- Email: [email protected]
TOUCH
ISSN 0031 9 4 0 6
AUGUST 10, 1989 VOLUME 75, No 8
JOURNAL OF THE CHARTERED SOCIETY OF PHYSIOTHERAPY
TOUCH TOUCH is a gentle word and not one which is commonly associated with manipulative physiotherapy. The Shorter Oxford English Dictionary defines touch as ‘a small quantity of some substance brought into contact with a surface so as to leave its mark or effect’. In this issue of Physiotherapy we can read about many different ways of touching in order to produce an effect. The whole of our profession seeks to achieve this same effect, ie to reduce symptoms and restore function. Depending on our specialisation and skills we do this with particular methods. In all areas of physiotherapy our specialist training enables us to do this with maximum speed and efficiency. Manipulative physiotherapists use their hands. We touch, feel and gain an effect by the use of either graded or high velocity movement. These procedures of touch are sometimes thought and spoken of with a degree of suspicion, but in fact they follow meticulous examination and considered assessment of the patient. The actual execution of techniques, be they mobilisation or manipulation of soft tissues (muscles, tendons, ligaments, discs) or joints, is brief by comparison with the process of deciding which in our opinion will be the most appropriate treatment for each patient. This process involves three stages, the first of which is to listen to what the patient considers to be his or her problem. Through detailed questioning there is established a line of communication and the foundation for trust between the patient and the therapist. The patient is then examined by the testing of movement and function of the appropriate areas. In the spine this involves active and passive movements, movement of the neuromeningeal tissues and establishing of reflexes, sensation and power. For the peripheral joints one would, in addition, test for ligamentous and meniscal stability, and muscle function. This is where touch comes in - palpation of skin, muscles, ligaments, joints and their related accessory movements, performed when a great deal of information has already been collected. Regardless of which school of thought one adheres to, the palpation is carried out in order to localise the culprit structure(s) and test their behaviour in relationship to the symptoms described. Aristotle, Descartes, Mennell, Stoddard, Cyriax, Grieve, Maitland, McKenzie, Kaltenborn, Edwards, Elvy, Butler, Gifford and many more have given us and in some cases will continue to give us, ways in which we may explore and treat the musculoskeletal system. The greater the variety of methods and skills, the greater our ability to help a variety of patients. However, the considered assessment of examination findings must surely be used by all physiotherapists regardless of their particular specialisation. The mystery and suspicion surrounding manipulative physiotherapy are undeserved. We are simply a group of experts among others.
14 BEDFORD ROW, LONDON WC1R 4ED TELEPHONE 01-242 1941 FAX 01-831 4 5 0 9
Secretary of the Society: M r T R M Simon M A Editor of the Journal: Mrs J Whitehouse BA Advertisement Manager: M r R T Denham Journal Committee: Mrs E 0 S Ricketts MCSP (chairman), Dr P Arnell PhD BSc MCPA MCSP (vicechairman), Mrs R M Burton MCSP DipRG&RT, Miss A M D Grirnley MCSP, Miss J James BA MCSP, Miss A Jennings MCSP DipRG&RT, Mrs M John MCSP, Mrs B Richardson MSc MCSP DipTP, Mrs J Sherriff MCSP, Miss C Smith MSc MCSP, Miss G M WalKer MCSP
CONTENTS Manipulation - 1 A Perspective on Manipulative Therapy R McKenzie 440 Cotitra-iiidicatii)iiP lo Spinal hldnipUlaliOn and Allied Treatments G P Grievc 445
General Paper Prograinmes for Disabled People in South Sudan P Baker 488
Treatment and Equipment Notes Endotrachcal Suction J Downs 454 A New I.ooli at the Vesra PPAhl Aid R thin. P Richardson, A Sweet 493
The use n l Iiitermittcnt Compression in Treatment of Fixed Flexion Deforniities of the Knee P J Smith 494
Regular Features News Letters hledia watch Personal view Annual subscriptions Courses and conferences Branch news Noticeboard and personal In other journals Proceedings of Council Book reviews
455 459 461 462 463 465 479 480 4Yl 482 486
AGNETA LAND0 MCSP
Chairman. Manipulation Association of Chartered Physiotherapists
439
AUGUST 10, 1989 VOLUME 75, No 8
JOURNAL OF THE CHARTERED SOCIETY OF PHYSIOTHERAPY
TOUCH TOUCH is a gentle word and not one which is commonly associated with manipulative physiotherapy. The Shorter Oxford English Dictionary defines touch as ‘a small quantity of some substance brought into contact with a surface so as to leave its mark or effect’. In this issue of Physiotherapy we can read about many different ways of touching in order to produce an effect. The whole of our profession seeks to achieve this same effect, ie to reduce symptoms and restore function. Depending on our specialisation and skills we do this with particular methods. In all areas of physiotherapy our specialist training enables us to do this with maximum speed and efficiency. Manipulative physiotherapists use their hands. We touch, feel and gain an effect by the use of either graded or high velocity movement. These procedures of touch are sometimes thought and spoken of with a degree of suspicion, but in fact they follow meticulous examination and considered assessment of the patient. The actual execution of techniques, be they mobilisation or manipulation of soft tissues (muscles, tendons, ligaments, discs) or joints, is brief by comparison with the process of deciding which in our opinion will be the most appropriate treatment for each patient. This process involves three stages, the first of which is to listen to what the patient considers to be his or her problem. Through detailed questioning there is established a line of communication and the foundation for trust between the patient and the therapist. The patient is then examined by the testing of movement and function of the appropriate areas. In the spine this involves active and passive movements, movement of the neuromeningeal tissues and establishing of reflexes, sensation and power. For the peripheral joints one would, in addition, test for ligamentous and meniscal stability, and muscle function. This is where touch comes in - palpation of skin, muscles, ligaments, joints and their related accessory movements, performed when a great deal of information has already been collected. Regardless of which school of thought one adheres to, the palpation is carried out in order to localise the culprit structure(s) and test their behaviour in relationship to the symptoms described. Aristotle, Descartes, Mennell, Stoddard, Cyriax, Grieve, Maitland, McKenzie, Kaltenborn, Edwards, Elvy, Butler, Gifford and many more have given us and in some cases will continue to give us, ways in which we may explore and treat the musculoskeletal system. The greater the variety of methods and skills, the greater our ability to help a variety of patients. However, the considered assessment of examination findings must surely be used by all physiotherapists regardless of their particular specialisation. The mystery and suspicion surrounding manipulative physiotherapy are undeserved. We are simply a group of experts among others.
14 BEDFORD ROW, LONDON WC1R 4ED TELEPHONE 01-242 1941 FAX 01-831 4 5 0 9
Secretary of the Society: M r T R M Simon M A Editor of the Journal: Mrs J Whitehouse BA Advertisement Manager: M r R T Denham Journal Committee: Mrs E 0 S Ricketts MCSP (chairman), Dr P Arnell PhD BSc MCPA MCSP (vicechairman), Mrs R M Burton MCSP DipRG&RT, Miss A M D Grirnley MCSP, Miss J James BA MCSP, Miss A Jennings MCSP DipRG&RT, Mrs M John MCSP, Mrs B Richardson MSc MCSP DipTP, Mrs J Sherriff MCSP, Miss C Smith MSc MCSP, Miss G M WalKer MCSP
CONTENTS Manipulation - 1 A Perspective on Manipulative Therapy R McKenzie 440 Cotitra-iiidicatii)iiP lo Spinal hldnipUlaliOn and Allied Treatments G P Grievc 445
General Paper Prograinmes for Disabled People in South Sudan P Baker 488
Treatment and Equipment Notes Endotrachcal Suction J Downs 454 A New I.ooli at the Vesra PPAhl Aid R thin. P Richardson, A Sweet 493
The use n l Iiitermittcnt Compression in Treatment of Fixed Flexion Deforniities of the Knee P J Smith 494
Regular Features News Letters hledia watch Personal view Annual subscriptions Courses and conferences Branch news Noticeboard and personal In other journals Proceedings of Council Book reviews
455 459 461 462 463 465 479 480 4Yl 482 486
AGNETA LAND0 MCSP
Chairman. Manipulation Association of Chartered Physiotherapists
439