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Manual medicine is the use of palpation and operator directed techniques to aid in the diagnosis and treatment of musculoskeletal disorders. Manual medicine is based, in part, on the belief that man is a self regulating being and that the body, when in normal structural relationship, is capable of self healing and defense against disease. “The goal of manipulation is to restore maximal pain free movement of the musculoskeletal system in postural balance”.
A manual medicine diagnosis is made using a comprehensive history, detailed and specific physical examination including Osteopathic, orthopaedic, neurologic, rheumatologic and Chiropractic exams, appropriate radiologic studies and the specific laying on of hands to palpate musculoskeletal parameters including but not limited to asymmetry of related musculoskeletal components, range of motion abnormalities of mobility, tissue texture changes, circulation of fluids and energy.
Manual medicine treatment includes the use of but is not limited to thrust/impulse, soft tissue mobilization, myofascial release, cranial osteopathy, functional release, and chiropractic. Manual medicine identifies a specific manipulable lesion, which is treated with an appropriate manipulative technique to resolve the condition. Physicians, M.D. and D.O., chiropractors, physical therapists and massage therapists practice manual medicine. Licensing and limitations in the scope of practice are variable throughout the United States and the world.
Manual medicine is as old as medicine itself. It was practiced in Thailand 4,000 years ago and used in ancient Egypt. Hippocrates, the founder of modern medicine, used traction and leverage techniques to treat spinal disorders. In the 19th century “bone setters” were popular in Europe and the United States. Dr. Edward Harrison, in 1784, Andrew Taylor Still, in 1874, and D.D. Palmer, in1896, began what is known today as manual medicine, Osteopathic medicine and Chiropractic respectively. In the 20th century James Mennell and Edgar Cyriax began the modern use of manual medicine in Europe and eventually founded the North American Academy of Manipulative Medicine (NAAMM). The NAAMM merged with the American Association of Orthopaedic Medicine (AAOM) in 1992. Today there are multiple medical societies and organizations devoted to the teaching, practice and research of manual medicine. Manual medicine has found application in orthopaedic, neurologic, rheumatologic, physical medicine & rehabiliatation and primary care.
1. Greenman, P. E., Principals of Manual Medicine, Williams and Wilkins, 1996.
2. DiGiovanna, E., and E. L. Schiowitz, and Stanley: An Osteopathic Approach to Diagnosis and Treatment, JB Lippincott, 1991.
3. Dvorak, J., V. Dvorak, and W. Schneider, Manual Medicine, Springer-Verlag, 1988.