Manual therapy

4. WHAT DOES MANUAL THERAPY MANAGEMENT LOOK LIKE?

1. At the first visit, we perform a precise and detailed initial assessment of our patients, where we ask about past injuries, surgical interventions and painful time periods since birth. Over the course of this discussion we keep on investigating and looking for correlations until we find the connection between the current complaints and past traumas. Thus, by understanding the symptoms, we can provide the most effective treatment for each and every patient.
2. After this, functional tests are performed to evaluate motions that are painful for patient.
3. Based on this, a functional diagnosis is established, which in turn helps us to prepare the treatment plan. This means that a thorough, in-depth discussion with the patient and the reactions for physical tests are both important factors in the selection of the treatment method.
4. After we have established the treatment strategy, the selected method will be put into practice, with continuous re-evaluation of the changes. If we see improvement, physical therapy can be started, which you will have to continue at your home. In case your condition did not improve, we prepare a new treatment plan and proceed with it according to the process described above.

5. WHICH MANUAL THERAPY METHODS DO WE APPLY AT OUR OFFICE?

It should be noted that there are numerous manual techniques; here we only list the ones we use in our office.

• VCT concept: Visceral therapy, which treats internal organ issues.
• The Maitland concept: A treatment method that uses special grips developed for the assessment of the joints, muscles and nerves of the spine and limbs.
• The Mulligan concept: Manual therapy corrects the position of the joint, while the patient simultaneously moves the treated joint actively to the appropriate directions.
• The McKenzie method: The basis of this approach is that when certain postures or movements cause pain, then the pain can also be stopped by repeating certain movements.
• The Barvichenko method: Primarily suitable to treat joint problems, this method aims to restore the motion dynamics, original statics or functions of the joint by manual mobilization.
• Stecco method for fascial manipulation: This treatment targets the fascia (the connective tissue system of the body), and corrects the already present dysfunction, for example headache, joint problems or certain internal organic problems.

6. WHICH MANUAL THERAPY TECHNIQUE IS EFFECTIVE FOR YOU?

As the above methods rely on various principles, it depends on the nature of your problem which method should be applied. It is important that each manual technique has its own place and role, therefore we always apply them on a case-by-case basis.

The best way to illustrate this is to comparing our body to the following horse-drawn carriage.

Bones Joints Muscles Fascia Brain

Coachman
fascia (connective tissue) Passenger
central nervous system Carriage
bones Wheels
joints Horses
muscles

If the muscle is weak

There are methods that focus on the muscles (strengthening, trigger points, physiotherapy), based on the principle that - using our examples - if the horses are strengthened, the carriage will move smoothly. Muscle strengthening is a key part of rehabilitation after an injury or surgery.

If the bone is damaged

For injuries involving bruising and fractures, the most important task is to restore the movement of the bone and the joint that contains it. Some manual therapy methods (McKenzie, Maitland, Mulligan, etc.) approach the issue from the side of joints and bones. The principle of these techniques is that if a wheel of a carriage gets damaged, it has to be hammered back and then the carriage can move on.

If the joint is damaged

If you sprain your ankle or your neck in a car accident, the most important thing is to restore the movement of the damaged joints. Some manual therapy methods (McKenzie, Maitland, Mulligan, etc.) approach the issue from the side of joints and bones. The principle of these techniques is that if a wheel of a carriage gets damaged, it has to be hammered back and then the carriage can move on.

If the connective tissue is stretched

In the case of chronic complaints without a real injury and appearing spontaneously, there is often a controlling problem. The horses are overloaded and the wheels get damaged as the carriage is being driven off the road. With the Stecco method, we approach the problem from side of the fascia, so we try to influence the coachman to keep the horses on the road more easily. Hence, the carriage is no longer burdened by the bumpy road and the horses can cope with the task more easily.

If there is a problem with the nervous system

The passenger determines the direction of the travel, which he or she commands to the coachman to take. If the communication between them is not good, the horse-drawn carriage will go to the wrong place. In such a case, the communication between the passenger and the coachman must be worked on. There are techniques (neurodynamics, neuro-movement correction, CBT) that target the central nervous system (brainstem, spinal cord) and the peripheral nervous system.

7. BENEFITS OF MANUAL THERAPY TREATMENT

• A natural remedy without side effects
• No medication required
• Treatments have an immediate effect
• In most cases, there is no need for too many or too frequent treatment sessions

8. WHEN TO SEE A PHYSICIAN AND WHEN TO SEE A MANUAL THERAPIST?

In case of musculoskeletal injuries, it is always worth asking for the opinion of a movement therapist, either a physical therapist or manual therapist, firstly because you will get professional answers to your questions, and secondly because this takes off the load from physicians. Also, it is often the case that doctors prescribe an anti-inflammatory drug for a minor injury, or you get a medical brace or an elastic bandage, which results in fixing the injury at this position – however, real healing will not start. All joints determine the state to which they should “recover” to based on their movements, thus it will only be able to properly regenerate with professional care. A movement therapist can help you the most in this.

Therefore, you only need to see a doctor if you have a serious injury, your pain is getting worse two days after the injury, or if the affected area becomes purple and swells. In such cases, the physician can decide based on an X-ray or MRI image whether surgery is necessary.

9. PHYSICAL THERAPY OR MANUAL THERAPY? A COMBINATION OF THE TWO CAN BE MUCH MORE EFFECTIVE

Regarding lower back pain, the following conclusion can be drawn based on research results and also on our own experiences: When the cause of lower back pain cannot be determined during the assessments, physical therapy exercises can help to improve your well-being, but it does not guarantee that all your complaints will cease. Because of this, the best option is to combine physical therapy with manual therapy.

10. WHAT IS THE DIFFERENCE BETWEEN MANUAL THERAPY AND CHIROPRAXY?

During manual therapy treatment – as we have mentioned above –, the therapist established a functional diagnosis after a thorough assessment and prepares a treatment plan on this basis. Treatment intensity varies individually – this depends on the patient’s condition.

It is worth noting that manual therapy can only be performed by a physiotherapist or physician with a higher-education degree, while chiropraxy is different: it is based on folklore traditions, as in Hungary, there are not any chiropraxy education programs recognized by the Hungarian National Public Health and Medical Officer Service or the Hungarian Medical Association. There are some courses (2 to 3 days!) which last for shorter or longer times, but anyone can complete them, no professional qualifications are required.

In chiropraxy, with the lack of appropriate technical knowledge, the thorough assessment before the treatment is usually omitted. In addition, chiropractors use sudden and rapid manipulation to treat the painful area – rather or completely disregarding the underlying problem –, and although this might improve the symptoms, the intervention can pose a serious risk to the patient: bone fractures, impaired circulation paralysis can occur, or the treatment can even be life-threatening.

Thus, you should be very careful and only turn to a trustworthy professional with the appropriate qualifications to treat your problems!

11. Manual therapy prices

Status assessment, is the first step to take in every case, which takes 60 minutes.
The status assessment session costs 17.000 HUF.
If a senior physical therapist performs it, it costs 22.000 HUF.
The status assessment includes consultation, testing and treatment.

The further treatment sessions are 50 minutes long and cost 17.000 HUF.
If a senior physical therapist performs them 20.000 HUF.