Editor's note: Part I, which appeared in the Jan. 14th issue, was authored by Andrei Pikalov, MD, PhD. Part two is co-authored by Vyatcheslav Kharin, MD, PhD.
The contemporary trend in manual therapy (MT) as a scientific and practical field of medicine presents two main directions: the first is MT as a method for treatment of degenerative and dystrophic elderly pathology of the locomotor system; the second direction is MT for the treatment of visceral pathology.
MT as treatment for pathology of the locomotor system is more elaborate and systematized, and several publications confirm this statement.1-8 Most of these publications are devoted to the problems of etiopathogenesis and methods of treatment of vertebral osteochondrosis and related vertebrogenous musculoskeletal neurologic disorders. Thus MT as a subject for investigation has the attention of such medical disciplines as orthopedics and neuropathology.
In comparison with American medical terminology, the term "osteochondrosis" is used by Russian doctors to describe the dystrophic and degenerative changes in the vertebrae which are named in American medical literature as discopathy, intervertebral chondrosis, degenerative joint disease of vertebrae, discogenic spondylosis or intervertebral osteochondrosis. The Russian term is approximated by the American term "spondylosis" (degenerative joint disease).
The synthetic conception of etiopathology of osteochondrosis is formulated in the theoretical and practical field of MT.2 This conception is a generalization of a number of different theories of osteochondrosis. Let me give the definition of osteochondrosis: It is the pathological process of degenerative and dystrophic changes of vertebral motion segments (VMS) because of the complex influence of external and internal factors. This influence leads finally to local overloads and decompensation of trophic supply for VMS.
European schools of MT are historically based on the manipulative approaches of Eastern treatment and health schools. One of them, shiatsu therapy, is well known and widely used in the Western hemisphere. Today, some European countries (Germany, France, Czechoslovakia) have schools of manual therapy. The term "manual medicine" could be used to describe the high level of their work.9,10
Russian schools of MT base their methods on the works of European authors, and use modifications of the common method of manual medicine.2,3,9
The basic method of all mentioned schools is manual influence on bones, joints, fibrosal tissues, muscles and reflexogenous zones of the human body. Such influence is directed in most cases to relieve pain and its related psychoneurologic symptoms of vertebral spondylosis and other chronic diseases of the locomotor system.
Methods of manipulation are extremely diverse, but from a biomechanical point of view, all MT procedures could be classified in the following basic groups:
- kneading (deep connective tissue massage)
- traction
- traction and compression (redressement)
- rotation
- reposition (setting)
- pressing (pressure)
As a rule, the procedures listed above are used in different combinations. These combinations, together with the proper procedure and place of application, constitute the major emphasis of MT.
The interest in treatment of visceral pathology was erased considerably during the last years. In a majority of scientific publications on this issue, the internal organ disorders have been investigated as a complex of symptoms of spondylosis of different parts of vertebrae. Visceral symptoms of cervical and lumbosacral spondylosis are mentioned most often (migraine, vestibulovegatative disturbances, vertebrobasilar insufficiency, cardiac syndrome, urogenital disturbances, etc.).
Several studies were published in recent years about the effectiveness of MT on thoracic (asthma, cardialgia) and abdominal (syndrome of abdominal pain, gastritis, gastroduodenitis, duodenal and stomach ulcer disease) vertebrogenous disorders. The authors connect these disorders with spondylosis of upper and lower thoracic vertebrae. The effectiveness of MT in the treatment of visceral pathology ranges from 25-100 percent (according to different authors) and depends on the character, severity, and duration of pathology both in the zone of the vertebral motion segment and internal organs.
The contemporary view of Russian scientists on MT is the following: MT, in treatment of internal organ disorders, is a new direction for research in care of many diseases which have traditionally been treated by internal medicine. The treatment effect of MT on internal disorders is provided by neuroreflex and neurohumoral mechanisms of regulation of visceral functions. In cases of chronic, repetitive forms of visceral pathology, MT could serve as an effective supplement to traditional pathogenetical therapy. The use of MT in such cases could decrease the healing time of traditional treatment and diminish the necessity for drugs.
References
- Brotman MK: Neurological Signs of Lumbar Osteochondrosis. Kiev, Zdorovie, 1975.
- Veselovskii VP: Practical Vertebroneurology and Manual Therapy. Riga, 1991.
- Korzh AA, Khvisuk NI, Prodan AI: Manual therapy of vertebrae osteochondrosis: Analytical review. Orthopedics and Traumatology, 1980(10): 69-76.
- Lekar P, Priborkin V: Etiopathogenetic peculiarities of cervical osteochondrosis. Kishenev, Kartja Moldovenjanske, 1970.
- Svaatko LG, Ivanichev GA: Manual therapy of hearing disorder related to cervical osteochondrosis. Vestnik Otolaringologii, 1987(2): 28-31.
- Sitel AB et al: Diagnosis and treatment of patients with vascular syndromes of cervical osteochondrosis. J Neuropathology and Psychology, 1990; 90(6):39-42.
- Suvak VV: Conceptual Modeling of Different Aspects of Genesis of Vertebral Osteochondrosis. Kiev, 1988.
- Umashev GS, Furman ME: Osteochondrosis of Vertebrae. 2nd edition. Moscow, Medicine, 1984.
- Lewit K: Manuelle Medicin im Rahmen der Medizinishen Rehabilitation. -- 3 Aufl. -- Leipzig, 1978.
- Maigne R: Douleurs d'origin vertebrale et traitement par manipulations. -- Paris Expansion Sci., 1968.
- Davudov OV: Pathogenesis and treatment of abdominal pain syndrome. Clinical Medicine, 1991; (4): 90-91 (in Russian).
- Manual Therapy in Neurovertebrology. Novokuznetzk, 1990. Collection of articles (in Russian).
Andrei Pikalov, MD, PhD
Cleveland College of Chiropractic
Kansas City, Missouri
