For  Manual Medicine we mean a diagnostic-therapeutic medical act that uses exclusively or mainly physical means constituted by the hands of the operator, possibly assisted by simple tools that amplify their effectiveness (1). 

The MM operator is and must therefore be a doctor who, with full knowledge of the facts, decides to use his own hands to positively influence a given pathology, alternatively or in conjunction with chemical means (drugs).

Accredited medicine

Manual Medicine is one of the five medical disciplines (together with Acupuncture, Phytotherapy, Homeopathy and Traditional Chinese Medicine) so-called complementary, accredited by the Tuscany Region, as considered scientifically appropriate, of proven efficacy and widely appreciated by the public.

Osteoarticular problems: first cause of medical consultation

Among the patients of the general practitioner, the pathologies of the Locomotor System (on which Manual Medicine has considerable efficacy) represent by far the first cause of consultation and to the same extent the response that Medicine offers to such users is particularly disappointing. , for which the latter resort to alternative treatments, which sometimes demonstrate competence, but more often uncertain and / or only provisional results.

Origin

If the origin of manual therapy and therapeutic massage can be said to be as old as humanity is, it is certainly an extremely recent field if we look at the various schools present today: Chiropractic and Osteopathy, Travell’s Trigger Point theory. Simons and the even more recent methods of Robert Maigne, Aldino Barbiero, Michel Furter and others.

A fundamental distinction

At this point it is good to distinguish between manual therapies that involve joint mobilization, traction and manipulation (eg. Chiropractic, R. Maigne’s method) and therapies that do not involve joint interventions, but only practice manual treatments on areas of the body considered appropriate (eg. . Trigger Point, Furter method).

Action field

Field of action of MM is not only the musculoskeletal system, but also everything that can be classified as functional pathology or organ dysfunction, such as, for example, pathologies such as irritable bowel syndrome, dyspepsia of unclear origin, some types of essential hypertension, anxiety-depressive syndromes, certain heart and respiratory ailments with no apparent cause.

Exclusion fields

Fields of exclusion on which MM is not competent concerns everything that is dermatological, infectious and oncological-degenerative pathology.

Mechanism of action

Regarding the hypotheses on the mechanism of action of MM, we have philosophical guiding principles, typical of Chiropractic and Osteopathy, the Robert Maigne vertebral articular hypothesis (DDIM) and the reflex neuro-hormonal mechanism of other more recent schools.

In practice

The practical-operative methods of intervention are the most varied and schematized with joint mobilization, joint manipulations with impulse, massages of various types on specific points and areas, applications on the same areas of physical means, such as dry needles, laser tools and other devices . Of particular interest is the type of semeiotics envisaged by the various disciplines and the methods for understanding which joint sectors to intervene on or which points and areas to treat.

NOTE

1. To date, I am not aware that there is a useful definition of Manual Medicine, but there are various realities that give their own definition or, better said, that self-attribute this denomination. Thus, if we go to the website of the Italian Academy of Manual Medicine, we find: “Manual Medicine … is an integral part of Conventional Medicine, a super-specialty practiced by specialists (Physiatrists, Orthopedists, Rheumatologists, Neurologists, Neurosurgeons, Doctors of the sport) that deal with painful disorders of the musculoskeletal system “. If we go to the site www.medicinamanuale.it instead, we find the following definition: «Manual Medicine is part of the so-called“ alternative medicine ”…» and continues citing Chiropractic, Osteopathy and more. At the website www.medicinamanuale.net, edited by Dr. Massimo Groppi, Sienese physiatrist, we find the statement that “Manual Medicine was born in the 1950s thanks to the work of Robert Maigne …”. In reality, Dr. Maigne, in the preface to his latest work, states that his therapeutic approach is part of the field of Manual Medicine, but it represents only one aspect of it. We therefore believe that the definition we propose can be more exhaustive and clarifying.