Manual medicine

from Wikipedia, the free encyclopedia

The Manual medicine together with the chiropractic (from ancient Greek χείρ cheir , hand '), a medical school, which is used for medical treatment when malfunctions of the musculoskeletal system cause discomfort. Since diagnosis and treatment are carried out exclusively by hand, manual medicine is differentiated from invasive and medicinal medicine. In some areas it builds on the methods of chiropractic and osteopathy , but is part of critical-rational conventional medicine .


Manual medicine is fundamentally concerned with restoring the mobility of joints that are intact in shape and composition, but whose function is disturbed. Functional disorders such as restricted mobility ( blockage ) of the spine and joints, fasciae and muscles are the target points of manual medicine. Diagnostics and therapy are based on biomechanical and neurophysiological principles and are carried out by hand with preventive , curative and rehabilitative objectives.

Both doctors and physiotherapists can receive further training at institutions recognized by the state medical associations. After passing the exam, specialists and general practitioners may use the additional designation “manual medicine / chiropractic therapy” either in the form of one of the two terms or in combination.

In evidence-based medicine, like osteopathy, chirotherapy is often considered a complementary medical treatment. The effectiveness of chiropractic therapy remains controversial. Max Geiser remarks, referring to osteopathy and chiropractic, the theories “to be able to cure various diseases caused by these“ deformities ”with the manipulative elimination of 'misalignments' of the vertebral joints [...] contradict all the facts recognized in the 20th and 21st centuries about the anatomy , physiology and pathology of the human organism. ”Like osteopathy, chirotherapy works in addition to evidence-based medicine.

Non-medical practitioners usually refer to themselves as chiropractors (or chiropractors), a more common but not protected term in Germany, behind which in individual cases a well-founded training or even little knowledge can stand.


The basis of manual therapy is the precise diagnosis of the blocked joints by looking for so-called irritation points , which indicate the position of the blocked joint via neurogenic interconnections. Then you have the option of treating blocked joints in a mobilizing or manipulative way.

In the mobilizing treatment, mobility is restored by gently and frequently repeated stretching movements.

In manipulative treatment (from Latin manipulus , 'handle', 'trick'), a blockage is treated with an impulse. The therapist applies a targeted neural stimulus to so-called nociceptors , which then experience a reset and relax the tense muscle blocking the joint. In the case of the vertebral arch joints, for example, the segmental rotatores breves muscles play a corresponding role. To achieve this effect, neither a great force nor a great path is required. The manipulative treatment with very quick and short movements on the spine is reserved for the doctor (in chiropractic ) and the non-medical practitioner (in chiropractic ). Physiotherapists specially trained in orthopedic manual therapy are also allowed to work with these techniques. Manipulative techniques on extremity joints as well as gentle mobilizing spinal column techniques can also be performed by appropriately trained non-medical persons. They are then not referred to as manual medicine, but as manual therapy .

In general, the prior imaging exclusion of spinal damage such as B. fractures or tumors by means of X-rays or CT / MRT are essential before any manipulation of the spine.

Definitions of terms


Chiropractic is defined as: “A system of healthcare which is based on the belief that the nervous system is the most important determinant of health and that most diseases are caused by spinal subluxations which respond to spinal manipulation.” (German: “Ein System der Health care based on the belief that the nervous system is the most important factor in health and that most diseases are caused by spinal subluxations that respond to manipulations on the spine. "

The purpose of chiropractic is purely to restore the disturbed joint play that was caused by subluxations of the joints. The effectiveness of chiropractic compared to other forms of therapy is low. According to E. Ernst and PH Canter, spinal manipulation is not a recommended treatment.

In the United States, Australia, and other countries, degrees in chiropractic can be obtained from specialized colleges and centers. After passing the exam, the title “Doctor of Chiropractic” is awarded.

In Germany only naturopaths and doctors are allowed to practice chiropractic. Chiropractors qualified abroad must therefore obtain a naturopathic license in order to practice in Germany. In practice, however, authorities have regularly requested a comprehensive knowledge test. In the recent past, some administrative courts have objected to this and ruled that training abroad should be recognized.


Osteopathy was founded in 1874 as an independent understanding of medicine alongside conventional medicine . This doctrine claims to use various kinds of manipulation techniques to loosen blockages in the nervous, blood and lymphatic systems and thus to influence almost all vital processes in the body.


Europe until 1850

Images of manual handles can already be found in ancient times . Records from the Middle Ages , for example from Hildegard von Bingen , are also preserved. Since modern times it has been mainly lay practitioners who practice manual techniques. Often it was shepherds , the so-called Boandlsetzer ' leg setters ' in Tyrol , who rearranged the animals that had stayed behind and reintegrated them into the herd. Reports are sparse, with only some of the handles being used on humans. During this time there were still the Bonesetters in England, Algebristas in Spain and the Renunctores in Italy. The American cowboys are also said to have learned about the handles from emigrated Tyrolean cattle herders and to have used them on the animals of their herds, whereby the knowledge came to the United States .

America from 1860

Around 1866, Jim Atkinson was a physician in Davenport , Iowa. Among his students were the two founders of osteopathy and chiropractic , which later went their separate ways. The surgeon Andrew Taylor Still broke with conventional medicine and turned - inspired among other things by the new theory of evolution and Indian medicine men - to a new, holistic view of medicine. In 1874 he proclaimed osteopathy, and in 1892 the School of Osteopathy was founded. Daniel David Palmer, on the other hand, was not a doctor, but a general store. He practiced his chiropractic as a lay therapist. The Palmer School of Chiropractic , which he founded in 1897, trained non-medical professionals to become therapists. Both variants of American manual therapy reached Europe in the early 20th century. Stoddard and Mennell brought the osteopathic school to England , from where it spread to Germany.

Germany from 1950

The surgeon Karl Sell served in field hospitals during the Second World War , where he was confronted with exhaustion, pain and joint blockages in soldiers. Based on his experience, he independently developed a school of manual medicine, which, similar to chiropractic, focused on restoring impaired joint function through manipulation. In 1952/1953 a Karl Sell school was founded in Isny -Neutrauchburg.

In Germany, the three different organizations (FAC in Boppard, originally based on osteopathy; MWE in Isny-Neutrauchburg; Manual Medicine Section of the Society for Physical Medicine of the GDR) merged to form a joint medical society in 1966, or after reunification in 1990 , the German Society for Manual Medicine (DGMM). The German Society for Chirotherapy and Osteopathy (DGCO) has the largest membership purely medical specialist society in Germany . 2011 was the first time in Germany, a professor in the art of chiropractic at Dietmar Daichendt , the President of the DGCO awarded.


In Austria there is the Austrian Medical Association for Manual Medicine in Vienna founded by Hans Tilscher (emerged from the FAC) and the Austrian Working Group for Manual Medicine according to Karl Sell in Graz. Both schools offer training diplomas independently of each other and are recognized by the Austrian Medical Association.


The SAMM has existed in Switzerland since 1959, originally founded by Hans Caviezel, a student of Karl Sell, later the work group around Jiri Dvorak determined the direction of the school.

Czech Republic

In the Czech Republic Karel Lewit (1916–2014) is considered to be the founder of the Prague School of Manual Medicine and Rehabilitation. He spread his reputation as an international expert in the field of manual medicine as the author of a specialist book that has been translated into numerous world languages ​​in several editions. He trained numerous doctors v. a. from the former GDR, Poland and Austria in his method.

See also

Web links

Individual evidence

  1. H.-P. Bischoff, H. Moll: Brief textbook of manual medicine. 5th edition. Spitta-Verlag, Balingen 2007, ISBN 978-3-938509-12-8 , p. 17.
  2. Chiropractic Information Examination and Treatment. (No longer available online.) In: Archived from the original on October 15, 2013 ; accessed on February 13, 2014 . Info: The archive link was inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice. @1@ 2Template: Webachiv / IABot /
  3. DGMM seminars. (No longer available online.) Archived from the original on February 21, 2014 ; accessed on February 13, 2014 . Info: The archive link was inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice. @1@ 2Template: Webachiv / IABot /
  4. Further training regulations of the BLÄK. (PDF; 452 kB) Accessed February 13, 2014 .
  5. Hancock et al .: Independent evaluation of a clinical prediction rule for spinal manipulative therapy: a randomized controlled trial . In: European Spine Journal . tape 17 , no. 7 , July 2008, p. 936-943 , doi : 10.1007 / s00586-008-0679-9 .
  6. Swiss Medical Journal. 2007, p. 758 ( PDF; 190 kB).
  7. ^ Edzard Ernst et al: The Desktop Guide to Complementary and Alternative Medicine: An Evidence - Based Approach. Elsevier Health Sciences, 2001, ISBN 0-7234-3207-4 , p. 45.
  8. ^ Edzard Ernst , PH Canter: A systematic review of systematic reviews of spinal manipulation. ( Memento of the original from May 11, 2008 in the Internet Archive ) Info: The archive link was inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice. In: JR Soc Med. 2006; 99, pp. 192-196. @1@ 2Template: Webachiv / IABot /
  9. WJJ Assendelft, SC Morton, I. Yu Emily, MJ Suttorp, PG Shekelle: Spinal manipulative therapy for low-back pain. Cochrane Database of Systematic Reviews 2004, Issue 1. Art. No .: CD000447. doi: 10.1002 / 14651858.CD000447.pub2 .
  11. a b c d e H.-P. Bischoff, H. Moll: Brief textbook of manual medicine. 5th edition. Spitta-Verlag, Balingen 2007, p. 13ff.
  12. patient in double nelson. In: Der Spiegel. 43/1953.
  13. ^ German Society for Chirotherapy and Osteopathy
  14. First German professorship for manual medicine (chirotherapy / osteopathy)
  15. Deutsches Ärzteblatt
  16. ^ Austrian Medical Association for Manual Medicine
  17. ^ A. Lechner: Formative personalities of manual medicine . In: Manual Medicine . tape 50 , no. 4 . Springer Medizin Verlag, September 2, 2012, ISSN  0025-2514 , p. 273-276 , doi : 10.1007 / s00337-012-0930-7 .
  18. Karel Lewit (accessed February 14, 2018)