Mobilization, is it as effective as they say?

Mobilization beats most rehabilitation methods in its popularity. Why is this the case and is it a therapy for everyone? Is the effectiveness of treatment with a therapist's hands that high? We asked our specialists why manual therapy is so popular and what it actually is.  

Manual therapy is an ever-evolving method of treating various types of musculoskeletal dysfunctions with the therapist's hands, applied after a detailed diagnosis of the patient. Its goal is to effectively and quickly improve the patient's comfort and restore his or her function as much as possible. The basis is a proper diagnosis, and for this we use specialized tests, individually tailored grasps, compressions and manipulations, and most importantly we take a comprehensive approach to the problem. All the steps we perform in the office are aimed not only at controlling the symptoms of pain - but most importantly, treating the cause of the pain. Based on the interview and examination, the physiotherapist selects the most effective method of manual therapy for the patient's current functional state.

Undoubtedly, this is one of the main reasons for the popularity of this method," says physiotherapist Przemysław Podbielski.

Mobilization is the basis of rehabilitation

- Physiotherapist Wojciech Solis. - Now for some details. Before starting therapy, the physiotherapist conducts an interview with the patient, as well as a palpation (tactile examination) and functional examination of the musculoskeletal organ. This examination takes place both at rest and during movements. The therapist evaluates the appearance and consistency of soft tissues, the range and quality of movement of bony elements, and the nature of resistance occurring when moving the various structures of the musculoskeletal system against each other. He examines the active and passive movements of the spine, joints and evaluates the responses of the musculoskeletal system to factors harmful to its structures.

What are the indications for mobilization?

- Przemysław Podbielski (P. P.): The list of indications is quite long.

On the spinal side, these include:

• sciatica
• intervertebral disc herniation
• discopathy
• headaches
• neck pains
• "lumbago", "roots".
• Whiplash (damage to the cervical region after traffic accidents).

In the case of complaints from the upper and lower extremities, we can mention:

• painful shoulder syndrome,
• frozen shoulder
• tennis elbow
• golfer's elbow
• carpal tunnel
• hip pain
• ITBS hip-band syndrome
• lateral patella
• jumper's knee
• chondromalacia of the patella

Manual therapy has excellent results in post-traumatic conditions, such as.

• damage, muscle strain
• sprain of the knee, ankle joint
• Pulling, tearing, rupture of cruciate ligaments of the knee joint
• Pulling, tearing, rupture of collateral ligaments of the knee joint
• meniscus injury
• dislocation / subluxation of the patella
• damage to the rotator cone of the shoulder joint
• fracture states
• conditions after immobilization

What manual therapy methods are used?

-WojciechSolis (W. S.) - I would first mention manual therapy according to the German school. Thanks to an elaborate differential examination scheme, the physiotherapist is able, by means of a detailed history and examination, to find the disturbed structures, determine the degree of their damage and analyze the mechanisms of the appearance of the ailment. Thus, he makes a hypothesis of the disorder in the patient.

Treatment involves abolishing the disproportion in the structures of the musculoskeletal system and restoring the physiological "symbiosis" between joints, muscles and nerve tissue.

Examples of techniques: joint mobilization, neuromobilization of nerve structures, treatment of soft tissues, i.e.: muscles, ligaments, tendons.

Also included in the therapy area is medical functional training using training equipment tailored to the patient's problems.

More recently, we have also been using pinotherapy (pinopressure). This is a non-invasive method that involves stimulation of areas on a person's skin.

The method is categorized as reflex therapy, where the body's self-repair processes are used. With the help of copper nails (called pins) and knives (katas), specific points on the body are pressed and stimulated. It should be noted that in pinopressure the skin is not pierced. The stimulation of the skin stimulates certain centers in the brain. As a result, our muscular or ligamentous system receives signals from the corresponding parts of the brain, which leads to a reflex relaxation of accumulated tensions and reduction of pain.
Pinotherapy is widely used in various types of orthopedic and neurological conditions.

It is recommended in cases such as:

• Myofascial pain,
• headache,
• Cervical, thoracic and lumbar spine pain,
• overload pains,
• Post-traumatic and post-surgical conditions,
• Limitations in the range of motion in the joints.

P. P. - Worth noting is the FDM (Fascial Distortion Model) method - a very effective and evidence-based system for diagnosing and treating musculoskeletal injuries.

This treatment system is based on six fascial deformities, each with a specific description of the nature of the pain. The key diagnostic element is the patient's body language, that is, the description of the pain they are experiencing. A knowledgeable physiotherapist is able to accurately assess the cause of the pain and select the appropriate therapy.

Therapy of internal organs of the abdominal cavity

When describing manual therapies, it is impossible to omit visceral therapy. It is a manual therapy of the internal organs of the abdominal cavity, aimed at restoring their normal tension, flexibility and mobility. Working through the system of internal organs, which has numerous anatomical and functional connections with other structures in the human body, makes it possible to effectively assess and eliminate various conditions of the patient.

A problem with the function of an internal organ can affect problems with the attachments of that organ, which again can cause pain and increase defensive muscle tension. This tension can also generate pain and give rise to joint problems. Such a chain of cause and effect can also work in the other direction, leading to an unresolved joint problem becoming the cause of a problem with the functioning of, for example, the stomach.

W. S. - It is extremely important to be able to assess the impact of visceral problems on the biomechanics of the spine and peripheral joints. Therapists' experience has shown that most chronic pain problems, which have their manifestation in joint and fascial mobility disorders, have many connections to the internal organs.

Who can be helped by visceral therapy?

Indications for visceral therapy include:

• Chronic and acute headaches and back pain,
• Specific problems of the gastrointestinal tract, such as irritable bowel syndrome, gastric neuroses, etc...,
• projected pain syndromes,
• pseudo-root syndromes,
• Nonspecific back pain,
• Urinary and fecal incontinence,
• constipation,
• painful periods,
• edematous and exudative problems,
• Varicose veins of the rectum and lower extremities,
• Some peripheral joint pain,
• Supporting the treatment of respiratory diseases.

I would also add that a referral is required for treatments. Paid patients can go directly to a physiotherapist for a treatment plan. Patients who opt for free treatment under the National Health Fund only need a referral for rehabilitation from a general practitioner or specialist, such as an orthopedist or neurologist.

Thank you for the interview.