 Traction

 Massage
 Trigger Point Therapy
 Active Release Techniques : A practitioner determines where adhesions
are through touch, the practitioner then couples a patient's active
movement with his/her touch. [3]

 Assisted Active Range of Motion  (AAROM)

 Passive Range of Motion
 Lymph Drainage
 Stretches (muscle, neural tissue, joints, fascia)
 Instrument Assisted Soft Tissue Mobilization

 Joint Manipulation: A passive, high velocity, low amplitude thrust

applied to a joint complex within its anatomical limit* with the intent to
restore optimal motion, function, and/ or to reduce pain. [4]
 Joint Mobilisation: A manual therapy technique comprising a
continuum of skilled passive movements to the joint complex that are
applied at varying speeds and amplitudes, that may include a small-
amplitude/ high-velocity therapeutic movement (manipulation) with the
intent to restore optimal motion, function, and/ or to reduce pain. [4] 

NB The terms "Thrust Manipulation" and "Non-Thrust Manipulation"

have been used in the literature.  "Thrust Manipulation" is used to describe
interventions described as Manipulation by IFOMPT, and "Non-Thrust
Manipulation" would be synonymous with the term Mobilization as proposed
by IFOMPT.  

Guide to Grading of Mobilisations/Manipulations

Maitland Joint Mobilization Grading Scale:
Grade I - Small amplitude rhythmic oscillating mobilization in the early
range of movement

Grade II - Large amplitude rhythmic oscillating mobilization in the

midrange of movement

Grade III - Large amplitude rhythmic oscillating mobilization to point of

limitation in range of movement

Grade IV - Small amplitude rhythmic oscillating mobilization at end of the

available range of movement

Grade V (Thrust Manipulation) - Small amplitude, quick thrust at end of

the available range of movement

Kaltenborn Traction Grading Scale:

Grade I - Neutralises joint pressure without separation of joint surfaces

Grade II - Separates articulating surfaces, taking up slack or eliminating play

within joint capsule

Grade III - Stretching of soft tissue surrounding joint

Three Paradigms for Manual Therapy Therapeutic Effects

1. Physiological: positive placebo response
2. Biomechanical and Physical: facilitates repair and tissue modelling
 3. Psychological: pain relief via- stimulates gating mechanism; muscle
inhibition; reduction of nocioceptive activity; reduced intraarticular or
periarticular pressure

Indications for Manual Therapy •

Manual therapy is indicated when there is

: – Mild pain –

A non-irritable condition –

Intermittent musculoskeletal pain

– Pain that is relieved by rest, or by particular motions or positions

Contraindications to Manual Therapy

• Absolute –

· Bacterial infection

– · Malignancy

– · Systemic localized infection –

· Sutures over the area –

· Recent fracture – ·

Cellulitis –

· Febrile state –

· Hematoma –

· Acute circulatory condition –

· An open wound at the treatment site

Absolute – ·

Bacterial infection

– · Malignancy

– · Systemic localized infection –

· Sutures over the area – ·

Recent fracture – ·

Cellulitis – ·
Febrile state

– · Hematoma

– · Acute circulatory condition

– · An open wound at the treatment site Contraindications to Manual Therapy •

Absolute – ·

Osteomyelitis – ·

Advanced diabetes – ·

Hypersensitivity of the skin – · .

Inappropriate end feel (spasm, empty, bony) –

Constant, severe pain, including pain which disturbs sleep, indicating that the condition is likely to be in
the acute stage of healing 1 2 3 4 5 6 7 8 11/22/2013 2 is likely to be in the acute stage of healing

– · Extensive radiation of pain –

· Pain unrelieved by rest

– Contraindications to Manual Therapy • Relative • · Joint effusion or inflammation • · Rheumatoid

arthritis • · Presence of neurological signs • · Osteoporosis • · Hypermobility • · Pregnancy • · Dizziness
Soft Tissue Techniques • Transverse Friction Massage

– A technique devised by Cyriax whereby repeated cross-grain massage is applied to muscle, tendons,
tendon sheaths, and ligaments

– Contraindicated for acute inflammation, hematomas, debilitated or open skin, peripheral nerves, and
with patients who have diminished sensation in the area