1. on
AWH SPECIAL COLLEGE KALLAI 14th bpt
Presented by,
Akhil Rahman
Akhila K.S
Aswathi senan
Aswathi K

2. INTRODUCTION
 Musculoskeletal pain is believed to arise from the
muscles,ligaments,bones or joints
 Pain may be due to local causes such as
tumours,fractures,infections and systemic and
neurological causes
 It can be localized or widespread
 Lower back pain is the most common type of muscular
pain,other common type include tendinitis,myalgia
and stress fractures

3. CAUSES
 Any injury to the
bone,joints,muscles,tendon.ligaments,nerve
 It can be caused by jerking movements, car
accidents,falls,#,sprain,dislocation,direct blow to the
muscles,overuse,poor posture,immobilization

4. Area of pain
35
30
25
20
15
10
5
0
lower back shoulder
neck
thoracic
knee
hip
buttocks

5. Type of pain
 Neuropathic
 Mixed
 Somatic referred
 somatic

6. symptoms
 Localized or widespread pain that can worsen with





movement
Aching or stiffness of entire body
Fatigue
Sleep disturbances
Twitching muscle
Sensation of burning in muscle

7. Types of MSK pain
 Bone pain
 Muscle pain
 Tendon and ligament pain
 Fibromyalgia
 Joint pain
 Tunnel syndrome

8. Treatment
it is treated by treating its causes
It includes
 NSAID and joint injections(medical Rx)
 Pain reducing electrotherapy modalities
 Manual therapy
 Using a splint to immobilize the affected joint and allow
healing
 Using heat or cold
 Reducing work load and increasing rest
 Reducing stress through relaxation and biofeedback
 Strengthening and conditioning exs
 Therapeutic massage and stretching exs

9. Manual therapy
Different type of manual therapy using for the msk pain. This
includes
OMPT(orthopeadic manual physical therapy)
 OMPT utilizes the application of hands-on manipulation to restore
pain-free living and proper function. Based on techniques originated in
Europe, and recognized by the American Medical Association, OMPT
is proven to more effectively stimulate the neuro-musculoskeletal
system, and promote greater joint motion and soft tissue function than
conventional approaches to physical therapy.
 benefits
• Relieves the symptoms by focusing on the cause of the problem
• Increases range of motion and joint mobility
• Reduces muscle tension and inflammation
• Provides pain relief and eases recovery
• Promotes proper circulation and the healing of soft tissues
• Restores proper joint and muscle function for optimal outcomes

10.  Swedish massage(Dr.johan George)
 Shiatsu massage
 Deep friction massage by James cyriax
 Soft tissue mobilization such as
A. Stretching
B. Myofacial release
C. Trigger point technique
D. Deep tissue technique
E. Active release technique
 PNF technique by Margaret Knott & Dorothy Voss
 Post isometric relaxation(European manual technique )

11. NEED FOR THE STUDY
 Pain and disability associated with musculoskeletal




conditions represent and significant health burden in
India
An episode of msk pain is of short duration, but it may
reoccur
The successful management of acute pain reduces the risk
of chronic pain
Simple interventions like physiotherapy providing early
recovery from acute stage and can prevent reoccurrence
This study mainly focuses on how manual therapy
effective in musculoskeletal pain

12. HYPOTHESIS
TRUE HYPOTHESIS
 Available evidence suggest manual therapy as effective
in treatment of msk
 From the techniques we could find out what are the
physiological effect gained from that
 For example mobilization with small amplitude
oscillatory and distraction are used to stimulate
mechanoreceptors that inhibit transmission of
nociceptive stimulus, thus pain is relieved

13. Evidences
Technique
Out come
1. Joint based
manipulation
Improved range of motion
mobilization
Decreases muscle spasm
Improved range of motion
2 Soft tissue based
Swedish massage
Improved circulation
deep tissue massage
Decrease muscle spasm
trigger point release
Relaxation
Re-align soft tissues, break adhesion
Increase range of motion
3 nerve based
neural dynamics
Decreases pain
Increase range of motion

14. Review of Literature
 Manual therapy techniques were practiced as a
treatment plan in past centuries
 Hippocrates described combination of traction and
manipulation
 The other evidence of manual therapy technique in
the olden days was by Sir Ambroise Pare who advice
the use of manipulation in the treatment spinal
curvature
 Mechanical diagnosis and therapy(MDT)proposed by
famous Newzealand physiatrist Robin
meckanzie.These treatment were used to treat spinal
discogenic dysfunction.

15.  Brain Mulligan the suggested as an etiology for joint
dysfunction thought to respond to a unique manual
therapy intervention called movement with
mobilization(mwm)
 A journal of orthopedics manual therapy published on
2010 also suggested the effect of manual therapy in the
treatment of MSK

16. METHODOLOGY
STUDY DESIGN :experimental study
STUDY SETTINGS: patients with MSK pain medically screened and
referred for PT by a physician in a multispecialty university teaching
hospital
Selection criteria: participants of any age, gender, with MSK were included
PROCEDURE: patients with low back pain,shoulder,knee and hip were
selected. They were treated for exs and manual
therapy,TENS,acupunture,NSAID and topical treatment and examined its
effects
EQUIPMENT: VAS(visual acquity scale )

17. RESULT
patients with MSK pain were selected& they were
divided into 6 groups with 5 patient in each. Each
groups were given different types of treatment like
manual therapy ,topical treatment,acupunture,jont
injection,NSAID,TENS & examined for 2 months ,all
the treatment were effective but each group of people
responded to the treatment in different way
 3o

18. 



Those who were given joint injection which are usually a
combination of a local anesthetic or numbing
agent,which provides immediate relieve and
corticosteriod,such as cortisone shots, reduces
inflammation and pain for temporary, but not the causes
People who treated for acupuncture was effective, but the
effects are not well understood
People who were treated for TENS ,pain were reduced but
was of short duration
Manual therpay:-people who were treated for manual
therapy was more effective than other treat ment.Many
techniques were used according to their cause of MSK
pain. Manual therapy finally resolved the underlying
cause and reduced pain after 2 wks of treatment., and the
reoccurrence was less compared to all other treatment

19. Topical applicants:- were effective for 2-4 hours
NSAID:-work in the body by altering the brains pain
receptor &blocking pain stimulus
technique
Effect of treatment(duration)
Manual therapy
6wks
NSAID
1 ½ wk
Joint injections
3days
Topical applicants
2-4 hours
TENS
2days
acupuncture
1 wk

20. Y-Values
45
40
35
30
25
20
15
10
5
0
Y-Values
(in days)
manual
therapy
NSAID
joint
injection
(Treatment)
topical
applicants
TENS

21. DISCUSSION
 The findings highlight the effect of manual therapy in
patient with MSK pain. Traditional literature
emphasized more on manual therapy techniques& its
mechanisms
 Understanding the pain mechanism would help
therapists to identify uniqueness in patients symptoms
& would facilitate better individualized treatment
planning and implementation
 Manual therapy are the most effective treatment of
pain and palliative care

22.  Bialosky explained the mechanism based role of manual
therapy in the treatment of MSK pain and this may thus be
applicable for other PT treatment as well
 Manual therapy was become a continuous and inextricable
part of PT
CONCLUSION
 Summarizing the physical cycle of pain, unless the
movement restrictions in the spine& extremities are
examined, identified, discovered & treated ,pain will always
be present, as long as there is movement restriction there
will always be compensation and there will always be pain
when this is the case ,pain pills, injection
shots, and acupuncture will just be masking the pain and
results will be just for temporary. However when the
mobility of the joints, muscles and soft tissues are regained
and maintained by manual therapy