical effect on the damage (herniation) he started to use mechanical diagnosis and therapy (hand traction) believing that this treatment could help the patients, in some cases he even observed this effect. His inspiration was also mrs. Čápová, who studies chiropraxy in the United States. Prof. Lewit also had the luck to observe her during her work with patients, learn and evaluate, under circumstances where chiropraxy has an effect.

On the clinic, prof. Lewit proved that chiropraxy in treatment of herniated disc definitely has its place, and he left for course in Germany, the only place for learning it in Europe. Soon after that he became an instructor himself. During the time when he met with a norwegian physiotherapist Kaltenborn, it was clear that chiropraxy alone is not enough, and they expanded the method with osteopractic techniques (work with soft tissues - muscles, tendons, fascia, …, soft mobilization of the spine and joints of the limbs).

Another inspiration for prof. Lewit was collaboration with prof. Janda, which thanks to his experience with treatment of poliomyelitis in cooperation with australian nurse Elizabeth Kenny. Together they led rehabilitations while keeping in mind, that the disorder of the organ (in this case muscle, joint …) is a results of disorder of balance among the individual muscles. For example the triceps of the arm, which extends the elbow, can be weakened because of the excessive tension in the biceps, which is flexing the arm. They proved that muscle coordination is very important (muscles, that cooperate together during the movement, for example bending arm) and antagonist muscles (muscles that are working against you - one muscles is flexing, the other is extending). Prof. Lewit and prof. Janda examined this discovery of mrs. Kenny and they came to a conclusion, that the imbalance of the muscles can be diagnosed, but also treated. Patients learn during this therapy how to relieve and exercise the muscles.

MODERN VIEW ON MYOSKELETAL MEDICINE

Over time and anatomical researches there was a proved connection between muscle tension and its sheath (fascia). In each muscle is in addition long and short muscle fibres, and if the muscle is overloaded, it will result in increased tension of the short fibres and formation of trigger points. These points are well tangible and they are in typical areas of the muscle and they occur also in the muscle chains. They affect function of the muscles in its whole length from start to end. This effect was observed by american doctors Travell and Simons.
Prof. Lewit continued in their findings, with his theory how does the restricted mobility in joints or spine relate to these trigger points and how to remove them with targeted manipulation and restore the spontaneous mobility of the given segment.

Video tutorial of physiotherapeutic technique for relieving the tension in the area of the back

Kibler massaging technique



Author:
Mgr. Iva Bílková, FYZIOklinika fyzioterapie Ltd, Prague, Czech Republic

Source: Internet - archive of the Czech Radio and Czech Television, informations gained during study on university by prof. Lewit

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