Manual Medicine Integration

An Overview of Selected Manual Medicine Methods
Cranial-Sacral Therapy (CST)
The cranial-sacral system addresses bones and membranes that surround the central nervous system. Restrictions here can strain neural tissues and affect correspondingly innervated somatic areas, organs, or tissues. CST uses light manual techniques aimed at inducing relaxation responses that decrease, unwind, or remove neural tissue strain. CST, while particularly effective for treatment-resistant headaches, also have positive bearing on varied cases of unresolved chronic muscle and joint pain. Case studies show usefulness in helping resolve some digestive and neuro-endocrine disorders. Learning curves, attention spans, and memory retention are often reported improved.

Movement Therapies and Postural Re-alignment
Postural habituation and any form of trauma or sudden mal-positioning are the most common causes of tissue structure / function imbalance. Compensations include often inappropriate tissue lengthening and shortening. Somatic dysfunctions over time build up and bear heavily on joints and their surrounding / supporting structures. Muscle length / strength imbalance identification allows for both prevention and proper resolution of Neuro-myofascial syndromes. Postural and Movement Rehabilitation addresses these imbalances.

Lymphatic Drainage Therapy (LDT) / Manual Lymphatic Drainage
Trauma, physical deconditioning, lack of exercise, myofascial restrictions, and local tissue / area inflammation can cause lymph stagnation. Buildup of cellular debris and inflammatory mediators reinforce the Nociceptive cycle and somatic dysfunctions. LDT can improves circulation and helps resolve edema. Joint and soft tissue swelling can be significantly reduced. Chronic pain syndromes can be improved or partially resolved.

Neuromuscular Techniques (NMT) / Neuro-myofascial techniques (NMF-T)
Fascial restriction and muscle hypertonus are highly responsive to various NMF techniques. Major techniques include Myofascial Releases, Muscle Energy Techniques (MET), Positional Release Technique (PRT), and Trigger Point-Proprioceptive Therapy.
Reflexive De-Afferentation Techniques (RDTs) have evolved from Neuro-myofascial techniques. Pain cycles easily broken with NMF techniques include headaches, nape and shoulder pain, TMJ pain, knee and foot pain. Mechanical and repetitive strain injuries that may be addressed with NMF-T include mechanical low back pain syndromes, thoracic outlet syndromes, “frozen shoulder,” carpal tunnel syndrome, lateral epicondylitis, and plantar fasciitis. Our suggested term would be “neuromyofacial-endocrine” techniques, given the profundity of effects from working on the fascia.

Articulatory techniques (ART)
Soft tissue injury and cumulative joint trauma result in joint ROM restrictions and / or pain. These techniques involve taking joints through their restrictive and compliant motion cycles. They improve joint range or motion and help ablate joint pain cycles.

Movement with Mobilization
Movement with Mobilization (MWM) is based on Mulligan's work.
His SNAGs = Sustained Natural Apophyseal Glides involve passively (operator) introduced translation that is maintained while the patient goes toward the restricted end-range. The translatory or gliding force is typically maintained while a return to passive neutral is established.

One of the easiest and most useful techniques that can be taught to patients is the one involving a towel drawn against the nape and tugged on forward by the patient via handhold on either side. These have been called self-MWMs.


The Functional Techniques of Osteopathy appear to be the closest analogue.


1) Visceral Manipulation (VM, Ventral OMT techniques)
Trauma, lack of exercise, physical deconditioning, cumulative soft tissue injury, inflammation, surgery, or obesity can displace, restrict, tighten, or scar ligament and fascia that surround, support, or suspend organs. Fascial and ligamentous injury can result in focal strains that cause tissue or organ dysfunction and injury. Pain and inflammation cycles are facilitated. VM uses soft vectoral techniques aimed at re-engaging normal suspension or movement of internal tissues / organs.
The notion of tissue restrictions or compliance to movement extends to the viscera. Organs, fascia, mesentery, and visceral ligaments move along and in relation to each other in much the same way that we know normal fascia-muscle compartments do. This notion of mobility in relation to each other is differentiated from intrinsic organ motility. Organs are mobile in relation to each other and often possess an internal movement or motility. As all fascia moves with breathing, the lungs move as we breathe, the stomach and intestines move in relation to each other during peristalsis, the urinary bladder shifts location somewhat when we piss. Viscera also move around a bit with ambulation. Visceral mobility restrictions are thought to restrict normal fluid, solid, and impulse conduction through individual organs. VM addresses these restrictions.
Musculoskeletal conditions linked to visceral involvement include:
1. Mid to low back pain: The colon’s attachment to the back of the abdominal compartment may be strained. This can lend ligamentous tightness or displacement which, in turn, can inhibit normal spinal movement. These spinal segmental dysfunctions result in their related pain constellations.
2. Neck stiffness and pain: The suspensory ligaments of the lung and the pericardium all attach to cervical vertebrae. Ligamentous involvement here can cause cervical joint compression and flexion cervical somatic dysfunction. A forward head posture may thus actually be more closely related to a lung problem than to a thoracic spine dysfunction.
3. Shoulder restrictions and pain: Most paramedical personnel are familiar with the fact that gallbladder inflammation can result in pain that radiates to the right shoulder. Nerves that supply the suspensory ligaments of the liver stem from the spinal segment that innervates the shoulder. Liver suspensory ligament involvement may thus result in shoulder somatic dysfunctions.
4. Peripheral joint pain: Visceral compartment restrictions can transmit tension via adjacent myofascial trains into the limbs. These tension lines can cause compressive and torsional joint irritation and dysfunction.
5. Comparative Studies have found Visceral Manipulation also Beneficial for:
Somatic-Visceral Interactions
Chronic Spinal Dysfunction
Headaches and Migraine headaches
Carpal Tunnel Syndrome
Hip and Knee Pain
Sciatica
Whiplash
Seatbelt Injuries
Chest or Abdominal Sports Injuries

Visceral Manipulation has been known to improve:
1. Fatigue: Abnormal fascial tension or scarring from at the visceral suspension system may result from inflammation, surgery, and blunt or countercoup trauma. Loss of organ mobility due to restrictions of surrounding and supporting tissues have been linked to general fatigue. By example, lessened fatigue has been reported by whiplash-injured VA patients. Faster recovery rates and lower incidences of depressive symptoms have likewise been reported.
2. GI motility disorders: Ileus, constipation, and irritable bowel syndrome: Abnormal fascial tension or scarring from at the small and large intestinal suspension system may result from inflammation, surgery, or blunt trauma. This causes restrictions that negatively alter bowel motility and function.
3. Hemorrhoids: The venous drainage from the rectum toward the liver is impeded when the hepatoduodenal ligament is abnormally tight. The resultant vascular congestion can cause or aggravate hemorrhoids.
4. Incontinence: Ligament us tightness and muscle hypertonus may limit proper urinary bladder expansion and emptying.
5. Comparative Studies have found Visceral Manipulation Beneficial for:
Digestive Disorders
Bloating and Constipation
Nausea and Acid Reflux
GERD
Swallowing Dysfunctions

Women’s and Men’s Health Issues
Chronic Pelvic Pain
Endometriosis
Fibroids and Cysts
Dysmenorrhea
Bladder Incontinence
Prostate Dysfunction
Referred Testicular Pain
Effects of Menopause Pain Related to
Post-operative Scar Tissue
Post-infection Scar Tissue
Autonomic Mechanisms


Pediatric Issues
Constipation and Gastritis
Persistent Vomiting
Vesicoureteral Reflux
Infant Colic

Emotional Issues
Anxiety and Depression
Post-Traumatic Stress Disorder

Bowen Therapy in the Philippines
Bowen Therapy and RDTs

For someone so used to mind-bogglingly fast functional results with OMT and a synthesis of Manual Medicine, I have recently gained an unexpected new respect for Bowen Work (Bowen Therapy). I have also regained foothold on the concept that, yes, it also matters who you learn your techniques from.

We've had the good fortune of leaning directly from Andrew Zoppos. Andrew learned Bowen's work from "Ozzie" Oswald Rentch, who was charged with spreading the techniques by the man himself, "Tom" Bowen. Having progressed in my Bowen work studies, I can now wholeheartedly agree with Andrew -- Tom Bowen was a genius. That the work came to Tom without osteopathic or mixed manual method training is truly astounding.

Recent findings in fascia research amplify my respect for the work of Tom Bowen. The fascial system is more and more being shown to be linked intimately to the neuroendocrine system. By example, the results of fascial therapy are different when a patient is anesthetized to unconsciousness. They do not hold as well. So, yes -- There really seems to be an intelligence we interact with when we move fascia. Then again, we've always known that the human body is an incredible machine. Kudos to the Brilliance of its Creator. Now, however, we regain a no-holds-barred astonishment at how profoundly complex the human body is.

How Tom knew which points to access in order to talk to the body in the way Bowen Work appears to do is beyond me. Perhaps it truly was a Gift from God. God is closer than most people would accept, anyway.

I can now understand how important it is to learn Bowen work the way it was passed on by Tom Bowen.

Rapid De-Afferentation Techniques, as remarkable as they are, are still evolving. Unlike RDTs, Bowen work appears to have been born fully evolved.

My patients deserve to have someone on their side who knows what he's doing. Plus, I'm a curious fellow. So I'm likely to look at what everyone else is doing. Despite the proliferation of a swarm of personalities offering some form or other of supposed modification or advancement of Bowen Work, however, I'd love to master the unaltered gift first. It's amusing, as I think of it now.. I've grown up in the age that gave us the Photocopier. I love that machine. But I still rarely see a copy as clear, organically detailed and unflawed as the original.

What is Gua-Sha?
Gua Sha / Gua-sha / Guasha is a connective / soft-tissue mobilization technique commonly used in Asia by practitioners of Traditional Chinese Medicine. Gua Sha is used by TCM clinics and practitioners with the most frequent intent of restarting circulation and releasing "Sha," held by many TCM practitioners to reflect blood "trapped" in the peripheral capillaries. Gua-sha would literally translate into "releasing (the) Sha."

In Gua Sha, a scraping handheld tool is applied to skin, to fascial depth, in longitudinal strokes. This is meant to release the "exterior Sha." A stimulation of movement of lymph and blood flow occurs. This is interpreted as a means of discharging "cold negative energy" via the skin surface. Many TCM practitioners swear by Gua-sha, saying it helps cure many diseases.

In the TCM context, Gua Sha is held to be valuable in the treatment of pain, in the prevention and treatment of acute infectious illness, upper respiratory and digestive problems, and the resolution of many acute or chronic disorders.

Gua Sha is the Traditional Chinese Medicine analogue of today’s Connective Tissue Mobilization Techniques that use tools. In a strictly Manual Medicine analysis of the technique and its results, Gua-sha is a local, direct, tool-enhanced myofascial release. The body of techniques Gua-sha is thus categorized in is more popularly known now as Instrument-Assisted Connective / Soft Tissue Mobilization (IASTM / IASCTM). The more popular of the branded techniques include the Graston Technique and SASTM (Sound-assisted Soft-Tissue Mobilization).

You’ll let us know as soon as you realize you want to learn CTM / IACSTM with us, won’t you?

Stay well, evolve, and prosper.