One physiotherapy modality that is fast becoming de rigor in the treatment of referred pain caused by stiff joints is manual therapy. Today, manual therapy is the mainstay of modern physiotherapy moving away from the dependency on Electro-Therapy Agents such as Ultrasound, Short Wave, and TENS as the primary treatment modalities.
Referred pain is a very unpleasant sensation localized to an area separate from the site of the causative injury or other painful stimulation. Often, referred pain arises when a nerve is compressed or damaged at or near its origin. In this circumstance, the sensation of pain will generally be felt in the territory that the nerve serves, even though the damage originates elsewhere.
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Manual therapy consists of a range of interventions, including hands-on techniques such as joint mobilization. Joint mobilization is thought to help maintain or improve extensibility and tensile strength of the articular tissues, reduce the effects of mechanical limitations, elongate hypermobile capsular, ligamentous, and connective tissue. It also stimulates mechanoreceptors and therefore may be responsible for inhibiting the transmission of nociceptive stimuli and in doing so, reduce pain perception. (Kisner and Colby 2002).
In Singapore, there are two common concepts of manual techniques used for spinal mobilization- the Maitland Concept and the Mulligan Concept.
Maitland's Concepts (often also referred to as the Maitland Technique) involve the application of passive and accessory oscillatory movements to spinal and vertebral joints to treat pain and stiffness of a mechanical nature. The techniques aim to restore motions of spin, glide, and roll between joint surfaces and are graded according to their amplitude.