Modalities or manual techniques
The primary aim of treatment is efficient and rapid tissue change to reduce pain and establish appropriate mobility without affecting structural integrity. However the line between pain and efficacy can be a fine one, and the immediate feedback between practitioner and the patient is important to positive outcomes.
Manual therapy can be initially uncomfortable and can produce discomfort for a couple of days post treatment. This is expected and heat treatment with wheat sacks, hot baths and epsom salts bathes, and hot water bottles are all recommended to ensure that you get best out of each visit to the clinic.
Everyone is different. If you have had positive or negative responses to different modalities in the past please tell me. As illustrated I have many different techniques and working out what works best for you is of the utmost importance to me.
Patients are required to do homework; 50 minutes with a therapist isn’t adequate – you have to own your own well-being. You need to enjoy getting better because the homework doesn’t stop, it becomes part of your new lifestyle; a fun part. Re-learning to play respectfully is absolutely vital to the quality of your new life. On-going treatments might include singing in the shower, juggling, skipping, beach walks and short periods of morning sun baking.
HVLA (High Velocity Low Amplitude) adjustment
Short quick trusts at the edge of restricted range of motion are utilised which often create a clicking sound as the articulation is cavitated. The same noise people can make when they crack their knuckles. This, when done exactly where there is physiological restriction, may increase mobility at the joint and reduce pain in the movement of that joint.
This technique can only legally be performed on a patient’s neck by registered Osteopaths, Chiropractors and or specifically trained and certified Physiotherapists and General Medical Practitioners.
HVLA is thought to reorder the neural response of the periarticular tissues – these extra articular areas are rich with nerve receptors both for pain (nociception) and for position and movement in space (proprioception).
Soft Tissue Massage
The traditional swedish techniques of effleurage (stroking), petrissage (kneading) and tapotement (percussion) are regularly used as treatment for soft tissue issues. To these are added deep tendon frictions and both long lever and short lever myofascial stretches, which may release hypertonic or knotted muscle tissues.
Humble as these techniques may seem they are vital to facilitate high velocity techniques and to provide whole treatment integration.
Cupping with glass jars and a lighted taper is a technique whose origins are lost in antiquity. Ancient Egyptian hieroglyphs depict the practice and it is still widely used throughout Eastern Europe and Asia. People often think of them as specifically part of Traditional Chinese Medicine, however the practice is much more wide-spread.
Laurie was originality trained in-house in the 1990s however he has kept his training up to date and can use cups to sedate hypertonic tissue, tonify hypotonic tissue and heat energetically deficient tissues. A powerful technique in terms of myofascial release, when used in conjunction with HVLA, they can significantly improve intersegmental mobility.
MET (Muscle Energy Technique)
These techniques involve the active involvement of the patient to treat muscles and fascia. The patient is asked to contract their muscles at the same time the practitioner controls the movement of the effected limb or trunk. Although isometric contraction is usually utilised to reduce tissue tension, however concentric and eccentric contraction may also be used to endeavour to strengthen or retrain neuromuscular tissue.
This whole body array of techniques requires the release of eight myofascial diaphragms; axillae, upper and lower thoracic, inguinal, and popliteal diaphragms. This is followed by manual pumping of the feet and or rib cage in combination with repetitive superficial effleurage.
These combined techniques may open the pathways of the lymph system and thus allow lymph to be pumped around the body.
Lymphatic drainage may have a beneficial effect of the body’s immune system.
Indirect techniques and craniosacral treatment
Unlike HVLA and most METs, indirect techniques such as Balanced Ligamentous Tension (BLT) and Strain and Counter Strain (SCS) work by stacking the planes of motion of the body into the ease. In this way the actions of the body are gathered into the most pain-free position the clinician can manage. In this state the painful stimuli may be reduced and muscle guarding may down regulate as the body moves back into a more natural and unaffected position.
Although the mechanism of action for these techniques remains uncertain, it is thought that they reduce the afferent bombardment of acute pain and allow anxious and highly strung patients a chance to relax and be pain-free.
Self mobilisation techniques
The most powerful techniques are performed on a daily basis by the patient themselves. These simple subtle yet powerful techniques are explained and practiced in clinic with the practitioner to ensure correct application. Laurence, who suffers from a significant lower back condition himself, spondylolisthesis, has been developing and working on self treatment techniques for decades and can attest to their efficacy and enjoys sharing his secrets to lower back pain management.
Acupuncture needles are applied to trigger points that produce a histamine reaction followed by the release of bradykini that dilates the vasculature in the area of the trigger point. This has the effect of reducing hypertonicity and guarding at the point. This technique is useful in areas too painful for cupping or soft tissue treatment or in the deep myofascia that is difficult to access with other soft tissue techniques.