Manual Therapy

Manual therapy means "hands-on" treatment. There are many different manual therapy approaches, each able to help a specific type of dysfunction. Our aim is to match our treatment to your body's individual problem, in other words we never use a recipe based approach & never treat everyone as if they were the same! 

All manual techniques affect more than one system of the body. For example, it is common for a technique to affect the musculoskeletal, circulatory, nervous and endocrine systems. We have listed some of the more common manual therapy techniques used within the practice under the system where they are thought to make the greatest change. These are some of the main techniques used within the practice but are by no means the only techniques employed. 

Strain Counterstrain

Strain counterstrain is a gentle yet incredibly effective manual therapy technique aimed at reducing muscle tension and rebalancing muscle tone in order to relieve pain and stiffness. This type of dysfunction is usually associated with a tender point, and believed to be caused by "overactive" stretch receptors within muscle. To relax tissue tension, the tense muscles are markedly shortened, which silences their stretch receptors and eliminates the tender point. If the joint is maintained in this position for around 90 seconds, and slowly returned to its normal position, the tender point will be far less sensitive and the muscle tension far less, allowing the joint to move more freely and with less pain.  Recent advances in this technique now enable the problem to be treated just as effectively in under 10seconds!  This makes it possible for us at Pain Solutions to give you a more comprehensive, total body treatment within your appointment, which usually results in a more effective reduction in pain and stiffness!  Recent advances in this field have discovered the use of strain-counterstrain to treat the organs, nerves, arteries, lymphatic and venous supply, making this a truly comprehensive method of treating the body!

Muscle Energy Technique

This is a gentle manual therapy technique targeting the muscular element of the musculoskeletal system. In this technique, abnormalities in muscle tension (hypertonus or "spasm") that affect joint alignment and motion are identified. Imbalances in muscle tension around a joint result in reduced motion and malignment of the joint, which can lead to joint pain. Treatment involves a gentle, specific muscle contraction supplied by the patient whilst the practitioner holds the joint in a specific position. After the muscle contraction, greater muscle relaxation occurs, and following several repetitions of the technique the joint is usually able to move further into its restricted range and the abnormal joint position is corrected, alleviating pain.

Articulatory & Manipulative Techniques

These techniques are directed at the skeletal or joint component of the musculoskeletal system. Articulatory techniques are usually applied to the joints in an oscillatory fashion at the barrier to motion of the joint. The aim of these techniques is to stretch the joint and its ligaments / supporting connective tissues, thereby allowing better movement with less pain. Manipulative techniques are also applied to joints at their barrier to movement, but this time a small high velocity thrust is applied rather than a slow oscillation. This is thought to create a period of electrical silence in all muscles surrounding the joint, allowing the central nervous system to correct tone imbalances within these muscles. The desired result is a restoration of normal joint range of motion.

Myofascial Technique

Focuses on fascia, which is a connective tissue covering all of the muscles and organs in the body. The fascia is continuous from head to toe and acts to bind all of the different elements of the body together. It forms a fibrous network that not only helps to hold everything together but also maintains the position of your nerves and blood vessels. It also provides fluid to lubricate the different parts of the body, so that everything from your muscles to your organs can glide and move easily over one another. Several fascial "slings" exist which consist of interconnected muscles and their fascia which run from head to toe. In the event of an injury or chronic irritation from overuse, inflammation occurs which produces scarring or protective posturing of the injured part. It is common for the fascia to distort to help unload the injured area, which in turn can lead to patterns of muscle imbalance about a joint. When muscle imbalance occurs, some muscles (and their fascia) become tight and strong, whilst others become weak. This can be a reason for ongoing pain after an initial injury because it leads to changes in postural alignment and to joint mal-tracking during movement. In some cases a problem within one part of a fascial sling can lead to problems elsewhere in the sling, which is another reason analysis of the entire body is important when dealing with chronic pain. Direct myofascial techniques aim to stretch tight fascia in order to help restore its flexibility and overcome the imbalance. There are several major ways to do this, including active, sustained and dynamic myofascial techniques.

Soft Tissue Techniques

There are a range of soft tissue techniques which are directed at improving flexibility, circulation or tension in the soft tissues (muscular and connective tissue components of the musculoskeletal system). These include the various forms of massage, frictions, stretching techniques, and ischaemic pressure. The goal is to reduce muscle spasm and fluid congestion and increase tissue mobility.

Cranial therapy (also known as Cranial Osteopathy or Craniosacral Therapy)

Cranial therapy involves extremely gentle treatment to improve motion in the bones of the skull.  It was long thought that the bones of the skull fuse once growth stops after puberty, but more recent research has shown that the cranial bones do not fuse. They are capable of movement throughout life, and are thought to undergo small rhythmical motion at all times. This movement is thought to be important for many reasons including movement of cerebrospinal fluid which surrounds the brain and spinal cord. Restriction of cranial bone movement may happen following trauma to the head (such as a fall) or may occur via adaptation to abnormal forces arising from other parts of the body (especially long standing dysfunction involving the neck). When this occurs the cranial restrictions are thought to be a possible contributing factor for a diverse range of symptoms, including obvious "cranial" problems such as headache and neck pain, but also may contribute to symptoms related to the nervous system and the various nerves which may become irritated by cranial bone dysfunction. These include symptoms related to the vagus nerve (which supplies the cardiopulmonary and gastrointestinal systems) and the accessory nerve (which supplies muscles in the neck/shoulder area). There are many other symptoms which may occur depending on the nature of the cranial dysfunction. For example in some cases it is thought to be a cause of vomiting and colic in infants. 

Visceral Manipulation

The organs have attachment to the spine, and, when tight, in spasm or irritated, are frequently the cause of referred spinal pain.  Visceral manipulation is a very gentle manual therapy approach which, like cranial osteopathy, requires a great deal of skill on the part of the practitioner. It involves assessing and treating the organs, their supporting ligaments / fascia and the autonomic nervous system. This approach is used to help restore normal physiology and reduce hypersensitivity of the organs.

Motion normally occurs between the organs themselves, the skeletal frame and the diaphragm. If an organ is no longer able to move in synchrony with the either other organs, the diaphragm or the skeletal frame due to restriction (for example adhesions within the supporting ligaments / fascia), this may create a source of chronic irritation within the body. Now the body must adapt and move around this point of restriction. This may lead to referred pain (for example in the back or neck), which is very common in adults. The referred pain occurs when the irritation activates sensory nerves which travel back to the spinal cord and report the problem. Musculoskeletal tissues also receive nerve supply from this same segment of the spinal cord and often become irritated in response to the organ irritation (called a viscerosomatic reflex), which usually results in some hypertonus (spasm) of the affected back muscles and restriction of spinal movement, not to mention spinal pain! In this way muscular spasm may have its origin in visceral dysfunction. The visceral restrictions can be assessed with very light hand palpation, and treated using very light but specific forces to stretch any restrictions present or to relax spasm of the hollow muscular organs of the digestive tract. To understand why this approach might be very useful, it helps to know that most organ problems cause referred pain, for example in the back or neck. Thus many people who have irritable bowel syndrome, heartburn or similar problems also have back or neck pain. In such cases (which are known to affect 1 in 5 adults in the western world) this approach can produce rapid improvements in the referred symptoms as well as help the associated organ symptoms as well. 

Chapmans Reflexes

These reflexes are considered to be a form of neurolymphatic reflex usually reflecting dysfunction or pathology of the internal organs, especially those involved in the endocrine or hormonal system of the body. They present as palpable tissue texture abnormalities within the superficial fascia. Treatment is directed at the tissue texture abnormalities and is thought to have an effect on the associated organ, improving its lymphatic drainage and function.

Bennetts Neurovascular Reflexes

Related to a manual therapy approach thought to improve the microcirculation via a neurovascular reflex. These reflexes are predominately associated with dysfunction of the internal organs and hormonal (endocrine) system of the body. They present as paired tender points in specific areas of the body that can be identified and treated with gentle manual techniques, and are thought to result in an improvement in the microcirculation of the affected organ, gland or nervous system, leading to improved function in these areas and a reduction in symptoms. They are especially useful in the treatment of fibromyalgia, and appear to be instrumental in reducing the generalized muscle tenderness such patients routinely experience.

Trigger Point Therapy

Trigger points are the most common painful dysfunction involving muscle. They are colloquially known as "knots" within the muscle, but are in reality are taut bands of spasm within a muscle which have a focal tender point known as a trigger point. They are very tender when pressed, and can become severe enough to cause referred pain as well as muscle stiffness. Most patients are completely unaware that the trigger point is the source of their pain - they only feel the referred pain. This is an incredibly common cause of some types of headaches, as well as many other pain syndromes affecting all areas of the body (depending on the specific muscle(s) involved). There are several treatment options which can be effective in eliminating the trigger point and thus the pain. Which approach is used depends both on the specific muscle involved, the severity and chronicity of the trigger point, and last but certainly not least the patients personal preference.  We see this problem daily in athletes, including many of the cyclists and triathletes we treat.