What is Manual Therapy?

Since the dawn of time, humans have sought to heal the ailments that afflict them. Initially, it’s a matter of reflex when we get injured.

We only have to think about the friction we apply to the elbow that we bump against an obstacle, or the hand we place on our stomach during heartburn.

Then, through observation, trial and error, humans have developed manipulative techniques that have evolved and spread throughout the world over the centuries.

Egypt

The first reference to manual therapy practices dates back to ancient Egypt, where a fresco discovered in the tomb of Pharaoh Ramses II (around 1298 to 1235 BC) shows a practitioner treating what appears to be an elbow injury.
Another document dating back more than 4000 years, the SMITH PAPYRUS (a copy of a document from the ancient Nubian Egyptian empire) which includes several cases of bone surgery and external pathology, inspired a certain Hippocrates.

Antiquity

In Greece, Hippocrates of Cos (460 to 377 BC), in his Treatise on Joints, describes in detail the maneuvers for joint reduction, either using traction instruments or purely manual techniques. These techniques are confirmed by several authors, including those in the history of the fight against disease, who state that the author of On Joints is well-versed in the principles of orthopedics.
Despite the accuracy of these methods, he sometimes suggests techniques that are likely worse than the ailment, or even fatal. For example, he proposes to hang hunchbacks by the neck or to tie them upside down to a ladder that will be violently struck against the ground.

“In Rome, Claudius Galen (131-201 AD), an heir to Hippocrates, commonly manipulated joints. As unbelievable as it may seem, he managed to reinsert an omentum into the abdominal cavity and performed the removal of a suppurating sternum from a slave. Not stopping there, he apparently cured the paralysis of the eminent Eudemus through a vertebral adjustment.

The East

Further east, “the Chinese also practiced manipulations as evidenced by texts dating back 3500 years BC. These writings say that by rubbing the painful area with the hands, the pain subsides and can even disappear. We also know that acupuncture and many massage techniques come from ancient China.

The Obscurantism of the Middle Ages

This period marks the advent of obscurantism characterized by a regression and the disappearance of the therapeutic arsenal of practices.
At the Fourth Lateran Council in 1215, the decision was made to prohibit doctors from practicing surgery, reserving exclusively the practice of medicine for them. Surgery therefore left the medical field and was reserved for laypeople who could only benefit from “on-the-job” training, as studies were only accessible to clerics. Manual therapy techniques will therefore fall into the hands of barbers; it is the discredit surrounding them that will reflect on the whole of Manual Therapeutics. This discredit was such that the barbers themselves eventually stopped using them for the most part.

Renaissance

Fortunately, some of them will perpetuate the use of manipulative techniques. This is the case of Ambroise Paré (1509-1590), a French barber-surgeon who holds the title of father of modern surgery. He is the inventor of many instruments and developed the ligation of arteries. He commonly practiced manipulation.
It is, from then on and until the end of the 19th century, the period where the art of vertebral manipulations will be practiced by bonesetters or rebouteux and transmitted through unofficial channels. It will take the birth of an American reformer for a new science based on manual therapy in physiotherapy to be erected.