Massage therapy Chiropractic Osteopathy Physical therapy.

1. Physiological effects
of manipulative therapy.
Dr. Satyendra Singh
BNYS, MD

2. Introduction
Manipulative therapy is the method performed in such a way that the
patient is unable to prevent it and that introduces movement beyond the
passive range of motion’s elastic barrier but does not exceed the anatomical
barrier.
Types of Manipulative therapies –
• Massage therapy
• Chiropractic
• Osteopathy
• Physical therapy.

3. Massage Therapy
• one of the oldest forms of treatment
• Hippocrates, in 400 B.C., defined medicine as "the art of rubbing.“
• Now considered an "alternative“ therapy,
• It is defined as the manipulation of soft tissue and includes holding,
causing movement, and/or applying pressure to the body.”.
• The practice of massage is to achieve positive health and well-being
(physical, functional, and psychological outcomes).

4. Analgesic Effect
• Massage has traditionally been used to relieve pain.
• It produces short-lived analgesia by activating the 'pain gate' mechanism.
• pain - stimulate shorter and less myelinated (less insulated)nerve fibers -
message takes longer to reach the brain - than the pressure message.
• Pressure stimuli - transmitted by more insulated and longer fibers - able to
transfer the stimulus faster.
• The message from the pressure stimulation reaches the brain prior to the pain
message and, thereby, “closes the gate” to the pain stimulus.

5. • Massage therapy “enhanced deep sleep leading to less substance P” – reduces
pain.
• Increasing serotonin levels - pain decreased - serotonin is the body’s natural anti-
pain neurotransmitter.
• Serotonin levels are increased by massage therapy and are also correlated with
decreased cortisol and depression.
The Effects of Massage
Therapy on Pain
Management in the Acute
Care Setting
Rose Adams, MHA, BSW,
LMT, Barb White, MS,
LMT, and Cynthia Beckett,
This study shows that integration of massage
therapy into the acute care setting creates
overall positive results in the patient’s ability
to deal with the challenging physical and
psychological aspects of their health
condition. The study demonstrated not only
significant reduction in pain levels, but also
the interrelatedness of pain, relaxation,
sleep, emotions, recovery, and finally, the
healing process

6. Effect of massage therapy on pain,
anxiety, and tension after cardiac
surgery: A randomized study
Author links open overlay
panelBrent A.BaueraSusanne
M.CutshallbLaura
J.WentworthcDeborahEngendPenny
K.MessnercChristina M.WoodeKaren
M.BrekkefRyan F.KellygThoralf
M.SundtIIIg
Patients receiving massage therapy
had significantly decreased pain,
anxiety, and tension. Patients were
highly satisfied with the
intervention. Massage therapy may
be an important component of the
healing experience for patients
after cardiovascular surgery.
Effects of massage therapy and
presence of attendant on pain,
anxiety and satisfaction during
labor
Seyedeh Hamideh Mortazavi,
Siavash Khaki,
Rayhaneh Moradi,
Kazem Heidari &
Seyedeh Fatemeh Vasegh
Rahimparvar
Findings suggest that massage is an
effective alternative intervention,
decreasing pain and anxiety during
labor and increasing the level of
satisfaction. Also, the supportive
role of presenting an attendant can
positively influence the level of
anxiety and satisfaction.

7. Sedative Effect
• Strong percussion relieves pain.
• Gentle stroking has an hypnotic effect, through reflex influence upon the nerve
centres.
• Centrifugal friction (rubbing down) diminishes the blood supply of the brain, and
hence lessens cerebral activity.
• Light friction over a deep lying organ gives sedative effect to the organ.
• Massage of the soft parts above a joint relieves pain.

8. The effect of massage therapy on
the quality of sleep in breast cancer
patients
Fahimeh Kashani1 and Parisa
Kashani2
According to the results of this
study, learning and applying
massage techniques by medical
staff causes health promotion and
improves the quality of sleep in
cancer patients. Furthermore,
massage therapy is suggested as a
non-pharmacologic method to
improve sleep quality in these
patients.

9. Restorative Effect
• Mental fatigue is relieved by massage, through its effect upon the circulation and
the eliminative organs.
• The toxic substances produced by mental activity, are more rapidly oxidized and
removed from the body, while the fastened blood current thoroughly repairs and
cleanses the wearied nerve tissues.
• General reconstructive effects is experienced by the entire nervous system
through the improved nutrition induced by massage.

10. Reflex effects
• All the procedures of massage produce powerful reflex effects.
• Some of the most striking effects - very light stroking, especially when applied to
certain reflex areas.
• Percussion and vibration are also powerful means of producing reflex effects
• Touch – affects neurochemicals – influences mood and behaviour - Increases
oxytocin level – supports positive health.

11. • Massage dilates superficial blood vessels - increase rate of blood flow - dilatation is
controlled by local axon reflexes.
• Connective tissue massage - increase blood flow to deeply seated organs & affects
sympathetic autonomic activity.
• Thoracic & lumbar stimulated vigorously - trigger cutaneovisceral reflex - cause
vasodilatation.
• Deep massage promote venous return - increase SV.
Circulatory & tissue fluid

12. • Whole body massage (20 mins) - reduces blood viscosity, haematocrit - cause
haemodilution.
• decrease DVT 82 %
Implementation of Matrix Rhythm
Therapy and Conventional Massage
in Young Females and Comparison
of Their Acute Effects on
Circulation.
Ferruh Taspinar
, Ummuhan Bas Aslan
, Nuran Sabir
, and Ugur Cavlak
After matrix rhythm therapy and
massage application, blood
velocity, artery diameter, and blood
flow in arteries increased. However,
matrix rhythm therapy caused a
more prominent increase in the
amount of blood flow in the
popliteal and in the posterior tibial
artery than did massage.

13. Heart rate
• Massage therapy - Increased vagal activity (The vagus nerve branch to the heart)
- enhanced attentiveness - associated with decreased heart rate.
• Moderate pressure massage - stimulation of pressure receptors - associated with
decreased heart rate.

14. Moderate Pressure is Essential
for Massage Therapy Effects
Tiffany Field,1 Miguel
Diego,2 and Maria
Hernandez-Reif3
The effects of massage therapy on
psychological and neuroendocrine
factors may be mediated by the
stimulation of dermal or subdermal
pressure receptors, innervated by
vagal afferent fibers. Baroreceptors
and to a lesser extent
mechanoreceptors within the
dermis are innervated by vagal
afferent fibers.
moderate pressure massage elicits
an increase in the high frequency
component of heart rate variability.
Also indicating that moderate
pressure massage therapy elicits a
PNS response characterized by
decreased heart rate

15. Connective tissue
• Friction massage - maintain or improve mobility of liigament, tendons, muscles -
prevent adherence scar forming.
• It causes limited tissue damage, hyperaemia, mild inflammation.
• During healing phase - collagen fibrin realign in patterns.
• Deep friction massage - treat athletes from overuse injuries to knee -effective for
reducing pain than a conventional treatment.

16. Muscular system
• Moderate pressure - changes the muscle activity - greater reduction in stretch reflex - reducing
excitability in alpha motor neuron
• Reduces Hyperexcitability(chronic pain syndrome).
• Massage will increase the blood supply to the muscles.
• Specific effects of massage :
To encourage nutrition and development of the muscles
To excite muscular contraction
To remove the effects of muscular fatigue

17. • Massage reduces discomfort, relieves the associated muscle spasm and permits
improved function.
• Denervated cat muscle - effleurage and petrissage for 10 min daily for a month
showed - weight loss but retained an almost unimpaired ability to generate force.
• Massage stretches and pulls muscles and, the authors found that
mechanosensory focal adhesion kinase–1 and its downstream effectors
extracellular signaling kinases 1 and 2 were activated, as revealed by their
increased phosphorylation.

18. • Several hours after massage, another downstream target of this pathway, PGC-
1α, this set of responses indicated that additional mitochondria were forming,
presumably accelerating healing of the muscle.
Massage Therapy Attenuates
Inflammatory Signalling
After Exercise-Induced
Muscle Damage
Justin D. Crane,1 Daniel I.
Ogborn,2 Colleen Cupido,1
Simon Melov,3 Alan
Hubbard,4 Jacqueline M.
Bourgeois,5 Mark A.
Tarnopolsky
In summary, when
administered to skeletal
muscle that has been acutely
damaged through exercise,
massage therapy appears to
be clinically beneficial by
reducing inflammation and
promoting mitochondrial
biogenesis.

19. In Preterm infants
• Moderate pressure massage for a week(15 min) - Increased vagal activity &
gastric motility - Leads to food absorption - Weight gain increased.
• A study by Tiffany Field et al, Higher levels of insulin & IGF-1 after 15 mins
massage/5 days – increase in weight gain.

20. Massage therapy research TiVany Field , Miguel Diego
a, Maria Hernandez-Reif a
say that stimulating pressure receptors under the
skin leads to events including: (1) stimulating the
vagus (increased vagal tone);
(2) activating the branches of the vagus including
the smart vagus (decreased
heart rate), as well as the vegetative vagus
(increased release of food absorption hormones
and increased gastric motility in preemies); (3)
increasing serotonin and dopamine and decreasing
substance P which may help alleviate
depression and pain; (4) decreasing cortisol, which
may facilitate immune function
i.e., increased natural killer cells, cortisol is noted
to kill natural killer cells, and natural killer cells
ward of viral and cancer cells; and (5) altering brain
activity, as in shifts to greater relative left frontal
EEG activation in depressed individuals and
enhanced attentiveness patterns, facilitating
cognitive function.

21. High blood pressure and associated
symptoms were reduced by
massage therapy
Maria Hernandez-Reif, PhD
Tiffany Field, PhD
Josh Krasnegor, BA
Z. Hossain
Hillary Theakston, BA
I. Burman, LMT
Although both groups reported less
anxiety, only the massage therapy
group reported less depression and
hostility and showed decreased
urinary and salivary stress hormone
levels (cortisol). Massage therapy
may be effective in reducing
diastolic blood pressure and
symptoms associated with
hypertension.
Massage Therapy and
Frequency of Chronic Tension
Headaches
Christopher QuinnDC, , Clint
ChandlerBS, and , Albert
MoraskaPhD
Compared with baseline values, headache
frequency was significantly reduced within the
first week of the massage protocol. The
reduction of headache frequency continued for
the remainder of the study (P = .009). The
duration of headaches tended to decrease
during the massage treatment period (P =
.058). Headache intensity was unaffected by
massage (P = .19).

22. Osteopathy
• Osteopathy is a form of drug free non-invasive manual medicine.
• Treating & strengthening the musculoskeletal frame work, which includes the joints,
muscles & spine.
• Osteopathy is based on the theory that diseases are due chiefly to loss of structural
integrity.
• And can be restored to harmony or equilibrium by manipulation.
• Begins in the United States in 1874.
• The term was coined by Andrew taylor.

23. There are four major principles of Osteopathy:
1) The body is a unit – an integrated unit of mind , body & soul.
2) The body possesses self-regulatory mechanisms – having the inherent capacity
to defend , repair & remodel itself.
3) Structure & function are reciprocal inter-related.
4) Rational therapy is based on consideration of the first three principles.

24. What are the benefits of osteopathy?
• Improved body function, flexibility, and mobility.
• A more restful, deeper sleeping pattern not interrupted by pain.
• An increase in your energy levels to help you function more adequately with
home, work and leisure activities.
• A reduction in stress levels and muscle tension.
• A positive effect on your mood, memory and mental health.
• A general improvement to your overall health and sense of wellness.

25. HOW OSTEOPATHY WORKS??
• Believed that every diseases or illness began with structural problems in the spine
which connects the to various organs in the body.
• Treatment is aimed at the structural problems present, not the disease entity.
• Treatments would return the nerves to their normal function.
• Allow the blood to flow freely throughout the circulatory system, with structure
restored ,the body’s own natural healing powers would be able to restore full
health.

26. What symptoms can an osteopath treat?
• Headaches and migraines
• Back pain and neck pain
• Sciatica
• Shoulder pain
• Knee pain
• Hip and groin pain
• Elbow, hand and wrist pain
• Foot and ankle pain
• Age-related joint pain
• Sport injuries
• Workplace injuries
• Repetitive strain injury and postural related pain

27. OMT to Address the Physiologic Effects of Stress
Danielle Emmet, OMS IV; Victor Nuño, DO; Stacey Pierce-Talsma, DO
• OMT techniques, including suboccipital inhibition and rib raising, are associated with increased heart
rate variability, improved autonomic homeostasis, decreased muscular tension, and reduced
perception of stress.
• Mental stress is known to cause increased muscular tension through complex neurologic reflex loops.
Suboccipital inhibition (suboccipital decompression) induces a parasympathetic response.
The vagus nerve exits the skull via the jugular foramen in the suboccipital region.
Increases parasympathetic tone and heart rate variability.

28. • Rib raising can be used to improve respiratory excursion
through the release of the costotransverse articulation
just anterior to this joint is the sympathetic chain ganglia arising from T1-L2,
improve autonomic homeostasis by decreasing sympathetic tone.

29. The effects of osteopathic treatment
on psychosocial factors in people
with persistent pain: A systematic
review
Madalina Saracutu
Jaynie Rance
Helen Davies
Darren J. Edwards
This review aimed to determine whether
osteopathy has an impact on psychosocial
factors in populations living with persistent
pain. Studies considered within the review
have revealed some effects of osteopathic
treatment, particularly on anxiety and fear
avoidance (patients undergoing osteopathic
manipulation showed decreased anxiety and
fear avoidance). Additionally, several studies
reported significant improvements in health
status (six out of seven) and quality of life
(three out of four). The effects of osteopathy
on psychosocial factors associated persistent
pain is limited.

30. Osteopathic manipulative treatment
for low back pain: a systematic
review and meta-analysis of
randomized controlled trials
John C Licciardone*1, Angela K
Brimhall2 and Linda N King3
The present study indicates that
OMT is a distinctive modality that
significantly reduces low back pain.
The level of pain reduction is
greater than expected level and
persists for at least three months.

31. The patient experience of
osteopathic healthcare
Paul J. Orrock These patients experienced that osteopathic
healthcare is a late health choice, involves regular
assessment, a range of manual therapies at multiple
regions, therapeutic advice regarding exercise and
posture, and education about the proposed aetiology
of their main problem. Their experience reflects a
patient-centred approach to healthcare. These
results also reflect elements of an evidence-based
management of the chronic pain patients common in
these practices.
The lack of formal clinical evidence supporting the
specific osteopathic intervention is concerning. This
data contributes to what is known about osteopathic
healthcare from the patients' experience of it, and
triangulated with other data can assist in developing
an authentic model of osteopathic healthcare that
may be tested for its effectiveness.

32. Conclusion
. The key principles are based on all parts of the body functioning together in an integrated
manner. If one part of the body is restricted, then the rest of the body must adapt and
compensate for this, eventually leading to inflammation, pain, stiffness and other health
conditions. When the body is free of restrictions in movement, Osteopathic treatment
assists the body with pain minimization , reduced stress and greater mobility providing
the body with the opportunity to heal itself.
Osteopaths use a broad range of gentle hands-on techniques including soft tissue
stretching, deep tactile pressure, and mobilization or manipulation of joints.
Thus Osteopathy is a unique holistic approach to health care.

33. Chiropractic
• System of healing based on the theory that the disease in human body results
from lack of nerve function.
• It is derived from Greek. The word chiropractic means ,one who treats or
conducts a practice by means of ones hand.
• D.D. Palmer found chiropractic in the 1890s and his son B.J. Palmer helped to
expand it in the early 20th century.

34. Effects of chiropractic
• improve the function of the nervous system by making adjustments to the spine.
• Balance Nervous System and Improve Immune System :
Inflame the stressed, injured or infected area to protect the rest of your body
(sympathetic nervous system).
When Parasympathetic nervous system activates
Stress caused by the injury or infection is reduced, heart and breathing rates return
to normal, and inflammation begins to dissipate.

35. • Relief of musculoskeletal pain
• Shortened time to recover from acute muscle pain
• Increase in passive range of motion
• Spinal Manipulation for Back Pain
• Spinal Manipulation for Neck Pain

36. Changes in pain sensitivity
following spinal
manipulation: A
systematic review and
meta-analysis
Rogelio A. Coronado,
Charles W. Gay a , Joel
E. Bialosky b,Giselle D.
Carnaby c , Mark D.
Bishop b , Steven Z.
George
The mechanism of SMT remains elusive, but
appears to modulate pain through both central
and peripheral pathways. Studies have
investigated the effect using variable
experimental pain modalities including
chemical, electrical, mechanical, and thermal
stimuli. SMT demonstrated a favorable effect
over other interventions on pressure pain
thresholds (PPT). Additionally, subgroup
analysis showed a significant effect of SMT on
remote sites of pressure stimulus application
further supporting a potential influence on
higher levels within the central nervous
system. Future studies using experimental pain
testing to examine the mechanisms of SMT
should include multiple stimuli and test at
multiple anatomical sites if determining
potential mechanisms is the goal.

37. Alterations in Cortical and
Cerebellar Motor Processing in
Subclinical Neck Pain Patients
Following Spinal Manipulation
JulianDaligaduMHSc
,HeidiHaavikPhD ,Paul
C.YielderPhD
,JulianneBaarbeBSC
BernadetteMurphyDC, PhD
When a single session of
chiropractic treatment is
provided before a 20-minute
motor training task in an SCNP
group, a pattern of cerebellar
modulation similar to that seen
in healthy controls is observed.
These findings suggest that
normalizing afferent input from
the neck may have restored a
more correct internal body
schema that allowed correct
sensorimotor integration and
normalized motor output.

38. Conclusion
• According to chiropractic, a disease may be caused or aggravated by disturbances
of nervous system and this in turn may be caused by derangements of Musculo-
skeletal structures.
• By restoring the body’s structural integrity is a key part of chiropractic that
greatly influences the body’s overall health and wellness.

39. Physical Therapy
• Physical therapy addresses the illnesses, or injuries that limit a person's abilities
to move and perform functional activities in their daily lives.
• Defined as the rehabilitative health that uses specially designed exercises and
equipment to help patients regain or improve their physical abilities.

40. Why Physical Therapy is Beneficial
• Relieve pain and restore muscle and joint function.
• Strengthen weakened parts of the body and improve gait and balance.
• Manage age-related issues .
• Effectively control blood sugar level.
• Recovery from injury or trauma.

41. Physiological Effects
There is an increase in metabolism due to :
• The increased demand for nutrition and oxygen.
• Regulation of body temperature.
• Eliminate the metabolic waste produced.

42. Effect on muscles
• Venous return increased - Due to the muscle pump and Respiratory pump
• Blood flow to the skeletal muscles is increased. At rest about 3 to 4 ml/100gm of
muscle/per month.
• Moderate exercise - 60-80ml , Severe exercise - 90-120ml.
• Vasodilatation leads to relaxation of the muscles.
• In the muscles end product of metabolism is lactic acid which is further non-
degradable & is also a stimulant for vasodilatation.

43. Effect on respiration
• During exercise there is increase in CO2 of blood
• Chemoreceptor in medulla are stimulated
• Stimulation of dorsal respiratory group of neurons
• Increase the rate of respiration
• Removal of CO2 is increased

44. Changes in blood
• Mild hypoxia: which increases CO2 concentration will lead to pH decrease.
• It stimulates the juxtaglomerular cells to synthesize erythropoietin. So that there
is a production of RBCs.
• Decreased blood volume results in Hemoconcentration i.e. water is lost through
plasma. That’s why severe exercise can even cause dehydration.

45. Cardiac output
• 5-6 liters of blood is pumped out of heart/min.
• In moderate - 20liters/min.
• Severe exercise - 35 liters/min
• Cardiac output is directly proportional to oxygen consumption. This is due to
increased heart rate and increased stroke volume (70ml/contraction).
• Cardiac output =HR x SV

46. Effect on elimination
• Skin - Sweating is improved
• Kidney - Urine output is increased
• Lungs – Carbon dioxide and other unwanted gases removed
• GIT- Excretion of feces is increased due to proper assimilation and proper
digestion.

47. Gait Speed Is Limited but Improves
Over the Course of Acute
Care Physical Therapy
Braden, Heather J. PT, MPT, PhD,
GCS1; Hilgenberg, Sean DPT2;
Bohannon, Richard W. DPT, EdD3;
Ko, Man-Soo PhD1; Hasson, Scott
PT, EdD, FACSM, FAPTA
Walking speed is a feasible
measure for patients admitted to
an acute care hospital. It shows
that patients walk slowly relative to
community requirements but that
their speed improves even over a
short course of therapy.
Treating Small Bowel
Obstruction with a Manual
Physical Therapy: A
Prospective Efficacy Study
Amanda D.
Rice,1 Kimberley
Patterson,1 Evette D.
Reed,1 Belinda F.
Wurn,1 Bernhard
Klingenberg,2 C. Richard
King,
The results from this study suggest that it can be
used to treat adhesions and scar adherence safely
in the recurrent SBO subject population,
demonstrating significant improvements in overall
pain, quality of life, and severity of pain and
improvements in gastrointestinal symptoms being
suggestive. Further, patients who were previously
concerned about having another SBO episode
reported a significant decrease in that concern
three months after treatment. The improvement in
quality of life for this patient population is positive
as a decline in quality of life is the largest complaint
from patients with bowel obstructions.

48. References
• Massage therapy research ,Tifany Field a,b,¤, Miguel Diego a, Maria Hernandez-Reif a a Touch
Research Institutes, University of Miami School of Medicine, P.O. Box 016820, Miami, FL 33101,
USA b Fielding Graduate University, USA.
• Massage Therapy Research Review.Tiffany Field, PhD1,2
• Massage Therapy Effects.Tiffany M. Field Touch Research Institute, University of Miami School of
Medicine, and Nova Southeastern University
• The Influence of Back Massage on Autonomic Functions.JEAN SCOTT BARR, M.S.and NORMAN
TASLITZ, Ph.D.
• Effects of massage as a recuperative technique on autonomic modulation of heart rate and
cardiorespiratory parameters: a study protocol for a randomized clinical trialNilton Mantovani
Junior,1 Eduardo Pizzo Junior,2 Malu dos Santos Siqueira,1 Allysiê Priscilla de Souza Cavina,1 Carlos
Marcelo Pastre,1,3 and Franciele Marques Vanderlei
• Effectiveness of manual therapies: the UK evidence report Gert Bronfort1*, Mitch Haas2, Roni
Evans1, Brent Leininger1, Jay Triano3,4
1,

49. • INCREASE OF PLASMA fl-ENDORPHINS IN CONNECTIVE TISSUE MASSAGE BIRGER KAADA* and
OVE TORSTEINBO Laboratory of Clinical Neurophysiology, Rogaland Central Hospital, N-4011
Stavanger, Norway
• Massage Therapy: Understanding the Mechanisms of Action on Blood Pressure. A Scoping Review
Nicole L. Nelson, MSH, LMT
• Rhythmical massage improves autonomic nervous system function: a singleblind randomised
controlled trial Georg Seifert, Jenny-Lena Kanitz, Carolina Rihs, Ingrid Krause, Katharina Witt,
Andreas Voss
• Effect of massage therapy on pain, anxiety, and tension after cardiac surgery: A randomized study
Brent A. Bauer a,*, Susanne M. Cutshall b, Laura J. Wentworth c, Deborah Engen d, Penny K.
Messner c, Christina M. Wood e, Karen M. Brekke f, Ryan F. Kelly g, Thoralf M. Sundt,
• Massage Therapy Attenuates Inflammatory Signaling After Exercise-Induced Muscle Damage.
Justin D. Crane et al.
• The Effects of Massage Therapy on Pain Management in the Acute Care Setting. Rose Adams,
MHA, BSW, LMT, Barb White, MS, LMT, and Cynthia Beckett,