Integrative Manual Therapy
I have written this article to describe our treatment philosophy here at Mission Hills Physical Therapy. Many times a patient and occasionally a doctor will ask what we do and why we are treating an area of the body when the patient's symptoms are located at a different site. The method we use is titled Integrative Manual Therapy an approach developed by Sharon Weiselfish-Giammatteo, PhD, PT. We have been influenced greatly by Sharon Weiselfish-Giammatteo, PhD, PT and Frank Lowen IMP,C and owe them a great deal of gratitude for their work and their willingness to share it. Our treatment philosophy is based on their ideas and in osteopathic principles. First is the principle that the body is a self-regulating and self-healing organism and given the chance to heal, it will do just that. Second is the rule of the artery which states that the artery is of primary importance to the body. The body will do anything to protect a vulnerable artery.
So based on these ideas we believe that the body, everyone's body, is doing the best it can do at any given time. That may seem hard to believe when you see how much pain and disability some people are living with, but even these people's bodies are doing the best they can do. Also, everyone's body has an enormous ability for healing and self-correction. Therefore, if we can tap into the body's ability to heal and self correct we can achieve optimal results. Instead of trying to impose our will on a patient's body we would rather work with their body to help them heal.
So the methods we use reflect this respect for the patient and their body. We use mostly what are termed indirect techniques. A way to see the difference between a direct method; one in which the therapist would impose their will on the patient and an indirect method; one in which the therapist would use the patient's healing abilities can be seen by an analogy. Say you had a stuck drawer in a chest of drawers. A direct method of releasing this restriction would be to pull and force it out. This could cause some damage to the drawer but at least it would be out. An indirect method would be to gently push it back in so that it could catch on the gliders and then slide out easily. There would be less chance to cause harm.
Another principle we use involves the use of fulcrums. Another analogy is useful here but I will also give a more specific explanation. Say you had a tangled phone cord. An active method would be to try to feed the telephone receiver through each loop of the cord until it was released. A fulcrum method would be to hold the receiver still and allow the base to unwind itself. In the actual patient an example would be if say a spinal segment was restricted and could not extend, side bend right, or rotate right. An active method would be to actively mobilize the segment into its restriction with multiple forceful movements or manipulations. It might loosen but the patient could also be in more pain and the segment could retighten. Even if it remained freely moveable this is the only segment that would be affected. A fulcrum would be a technique Sharon Weiselfish-Giammatteo, PhD, PT calls muscle energy and beyond technique (MET). It is an adaptation of osteopathic muscle energy technique. In MET, the segment would be placed in a position just before the barriers of extension, side bending right and rotation right and held very still. The segment is now at precisely the range of motion at which it is restricted. With a very small muscular contraction and maintaining this contraction the body can start to unravel restrictions that are contributing to the dysfunction. With this technique not only can the segment regain its motion but also surrounding segments and even far removed areas of the body are able to unravel as well. The body will unwind restrictions because it does no like to be held still especially if it is held still at precisely the position that it is having a problem.
The above examples were used to show how we can use the body's own self-healing and self-correcting properties to treat our patients. Next, by understanding how the body protects itself, we are able to determine with greater efficiency and effectiveness where to begin treatment. There are many different systems in the body. We classify them as systems as if they are separate and as if they work independently of each other; but in reality this is just a classification for our own convenience and they actually are interrelated and work to protect each other. This brings us back to the osteopathic rule of the artery ; the idea that the body will do anything to protect an artery. The body will protect an injured muscle by creating spasm and splinting the area. Muscles are important but joints are more important. The body will spasm more areas and cause more swelling and inflammation to protect a joint. However there are structures that are much more important to the body than muscles and joints. In fact, there is a hierarchy of importance. The order is as follows:
- Arteries
- Bone
- Veins
- Nervous system (central, peripheral, autonomic)
- Viscera (organs)
- Lymphatics
- Joints
- Myofascia (muscles and fascia)
For example there is a phenomenon termed leaky gut syndrome which Sharon Weiselfish-Giammatteo, PhD, PT, refers to as disruption of membrane . With disruption of membrane (DOM) in for example a sigmoid colon, the contents of the colon have a tendency to leak out into the abdomen. The body does not want these contents anywhere except inside the colon. It's a poison or an antigen to the body if it is anywhere else except the colon. So the body will spasm the colon and if it needs more protection, set up a compression syndrome in the area. The leak may be stopped but now the sigmoid colon is in spasm and may even adhere to the pelvic bones so the pelvis and hip become restricted and painful. Now, as therapists this person could come in to see us for a painful hip or back but treatment directed to these tight back and hip structures would only help temporarily. That is because the body is just using these restrictions to protect a more important structure; the sigmoid colon.
To carry this example further, say for example this leaky gut syndrome allows some of the contents of the stomach to leak onto the femoral or iliac artery, a leaky vessel syndrome could develop in the arterial system. Optimal treatment then would be to help the body correct the DOM in the artery and in the sigmoid colon.
The body will do anything to protect an artery. It will spasm a muscle, restrict a joint, and it could even cause scarring or fibrosis in a nerve to protect an artery. So forcing a muscle to let go or stretching a joint that is needed by the body to protect an artery could cause harm and probably would not produce a lasting benefit. Instead a technique that allows healing of the structure that the body is protecting would be useful. Then the muscles and joints protecting it would no longer be needed for protection and would let go and have no reason to retighten. So finding the right technique to allow the body to correct the primary problem is the key to our treatment. In order to do this effectively and efficiently we need to be able to find the primary area and structure that the body is protecting. Is it a joint or a bone or a muscle or is it an organ or nerve or an artery? We don't know until we perform our evaluation and systematically locate the primary problem.
Osteopaths such as Jean Pierre Barral, DO and Paul Chauffour, DO and physical therapists such as Sharon Weiselfish-Giammateo, PhD, PT as well as therapists such as Frank Lowen, IMP,C have developed effective manual diagnostic scanning methods that quickly and precisely locate areas of primary dysfunction in the body. By learning and using these methods we can determine which structure is primarily at fault in the cause of the patient's problem and which technique(s) are indicated. Some of our treatment methods include:
Strain-Counterstrain (to release the muscular spasm in skeletal muscles). Developed by Lawrence Jones, DO Advanced Strain-Counterstrain (to release the muscular spasm of involuntary muscles and the autonomic nervous system) some examples would be the smooth muscle of the artery, vein or lymph vessel or of the heart or lung. Developed by Sharon Weiselfish-Giammatteo, PhD, PT and Tom Giammatteo, DC, PT Muscle Energy and Beyond Technique (to improve articular balance and joint space in spinal and extremity joints). Developed by Sharon Weiselfish-Giammatteo, PhD, PT based on osteopathic principles Neural Tissue Technique (to improve the ability of nerves to glide and to improve the health of the nerve). Developed by Sharon Weiselfish-Giammatteo, PhD, PT. Based partly on work done by David Butler, PT, and Robert Elvey, PT. Visceral MET (to improve the ability of the organs to glide against each other and to improve the space around organs and inside organs). Developed by Sharon Weiselfish-Giammatteo, PhD, PT. Cranial Therapy (to improve the health of the central nervous system, including the brain, spinal cord, dural tube, and the flow of cerebrospinal fluid). Developed by William Sutherland, DO and advanced by Sharon Weiselfish-Giammatteo, PhD, PT. Myofascial Release (an indirect method of releasing restrictions in muscles and fascia). Developed by Weiselfish-Giammateo, PhD, PT Compression Syndrome release technique (a fulcrum technique to release higher level protective modes, i.e. those protections mediated by the brainstem). Developed by Sharon Weiselfish-Giammatteo, PhD, PT. Disruption of Membrane technique to help the body restore membrane wall integrity in arteries, veins, lymphatic vessels, organs and other structures. Developed by Sharon Weiselfish-Giammatteo, PhD, PT. Bone Bruise technique to use the body's self-corrective forces to help heal microtrabecular bone bruises. Developed by Sharon Weiselfish-Giammatteo, PhD, PT. Techniques to locate and treat areas of the body that have diminished immune support. More and more research is finding that infection is one of the significant findings in a variety of problems, from heart disease to ulcers to other gastrointestinal problems. There are many documented studies showing that the body stores infection in arteries, bones and other spaces of the body. This technique supports the body's immune system. Developed by Sharon Weiselfish-Giammatteo, PhD, PT.
The leaky gut syndrome, bone bruises, and infection in arteries and bones have been studied extensively. For more information I recommend searching the basic science and medical journals. More information on this particular method, Integrative Manual Therapy and Sharon Weiselfish-Giammatteo, PhD, PT can be found at www.centerIMT.com.