Manual therapy

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In medicine, manual therapy is used to treat functional disorders of the musculoskeletal system (joints, muscles and nerves). It is the part of manual medicine carried out by physiotherapists with special training (from the appendix to the contract in accordance with Section 125 SGB ​​V on the provision of physiotherapeutic services) and includes examination and treatment techniques. In alternative medical forms of treatment, the treatment of a wide range of complaints in other parts of the body and generalized disorders are also understood as manual therapy. It differs from medical manual medicine in that in Germany it is not allowed to use jerky techniques, so-called techniques with impulse (manipulation) on the spine , but there is no clear legal regulation.

history

In classical antiquity, back pain was treated with certain grip and massage techniques . In addition to the traumatic dislocations , Hippocrates also described slight vertebral shifts and indicated how these should be corrected. In the Middle Ages, innumerable lay practitioners (“bone setter”, “limb setter”) were out and about to treat the pain neglected by competing doctors. On prepared skeletons, the idea of dislocations and jamming , especially of the vertebral joints, was developed, which could not be confirmed by today's medicine.

In the USA, so-called bonesetting had been very common since the 18th century. Since the 19th century it has been reintroduced in Europe in various forms and under numerous names, initially by alternative practitioners, and since the Second World War also increasingly by orthopedic or general practitioners. The orthophysiological theory of conventional medicine focuses primarily on muscular tension and imbalances that are triggered by improper loads , instead of bone "dislocations" . The biomechanics of the joints and the complex approaches and orientations of the muscles have different shape into account what incoming anatomical knowledge requires.

In the 20th century, alternative medical manual therapists developed the claim to influence other diseases and disorders in addition to the simple stress-related pain in the musculoskeletal system. Similar to acupuncture , neural, reflex or “ energetic ” connections between the bones and joints and the rest of the body are postulated, although their existence has not been proven. In addition to gastrointestinal complaints, psychological complaints, anxiety neuroses, depression and developmental disorders are a frequent target of manual therapeutic interventions. The KISS syndrome (head joint-induced symmetry disorders in children) is an example of a common alternative medical diagnosis that is treated by manual therapy but has no equivalent in scientific medicine.

Designations

Main directions

Chirotherapy / manual medicine has been a protected additional designation in Germany since 1976 for doctors who offer manual treatments. The procedures recognized in evidence-based medicine are based on passive mobilization and active exercises on the joints and the spine and dispense with esoteric notions of illness, such as meridians or “energy flows”. In order to use the additional designation, doctors must prove that they have had training recognized by the responsible state medical association . Under Manual therapy in the narrower sense is the application developed by the chiropractors techniques by specially formed continuous physical therapists / physiotherapists. In contrast to the treatments offered by non-doctors, German health insurance companies pay for this therapy, provided that it is carried out by appropriately trained manual therapists on medical prescription.

In Germany, manual therapy is a protected form of physiotherapeutic treatment that can be prescribed by the attending physician by means of a prescription for medicinal products after a prior diagnosis has been made. The amount of prescribed therapies depends on the diagnosis and the national catalog of medicines from 2004, which determines the amount of treatment. The training to become a manual therapist comprises at least 260 hours of advanced training, which in most approved advanced training institutions goes well beyond this minimum number of hours. As a rule, this comprises around 400 hours with an additional final exam. This additional qualification entitles the physiotherapist / masseur to settle the manual therapy item . Since the mid-2000s, fully trained physiotherapists in Germany have had the opportunity to acquire the qualification Orthopedic Manual Therapy (OMT). This additional qualification, which builds on the normal manual therapy training, is offered in Germany by the German Federal Working Group for Manual Therapy . The DFAMT umbrella organization includes four OMT schools that train and certify therapists in Germany. Internationally, this training is standardized by the International Federation of Manipulative Physiotherapists (IFOMPT). The national schools include the DVMT, AGMT, DFOMT and DGOMT. This training comprises at least 660 hours of training, which as a rule comprises well over 1000 hours. Since the 2013 winter semester, it has also been offered as a master’s course at the Osnabrück University of Applied Sciences and, from the 2014 winter semester, also at the Fresenius Idstein University of Applied Sciences . The degree takes place as a Master of Science .

  • Chiropractic ( or -praxis , English chiropractic ) (from Greek made by hand ) comes from the American alternative medicine practitioner Daniel David Palmer , approx. 1897: "Dislocated" vertebrae are straightened by pressure and tension, followed by relaxation and stretching exercises Arms and legs. According to its representatives, chiropractic should represent a further development in that, in addition to the spine, the other joints are also treated. Today, the bitter rivalries between osteopaths and chiropractors of the 19th and early 20th centuries are hard to understand.
  • Cranio-Sacral Therapy is also a development from the USA by the osteopath William G. Sutherland (1936). It clearly has esoteric components; in particular, an assumed “flow of energy” in the cerebral fluid is to be restored by treating restricted movement of the spine. The importance of CST today is less than that of osteopathy and chiropractic.
  • Naprapathy (a diagnosis and treatment system of neuro-skeletomuscular medicine) has been a protected professional title in Sweden for several years for so-called Doctors of Naprapathy or Doctors of Naprapathic Medicine, D.N. or DN, (leg. Naprapat) who offer orthopedic-manual medicine. To be able to practice, naprapaths in Sweden need a state license (legitimation). They are under the supervision of the national health authority and have an autonomous, diagnostic responsibility for neuroskeletomuscular dysfunction. The training to become a legitimized Naprapath, D. N. takes five years. Many naprapaths are active in sports medicine and in national teams. Naprapathy is the largest form of orthopedic medicine in Sweden. Many leg. Naprapaths have additional qualifications, e.g. B. in nutrition or acupuncture. There are training courses in the USA, Finland and Sweden.
  • Rolfing's method of structural integration, primarily starts with the fascia and aims to bring the body structure into a more harmonious alignment with gravity.
  • Orthopedic Manual Therapy (OMT) Further training courses are offered on top of the basic physiotherapy training and the certificate in manual therapy. After completing at least another 666 hours of advanced training, a passed exam with treatment directly on the patient and an additional thesis, the additional qualification "OMT" is awarded. This training is currently carried out in German-speaking Europe according to the standard of the "IFOMPT" (International Federation of Orthopedic Manipulative Physical Therapists). The associated German umbrella organization is the DFAMT, which unites the four associations that offer this training. In total, an OMT therapist has at least 1000 hours of advanced training in manual therapy. An OMT therapist is a specialist in musculoskeletal findings and treatments. This treatment concept includes manual techniques and therapeutic exercises that are combined.
  • Osteopathy , English osteopathy is an old term; founded by the American doctor Andrew Still around 1870. Still referred to his own experiences and traditional folk medicine of the American rural population. Special loosening and grip techniques are supposed to remove "movement restrictions" in the bones and muscles, which are responsible for pain, digestive problems, menstrual cramps and other symptoms. Almost all manual therapists still refer to Still as their first modern predecessor.

Regional variants

  • Vitalogy , also called atlaslogy , are current names used by German and Swiss practitioners for treatments on the first cervical vertebra ( atlas ).

Web links

Individual evidence

  1. ↑ German Federal Working Group for Manual Therapy e. V. (DFAMT)
  2. ↑ German Association for Manual Therapy e. V. (DVMT)
  3. ↑ Manual Therapy Working Group (AGMT) in the German Association for Physiotherapy (ZVK) eV
  4. ↑ German specialist group for orthopedic manual / manipulative therapy e. V. (DFOMT)
  5. ↑ German Society for Orthopedic Manual Therapy e. V. (DGOMT)