世界の徒手療法の課題と展望

Japanese Physical Therapy Association

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I

The

History

and

Present

of

Manual

Therapy

in

Circumstances

the

World'

Ian

E.

Searle'*

I would

like

to mention that the Terms

"MANUAL _THERAPY"

and "MANIPULATIVE

THERAPY" are Interchangeable

from

Country

to

Country,

and

I

would

like

to

introduce

the

HISTO-RY of MANUAL THERAPY under the following TOPICS.

1.

AncientHistory.B.C.

2, Medieval History.

3.

Middle Ages,

l5th

Century.

4, FolkMedicine. 5. Bone

Setters

6.

The 19th

Century,

which includes the

impact of OSTEOPATHY and TIC.

7. The Present Day, 2bth Century.

I

.

History

of

Manual

Therapy

1.

ANCIENTHISTORY

The

first

in

Recorded

History

to

describe

and

il-lustrate

JOINT

MANIPULATION was

HIPPOCRA-TES 460-355 B.C. He wrote Cofpus IIippocrzzteum

in

which

he

described

Peri

Arthron

`'qbout

Joints"

and MOCHLIKON "the _{Lever". He had a teaching}

hospital

on the

Island

of Kos

in

the

Mediterranean,

theruins, _present tothis

day.

He

must

be

_the

Father

of

Manipulative

Therapy'

and advocated strong TRACTION :the _procedures of sitting on the back,standing on the back, lever-age with a

board,

all safely performed so

long

as

the TRACTION was imparted. He also advocated

*

LHfiont4rklko//MwaLffce

" _IFOMT$thzaft

Sect.ITreasurerof the International Federatienof

Orthopaedic Manipulative Therapists _(IFOMT)

methods of Tractional reduction of

dislocated

Hip

and Shoulder,

ANCIENT

MEDICAL HISTORY starts with a

great name and ends with an equally famous name,

CLAUDIUS GALENOS or GALEN, 131-202 A,D.

who in 97

Commentaries

described much of

the

work of HIPPOCRATES utilising TRACTION and

SUSTAINED PRESSURE. 2,

MEDIEVALHISTORY

")

ABU

ALI IBN

SINA

980-1037

A.D,

also

known as AVICENNA. Textbook "CANON"

Arabi-an Textbook.

(2)

ABU

L

QUASIM

1013-II06

A.D.

Textbook

ALTASRIF Spanish Arabian.

(3)

CHARAF ED DIN

1465

A.

D.

Described

hang-ing

from

the _patient whilst suspended

in

TRAC-TION.3.

THEMIDDLEAGES

15th

Century

A.D.

A

decline

inrnedical

knowl-edge throughout the WESTERN

WORLD,

The

Es-tablishedChurch was for most

healing,

and

dissec-tionwas not _permitted.

VIDIUS VIDIO, 1500-1569 A.D._gives us the

first

illustration

of

``HANGING"

the _patient

in

TRAC-TION

using the

board

also for _pressure on _the

lumbar

spine.

AMBROSE PARE, 1510-1590

A.

D. Famous

sur-geon toFRENCH KINGS

did

much

to

raise the sta-ndards of ORTHOPAEDICS in Europe.

He

ad-vocated the manipulative techniques of

HIPPOC-RATES.

4. FOLKMEDICINE

The method6 handed down

GENERATION

to

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66

fiilgdiza4P

GENERATION through

different

races

from

BUD-DHIST

practisesof EXTENSION manipulation to

MOMI-ryoji

of

JAPAN,

to

OMI-OMI

in

the

Pacific

Islands.

STAMPING

or

TRAMPLING

was _popularLy carri-ed out

by

womanfolk, as were procedures

known

as

the"FARMERS

PUSH"

or the "SHEPHERDS

HUG".

WEIGHTING

SALT

was practisedin

Europe.

5.

THEBONESETTERS

Were NON

MEDICAL

practitionerswhose skills at replacing small

BONES

out of

PLACE

were

rec-ognised by the

PUBLICi

Mrs.SARAH

MAPP,

through to the

British

Royalty,

Sir

HERBERT

BARKER.

The

British

medical men, slowly moved away

from the conservative methods of treating

TUBER-CULAR

SPINE

to absorbing and utilising BONE

SETTERS methods.

1867 Dr.WHARTON

HOOD

described

RICHARD

HUTTONS

methods, 1868

Sir

JAMES

PAGET.

1878

HUGH

OWEN

THOMAS, 1900 SirROBERT

JONES.

6.

19th CENTURY, OSTEOPATHY AND

CHIRO-PRACTIC

The influenceof ANDREW T,

STILL

1828-1917,

the

'Founder

of Osteopathy whose

Divine

revelation

June

1874 _proclaimed the

'`RULE

of the

ARTERY."

In 1917 an English _physician

LITTLEJOHN

took

Andrew Still'steaching toENGLAND, founding

Os-teopathy

in

Great

Britain.

Osteopathy

isrecognised

in

the

United

Statesof

America,

but

the

definition

of

Osteopathic

LESION has aLtered since "STILL'S"

first

description.

In 1895 DANIEL DAVID PALMER founded CHI-ROPRACTIC, that a displacement inthe spine

im-pinges structures and will influence the body. DANIEL DAVID PALMER manipulated the

EX-TREMITY

JOINTS

also, and founded the

MIXERS

colleges. The son of Daniel David Palmer manipul-ated only the

SPINE

and founded the

STRAIGHTS.

Both methods are _practisedthroughout theworld

today.7.

THE20thCENTURY

The

influence

of

MEDICAL

PHYSICAL

MEDI-CINE

practitionersand more importantly the role

played

by

PHYSICAL THERAPISTS has advanced

the

science of manipulative _practise remarkedly.

ca

21

igag

2

･e

Many

contributions ean

be

listgd,

1) MEDICALINFLUENCE

Firstly

by Dr. EDGAR F.

CYRIAX

wrote

ex-tensively,especially describing the effect of

FRIC-TIONS.

DR.

JAME

MENNELL

wrote

the

"SCIENCE

and

ART

of the

JOINT

MANIPULATION". He

recogni-sed theACCESSORY RANGE of MOTION ina

joint

and

believed

the

FACET

joint

_played a _{great part}

in

SPINAL

DERANGEMENT.

DR.

JAMES

CYRIAXITo

whomIam

indebted

for

the use of the

illustrations

used

in

this

presenta-tion,

is

the

MODERN

FATHER

of manipulative medicine. DR.

CYRIAX

textbooks "TEXTBOOKS

of

ORTHOPAEDIC

MEDICINE"

remain

the

ciassic ref-erence fer

Physicians

and Physical Therapists.

He

believed

PHYSICAL

THERAPISTS

were the most

qualifiedto perform

Manipulative

procedures and

taught many at

SL

Thomas

Hospital,

London,

Eng-land,

advocating safe strong traction which

in-fluenced

thespinal

disc

in

_particular.

DR.

ALAN

STODDARD

:Taught Osteopathic

tec-hnique$

to Phy$ical Therapists and his two

text-books,

O)

OSTEOPATHICPRACTICE.

(2)

OSTEOPATHICTECHNIQUE

are

important

contributions to

Manual

Therapists.

2) PHYSICALTHERAPYCONTRIBUTIONS

FREDDY KALTENBORN,

(NORWAY):

Trained

in

Osteopathy

and

Chiropractic

has

written

"EX-TREMITY

JOINT

MANIPULATION",

strong

sup-porter

of High Standards of Physical Therapy and

Manual Therapy throughout the world. His texts are the firstto relate manipulation to the new

knowledge of

Arthrekinematics.

He

is

a founder

Consultant

for

I.

F.

O.

M.

T.

GEOFFREY

MAITLAND

(AUSTRALIA)

:

Publi-shed 1964 VERTEBRAL MANIPULATION in

which he refined theart of oscillatory manipulation and used itto, almost exclusively, totreat

"repro-ducible signs".

By

thismeans

he

combines `Cgate

control mechanisms" with mechanical mobilisation.

His

two

texts

"PERIPHERAL _{MANIPULATION"}

and "VERTEBRAL _{MANIPULATION"}

explain his method.

ZEA-Japanese Physical Therapy Association

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･U"diftIiestwdieceetffus

LAND)IFirst

Iecturer

in

Manual

Therapy at the

N.

Z.

School

of

Physiotherapy.

His

teaching moved

from

diagnosis

to what

he

then called the

"LESION"

and

later

to `'DYSFUNCTION".

He

coined the term i`component

motion" to

denote

those movements in a

joint,

that when combined make up an active motion. Conversely

then

all active movements can be broken down into their components forthe_purpose of evaluation and

ttt/

ment. He isa Past Presidentand Founder Chairpe-rson of I.

F.

O.

M.T.

Inthe 1960-70 up until the_present day New

Zea-lander ROBIN McKENZIE has

_published

and

ad-vocated the concept of SPINAL EXTENSION for

treatment of selected Low Back Pain. He feltthat

the centralization of pain which often

follows

repet-itivemotion was

due

to the reduction of the disc

and not to the

GATE

CONTROL

mechanism.

ll

Present

Day

Schools

of

Thought

CLASSIFICATION

by

PRINCIPLE PURPOSE

There

is

not now, nor

is

there

ever

Iikely

to

be,

totalagreement on

how

joint

manipulation or other manual physical therapy procedures should

be

prac-ticed.

The

most

irnportant

factor

differentiating

be-tween the groups that practice

joint

manipulation

is

the

intended

purpose of

the

treatment.

In

nearly

alr cases manipulations are _performed with _goalsof

relieving nerve root _pressure, directly relieving

pain,or

for

restoring motion

to

a

joint,

Some

of

the groups practicespecific techniques, where the treatment i$applied toonly a single articulation at

a time, and some practice nonspecific techniques,

where several articulations may

be

involved inthe manipulation. The following categories separate

the groups according

to

the

_purpose of the

treat-ment:

1. MANIPULATION PHILOSOPHIES BASED ON RELIEVING NERVE ROOT PRESSURE.

BONE

SETTERS:

The

purpose ofthistechniques

is

to click

bones

back

into

_place.

These

techniques

are specific.

CHIROPRACTIC

(traditioRal):

The _purpose isto

move yertebra to relieve nerve root _pressure.

These techniques are specific,

67

CYRIAX:

The

spinal techniques are

designed

to

move the

disc,

and thus relieve nerve root _pressure,

Cyriax techniques are nonspecific.

2. MANIPULATION PHILOSOPHIES

BASED

ON RELIEVING PAIN,

MAITLAND: Oscillationsare used toeliminate

reproducjble signs.

The

techniques

are specific,

MAIGNE: The manipulations _performed must

produce "no

pain",and the directionof

manipula-tion

is"contrary"

to

the

direction

of greatest

hypo-mobility

(least

directionof restriction). Maigne

tec-hniques are derived from osteopathic

joint

tech-niques, and

they

are specific,

McKENZIE: Repetitive motion isused

for

cen-tralization of _pain.

3.

MANIPULATION

PHILOSOPHIES

BASED

ON

NORMALIZING

JOINT

MOBILITY.

OSTEOPATHY:

Joints

and

body

are mobilized

for

increased

motion.

The

techniques

are specific.

MENNELL:

Emphasis

is

on restoration of normal "joint

play". The techniques are specific

for

the

extremities,

Less

so on spine.

KALTENBORN:

Emphasis

is

on

arthrokine-rnatics, _particularly convex-concave. relationships.

Techniques

are very specific and somewhat

eclec-tic.

PARIS:

Emphasis

is

on restoration of normal

ar-throkinematics, especially component and

joint

play motions.

Pain

is

de-emphasized.

Techniques

are specific and eclectic.

M.

The

Formation

of

the

International

Federation

of

Orthopaedic

Manipulative

Therapists

We

have

seen thatas

Manual

Therapy has

devet-oped as a "SPECIALITY"

in

the

_profession

of

`iPhy-siotherapy" that

different

LEADERS

and

TEACH-ERS emerged indifferentcountries, using Different methods. DifferentSTANDARDS applied, and

dif-ferent medical and _politicalrecognition applied

in

each country.

Dr.

Cyriax

feltthat the discussionsthat Geoffrey Maitland, Freddy Kaltenborn,

Stanley

Paris,

Greog-Qry Grieve

had

held

in

England, shou}d

be

the

basis,in regard tothe setting up of a world

i`Con-federation of Manual Therapy" and should be

Japanese Physical Therapy Association

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68

ve\taza\

malized.

A

meeting

in

Amsterdam

in

1970

decided

toCONSTITUTIONALLY achieve this,at a future meeting _planned

for

1974 inMontreaL

However matters moved

detrimentally

to

Manual

Therapy _politically,inEurope. Freddy Kaltenborn feltthat STANDARDS needed tobe _proved tothe

World Medical Fraternity,resulting ima call

for

an

Internationalmeeting at Sun Wing, San Augustin,

Gran

Canary

in

1973,

of

Internationally

invited

Manual Therapists. An interchange and demon-stration of Manual Therapy applications took _place over a month and examinations by Professor

Harold Brodin, Sweden, Dr.James

Cyriax,

United Kingdom, Dr.Aran Stoddard, United Kingdom, Dr. H.Frisch,Germany, took _placewhere the Standards of Manual Therapy were assessed

by

Medical

ex-perts.

Thereby arose a basis of STANDARDS. These

STANDARDS were accepted at the

CONSTITU-TIONAL MEETING chaired by Dr.S.Parisin

Mon-trealin 1974 and thereby the INTERNATIONAL

FEDERATION of ORTHOPAEDIC

MANIPULA-TIVE THERAPY was founded. Dr.Richard Erhard

founding President.

The Federation has moved from strength to strength,

STANDARDS

have

been

cempiled and

ap-proved, and Fourteen

Counties

have achieved

rec-ognition and are FULL

MEMBERS.

Ten

IFOMT

Meetings have been

held

subsequently, which

in-clude teaching courses, and General Meetings. Pre

and

Post

WCPT

technical

courses, as well as half

day

contributions to each of the

WCPT

Confer-ences held since 1974 have been held,and inIsrael

in

1978

WCPT

GENERAL

ASSEMBLY accepted

IFOMT as the firstrecognised "SUB _GROUP"

of the

World Cenfederation of Physical Therapists,

IFOMT will remain a potent force in Physical Therapy, especially, inthe interestshown by

coun-eg21geg2e

trtes,who show an

interest

in

Manual

Therapy

training and

have

registered as

REGISTERED

IN-TEREST

COUNTRY,

hoping

toset up recognised

SPECIAL

INTEREST

GROUPS

within the

Physio-therapy profession of theircountry, and

AIM

tothe

STANDARDS required

for

FULL

MEMBERSHIP

of

this

FEDERATION.

We would cordially

invite

JAPAN

to consider

thisoption.

CONCLUSION

For hundreds, even thousands, of _years

Manipu-lativetreatment of Spinal _pain,has been common

practiceby very differentmeans and with entirery

differenttheoreticalaims.

Hippocrates straightened a Kyphos,

Galen

repla-ced outward dislocated vertebrae and Ambroise

Pare wrote about Luxations of the spine. Patients

have been TRAMPLED ON,

been

given BLOWS

to

the BACK, with differentTOOLS, THEY HAVE

BEEN LIFTED BACK to BACK and have been

SHAKEN. Bone Settershave replaced small

bones.

Osteopaths have treated the Osteopathic Lesion. Chiropractors have replaced subluxated vertebrae,

Orthopaedic

Surgeons

have manipulated the

Sacro-11iac

joint,

Neurelogists have stretched the

Sciatic

Nerve. AllMETHODS have met with some success.

History

has shown

that

with adequate

EXAMINA-TION, TRIAL TREATMENT, REASSESSMENT

using TRACTIONAL HIPPOCRATIC method,

Re-assessment, that"Manual _Therapy"

purely a

physi-cal therapy refinement, _previously thought ef as an

ART, now is_proven to be scientifically efficatious

in

the

hands of a TRAINED

PHYSIOTHERAPIST,

AND incorporates _patientINFORMED CONSENT. We look fQrward tothe Future and invite

JAPA-NESE PHYSICAL THERAPISTS to

_join

with us, in