it will give the brief idea about the different house of manual therapy.

1. Essentials of Spinal Manual
Therapy
Prof. Satyen Bhattacharyya
Associate Professor BIMLS, Burdwan
Chief Physio – Fit O Fine Physiotherapy Solutions

2. House of thoughts or confusion?
• Which one to select?
• Should we assess first?
• Should we apply only one house of
thoughts?
• Or we should combine and deliver?
• Hippocrates (460 BC – 370 BC)
• Cato, Galen
• Bone setter
• Hutton’s manipulation
• D.D.Palmer, B.J.Palmer
• A.G.Timbrell Fisher
• James Cyriax
• John Mennel
• F.M.Kaltenborn
• G. Maitland
• R. McKenzie
• B.R.Mulligan

3. Then what to choose?
Go by
choose your treatment according to that
before that know the biomechanics

4. Assessing and Decision making
• PAIN is your fiend
• Nature of pain will describe about pathology
• Types of Pain
by origin – by receptors-
local(intact outer annulus fibrosus)
referred (herniated disc) thermal
radicular (herniated disc) chemical (organ ref. pain)
central (intact outer annulus fibrosus) mechanical(structural changes/positional fault etc)

5. once it’s diagnose with chemical pain
or else treat

6. • YELLOW FLAGS
• Osteopenia
• Hypermobility
• Pregnancy
• Patient on anti-coagulant
• Acute arthritis of any type
• RED FLAGS
• Osteoporosis
• Active inflammation
• Infection
• Tumor
• Tuberculosis
• Metabolic bone diseases
• Myelopathies
• Neurological deficit
• Unstable joint fracture, non united fracture
• Unwilling pt/intolerant pt
• Undiagnosed pain

7. Mobilization
Therapist
overpressure
Patient
overpressure
Patient
generated
Manipulation
Totally
Independent
70%
Totally
dependent
Can apply Mulligan,
Maitland
McKenzie is the best option here

8. • Apply mulligan to get
immediate effect.
• How will you know that
mulligan is indicated?
Pain should
decrease &
increase ROM
Change your FLAPS
Force
Level
Angle
Pressure
Side

9. Try to Treat in
weight bearing
position as patient
complaints of pain
in loaded only
When to treat not
loaded?
Joint is inflamed
or the SIN
(severity,
irritability &
nature of pain) is
high

10. Active movement followed by passive overpressure
• To be done if it is not painful.
• To be given when you find out new P1 & R1
• Should be given by patient himself(best option) otherwise by
therapist
• If new P1 & R1 is not achieved then follow FLAPS
NO PAIN NO GAIN THEORY DOESN’T WORK HERE, IT SHOULD BE
ALWAYS PAIN FREE WAY

11. • DON’T TRY IN HUMAN BEING, THEY ARE NOT DALL – BE SURE
• DON’T HARM THE PATIENT
• DON’T BE OVER ENTHUSIASTIC
• TRY TO KEP THE PATIENT INDEPENDENT(SELF EXERCISES)

12. THANK YOU
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