Manual therapy- this is the impact of hands on the problematic area. Hand treatment is aimed at correcting or destroying painful lesions formed due to pathology in the muscles, joints, ligaments and segments of the spinal column and more.

The goal of manual therapy is to eliminate pain and restore the functioning of organs, joints and vertebrae. Each vertebra should take its place, only in this case our “backbone” works correctly. Our entire body is innervated through the spine, so many somatic diseases arise due to the fact that an important “wiring” for them is pinched. Chiropractors are confident that half of the complaints about dizziness, headaches, pain in the heart and other organs are caused by problems of the spinal column. A disruption of the blood supply to the blood vessels of the brain often occurs due to damage to the cervical vertebrae.

Cost of manual therapy

Manual therapy methods

Manual therapy methods can be therapeutic and diagnostic. The techniques used in these cases are varied. When choosing an appointment, doctors take into account the pathology process, the cause of its occurrence, and the patient’s age.

Treatment methods

There are “soft” and “hard” healing movements. The “soft” technique is the safest, the application force is the smallest in the range of muscle tissue capabilities. A “hard” attack occurs on a joint, a segment of the spine. The work of a chiropractor must be meticulous. The intensity of blood flow after correct sessions increases 3-4 times.

Diagnostic methods

Diagnostic techniques are used before determining a treatment regimen. The patient lies in a relaxed position, and the doctor carefully palpates the spine and joints, determines their mobility, evaluates changes, identifies pain areas and areas of muscle tension. A qualified specialist carefully selects techniques and determines their optimal ratio for each situation.

Indications for manual therapy

Dizziness, headaches.
Muscle pain.
Rachiocampsis.
Intervertebral hernias (to unload the problematic area).
Rehabilitation period after some injuries.

Contraindications to manual therapy

Manual therapy is not indicated for all patients. Manual technique is not recommended for patients with the following diseases.

Spinal tumors.
Cracks.
Inflammatory processes.
Acute infectious diseases.
Severe osteoporosis.
Recent injuries or conditions following spinal surgery.
Recent stroke or heart attack.
Pregnancy and lactation period.

A competent doctor will correctly assess the patient’s body and determine contraindications in each specific case.

Benefits of Manual Therapy

Surgical interventions on the spinal column can be avoided.
The function of muscles and joints quickly improves, and vertebral mobility is restored
Pain disappears or decreases without the use of medications.
Relieves muscle tension and fatigue.
More effective compared to hardware methods for treating spinal diseases.

Be careful when choosing a specialist! If the doctor is illiterate, then the treatment may end in disastrous results. The appearance of an intervertebral hernia, vertebral fracture, stroke, muscle rupture is far from a complete list of complications if the patient falls into the hands of an unqualified doctor. A certified, experienced doctor cannot have complications!

How does a manual therapy course work?

The first consultation can take up to half an hour. The doctor will ask about the history of life and illness, identify concomitant ailments, and conduct a detailed examination of the patient. Additional studies may be ordered as needed. For minimal treatment results, a course of 10-15 sessions is required. One session can last from two to three minutes to one hour. After the course of treatment, the doctor may prescribe a repeat cycle in one to two months. Then the doctor will give recommendations for performing gymnastic exercises at home. It is very important to choose exactly those therapeutic exercises that will not cause harm, will not contribute to the formation of intervertebral hernias, torsion of the vertebrae and disruption of blood flow to the spinal cord. In order for the treatment effect to be better, the doctor will show you some self-massage techniques for the treated areas, which can be used at home. Many patients believe that there will definitely be pain during sessions, but this is not true. If the procedure is performed correctly, the patient should not experience severe pain, but may experience discomfort. If discomfort occurs, the doctor can involve physical therapy sessions.

Manual therapy at the European Center for Orthopedics and Pain Therapy

It is very important to find a professional chiropractor who will approach the problem responsibly and will not aggravate the process. At the European Medical Academy named after. Paul Ehrlich has skilled orthopedic doctors, so they do not promise to relieve pain instantly. The healing process, as a rule, takes several sessions, and maybe several courses. Our patients can be sure that no harm will be caused to them, since the Center’s specialists strictly follow the medical principle of “do no harm.”

There are practically no people with a healthy spine! Patients do not even suspect that many complaints are caused by pathology of the musculoskeletal system. They continue to play sports, confident that they are benefiting their body, but constant jumping, squats, overloads, twists and turns of the spinal column only further injure the spine! Manual therapy doctors say that if you have a sedentary lifestyle, you need to undergo 2-3 courses of sessions throughout the year. Don't miss out!

Slonimsky Alexey Alexandrovich

Chiropractor, traumatologist-orthopedist

Manual therapy is a method of treatment and diagnosis of orthopedic diseases and diseases internal organs through the impact of hands on the human body. The procedure must be performed by a certified, experienced physician with experience.

Osteochondrosis is treated in many ways: medications, physical therapy, massage. No less relevant is the correction of the spine using hands - manual therapy: unlike massage procedures, it has a positive effect not only on muscle tissue, but also on the vertebrae.

The essence of manual therapy

This method of treating osteochondrosis is used to restore the functions of the spinal column, its joints, and muscle tissue. Thanks to precise movements performed by a qualified specialist, it is possible to put the vertebrae in place. The result of manual procedures is a decrease in compression of intervertebral discs and nerve roots (spine mobility is restored, pain is reduced).

The use of special techniques of manual pressure on the spine contributes to:

normalization of blood circulation in bone and cartilage tissues;
improving the tone of the back muscles;
elimination of spinal column deformity;
reduction of pain syndrome;
restoration of vertebral functions.

The use of manual therapy for degenerative changes in the spine also has a beneficial effect on the condition of muscle tissue: the frequency of their spasms and tension decreases (pain decreases). Its use as a method of treating the spine makes it possible to minimize the use of medications, and in some cases, to completely abandon them.

Impaired mobility of the spinal column with osteochondrosis leads to a deterioration in metabolic processes in tissues. Carrying out manual and massage procedures improves blood flow to the affected intervertebral discs. The technique of manual pressure on the spine and surrounding muscles is used for therapeutic and preventive purposes.

Indications

Manual therapy is prescribed for initial stages development of degenerative processes in the tissues of the spine (when bone growths on the vertebrae are not formed). The need for its use is determined by the doctor after examining the vertebrae and intervertebral discs with X-ray and MRI devices.

The main task that needs to be completed when performing manual procedures is to eliminate the blockade of the vertebrae and restore their functions. The secondary goal is to reduce muscle tension.

In case of osteochondrosis complicated by intervertebral hernia, the use of manual treatment should be as careful as possible. The method of manual impact on deformed structures of the spine depends on the location of the prolapsed disc (identified after undergoing a magnetic resonance examination).

Manual therapy is used in the early stages of the disease. For hernia and other complications of osteochondrosis, complex treatment is recommended.

As a rule, manual treatment is prescribed in the following cases:

latent period of osteochondrosis;
pain caused by compression of nerve endings by displaced vertebrae;
impairment of the motor and support functions of the spine (excessive mobility, decreased degree of fixation);
disc protrusion, intervertebral hernia.

Incorrect technique for performing manual procedures can aggravate the patient's condition. Possible fractures, displacement of vertebrae, injuries to paravertebral nerves, blood vessels (when affecting the cervical spine), ruptures of connective and muscle tissues. That is why it is important to take a responsible approach to choosing a chiropractic specialist.

The need for manual therapy for osteochondrosis is confirmed by the results of the following studies:

X-ray – allows you to see the condition of bone tissue.
Computed tomography (performed as directed by a doctor).
Magnetic resonance therapy. With its help, it is possible to identify protrusion, the site of prolapse of the disc nucleus (herniation).
Ultrasound diagnostics of the brain and cervical spine (to determine the condition of blood vessels), thyroid gland and organs located in the pelvic area.
Urine and blood examination.
Densitometry – used to screen for osteoporosis (decreased bone density)
Electrocardiogram.

The list of procedures that should be completed is prescribed by the chiropractor after examining the patient.

The photo shows an MRI (computed tomography) scan of the cervical spine. It shows the pinching of the spinal cord by the affected intervertebral disc.

Contraindications

Despite the benefits of manual therapy, there are factors that exclude the possibility of its implementation. These include:

diseases caused by infection in the body;
presence of cancer;
state of alcoholic intoxication;
inflammation in the body;
recovery period after surgery (especially after spinal surgery);
dystrophic non-inflammatory injuries of the spinal cord (disc myelopathy);
pregnancy;
pathologies of spinal development;
high blood pressure;
inflammation of the tissues surrounding the joints (polyarthritis);
dystrophic changes in articular cartilage (arthrosis);
dysfunction and structure of blood cells;
complications of intervertebral hernia (loss of part of the nucleus pulposus);
damage to the spine and its joints.

The presence of even one of the above signs indicates that the use of manual therapy is unacceptable.

Basic methods of manual therapy

The technique of manual manipulation of the spine varies, but the following types are considered the most common:

Applied kinesiology– a method for diagnosing and treating osteochondrosis, based on the study of muscle tone associated with certain internal organs. Due to the lack of reliable facts confirming the effectiveness of this method of treating the spine, many scientists are skeptical about it.
Acupuncture is a well-known treatment method for many diseases used in Chinese medicine. It is based on the principle of influencing certain parts of the body by introducing biologically active points special needles or medications in moderate doses (pharmacopuncture).
Acupressure– a type of reflexology in which a positive effect is achieved by influencing points in the body. Unlike acupuncture, this method of treating osteochondrosis uses finger pressure on certain areas of the body. Performing acupressure does not require any special skills. Anyone can master the massage technique and carry it out independently, but only after consulting a doctor (he must explain which points need to be developed).
Shiatsu – Japanese way treatment, the essence of which is to influence parts of the body with the fingers, as well as with the palms of the hands. In practice, shiatsu is used primarily to treat systemic ailments. In case of destructive processes in the spinal column, it is not used so often.

There are also other types of manual therapy (myofascial release, craniosacral therapy), but they are rarely prescribed to restore the supporting and motor functions of the spine.

The techniques used in manual procedures vary depending on the location of the spinal lesion:

Automobilization – used for degenerative changes in the cervical spine. The patient props up his chin with one hand, while simultaneously holding the top of his head with the other limb (the head must be tilted forward). After this, he smoothly turns his head to the maximum, makes slow turns with his head: clockwise. Sometimes a crunching sound is heard.
For thoracic osteochondrosis, which appears as a result of scoliosis or curvature of the spine, therapeutic exercises, massage, physiotherapy and manual therapy are prescribed (strengthen muscles, correct posture).
If the lumbar region is affected, you need to lie on your right side, bending the opposite leg (your foot is on the knees of your right leg). As you exhale, we lift and move back the left arm, simultaneously turning the head and body (the spine is stretched and tense). Having turned to the maximum, we fix the position for a few seconds and make light swings with our hands.

Depending on the object of influence, several more techniques of manual therapy are distinguished. The technique of relaxation, mobilization, rhythmic or simple traction, manipulation is used to relieve blockade of joints. Reducing muscle tension is facilitated by stretching, stretching, and massage procedures. The technique for working out ligaments includes deflection and torsion.

Basic Techniques

Manual therapy should be carried out by a qualified specialist, since the slightest mistakes when performing basic techniques independently can cause negative consequences (injury to the cervical vertebrae, dizziness, muscle cramps, and other severe injuries to the spine).

For treatment cervical osteochondrosis use the following techniques:

Massage(relaxing, segmental) – kneads the muscles well, helping to warm them up and relieve tension.
Mobilization– a set of movements performed by a chiropractor to restore the basic functions of the affected joints. It is carried out passively or using the traction method.
Manipulation– intense, quick thrusts that help free the joints from the blocking factor. Despite the fact that the procedure is very unpleasant (accompanied by crunching), it allows you to fully restore the functionality of the deformed joint. For a similar purpose, post-isometric relaxation, simple and rhythmic stretching, and positional mobilization are used.

The main task when performing manual therapy techniques is to restore the natural mobility of joints and vertebrae, to stabilize the spine by influencing degenerative tissues. As a rule, mobilization techniques are most often used for this.

Who should you trust to perform the procedure?

Until recently, only specialists with appropriate education (neurologist, orthopedist-traumatologist) could engage in manual treatment. Today, before using it, all doctors must provide a valid certificate to confirm their skills and legal activities (received after completing special courses in manual treatment).

In Western countries, to restore the spine and the body as a whole, they practice the use of an alternative method of manual intervention - osteopathy. In Russia, it is not included in the list of medical specialties, therefore this treatment method is considered illegal (due to the lack of a license).

The specialty “manual doctor” was included in the list of medical professions on December 10, 1997 (according to order of the Russian Ministry of Health No. 365). Techniques for performing manual therapy were developed on the basis of acquired knowledge in the field of such sciences: neurology, orthopedics, neurophysiology. The effectiveness of their use is confirmed by good practical results: a relatively rapid restoration of the motor and support functions of the spine, joint mobility, a decrease in the frequency of muscle spasms, and correction of posture.

The use of manual therapy for osteochondrosis is prescribed by a specialist (neurologist, orthopedist) after examining the patient and conducting a more accurate examination of the spine. The clearest picture of the development of the disease is shown by data obtained after undergoing MRI (allows you to see intervertebral hernia and protrusion, find out their location, assess the degree of damage to the vertebrae and paravertebral structures).

Manual therapy is carried out if the symptoms of osteochondrosis are mild or completely absent. In the acute period of the disease, with spinal injuries, high blood pressure, the presence of cancer and dysfunctions in the functioning of internal organs, or pregnancy, the use of the procedure is unacceptable.

Using this method for treating spinal diseases without appropriate preparation threatens to worsen the patient’s well-being. It must be performed by an experienced specialist with a medical education and a certificate confirming his skills in manual therapy.

What effect to expect

A positive result from the use of manual therapy is possible only in cases where several techniques of mechanical influence on degeneratively changed structures of the spine are used at once.

The use of manual therapy techniques in combination allows you to stop destructive processes in bone and cartilage tissues, reduce the manifestation of the main symptoms of osteochondrosis (impaired mobility and loss of joint flexibility, pain).

Carrying out manual therapy in the early stages of the development of osteochondrosis helps strengthen muscles and reduce pressure on nerve roots, relieves blockade of joints and vertebrae (symptoms of the disease become less pronounced or disappear altogether). With the correct impact on the affected thoracic spine, it is possible to eliminate not only pain, but also restore the functions of internal organs.

It is worth noting that treatment of osteochondrosis using only folk methods (compresses, rubbing) and traditional medicine (injections) can reduce pain, but they do not act on the cause of its occurrence. That is why they must be used in combination with manual therapy. The procedure has a beneficial effect on the condition of the neck and back muscles and accelerates recovery processes in the spine (the vertebrae are aligned with each other).

In general, the use of therapy as a method of treating osteochondrosis helps prevent further development of the disease and has the following effects:

elimination of physical inactivity (the main cause of cervical osteochondrosis);
absence of congestion in the neck muscles and blood vessels located in this part of the spine;
reduction of headaches, neck spasms (dizziness stops, the feeling of weakness in the body disappears);
slowing down destructive processes in the spine, reducing the risk of complications of osteochondrosis;
restoration (full or partial) of the functions of joints, bone and cartilage tissues;
improved hearing (tinnitus disappears);
reduction of pain in the affected area, and sometimes its complete absence;
restoration of mobility of the neck and shoulder muscles;
return of sensation in the limbs;
relaxation of the back and neck muscles.

The duration of manual therapy sessions depends on the individual characteristics of the person and other factors. The average period of treatment with this method is from a week to three months.

When the cervical spine is affected, manual procedures are prescribed as part of the complex treatment of the disease. It is not recommended to carry them out without the supervision of a specialist.

Possible complications

Manual therapy is considered the safest way to influence a damaged spine, therefore, in most cases, the appearance of negative consequences after its implementation is not observed. Deterioration of the patient's condition is possible only if correct execution techniques, using this treatment method, despite the presence of contraindications:

excessive mobility of the spinal column;
injuries of the vertebrae (fracture of the processes), ribs, and other bone structures;
compression of spinal hernia;
displacement of the vertebrae, their blocking;
acute circulatory disorder in the brain (ischemic stroke);
damage to ligaments, muscle tissue (rupture).

Performing manual therapy by a qualified specialist eliminates the possibility of negative consequences. He always pays attention to limitations and possible contraindications, performs all movements correctly and accurately. This is why you need to be careful when choosing a chiropractor. You should not engage in independent treatment of osteochondrosis without first consulting him.

There are many rumors and conjectures surrounding this treatment method. To some extent, this happened due to the fact that it is quite difficult to find an accurate description of manual therapy - the authors put different components into this concept.

Another problem of lack of awareness is the small number of chiropractors. This is due to the fact that in our country there are only a few centers for teaching this method - in Moscow, St. Petersburg, Novokuznetsk, Kazan and other cities. Specialists from the regions are forced to go to these cities to gain a profession or improve their skills.

So what is manual therapy? How is it different from massage? Is it true that this treatment is painful? Answered these and other questions Doctor of manual therapy at the medical center Askhat Kokbaev.

What is manual therapy and who does it?

"Manual therapy is a part of manual medicine; a system of manual techniques aimed at diagnosing and treating disorders of the musculoskeletal system, expressed in functional blockades, local hypermobility and regional postural muscle imbalance,"- Askhat Kokbaev said.

According to the doctor, manual therapy is performed by surgeons, orthopedists-traumatologists, and part-time neurologists. Previously, only neurologists who had worked for three years in their main specialty, or orthopedic traumatologists, were trained in the specialty of manual therapy. Since 2007, pediatricians and therapists have been added.

“Manual therapy is a classic, very serious method of treatment, it is even called dry surgery. Treatment is prescribed strictly according to indications, and only a doctor should perform manual therapy.”

Can I prescribe manual therapy for myself?

“Under no circumstances should you prescribe manual therapy for yourself. I always say: if you’re sick, run to the doctor. Two main specialists, a neurologist and an orthopedist-traumatologist, can refer you to a chiropractor. They examine the patient, make a diagnosis and prescribe treatment.”

Remember - without prior consultation with specialists and an accurate diagnosis, the chiropractor will not perform any manipulations.

How is manual therapy different from massage?

Many people confuse massage with manual therapy, believing that they are the same thing. The chiropractor hastened to dispel one of the most common misconceptions:

Massage is an effect aimed at soft tissues - skin, subcutaneous fat, muscles. Manual therapy is working with joints - that is, the point of application of manual therapy is any joint, everything that can move. Manual therapy and massage are two different methods that complement each other. Massage is almost always used - this is the base. It precedes, or even better, it always precedes manual therapy. During the massage, muscles relax and blood circulation improves. When the muscles are relaxed, when the person is prepared, then manual therapy techniques can be performed.

Manual therapy can be used for diseases where massage cannot be done, for example, during tumor processes. This is possible thanks to a short-term technique - manipulation. It’s easy to remember - when the doctor performs a manipulation, a characteristic “crunch” is heard in the joint area.

“Such twisting with a crunch, when at the same time someone screams, someone groans, mainly from fear, not from pain, many associate with manual therapy. This technique is very impressive, effective - it is a quick, high-speed impact,”- noted Askhat Kokbaev.

But besides manipulations in manual therapy there are other equally effective, but more gentle techniques - mobilization, post-isometric relaxation, traction, post-reciprocal relaxation and others. These are the so-called “soft techniques”. And, of course, a modern chiropractor must be able to master osteopathic and muscle-energetic techniques.

When is the help of a chiropractor needed?

A chiropractor works with cases where the range of motion in the joints decreases. But a specialist gets down to business only when the changes are reversible, that is, the volume of movement can be returned back. This is called "functional blockades or blocks." There are terrible diseases when the cartilage “ossifies”, when the disorders cross a certain line - in such situations it is impossible to restore the range of motion, and if you influence the affected area using manual techniques, you can cause injury to the patient.

Are there any contraindications for manual therapy?

Contraindications regarding the effects of manual therapy methods are divided into two types: absolute and relative.

Absolute:

Reluctance of the patient (when a person becomes scared, he cannot relax; muscle tension prevents the chiropractor from working);

Uncertainty or inability of the doctor.

Relative:

Disc herniation;

Acute conditions;

Severe hypermobility and others.

It all starts with osteochondrosis - this is a natural aging process of our spine. We lose water and experience constant axial loads. A chiropractor does not treat osteochondrosis itself; it can never be cured; he treats complications of osteochondrosis, expressed in pain and functional blockades.

Does manual therapy hurt?

Having heard about manual therapy, many feel horror - they immediately hear the “crunching” of the joints and feel a feeling of pain. The specialist refuted this common myth: "Pain during a manual therapy session is not true. It happens that a person comes with an acute pain syndrome. In this case, not only can’t you “twist and press”, you can’t even stroke. First you need to cope with the pain. This can be achieved with the help of pharmacological , physiotherapeutic and other influences. And only then, at a certain stage, when the pain syndrome subsides, you can use manual therapy methods. There should be no pain during the session, we do everything along physiological axes and angles. There are such concepts as pretension, thresholds. , a hard barrier, an elastic barrier, we don’t cross them. If something comes with pain, then the doctor should think about whether it’s worth continuing, or even better, further examining the patient.”.

Remember: medical massage should never be painful.

How often can manual therapy be performed?

Treatment sessions should be carried out no more than twice a week, but once a week is possible. The number of sessions is from 3 to 5-7. In exceptional cases - ten. Most often, five sessions are enough. Next, the specialist evaluates whether manual therapy helps, and if not, the treatment method changes.

Is it possible to relieve a person from joint pain with one touch?

If you are offered pain relief in one visit, you should think twice. The pain varies - in some cases, indeed, one session of manual therapy is enough, and the person feels a noticeable improvement.

“It happens that I twisted my neck incorrectly, something got stuck somewhere - if this condition has recently begun and the pain syndrome is of moderate intensity, then you can “fix it, put everything in its place” in one go,” says the doctor . - Then fix and stabilize with an orthosis. Next, the body itself will turn on the recovery processes. If you have had pain for 30 years, you definitely won’t get rid of it with one touch or one press. Often a simple condition is aggravated by the fact that a person does not have the opportunity to immediately seek help from a specialist, and by the time he reaches the doctor, complications have time to arise. There is no need to delay, there is no need to cultivate the disease."

Previously, it was believed that osteochondrosis and joint problems were the lot of patients over 50 years old. Today this disease, like many others, has become very young. Askhat Kokbaev explained how these problems can be prevented:

In my practice there are 13-14 year old children with osteochondrosis. Everyone now sits at computers, sometimes for hours. And before, children played sports. The computer is enemy number one; a child can spend no more than 20 minutes on it without a break, then a 5-10-minute rest. In general, the key to health is adequate physical activity and proper, moderate nutrition. By nature, our joints and spine were created in order to move. Therefore, to be with them less problems, use them for their intended purpose - move.

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What is a chiropractor?

Chiropractor- this is a specialist ( often with medical education), who received training in the field manual therapy. This area of medicine is a collection of various methods diagnostics and treatment, which are carried out by the hands of a chiropractor.

Some believe that the professional activity of this specialist is similar to the work of a chiropractor. But this opinion is erroneous, since a chiropractor specializes in straightening bones and joints, while the work of a chiropractor is more like massage.
Since manual therapy has a direct effect on the nervous system, bones, and muscles, manual therapy is inextricably linked with such disciplines as neurology, orthopedics, and traumatology.

What is the job of a chiropractor?

The main principle of this specialist’s work is to provide therapeutic massage. Manual therapy differs from regular massage in that the doctor affects only certain areas of the body, using special techniques.

Most often, people with pathologies of the musculoskeletal system turn to a chiropractor. This doctor also provides professional assistance to those who suffer from diseases of muscle tissue, circulatory or metabolic disorders. The impact that a specialist has on muscles and joints helps improve blood supply and nutrition of tissues, due to which a healing effect is achieved.

Most often, people turn to a chiropractor for diseases of the following organs:

Head. Headaches due to impaired blood supply to the neck are a common reason for visits to this doctor. The massage performed by the therapist normalizes blood circulation, resulting in improvement.
Joints, bones. Patients often come to this doctor on the referral of other doctors after fractures, dislocations and other injuries. Manual therapy promotes rapid and proper bone growth.
Organs of the digestive tract. For some problems of the gastrointestinal tract, therapeutic massage can significantly improve the patient's condition. This occurs due to such positive effects of manual therapy as accelerating metabolism and improving intestinal motility.
Back. Frequent patients of a chiropractor are people who spend a lot of time at the computer. Staying in a sitting position for a long time leads to curvature of the spine and, as a result, pain. Strengthening muscles through manual therapy helps correct posture and maintain a straight back in the future.

One of the distinctive properties of manual therapy is the absence drug treatment. This doctor does not prescribe medications (in rare cases, vitamins), but may prescribe physiotherapy and physical therapy.

Chiropractor courses

Chiropractor courses are educational theoretical and practical lessons, allowing you to obtain the necessary skills to work in this specialty. The duration of training depends on initial training student. Thus, for classical massage specialists and other people who have massage skills, courses lasting no more than 24 hours are usually held. In the absence of any skills, courses can last from several weeks to several months.

Upon completion of training, diplomas are issued that allow you to work as a chiropractor. The entire learning process can be divided into three main stages. The duration of each stage depends on the type of courses.

The first stage of manual therapy courses
At the first stage, students gain general knowledge of the anatomy and physiology of the human body. This knowledge is especially important for maintaining safety guidelines when performing massage therapy. They also help chiropractors to correctly interpret patient complaints in the future, determine the presence of contraindications and draw up an anamnesis ( medical history).

At the first stage of the courses, the structure and functions of the following body systems are considered:

bones, joints, ligaments;
circulatory and lymphatic systems;
muscles of the head, neck and other organs;
organs of the chest, abdominal cavity and pelvis;
innervation ( nerve supply) organs and tissues.

The second stage of manual therapy courses
The second stage is devoted directly to the techniques on which manual therapy is based. Students learn the basic methods of therapeutic massage, the rules for their implementation and the situations in which they will be appropriate. Theoretical knowledge is supported by practical exercises.

At the second stage of the course, the following manual therapy techniques are studied:

Cranial. This type of therapy involves influencing the bones of the skull and sacral spine. The main technique is soft stroking movements.
Visceral. This direction of manual therapy involves influencing the internal organs of the abdominal cavity, chest and pelvis. Visceral therapy is based on soft pressure, point pressure, squeezing, and gentle twisting.
Structural. This technique is used for problems with the musculoskeletal system and involves effects on bones, ligaments, and muscles. Structural therapy is performed with pushes, blows and slaps of medium and high force.
Myofascial. This type manual therapy is more often used during diagnostics. The therapist presses the soft tissue with his fingers or palm to detect painful areas on the patient's body.

The third stage of manual therapy courses
At the final stage, much attention is paid to the psychological aspect in the work of a chiropractor. The ability to make a positive impression, establishing contact with the patient, mechanisms for preventing conflict situations - all these points are considered at the third stage of training. Also, specialists who teach manual therapy courses touch on issues of professional ethics, sanitary and hygienic rules of massage, and safety measures for both the therapist and the patient.

What does a chiropractor treat?

The competence of a chiropractor covers a wide range of diseases. These are mainly diseases of the musculoskeletal system and muscular system. Manual therapy is also recommended for diseases of cardio-vascular system, metabolic disorders, flat feet. At the same time, there are limitations to manual therapy.

As already mentioned, the main indication for manual therapy is musculoskeletal pathology. The essence of this treatment method is to eliminate pathological phenomena in the musculoskeletal system. Such a phenomenon may be displacement of the vertebrae, osteochondrosis, hernia. Correction of these pathological phenomena occurs with the help of the hands of a chiropractor without the use of medicines. At the same time, manual therapy is most effective when combined with reflexology and physiotherapy.

Manual therapy for osteochondrosis

Osteochondrosis is called chronic illness spine, which affects the elastic intervertebral discs. These discs play a big role in the shock absorption function ( softens loads), make the spine flexible and elastic. With osteochondrosis, due to impaired metabolism and blood circulation in the spine, degenerative processes begin to develop in the intervertebral disc. As a result, the disc loses its elasticity, strength and resilience. It dries out very quickly, becoming thin and less durable. Such a disc ceases to perform its main function of shock absorption and cannot withstand the load from the spine. In the future, if no measures are taken, the disc ring may bulge, forming a hernia.

The main causes of osteochondrosis include:

irrational physical activity with improper distribution on the spine;
sedentary lifestyle;
congenital anomalies of the spine;
chronic infections of the body;
injuries;
metabolic disorders.

Osteochondrosis can affect various parts of the spine, and depending on this, its symptoms will differ.

Types of osteochondrosis include:

Osteochondrosis of the cervical spine. The main symptom is aching or acute pain in the neck, painful sensations when turning the head. Associated symptoms may include blurred vision ( spots before eyes), tinnitus, dizziness.
Osteochondrosis of the thoracic region. Manifested by aching sensations in the chest ( maximally expressed with a deep breath), pain between the shoulder blades, between the ribs, especially when walking.
Osteochondrosis of the lumbar region. It is the most common type of osteochondrosis. Manifested by lower back pain, which can be sharp or aching. The pain intensifies with physical activity and can radiate to the tailbone or leg.

Using special manual techniques, the chiropractor distances the surfaces of the vertebral joints from each other. Basic treatment for osteochondrosis is to relieve stiffness ( blockade) spine, after which the therapist moves on to relaxing techniques. Before proceeding to the spine, the chiropractor warms up the muscles smoothly without sudden movements. Next, by directly pressing on the vertebrae, the specialist restores their previous position. As a result of deep warming up of the muscles, the natural curve of the spine is restored, the discs are inserted into place, and pain is relieved. It is important to know that manual therapy is recommended in the first three stages of osteochondrosis, when there are no bone growths.

Manual therapy for hernia

Lumbar hernia is a common complication of osteochondrosis. It is a protrusion of the intervertebral disc into the spinal canal. In turn, this leads to pinching of the nerve roots, which is manifested by severe pain.
It is important to know that manual therapy is used only in mild cases of intervertebral hernia, which are not accompanied by rupture of the fibrous ring. In other cases, drug and surgical treatment is indicated.

When a hernia has formed, the chiropractor applies his hands to the site of the hernia projection, having previously warmed up the muscles. This creates negative pressure, which allows the hernia to retract back to its location. Next, the therapist works on the entire spine, which improves circulation in cartilage and bone tissue and promotes their restoration.

Chiropractor in mandatory must review all previous examinations of the patient, and if they are not available, order them. So, it is recommended to consult a neurologist, do an x-ray, and sometimes magnetic resonance ( MRI) . If examination shows ligament rupture or protrusion ( bulging) disc, against the background of vertebral displacement, then this is an absolute contraindication to manual therapy.

What is the difference between an osteopath and a chiropractor?

An osteopath is a doctor who has specialized in alternative medicine with a specialization in osteopathy. In turn, osteopathy is a branch of medicine that considers a violation of the anatomical relationships between organs as the cause of the disease. An osteopath and a chiropractor, first of all, differ in their approaches to treatment. The main task of a chiropractor is to eliminate any symptom, while an osteopath treats the entire body. We can say that manual therapy is the “daughter” of osteopathy. What is common in both disciplines is that the healing instrument is the hands of a specialist.

So, an osteopath, like a doctor, works with the whole body. In his work, he uses techniques such as relaxation, normalization of blood flow, drainage of the lymphatic system, and restoration of micromobility. The chiropractor mainly uses pressing and reduction techniques.

Chiropractor for children

Manual therapy is a non-drug treatment method that is also indicated for children. In his practice, a pediatric chiropractor uses non-aggressive methods of influencing the child’s body.

What does a chiropractor treat for children?

A chiropractor treats a wide range of childhood conditions. First of all, these are diseases of the musculoskeletal system and muscle pathology. However, recently manual therapy is increasingly recommended for somatic ( bodily) diseases, for example, bronchial asthma.

Indications for manual therapy in children are:

birth injuries in infants;
scoliosis or kyphosis;
infantile torticollis;
muscle pathology.

Birth injuries
Unfortunately, birth injuries are not uncommon in pediatrics. The reason for this may be incorrect presentation of the fetus, rapid or, conversely, prolonged labor. At rapid birth The upper cervical spine is most often injured. If unqualified actions of an obstetrician are added to the pathology during childbirth, then this is complicated by the confusion of the vertebrae, the development of torticollis and plexitis ( brachial plexus lesion).

First of all, birth injuries require manual therapy. The sooner help is provided, the fewer complications will accompany the child.

Scoliosis
This is one of the most common spinal pathologies in children. Most often it appears in preschoolers and school-age children when there is a load on the spine. The spine does not always cope with this load, which is manifested by its deformation in various planes. Scoliosis is a deviation of the spine in the frontal plane. This disease can be either congenital or acquired. Depending on the stage of scoliosis, different treatment tactics can be used. So, in case of severe curvatures, surgical treatment is carried out, which consists of installing special metal structures, fixing the vertebrae together. In addition, corset therapy, anti-scoliosis gymnastics and manual therapy are used. During manual therapy, much attention is paid not to the spine itself, but to the muscular frame. So, if the muscles are weak for some reason, then they cannot support the spine.

Infantile torticollis
Torticollis is a common childhood pathology that can be congenital or acquired. The most common condition is acquired post-traumatic torticollis.

Symptoms of torticollis may include the following:

The head is always directed in one direction. Moreover, this is always observed at rest, in motion, in sleep, while swimming.
It is difficult to turn the head in the other direction. When you try to turn the baby's head, he resists.
When the child is positioned on his stomach, an s-shaped curve of the spine is visible.
In a dream, a child clenches only one fist.
Sometimes cranial deformities are visible.

Torticollis should be treated immediately, as it does not go away with age. The main treatment, which should begin from two weeks of age, comes down to manual therapy, gymnastics, and electrophoresis. During treatment, it is important to pay attention to the whole body, and not just the sore muscle. So, massaging the muscle should be combined with massage of the baby’s chest and back. The sore muscle must be massaged from its attachment point behind the ears to the collarbone and back. It is also important to relieve tension from the muscles; for this it is recommended to place the child on a fitball ( fitness ball) and, holding him by the legs, let him fall. It is important to consider that a healthy muscle also needs a massage, but more energetic.

In parallel with manual therapy, daily exercises are recommended for children with torticollis. It is best done in the pool, where the muscles relax as much as possible.

Muscle pathology
Muscle pathology is also an indication for manual therapy. However, it is necessary to take into account the nature of the disease. Hypertonicity is most common in newborns due to perinatal trauma. This condition is characterized by increased tone of all muscle groups, as a result of which all the child’s muscles are constantly tense. This disorder occurs quite often - in every tenth child.

Manifestations of hypertension in a child may be the following:

the baby behaves restlessly and cries constantly;
often arches;
throws his head back;
constantly demands the breast, as he is constantly hungry;
screams monotonously and piercingly;
during sleep, the limbs are pressed tightly against each other, and the head is thrown back;
gait on tiptoes, and not on the whole foot.

Before you begin treatment, it is important to find out what caused this condition. After all, hypertension is a symptom, not an independent disease. Most often, the cause is birth trauma and pathology of the central nervous system. Treatment in this case is complex and, in addition to manual therapy, includes other methods.

Treatments for hypertension include:

manual therapy;
gymnastics;
aquatherapy;
physiotherapy.

Manual therapy courses are carried out continuously with breaks of 4–5 days. At the same time, the massage is relaxing.

The opposite state of hypertonicity is called hypotonicity - decreased tone in all muscle groups. The main manifestation is muscle weakness. As a rule, it is a consequence of past infections or congenital anomalies.

Causes of hypotension include:

birth trauma and, as a result, insufficient blood supply;
unbalanced nutrition of the baby;
chronic infections;
malnutrition ( underdevelopment) child.

With hypotonicity, the sucking reflex is impaired, and the child often falls asleep during breastfeeding. There is no flexion characteristic of newborns ( bending) limbs. When the baby sleeps, his legs are fully extended. Also, such children move little, do not cry, and sleep more often than others. The main treatment is massage and gymnastics.

Manual diagnostics

Before starting treatment, a detailed manual diagnosis is necessary. It consists of collecting anamnesis ( medical history) and examining the child. Anamnestic data are very important, as they allow us to find out what caused the injury and the development of perinatal pathology. It is important to know how the birth took place ( were they long or fast?), how the pregnancy proceeded, whether auxiliary manipulations were used to extract the child. Information about the birth of the child and his early development, namely when he began to hold his head up, roll over, and take his first steps.

After a thorough history taking, the chiropractor begins to examine the child. The inspection should be carried out in a well-lit room.

Principles of examining a child by a chiropractor
Initially, the therapist pays attention to the proportionality of the child’s development and overall physique. A newborn baby is characterized by slight hypertonicity - the arms and legs are in a flexed position, the hands are bent into fists. While lying on his back, the child can turn or throw back his head. The baby's facial expression is noteworthy - it can be gloomy, suffering or calm.

With various perinatal and congenital pathologies, the child can take various pathological positions ( for example, frog pose). Next, the chiropractor should evaluate the upper and lower extremities. They can be sharply bent, straightened or brought towards the body ( like a soldier). Determination of muscle tone should occur from head to toe. In this case, symmetry, tone and the presence of edema should be taken into account. So the muscles can be in a state of hypotonicity or hypertonicity, and this, in turn, can be one-sided or bilateral ( that is, symmetrical). In parallel with the assessment of muscle tone, an examination and skeletal system. It is important to assess the condition of the ribs, the position of the collarbones, and the structure of the sternum.

Tests used in manual diagnostics include:

Head flexion resistance test. The result may be normal, low or high.
Traction test. From a supine position, lightly take the child by the arms and pull him towards him. At the same time, moderate resistance is felt.
Resistance to hip abduction. The lower limbs of the child, also lying on his back, are moved to the side with a moderately sharp movement. In this case, resistance should be felt.

Sometimes correct diagnosis will help identify existing problems before they appear. After all, birth injuries can manifest themselves both immediately and after a certain time.

Manual therapy in pediatrics is considered one of the official methods of treatment. Its value is also very high. This is explained by the high plasticity of the musculoskeletal and muscular system in children.

Appointment with a chiropractor

An appointment with a chiropractor is no different from other doctors and is a patient’s visit to a doctor for the purpose of diagnosis and subsequent treatment ( if needed). At the initial consultation, the therapist listens to the patient’s existing complaints and also conducts a manual examination. First, the doctor visually assesses the patient’s figure and posture in order to determine whether there are spinal curvatures and other pathologies. He then performs palpation to determine muscle tone and other deformities ( fingering), which can be superficial, sliding, pinched, deep.

Based on the data obtained, the doctor makes a conclusion about whether the patient needs manual therapy sessions. Often, in order to make a decision and exclude the presence of contraindications, a chiropractor prescribes instrumental examinations or consultations with related specialists. Among the most prescribed studies by this doctor are radiography, magnetic resonance or computed tomography.

Your own chiropractor

Before use, you should consult a specialist.

Chiropractor is a specialist doctor who uses manual techniques to treat diseases - techniques produced by the hand. Chiropractor literally means “he who treats with his hand” ( "manus" means "hand" in Latin). The branch of medicine that this specialist studies and practices is called “manual medicine.”

Manual medicine is the science of manual methods of influencing the musculoskeletal system, joints or ligaments, including the ligamentous apparatus of the internal organs of a person. A chiropractor has a higher medical education, a medical specialist diploma and a certificate as a specialist in manual therapy. A doctor is trained in manual therapy for 2 years, however, in order to be able to undergo professional retraining, a doctor, after graduating from a medical university, must receive one of the narrow specialties related to manual therapy.

The following specialists can become a chiropractor:

sports doctor- specialist in physical therapy and sports medicine;
neurologist- specialist in diseases of the nervous system ( brain and spinal cord);
therapist- general practitioner;
pediatrician- general pediatrician ( it is he who becomes a children's chiropractor);
traumatologist- a doctor who treats bone fractures;
orthopedist- a doctor who treats various pathologies of the musculoskeletal system;
maxillofacial surgeon- a doctor who treats diseases of soft tissues and bones in the face and jaw;
rheumatologist- specialist in autoimmune connective tissue diseases ( rheumatic diseases), which affect bones, joints, muscles and internal organs;
reflexologist- a doctor who treats by influencing biologically active points on the human body.

The presence of these narrow specialties distinguishes a chiropractor from an osteopath ( oriental chiropractor) and a reflexologist, since practicing doctors of all specialties can learn osteopathy and reflexology. The fact is that manual therapy, unlike other similar specialties ( working with hands), requires deeper knowledge about the nervous, musculoskeletal system and diseases of internal organs.

Until 1997, the medical specialty “chiropractor” did not exist in the CIS countries, but patients still turned to manual therapy specialists who then did not have a medical education. They “treated” only the symptoms, without delving into the cause, so their help could bring not only benefit, but also harm. In 1997, in Russia, manual therapy was included in the list of medical specialties, due to the need for this specialist. The need was to increase the number of patients with pathologies of the musculoskeletal system for whom manual therapy effectively helped get rid of painful symptoms.

A chiropractor can work in the following medical institutions:

hospitals ( in the department of neurology, traumatology, therapy or in a specialized manual therapy department);
clinics ( in a manual therapy department or office);
sanatorium and resort institutions.

What does a chiropractor do?

A manual therapist has theoretical and practical skills in the field of manual therapy and studies, diagnoses and treats specific conditions of the muscles, joints, bones and ligaments that can be corrected using manual techniques. As a reason pain and movement dysfunction, the chiropractor sees a block and a suboptimal motor pattern. A block is a violation of natural movement in the joints or a limitation of mobility. As a result of the block, the body begins to adapt to the painful state, reorganizing itself in such a way as to reduce the load on the overloaded ( blocked) plot. Such a habitual and almost imperceptible condition for the patient is called pathological ( suboptimal) motor stereotype. Based on this, the chiropractor works according to the principle “no block - no pain.”

A chiropractor deals with the pathology of the following structures:

spinal column;
bones;
joints;
ligaments;
fascia ( membranes of muscles and organs);
muscles.

All of the above structures make up the musculoskeletal system, with the passive part of the apparatus consisting of bones and joints ( joints), and the active part is made of muscles. While other specialists restore these structures through something else ( physiotherapy, medications), then the chiropractor acts on them directly. The musculoskeletal system is the subject of study by an orthopedist and traumatologist, and the nervous system by a neurologist. So it turns out that a chiropractor must know neurology and orthopedics, and also be able to distinguish “their” pathologies from those that cannot be eliminated with the help of manual therapy.

Musculoskeletal and peripheral nervous system (nerve fibers) are of interest to the chiropractor from the point of view of movement function. The functional unit of movement in the spine is the spinal motion segment.

Spinal motion segment(PDS)consists of the following components:

two adjacent vertebrae, which form the intervertebral joint at three points - two articulations using the processes of the vertebrae and one through the intervertebral disc;
one intervertebral disc ( cartilage) , which connects the vertebrae, acting as a shock absorber ( thanks to the disc, the vertebral bodies are not injured during movement);
ligaments and muscles- provide the connection of two intervertebral discs and create one spinal column.

There are 24 such segments in total ( 7 cervical, 12 thoracic and 5 lumbar). Each motor segment forms openings that are designed for exit ( or login) spinal roots ( nerves), vessels and veins. Each anterior root ( nerve leaving the spine) has its own muscle group that it can regulate - the myotome ( “myo” - muscle and “tome” segment). At the same time, the same segment of the spine has sensitive dorsal roots ( nerves entering the spine), which receive information from a specific area of the skin - the dermatome ( dermis - skin). Ligaments, fascia, tendons and periosteum receive their “portion” of nerves from the roots ( sclerotome).

Thus, with pathology of the spinal motion segment, muscle tone, skin sensitivity, the degree of ligament tension and organ function are disrupted.

The chiropractor sets himself 2 goals, which are achieved using the same techniques - eliminating pain and restoring impaired movement function. They have the same cause - a block in the spinal motion segment.

Traffic violation(block)in the motor segment there may be:

functional- reversible disorder not associated with pronounced changes in the structure of the organ;
organic- irreversible restriction of mobility and changes in the structure of the organ.

A function block may have the following causes:

abnormal voltage- passive limitation of joint mobility within the limits of its natural function;
local hypermobility- reversible increased mobility of the joint due to excessive stretching of the ligaments.

The outcome of a functional block is an organic block, and hypermobility can turn into organic instability.

Organic movement disorders can be:

fixed ( constrained, stable) - when the patient’s posture changes, the relative position between the two segments does not change;
unfixed ( overly relaxed, unstable) - segment offset ( vertebrae) varies depending on the pose.

The work of a chiropractor is to restore the function of movement before the pathological process becomes irreversible, and such a moment as the reserve of movements is important. The reserve of movements is the ability to loosen the joint with the help of joint play. This reserve is associated not so much with the bones, but with a spasm of the muscular-ligamentous apparatus, which disrupts movement in the joints. To perform manual therapy, the reserve must be preserved ( this is a function block). Thus, manual therapy does not affect the processes occurring in bone tissue. No osteoporosis or osteochondrosis ( bone tissue pathologies) a chiropractor does not treat, he only corrects impaired functions. This is important to consider, since manual therapy is not a panacea and does not replace other treatment methods, but complements them.

The work of a chiropractor, depending on the stage of therapy, can be:

diagnostic- manual diagnostics;
medicinal- manual correction or therapy;
preventive- manual therapy after correction.

How does an appointment with a chiropractor work?

The chiropractor's office is equipped in the same way as a doctor's office of any other specialty; there are no decorative elements typical of massage parlors. Posters with pictures of anatomy can be hung on the walls. musculoskeletal system. The main thing that is present in a chiropractor’s office is a couch for manual therapy, on which the patient lies down or sits during manipulations.

In order for a chiropractor to “have a hand”, it is necessary to undergo a detailed examination and find out the causes of the ailment, that is, consultation and diagnosis are required from therapists, neurologists, traumatologists, orthopedists, rheumatologists. The chiropractor receives the patient with materials about his illness. This is very important because there are a number of contraindications for manual therapy, and they must be excluded before contacting a chiropractor.

An appointment with a chiropractor includes the following steps:

questioning the patient- clarification of complaints, circumstances that led to illness, living and working conditions, other past or current illnesses;
inspection- the doctor examines the condition of the skin, changes in the joint area, their mobility, soreness, muscle tension and soreness, curvature of the spine;
anthropometry- the doctor measures the patient’s height and weight using a measuring tape and floor scales;
general therapeutic examination- measuring blood pressure, pulse, listening to the lungs, examining x-ray films of the area of interest;
neurological examination- assessment of reflexes using a neurological hammer;
orthopedic examination- assessment of the patient’s posture ( free, forced, protective), its constitution, posture, bone elements and natural curves;
spine examination- comparative assessment of symmetrical zones, conducting diagnostic techniques of manual therapy;
manual muscle testing- assessment of the strength and functionality of individual muscles, which is carried out using test movements performed jointly by the doctor and the patient;
determination of change in center of gravity- carried out using a plumb line ( thin thread with a small load), which is lowered from the middle of the distance between the occipital protuberances or from the corner of the shoulder blade to the heel.

During your appointment, your chiropractor may ask the following questions:

Where does it hurt and where does the pain go?
When did the complaints first arise?
Are there sharp, shooting, piercing pains?
Does the pain get worse with exercise? movements, lifting weights)?
Is it typical to experience pain when you start to move?
What movement causes pain?
Does the pain get worse during exercise?
Does the pain decrease with movement?
Do you have pain at rest?
Does pain improve with rest?
Does pain increase at rest or during sleep?
Do you experience a feeling of numbness, tingling ( "goosebumps")?
Is there muscle weakness?
Has the person been involved in sports? athletes feel pain weaker than it actually is)?

Before performing diagnostic techniques, the chiropractor evaluates the movements that a person in most cases performs “automatically.” These habitual movements may be incorrect, which in manual therapy is called a pathological motor stereotype ( is a consequence of the block). To identify a motor stereotype, the doctor asks the patient to sit on a chair, get up from a chair, and lift weights from the floor.

After a hands-free examination, the chiropractor asks the patient to take off his clothes ( During manual therapy sessions, men prefer to wear shorts, and women prefer bikinis.). This is necessary so that the chiropractor’s hands do not slide over clothing while performing techniques ( the technique requires fixing the hands at certain points). The patient sits or lies down on the couch, and the chiropractor begins to search for the blocked area. If there are no contraindications to manual therapy, this block is removed. The chiropractor searches for the block using his hands.

Diagnostic techniques of manual therapy

Diagnostic appointment	Description
*Palpation*	Palpation is the feeling of joints, muscle tissue, and skin. Using this technique, the chiropractor assesses pain, increased muscle tone, tightness, barrier and functional reserve.
*Stretching*	The degree of extensibility of the “sick” muscle is determined in comparison with the symmetrical muscle on the other side.
*Joint examination*	Joint examination includes assessment of active ( produced by the patient) and passive ( made by a doctor) movements in the joint. In addition, the chiropractor identifies specific joint phenomena, such as joint play ( "springing"), which determines the degree of change in the biomechanics of the joint ( degree of blockade).
*Push palpation of joints*	This method examines the spinal motion segments of the spine ( joints). The doctor performs rhythmic shocks in the direction from the spine to assess the functional reserve and mobility of these spinal motion segments.

After the appointment, the chiropractor makes a functional diagnosis - a conclusion about the degree of dysfunction. This diagnosis is designed to develop a treatment plan. The plan depends on where it hurts and where the pain comes from ( where is the block), as well as on the severity of the reserve of movements. Thus, the manual therapy doctor looks at the patient’s condition from a slightly different angle. His diagnosis is a syndrome, which in turn is the result of a disease.

What pathologies do people consult a chiropractor for?

Symptoms that lead a person to to this specialist- this is pain and impaired movement ( dysfunction of an organ or body part). A chiropractor treats or alleviates the patient’s condition with many diseases, but not all pathologies are “subject to” the hands of a chiropractor. There are clear indications and contraindications for manual therapy, which are known to doctors of other specialties. If the pathology is at the stage of dysfunction without deep ( irreversible) violations of the structure of the organ, then medical specialists advise contacting a chiropractor.

According to one of the teachings of manual therapy, all diseases originate from the spine. It is believed that if nerves go to each organ through the spine, then by acting on the spine, it is possible to restore the normal innervation of the organ ( nervous support and regulation). That is why all pathologies dealt with by a chiropractor are considered from the point of view of their connection with the spine.

The pathologies that a chiropractor deals with are:

vertebrogenic ( vertebralis - vertebrate, genesis - origin) - pathologies associated with spinal disease;
nonvertebrogenic- not associated with a disease of the spine or musculoskeletal system or, translated into the language of manual therapy, not caused by changes in the spinal motion segment.

Vertebrogenic pathologies can manifest themselves as the following syndromes:

vertebral syndromes- local pain, the location of the source of pain and the pain zone coincide;
extravertebral ( neural, muscular, vascular) - the area of pain and movement disorders does not coincide with the location of the source of their cause.

Simply put, spinal pathology can have many masks that do not directly relate to the spine. Such “masks” can occur when nerves and blood vessels are compressed ( compression syndromes) or during their reflex contraction ( reflex syndromes).

The most common pathology of the spine, which has many “masks,” is osteochondrosis - dystrophic changes in the spinal motion segment.

Osteochondrosis includes:

disc degeneration- damage causing compaction and protrusion of the disc;
intervertebral arthrosis- disturbance of movement in the joints of the motor segment of the spine;
spondylosis- growth of bone tissue on the surface of the vertebrae.

At the same time, if pain and movement disorders are associated with the spine, this does not mean that a chiropractor can eliminate them. It is important to know that manual therapy is not effective, and sometimes even dangerous, for acute inflammatory, infectious and malignant diseases, as well as fresh injuries and diseases that require surgical treatment.

Contraindications for manual therapy include:

tumors of the spinal cord and spine;
spinal osteochondrosis above stage 3;
complications of intervertebral hernia ( gap);
any malignant tumors with metastases;
ankylosing spondylitis ( inflammation of the intervertebral joints);
acute cerebrovascular accidents;
acute cardiovascular failure;
scoliosis ( in adolescence and above 2nd degree);
congenital vertebral anomalies;
severe diseases of internal organs ( bleeding, wounds, rupture of internal organs, inflammation);
acute infectious diseases;
tuberculosis lesion of the spine;
osteomyelitis ( purulent inflammation) spine;
osteogenesis imperfecta;
vertebral dysplasia ( structural change);
osteoporosis ( decrease in bone density) spine;
spine surgery;
fixing ligamentosis ( degenerative changes in ligaments);
blockage of the lumen of the vertebral arteries by a thrombus;
paresis ( partial paralysis) lower limbs;
atrophy ( tissue volume reduction) muscles of the limbs;
common areas on the body with weakened or lost sensation.

The list of indications for manual therapy is longer and includes many syndromes that get their name depending on where the pain is or where the block is located. It is also important to know that different stages of the same disease can be both an indication and a contraindication to manual therapy.

The most common pathologies treated by a chiropractor

Pathology	Mechanism of occurrence	*Manifestations of pathology ( symptoms)*	The effect of manual therapy in this pathology
*Syndromes with local pain ( vertebral)*
*Cervicalgia*	Cervicalgia ( cervix - neck, algia - pain) occurs due to damage to connective tissue ( bundles) cervical spine and reflex tension of the neck muscles, which is often a consequence of osteochondrosis of the cervical spine.	pain in the neck that spreads to the occipital, parietal or temporal region ( if the first two motor segments are affected) or in the shoulder girdle or shoulder area ( with damage from segments 3 to 7); pain appears or worsens with coughing, sneezing, laughing, or neck movements.	The therapeutic effect is due to the elimination of reflex spasm of the cervical muscles and block in the spinal motion segment of the spine, as a result of which tissue tension and the formation of pain impulses stop.
*Dorsalgia*	Dorsalgia ( dorsum - back) occurs in the presence of a block of costovertebral joints or in pathology of the intervertebral disc ( osteochondrosis) in the thoracic spine. This causes tension in the paravertebral ( paravertebrates) muscles.	restriction of spinal movement in all directions; “rocky” back muscle density; constant or paroxysmal pain in the upper and middle back, especially with a sharp turn of the torso or a deep breath.	The pain disappears if the chiropractor achieves muscle relaxation and adjusts the location of the components of the motor segments ( reduces subluxation). Thus, on the one hand, the root cause of nerve compression is eliminated ( block), and on the other hand, muscle relaxation relieves pain.
*Lumbodynia*		joint pain; restriction of movement in joints; “clicking” in the joints during movement.		The therapeutic effect is achieved by eliminating chronic pain in a tense joint muscle. The absence of pain inhibits further changes in the structure of the periarticular tissues and makes it possible to work on the joint, restoring its function.
*Tunnel syndromes in the arm area*	Tunnel syndromes occur when the nerve plexuses are compressed inside their bed - this is the name of the place between the muscles and fascia of the limb, which is intended for the passage of nerves ( that's why they are called tunnels). The cause of compression may be overload of the muscles that form this tunnel, a tendency to edema, or the congenital narrowness of the tunnel. For the lower extremities, the shoe factor is also important.	pain, tingling ( "goosebumps") or decreased sensitivity in the area of the forearm, hand, elbow, fingers, which arises or intensifies when performing certain actions.	The therapeutic effect of manual therapy is due to a change in the motor stereotype, which caused pinched nerves inside the muscular-fascial canals. This is achieved through exercise and muscle relaxation.
*Tunnel syndromes in the leg area*		pain and numbness in the groin, inner, front or side of the thigh, lower leg and foot ( in the sole and toes), which arise or intensify when performing a certain movement; intermittent claudication.
Vertebral artery syndrome(vertebrobasilar disease)	The mechanism of occurrence of the syndrome is associated with irritation of the nerve plexus of the vertebral artery ( passes through the vertebral foramina), which most often occurs due to instability ( offsets) discs of the middle cervical segments. As a result of such instability, the artery is compressed, its lumen decreases, and into the main vessel of the skull ( basilar artery) less blood flows.	headaches in the neck and back of the head, spreading to the temple and forehead; dizziness ( occurs when the head position changes); increased blood pressure; visual impairment.	The therapeutic effect for this pathology is due to the reduction of the displaced cervical vertebra, as a result of which the compression of the artery stops.
*Heel spurs* *(plantar fasciitis)*	Heel spurs are called bony growths on the heel bone. The reason for their formation is excessive tension of the plantar ( plantar) fascia and its microtraumas ( fascia actively works during walking). This results in a blockage in the ankle joint, causing painful tension in the fascia.	sharp pain in the heel while walking.	The analgesic effect of manual therapy is due to the relaxation of the muscles and fascia of the foot and ankle joint.
*Functional dysphonia*	If there is a block in the cervical spinal motion segments, the coordinated activity of the laryngeal muscles is disrupted, they are shortened ( spasm) or lose tone ( become lethargic).	sensation of a “ball” in the neck or larynx; the need to cough during a conversation; hoarseness or decrease in the “span” of vocal capabilities ( especially noticeable among vocalists).	The therapeutic effect of manual therapy is due to the reduction of displaced segments ( block removal). This normalizes nerve transmission to the muscles of the larynx.
*Sliding costal cartilage syndrome*	The reason for “sliding” is increased mobility ( hypermobility) ends of the costal cartilages in the place where they are attached to the sternum. This can occur when the muscles that attach to the sternum and ribs are overly tense. This is where the block is located.	sudden pain in the ribs that spreads to the sternum, shoulder ( looks like a heart attack); pain occurs when inhaling, coughing, bending the body, or pressing on painful points of the ribs ( there is a clicking sound).	Manual therapy addresses instability in the area where the ribs attach to the sternum by realigning the misalignment and relaxing the muscles associated with these bones.
*Temporomandibular joint dysfunction*	Movement disorders in the temporomandibular joint occur due to increased tension ( spasm) masticatory muscle. High tone can be observed with trigeminal neuralgia or any pathology in this area that causes a reflex muscle spasm.	pain when opening the mouth; reduction in the size of the mouth gap; difficulties with the act of chewing; “crunch” in the joint.	Restoring movement in the joint is achieved by improving blood supply and relieving tension in the joint. masticatory muscle, interrupting the pain signals that cause its spasm.
*Respiratory disorders*	In some cases, breathing disorder may be caused by a violation of the synchronization of movements of the respiratory muscles, if the motor segment of the ribs is blocked ( joint) joins the act of breathing later than the others, and finishes its movement before everyone else. Another reason could be soreness in the chest and abdominal muscles.	shortness of breath and a feeling of incomplete inspiration; tightness of the chest in the form of a hoop.	Restoring breathing with the help of manual therapy occurs due to the removal of the block that interfered with the synchronous movement of the chest and the elimination of pain points in the muscles that cause pain during breathing.
*Functional disorders of internal organs*	The presence of a block in the spinal motion segment changes the normal transmission of impulses to the organ along nerve fibers ( although anatomically the nerve pathways are preserved). This leads to disruption of the motor activity of the muscles of the organ ( spasm or loss of tone) and tightening of its ligaments. This can also be considered an abnormal motor pattern that is manifested by the disease.	vegetative-vascular dystonia ( arrhythmias, high pressure, shortness of breath); bronchial asthma ( tendency to bronchospasm); chronic diseases of the gastrointestinal tract ( gastritis, enteritis, colitis, flatulence); biliary dyskinesia ( bile movement disorder); visceroptosis ( prolapse of internal organs); adhesive disease; reproductive diseases ( sexual) organs; chronic prostatitis;	Manual therapy improves blood circulation in these organs, increases sensitivity to nerve impulses, which stimulates recovery processes. In addition, the therapy restores the normal relative position of internal organs, that is, corrects the motor stereotype.
Pathologies in children
*Birth trauma of the cervical spine* *(craniocervical injury)*	The cervical spine of the fetus experiences the greatest load during childbirth ( although other parts of the spine may also be affected). For any pathology of labor or abnormal position of the fetus in the uterus ( breech presentation) this load increases. As a result, there is displacement of the vertebrae and their instability in newborns ( "children's" osteochondrosis).	the child cries and sleeps poorly; jerks his hands and clenches his palm into a fist; the child’s physical development and brain maturation are disrupted ( learning difficulties); posture changes and the spine bends.	Vertebral instability in children is eliminated in the same way as in adults. The therapeutic effect is achieved by realigning the vertebrae and relieving muscle spasm.
*Torticollis*	The cause of “congenital” torticollis is the uncomfortable position of the child in the uterus during pregnancy or osteochondrosis in childhood. As a result, a block occurs in the cervical spinal motion segments, which causes compression of the nerves and a reflex spasm of the neck muscles.	the head leans towards one shoulder.	The therapeutic effect is due to the relief of muscle spasm, reduction of vertebral subluxation and correction of the motor stereotype ( "training" of muscles).
*Scoliosis*	Scoliosis develops if a child’s spine is in an incorrect position for a long time ( playing the violin, uncomfortable sitting position) or carries weights on his back ( backpack). As a result, some of the spinal muscles are constantly overstrained and “tighten” the spine. There is also scoliosis, which occurs due to uneven tissue growth.	lateral curvature of the spine.	The chiropractor directs his skill at changing the muscle stereotype - relieving habitual muscle tension. On the other hand, manual therapy stimulates the growth of muscles that have lagged behind in development.
*Myopia*	The cause of this pathology in many children is a functional blockade of the craniovertebral junction - the base of the skull, which is formed by the occipital bone and the first two vertebrae ( atlas and axis).		The therapeutic effect of manual therapy is based on the removal of blocks in the area of the base of the skull, which eliminates myopia in children in 97% of cases. In adults, this percentage is much lower, since over the years of life other causes of myopia may join the functional block.

What types of manual therapy are there?

Manual therapy is called a complex manual technicians, which have been used since ancient times, but scientific confirmation was found relatively recently. Many experts still do not recognize the “manual” as science, considering it a pseudo-teaching. Manual therapy acquired such a reputation due to the fact that in the United States, due to high profits, they began to “produce” too many chiropractors, who were called chiropractors ( hiro - hand). The work of chiropractors was effective, but was not recognized by doctors, since chiropractors did not have medical education. Due to the lack of contact between doctors and chiropractors, manual therapy in this form developed independently of traditional medicine.

Osteopaths existed at the same time as chiropractors. Osteopathy is the same manual therapy that belongs to alternative ( unconventional) Eastern methods of treatment.

We can say that manual therapy is a Western version of eastern alternative medicine, which has an evidence base, that is, it can prove exactly how this therapy works in medical language. This is one of the main differences from osteopathy, which uses "tongue" ( terminology) oriental alternative medicine.

Manual therapy techniques

A technique is an action of a chiropractor with the aim of restoring the original physiological state of the motor segment or its controlled structures ( muscles). Performing an appointment requires the doctor to have in-depth knowledge of anatomy and physiology, neurology and orthopedics. Each part of the musculoskeletal system or part of the body has its own techniques, but they are all grouped depending on the method of influence.

To the methods of influence(techniques)manual therapy include:

mobilization- smooth, rhythmic, as if playing or loosening movements in the joint ( multiple movements), which ultimately pull the displaced component, freeing it from the load, and help return to “its place”;
manipulation- rapid movement against the background of relaxation, which has little force and small “span”, leading to the realignment of the displaced part in one moment ( reposition);
relaxation- techniques that relax muscles.

All three techniques are often used together, being stages of one technique. Mobilization and relaxation are “soft” techniques, and manipulation is “hard”. When performed correctly, “hard” manipulation is performed softly ( in contrast to reductions of dislocations performed by traumatologists).

Some chiropractors add a fourth technique to these three techniques - pressure. Pressure is an effect on painful points, which occupies an intermediate place between massage and manual techniques.

Manipulative techniques include:

push;
traction push ( forceful traction);
hit.

Mobilization techniques include:

rotation ( rotation);
flexion;
extension;
deflection;
traction ( traction);
distraction ( stretching);
tensia ( pressure, tension);
nutation ( rocking);
twisting ( twisting);
reduction ( retraining a relaxed muscle).

Relaxation techniques include:

- the doctor causes muscle tension that is not accompanied by movement ( abbreviation or shortening), after which the muscle relaxes as much as possible for some time;
postreciprocal relaxation- stretching and relaxation of the “sick” muscle occurs in an active way, for which the patient himself “moves” the muscle, which causes movement in the other direction ( for example, if the flexor is sick, the extensor is activated).

Chiropractors use the term “mobilization” more often, and it may seem that they only perform these techniques, but this is not at all the case. It all depends on the goal. By mobilization, therapists mean loosening, which sets the tissue in motion. Loosening can relax a muscle or realign a vertebra, so mobilization techniques can be used on joints as well as muscles, ligaments and fascia. The main difference between mobilization and manipulation is the number of movements. If the movement is performed once, this is manipulation; repeated movements in the same place are mobilization.

A chiropractor may use massage techniques as a complementary method in their practice, but massage is not a purely manual therapy. Classic massage, although performed with the hands, belongs to reflexology. The “massage” performed by a chiropractor is more like kneading tissue.

Depending on the point of application(block location), there are the following types of manual therapy:

cutaneous-subcutaneous-myofascial manual therapy;
arthro-vertebral manual therapy;
craniosacral manual therapy;
visceral manual therapy.

Cutaneous-subcutaneous-myofascial manual therapy

According to the principle of manual medicine, muscle movement and skin sensitivity are impaired in the presence of a block in the spinal motion segment. This means that the chiropractor does not directly treat muscle pain and skin-subcutaneous thickening and tightening. But pain and dysfunction of muscles and skin are eliminated if the block in the spine is removed. On the other hand, muscle pain maintains the vicious circle of pain syndrome due to the formation of an incorrect muscle-motor stereotype ( pain - muscle spasm - dysfunction - pain). With the help of cutaneous-subcutaneous-myofascial therapy, the chiropractor removes one of the links from this chain - pain, which breaks the vicious circle. Yet, despite this analgesic effect, cutaneous-subcutaneous-myofascial therapy is not so much a therapeutic method as a diagnostic and preparatory method.

The diagnostic component of this therapy is that by determining increased or decreased muscle tone, painful points ( trigger points), compacted lesions and areas of skin numbness, the chiropractor finds out exactly where the blockage occurred.

As a preparatory stage, cutaneous-subcutaneous-myofascial therapy is a mandatory component of treatment. To manipulate or mobilize a blocked motion segment, the muscles that receive nerves from that segment must be relaxed. IN preparatory stage Therapy techniques also help relieve pain, but the cause of the pain, that is, a block in the spinal motion segment, remains. This means that if the next stage of treatment is not carried out, the pain will return after some time.

Arthro-vertebral manual therapy

Arthro-vertebral manual therapy, as the name suggests ( arthus - joint, vertebralis - vertebral), is aimed specifically at the motor segments of the spine in order to remove the block. This type of manual therapy involves the use of mobilization and manipulation. Manipulation is carried out using pushes or blows, which are believed to cause a “crunch” when performed correctly. In fact, the appearance of a crunch during manipulation is not at all necessary. The cause of the “crunch” is the impact of two articular surfaces in the blocked segment, which occurs reflexively at the moment when the doctor stretches the muscles around the joint.

This type of therapy involves the use of both soft and hard techniques ( latest doctor carried out only with the consent of the patient).

Joint blockades are eliminated using the following techniques:

manipulation- push, push with extension, blow;
mobilization- rhythmic rocking in the joints;
traction- rhythmic or non-rhythmic stretching to the limit;
post-isometric relaxation- relaxation of a muscle after tension.

Craniosacral therapy

Craniosacral therapy is gentle manipulation of the skull bones in the suture area ( junction of cranial bones). The term “craniosacral” itself consists of two words. "Cranium" means "skull" and "sacrum" means sacrum or "holy bone". This combination of words indicates the effect of craniosacral therapy - normalization of the flow of cerebrospinal fluid along the “skull-sacrum” axis. There are not many specialists working using this method. The fact is that craniosacral therapy is slightly different from other classical methods of manual therapy; it is more related to osteopathic methods of treatment. However, since a chiropractor and an osteopath are like two people who look at the same mountain from its different slopes and therefore see different landscapes, craniosacral therapy, in a slightly modified interpretation, also refers to manual therapy methods.

A chiropractor who uses craniosacral therapy assumes that the bones of the skull, despite the absence of joints between them, still tend to move due to the elasticity of the bone sutures. If this “movement” is disrupted, then various symptoms and diseases of the organs develop. The main difference between craniosacral therapists is that all manipulations are carried out exclusively within the skull.

Craniosacral therapy has advantages and disadvantages. Among the disadvantages, the duration of the procedure should be noted ( at least 1 hour), and among the advantages - the absence of unpleasant sensations and the need to be naked in front of a doctor.

Visceral manual therapy

Visceral ( viscera - innards) manual therapy literally translates as “treatment of the insides with the hand,” meaning non-surgical intervention. Internal organs, as we know, are covered with membranes and have muscles, therefore, they can also move and become blocked, like muscles and joint capsules. This blocking is especially pronounced when the spine changes ( curvature). To breathe normally, pump blood through the vessels, move food through the gastrointestinal tract, empty the intestines and bladder, have sexual intercourse and give birth, it is necessary that the movement of these organs is not blocked.

Visceral manual therapy involves the use of the following techniques:

direct mobilization- the doctor directly touches the organ with his hands from the side or from the edge, producing rapid rhythmic loosening;
indirect mobilization- the doctor acts on organs that cannot be touched directly ( internal organs, such as the heart) through muscles and ligaments that have functional connections with an organ or bone structures through which nerves pass to this organ.
parallel mobilization shifts- carried out to eliminate constriction of organs in the presence of adhesions.

Visceral therapy is carried out on the following organs:

lungs;
pleura;
heart;
diaphragm;
gallbladder;
liver;
duodenum;
small intestine ;
colon;
kidneys;
bladder;
uterus and ovaries;
prostate.

What methods does a chiropractor use to treat?

In each specific case, the chiropractor selects the necessary and most appropriate techniques and techniques ( adequate means “directed to the cause”). There are a lot of methods, some of them are proprietary. They differ from each other in a different combination of techniques. Still, there is a conditional division of all methods, depending on the point of influence and the goal. It is conditional, because the chiropractor will not say “you have been prescribed such and such a technique,” he will describe the techniques that he will perform. Externally, these techniques do not differ from each other for the average observer ( the doctor presses on something, pulls on something, bends, unbends). In addition, the patient often has a block not in one place, but in several at once. That is why the same patient may require the use of different techniques at different stages of manual therapy, even if the initial cause is the same.

It is important to note that a chiropractor is supposed to use only their hands. This differs from a vertebrologist, who can use not only manual therapy, but also other methods of eliminating blocks in the spinal motion segment ( physiotherapy, drug pain relief). This is a fundamentally important difference, since chiropractors believe that non-manual techniques do not relieve a block in the spinal motion segment, but only its symptoms ( and even then temporarily).

Techniques used by a chiropractor

Manual therapy technique	Mechanism of therapeutic action	For what pathologies is it used?	What is the duration of treatment?
*Cutaneous-subcutaneous-myofascial manual therapy*	The point of impact with this technique is soft tissue. This method improves blood circulation and lymphatic drainage by affecting the sensitive nerve endings of muscles, tendons and skin, which causes their reflex relaxation. Pressure on pain ( trigger) the points cause a reaction from the body - it activates the anti-pain system.	cervicalgia; dorsalgia; lumbodynia; sacralgia; coccydynia; radiculopathy; radiculoischemia; anterior chest wall syndrome; inferior oblique muscle syndrome; anterior scalene syndrome; scapular-costal syndrome; interscapular syndrome; piriformis syndrome; crumpy; iliopsoas syndrome; arthrosis and periarthritis of the joints of the limbs; vertebral artery syndrome ( vertebrobasilar disease); heel spurs ( plantar fasciitis); functional dysphonia; sliding costal cartilage syndrome; respiratory disorders; tunnel syndromes; myopia; birth injury of the spine; torticollis; scoliosis.	The average number of manual therapy sessions is about 10 sessions; the maximum number of sessions is 15. Several courses of manual therapy may be required throughout the year.
*Arthro-vertebral manual therapy*	Point of application - joints ( spine and limbs). This therapy is carried out with the aim of restoring the biomechanics of the motion segment ( relative arrangement of elements) and remove the block. After removing the block, abnormal tension in the muscles, ligaments and joint capsules is eliminated, blood flow and lymphatic drainage are improved, posture is corrected and the function of internal organs is normalized.
*Visceral manual therapy*	This therapy restores the relative position of internal organs ( pathology of the musculoskeletal system of internal organs), which changed when a functional block occurred in the spine. The visceral technique allows you to eliminate secondary blocks, that is, return the internal organs to their original position, which was before the formation of blocks in the spine.	vegetative-vascular dystonia; bronchial asthma; chronic gastritis, enteritis, colitis, flatulence; biliary dyskinesia; kidney pathology; prolapse of internal organs; adhesive disease ( after operations); gynecological diseases; chronic prostatitis; miscarriage.	Most often, 7 to 10 sessions are prescribed.
*Craniosacral manual therapy*	This technique uses gentle methods of rhythmic mobilization of bone elements and ligaments in the area of bone sutures, which leads to improved blood flow in the vessels of the brain, normalizes the movement of cerebrospinal fluid and promotes the “return” of the vertebrae to their places.	cervicalgia; dorsalgia; lumbodynia; scoliosis ( with tissue underdevelopment); functional disorders of internal organs; subclavian artery syndrome ( vertebrobasilar insufficiency); dysfunction of the temporomandibular joint; prevention of adhesive disease ( carried out after surgery).	1 session lasts within one hour ( at least 30 minutes). The total number of sessions is determined individually, depending on the pathology.

Manual therapy examination. What examination should be completed before prescribing manual therapy? Who can be a “manipulator”