Manipulative Therapies

Manipulative therapies can be defined as methods of resetting a particular body part in order to precipitate a healing response in that body. Quite often the treatment is applied at a distance away from the actual symptoms, to obtain satisfactory results.

There are several types of manipulative therapies, among which most importantly are: osteopathy, craniosacral therapy, visceral manipulation, articular manipulation, neuromeningeal manipulation, chiropractic, massage and reflexology, to name a few.Every method described below has a video following it to present it in greater detail.

Osteopathy is a therapy that uses manipulation on the whole body in order to reduce discomfort, improve muscle performance, joint movement and restore the person to full health, by working on the muscles, ligaments and skeleton.

Craniosacral therapy is a gentle, hands-on method of evaluating and enhancing the functioning of a physiological body system called the craniosacral system – comprised of the membranes and cerebrospinal fluid that surround and protect the brain and spinal cord. Using a soft touch generally about the weight of a nickel, practitioners release restrictions in the craniosacral system to improve the functioning of the central nervous system.

Visceral manipulation

is a gentle hands-on therapy that works through the body’s visceral system (the heart, liver, intestines and other internal organs) to locate and alleviate these abnormal points of tension throughout the body. At optimal health, the relationship between the organs (viscera) and structures of the body (muscles, membranes, fasciae and bones) remains stable despite the body’s endless varieties of motion. But when one organ can’t move in harmony with its surrounding viscera due to abnormal tone, adhesions or displacement, it works against all the body’s organs and structures. This disharmony creates fixed, abnormal points of tension that the body is forced to move around. That chronic irritation, in turn, paves the way for disease and dysfunction.

Articular manipulation, another part to the manipulative therapies curriculum, works on the premise that different layers of the body starting right from the deepest layer of bone to the muscles, ligaments, blood vessels and nerves, all working together to create an interdependence and unity of the body’s structure. These layers interact with the central nervous system through neural components and motor components. Specific emotions with specific personalities also have an effect on the CNS which affects all these layers. Keeping a balance in these different layers maintains joint pressure. The pressure inside a joint is important. In a healthy joint exists a negative pressure,. All the joint structures stick together to create a sucking effect inside the joint, a kind of “togertherness”. When dysfunctional the negative pressure decreases (becomes more positive pressure) which destroys the cartilage, and the joint falls apart.

Neuromingeal manipulation is a precise treatment of nerves in the body that are causing pain. This is achieved by rolling or gliding movements of the said nerve combined with movement of the extremities or joints in order to relieve any loss of mobility or tightness the nerve  may have.

Chiropractic is a therapy which involves treatment on the musculoskeletal system with paticular emphasis on the spine and nervous system. it can help shoulder and low back pain and help relieve asthma,constipation and digestive problems.

Massage, another modality in the manipulative therapies family is a very pleasant therapy that utilizes stroking, kneading and other techniques to manipulate the soft tissues of the body. It is ideal for stress relief, relaxation and as a remedial treatment for physical and emotional problems.

Reflexology falls into the manipulative therapies category mainly for its ability to relieve stress and decrease digestive problems. The technique involves applying pressure to points on the feet and sometimes the hands. therapists believe that they can stimulate energy by reflex action to a related muscle or organ and encourage healing.

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Stretches for Knee Pain

Stretches for knee pain requires that one consciously works towards achieving complete ROM in not just the knee but in all the joints of the leg, i.e.: the hip and ankle as well.  Statistics have shown that 90% of knee pain comes from tightness in the quadriceps, hamstrings and calf muscles. Hence complete flexibility of all the muscles that surround these three joints are key to alleviating knee pain. Stretches for knee pain are done as 5 reps, each with a 30 second hold. You can work muscle groups in pairs.

Stretching the hip flexors and quadriceps together:

  1. In half kneeling, i.e. while you are bearing weight on one knee, you are supporting yourself with the other leg bent at 90 degrees at the hip and knee.
  2. The foot of the weight bearing knee is placed up on a chair behind you.
  3. Bend backward gently to stretch out the quadriceps. You can reach back to hold the chair if you wish. Hold/ repeat as suggested above
  4. Lean forward on your supporting knee, so that your hip is flexed well on the supporting leg. This will stretch the opposite hip flexors. Hold/repeat as is required.

Stretching the hamstrings and calf muscles together:

  1. In standing, place your toes on a rollthat is 4-6” in diameter while staying on your heel. Place your supporting leg comfortably behind you.
  2. Tighten your quadriceps to relax your hamstrings
  3. Gently bend at your hips till you fingers reach the floor. Hold/repeat as suggested above.

Along with stretches for knee pain, strengthening of all the muscles around the hip, knee and ankle is also very important. Of these, the exercise to pay most attention to are gentle isometric contractions of the knee. To do this, sit with your leg stretched out. Place a pillow under your knee. Gently squeeze down onto the pillow while your foot lifts of the surface you are on. Hold for a count of 5. Repeat 10 times. This is a set. Perform 5 sets.

Pain is your body’s signal for help. Doing a regular exercise routine will ensure the health and stability of your knee joints. Since strengthening shortens muscles, it is advisable to start with “knee isometrics” to warm up, continue with the strengthening routine and finish with the stretches for knee pain.

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Medial Knee Pain-Understanding The Muscles

Medial knee pain is sometimes very debilitating. Don’t ignore pain. Pain is your body’s way of protecting you from hurting yourself further. I always offer this advice to my clients: “ When in pain, find out why!” Find out from your doctor what is the cause of  the medial knee pain is. Most often a torn medial meniscus or pes anserine bursitis  are the cause of medial knee pain.

Once the cause is established, physical therapy and exercises are very effective in reducing medial knee pain. It is not unusual to experience mild stiffness and aching of the muscles that lasts up to a day after exercising. But hardly being able to move for a few days after exercising means you have overdone it.

Weak or fatigued muscles are the result of pain. These cannot adequately support, in this case,  the knee joint or absorb shock before it gets to the knee and the extra stress placed upon the knee can cause further injury to the structures of the knee. Strengthening the muscles that support the knee with knee exercises is most important in increasing support and protecting your knees from further injury and medial knee pain. Strength must be built up gradually. Start with a few reps. I recommend starting with 5, increasing by 1 every other day till you are doing 10 contractions per session of a muscle group. This is one set. Usually 3 sets per session is what I recommend to be done 3 times daily. You need to increase the duration of your knee exercises gradually to avoid overuse injuries and knee pain. Be patient. You will see results.

Strengthening exercises shorten muscles so follow strength exercises with stretching exercises for maximum results. Flexible muscles are not as easily injured as tight muscles. Tightness of muscles connected to the knee can also pull the knee out of alignment. When doing stretching knee exercises, be careful to go slowly and not to overstretch. You do not want to tear a muscle. Stretching knee exercises can be done more often. You do need to hold the stretched position for 30 seconds to be completely effective.

It can happen that you have overdone your knee exercises. If this happens, “relative rest” is important for inflamed muscles/tendons. Applying ice wrapped in a cloth can help reduce inflammation and pain and speed up healing. Cut back on the strengthening reps and decrease the stretching program. Lightly exercising the sore muscle help decrease muscle soreness from overuse. However a significant increase in pain, calls for discontinuation of your exercises. Visiting your doctor is mandatory.

Main Muscle Groups Affecting Knee Stability:

Several muscle groups support the knee. The two main muscle groups that control knee movement and stability are the quadriceps and the hamstrings.

THE QUADRICEPS is a four-part powerful muscle that run along the front of the thigh and attach to the front of the shinbone, just below the knee. these are:

  • the rectus femoris,
  • the vastus intemedius,
  • the vastus lateralis, and
  • the vastus medialis.

The quadriceps control the straightening of the knees and movement of the kneecap (patella). the quadriceps is used to extend the leg, and is essential for standing up, walking upstairs and downstairs, walking uphill, and running.

THE HAMSTRINGS are muscles that run make up the back of the thigh, and attach to the back of the shinbone, just below the knee. The hanstrings comprise:

  • the semi-tendinosis,
  • the semi-membranosis, and
  • the biceps femoris

The hamstrings are used to bend the knee and are also needed when you are pushing against something.

Imbalance of the quadriceps is common, especially in women – The quadriceps is divided into 4 divisions. If the inner division if weak, which is most often the case, the stronger outer division tends to pull the kneecap toward the outer side of the leg. Tightness of the quads can also pull the knee towards one side so stretching as well as strengthening of muscles that support the knee is important. Typically, the quadriceps should only be about 25% stronger than the hamstrings. There are cases however when the quadriceps is significantly stronger than the hamstrings. This can cause weakness of the knee. Here, concentrating on strengthening exercises for the hamstrings, and stretching exercises for the quadriceps is recommended.

Other Muscles Affecting Knee Stability:

Since the body functions as a unit and even muscles not near the knee can affect its function. Other muscles that affect knee stability, to a lesser degree than the quadriceps and hamstrings are:

  • the calf muscles(the gastrocnemius),
  • the hip abductors located on the outer thigh,
  • the hip adductors located on the inner side of the thigh, beginning in the groin.
  • the iliotibial tract (fibrous tissue on the outer thigh, extending front the hip to below the knee), and
  • the glutes ( buttocks) inserts into back of the thigh bone and iliotibial band

When exercising the knee, consistency pays off. The plan is to keep your knees from recurring symptoms. Exercises must never be discontinued when managing medial knee pain.

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Integrative Healing Dynamics to treat a Torn Medial Meniscus

Integrating healing dynamics is a holistic approach and is a synthesis of several anatomically directed healing techniques. Here the techniques used  include:

  • Barral’s global joint manipulation
  • Craniosacral therapy
  • McConnell’s taping

Usually after the knee joint begins to degenerate from wear and tear and osteoarthritis slowly sets in, you have a patient walk into your office, unable to straighten out his/her knee. Several reasons contribute to this…here we will discuss one of the more commonly occurring types of tears in the medial meniscus. The meniscii have a front or anterior horn and a back or posterior horn. This tear causes the anterior horn of the meniscus to spread forward and be displaced from its regular moorings. This can be felt like a small bump in the space between the tibia and femur, medially on the inside of the knee joint.

The Upper End of the Tibia, displaying its Upper Surface

Treatment would include the following steps, as in the teachings of Jean-Pierre Barral: The patient lies on his/her back. You place the foot of the patient’s affected side on your shoulder for Steps (1) and (2). In Steps (3) and (4) the patient’s leg is treated lying straight on the table.

  1. Gently grip the upper border of the tibia with both hands and follow the motion of the knee as it rotates. It does so, first inward then outward.
  2. Next, continue to grip the upper border of the tibia. This time, make firm yet gentle contact both the sides of the knee cap, with both your thumbs, along the knee joint line. Gently but very firmly (without causing pain), nudge the protruding anterior horn back into its original space, using a series of knee bends/straightenings. This usually completely straightens the knee.
  3. The knee cap is usually displaced laterally, in these cases. Lift the knee cap upward and pull/push it gently toward the inside of the knee.
  4. Now open up the back of the knee. Stretching the muscles (in this case the semi-membranosus tendon) from medial to lateral side does the trick. Gently grip the back of the knee with both hands, while holding the knee cap in place with both thumbs and stretch outward , each hand away from the other.
  5. This is a good time to tape the knee with KinesioTape, pulling the knee cap lateral to medial to maintain the tracking achieved earlier.
  6. Exercising the knee with gentle knee presses down into the table, is best done now. I advice my patients to do these “24/7”.
  7. Finally I do a release of the lower back and spine using craniosacral techniques to afford complete relief.
  8. The patient is then shown a series of home exercises to maintain the range achieved and to strengthen both knees, in order to reduce the strain pattern developing in the normal leg.

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