What is Manual and Manipulative Therapy?
• Manual therapy, also known as mobilization or manipulative therapy,
is a form of hands-on treatment where a physiotherapist carefully
moves the tissues and joints of the body to restore movement and
• Research studies indicate that this treatment is essential for recovery
from many musculoskeletal issues and injury types.
The goal of manual therapy
• The goal of manual therapy is to treat the neuro-orthopaedic aspect
of the patient’s condition. The application of this treatment addresses
the condition directly, rather than just its symptoms. Manual therapy
involves the evaluation and treatment of musculoskeletal system
using specialized movements applied by a trained professional.
When Can It Be Used?
• Manual and manipulative therapy is effective in regions throughout
the body. For example,in the head, manual therapy, headaches and
jaw pain. Within the neck, this therapy is used to treat chronic neck
and spine pain, whiplash, and radiating nerve pain.
• Manual therapy is applied to the mid-back to treat muscle imbalances
and shoulder blade pain. It is used in other parts of the back to attend
to pelvic pain, a herniated disc, and degenerative disc disease. Within
the arms, it is applied for cases of tennis elbow, fractures and rotator
cuff pain. In the legs, manual therapy is used to treat movement loss
and pain from joint replacements, ankle sprains and arthritis.
Benefits of Manual and Manipulative Therapy
• In cases like chronic or acute shoulder pain, manual therapy can reduce
• It also addresses problems in the fascia, mobilization of nerves, and soft-
tissue injury. Following treatment, patients report that the muscles feel
loosened and relaxed, with a sensation of increased circulation. The aim is
to allow movement to extend beyond the restricted range of motion the
patient is experiencing.
• Our clinic sites are recognized as facilities providing advanced manual and
manipulative therapy treatment, and it is a component of most treatment
plans. Many of our clinic associates are Fellows of the Canadian Academy
of Manipulative Therapy(FCAMPT).
What are some manual therapy techniques?
• Manual therapy techniques include soft tissue mobilisation, joint
mobilisation and joint manipulation. These are all hands on skills
performed by a physiotherapist
How does manual therapy reduce pain?
• Manual therapy works to restore normal movement in the joints can
help calm muscles in a state of spasm. Physical inputs to the body
from motion and touch flood the nervous system with sensory
signals. These signals tell your body where your limbs lie in space and
what is occurring in the muscles and joints. Your brain prioritizes
these signals, which helps block the transmission of pain.
Is manual therapy the same as massage
• Massage therapy primarily focuses on soft tissue techniques that
address the muscles and fascia. While manual therapy by a
physiotherapist may incorporate some soft tissue techniques, the
primary focus is often restoring joint mobility and function. This is
achieved by the use of joint mobilisation and manipulation
INTRODUCTION touch healing (HT)
• Over the last 28 years, HT Therapy has been effective in demonstrating a positive impact in the health care
• HT is widely respected and increasingly accepted, not only in the United States, but in many countries
around the world and considered as one of the leading energy medicine programs in healthcare around the
• HT is now part of patient care systems in more than 30 hospitals in the United States since the effective
results were seen over recent years.
• HT skills are becoming increasingly validated in healthcare systems around the united states Hospitals that
support the practice of HT as part of their integrative health care system have found that it facilitates the
return of compassion to the forefront of patient care.
• Hospitals, nursing and medical schools, and other allied health professions throughout the world are
increasingly embracing Integrative Medicine as consumer demand multiplies and as research supports its
• HT has had an active research program for over 10 years and more than 50 HT studies have been completed
at universities, medical centers and in other settings.
• HT is non-invasive techniques utilize the hands to clear, energize, and
balance the human and environmental energy fields, thus affecting
physical, emotional, mental, and spiritual health and healing.
• Potential illness appears in the energy system before physical symptoms
• A person’s health and quality of life are affected by the health and quality
of the energy system.
• In a HT session, the practitioner begins with a centering process to calm
the mind, access a sense of compassion, and become fully present with
• The practitioner then focuses intention on the patient’s highest good and
places his or her hands lightly on the patient’s body or makes sweeping
hands motions above the body.
• Central to HT is the belief that a vital energy or life force flows freely
through space and sustains all living organisms. In a healthy person, this
energy is thought to flow in and out of the body in a balanced way. It is
believed that illness results when the energy flow is out of balance.
• Practitioners of HT use their hands in an attempt to change a person's
energy flow and restore health. HT does not require contact between the
practitioner and the person during treatment. The practitioner moves his
or her hands several inches above the person's body.
• Like other complementary medicines, HT starts with the idea that people
are naturally healthy. The way people live and think may disturb their
natural energy, and they may become ill.
• The HT Program has been taught since 1989 to more than 100,000
• 1970= Introduced by Prof. Dolores Krieger, PhD from New York University
• 1980 = The program (originally known as Colorado Center for HT) by Janet
Mentgen, HNC, CHTP/I, as a medically-based energy therapy training
program in Colorado USA
• 1989 = Pilot program at the University of Tennessee and in Gainesville,
• 1990= HT Program Sponsored by the American Holistic Nurses' Association
• 1993 –1996 AHNA Certification Program
• 1994= Energy Field Disturbance Nursing Diagnoses approved by NANDA (1.8)
which represents a specific theory-Human Energy Field Theory.
• 1996 = HT International Certification.
DEFINITION OF HT
• The aim of HT is to focus (or channel) healing energy to restore natural health.
• HT is based on the belief that human beings are fields of energy that are in
constant interaction with others and the environment.
• HT is an "energy therapy" that uses gentle hand techniques thought to help re-
pattern the patient’s energy field and accelerate healing rejuvenation of the body,
mind, and spirit.
• HT is a therapy that uses touch to influence the human energy system, specifically
the energy field that surrounds the body, the energy centers that control the
energy flow from the energy field to the physical body.
• HT complements other healing techniques a patient may already be using,
including conventional medical practice in hospitals, clinics and in-home care, or
other body-mind oriented therapy such as massage, guided imagery, music therapy,
acupressure, biofeedback, and psychotherapy.
THE GOAL OF HT
• HT is to restore harmony and balance in the human energy
system by creating an optimal environment to enable the
body's innate tendency for healing to occur.
• HT is to purposefully use the energetic interaction between
the HT practitioner and the patient to restore harmony to the
patient’s energy system which places the client in a position to
• HT is a conscious, intentional process of directing energy
through the hands of the practitioner to the patient to
facilitate the healing process.
BENEFIT OF touch healing
• HT Benefits that have been documented in at least one research study and
related to wellness and aging:
• Immune system strengthening and support.
• Decreased agitation in those with dementia [calming of those with dementia]
• Pain relief or decrease in pain level
• Acceleration of Post-operative recovery
• Symptom relief during or after chemotherapy
• Development or deepening of a spiritual connection
• Increased Relaxation and decrease depression, stress and anxiety
• Improved mood and quality of life (QOL)
• Assistance with the dying process (relaxation, peace, acceptance)
• Decreased use of pain medications post-operatively
BENEFIT OF HT (cont)
• Decreased negative effects of trauma/chronic pain/ and
post traumatic stress
• Improved symptoms in auto-immune disorders
• Acceleration of wound healing
• Reduced need for pain medicine
• Prevention of illness
• Enhancement of spiritual development
• Aid in preparation for and follow up after medical
treatments and procedures
• Increased energy/relief for chronic fatigue
• Support for the dying process.
BASIC THEORY OF HT-ENERGY
• Three distinct parts of the human energy system
that work interchangeably:
• Energy field-Aura
• Energy centers-Chakras
• Energy tracts-Meridians
• HT is an integrative energy therapy used in
conjunction with traditional therapies or as a
HT & ENERGY THERAPY
• According to the National Center for Complementary and Alternative Medicine
(NCCAM) USA, this category of complementary therapy involves the use of various
types of energy fields.
• HT is a relaxing, nurturing energy therapy. Gentle touch assists in balancing
physical, mental, emotional, and spiritual well-being.
• HT works with client's energy field to support your natural ability to heal. It is safe
for all ages and works in harmony with standard medical care.
• In general, the goal of energy therapy is to bring energy into the patient or balance
the energy within a patient. There are many kinds of energy therapy, some which
use treatments such as light, sound, and magnets.
• HT is a complimentary (or integrative) energy therapy that can be used in
conjunction with traditional therapies.
• HT is a series of energy-based therapy classes in which students use a variety of
hands-on techniques that facilitate energy balance for wholeness within the
individual, supporting physical, emotional, mental and spiritual wellbeing.
EVIDENCE BASED AND RESEARCH IN HT
• There is a growing body of research in HT. New instruments, such as the superconducting
quantum interference device (SQUID) are showing promise for research with energy therapy.
Some of this is research that is done for quality assurance purposes and has not been peer-
reviewed. Some of this is peer-reviewed published research that has been approved through an
• Research either completed or in progress through September 2006 can be found in abstracted
form in touch healing International's Research Survey. Dianne Wind Wardell, PhD, RNC, HNC,
CHTI, Associate Professor of Nursing, The University of Texas Houston, Health Science Center, is
the Research Director for touch healing International.
• Dianne Wind Wardell and Kathryn E. Weymouth published a Review of Studies of touch healing in
the Journal of Nursing Scholarship, Second Quarter 2004.
• The Complementary Medicine Pain Clinic (CPMC) employs complementary medicine techniques
to help patients with pain. These techniques are used alongside pain management techniques
from Western medicine. Patients are offered instruction, as appropriate, in how to use these
techniques on themselves.
• The National Institutes for Health, through the National Center for Complementary and
Alternative Medicine, has either funded or is involved in four current touch healing studies. No
information on results is available for these studies at this time.
EVIDENCE BASED AND RESEARCH IN HT (cont.)
• Quantitative Results and Pain
• In a retrospective descriptive study of chronic pain, Wardell (2000)
found that of 10 respondents of 12:
• Four reported an absence of pain
• Two reported decreased pain
• Two had decreased pain but eventual return
• Two reported no change.
• 80% had improvement!
• In a 1999 report to Joint Commission for Accreditation of Hospitals,
Protzman (2002) found: A 4-point decrease in perceived pain on a 10-
point rating scale in inpatient and outpatients, after touch healing
Treatments and relaxation was also reported
EVIDENCE BASED AND RESEARCH IN HT (cont)
• Summary of Nine Quantitative Studies concerning
chronic pain after touch healing:
• Seven indicated decreased pain
• One reported decrease but HT was paired with
• One reported no change
• These are important findings considering the challenges
of dealing with Chronic Pain (Wardell, 2004)
EVIDENCE BASED AND RESEARCH IN HT (cont)
• touch healing after Bypass - Arom & MacIntyre
(2002) studied the effects after bypass surgery in
400 patients. Preliminary results show 174 patients
are trending toward better outcomes in:
• Surgery time
• Pump time
• Length of Stay
• Post op arterial fibrillation
• Post op blood transfusion
• Anti-emetic use.
MODELS OF TOUCH
• Hand Exercise of HT uses touch to influence the
human energy system, specifically the energy field
that surrounds the body, the energy centers that
control the energy flow from the energy field to:
BASIC HT PRACTICE SEQUENCE
• Intake & Assessment
• Healer Preparation
• Pre-treatment assessment
• HT interventions
• Post-treatment assessment
• Ground and Release
• Evaluation and Feedback
SCOPE OF PRACTICE
• In the United States, there are four levels of HT:
• Student of HT (Levels 1 -4)
• HT Practitioner Apprentice (Level 4 –5)
• HT Practitioner (Completion of Level 5)
• Certified HT Practitioner/Instructor.
• HT practitioners believe that this process balances and realigns energy
flow that has been disrupted by stress, pain, or illness. The process
eliminates blockages in the energy field so that the patient is in an
optimal state for healing to occur.
• Many of the techniques used in energy therapy come from practices in
shamanistic and Asian traditions with thousands of years of use. For
example, more than 2,000 years ago, Asian healers believed that the
flow and balance of life energies were important in maintaining health,
and that illnesses were due to energy imbalances.
• HT Fosters a heart-centered, caring relationship in which the
practitioner and client come together energetically to facilitate the
client’s health and healing.
• Darbonne, M. (1997). The effect of HT modalities on patients with chronic pain. Master’s Thesis. Northwestern State
• Garcia, K. (2006). HT Program Survey at St. Joseph’s Hospital. HT International, Inc Research Survey 8th Ed. Lakewood, CO
• Hover-Kramer, D. (2001). HT: A Guidebook for Practitioners. Delmar Publishers: Albany, NY.
• Jones, J. (2008) HT. National VA Pain Teleconference. www1.va.gov/pain_management/docs/Teleconference3-2008.pdf
• Kiley, S. (2006). The evaluation of HT for headache patients. HT International, Inc. Research Survey 8th Ed. Lakewood, CO.
• Protzman, L., (2002). The effect of HT on pain and relaxation. HT research survey. Lockwood, CO. (HT International report to
• Wardell, D.W. & Weymouth, K. (2004). Review of studies of HT. Journal of Nursing Scholarship: Image, 36(2), 147-154.
• Hutchinson, C. (1999). A simple yet powerful tool. HT Newsletter, 9(4), 6-7.
• Protzman, L. (1999). The effect of HT on pain and relaxation. HT International, Inc Research Survey 8th Ed. (2006). Lakewood,
• Stouffer, J. (2004). HT patient survey for pain and/or anxiety relief. HT International, Inc Research Survey 8th Ed. (2006).
• Wardell, D.W. (2000). The trauma release technique: How it is taught and experienced in HT. Alternative and Complementary
Therapies, 6 (1), 20-27.
• Wardell, D. Rintala, D. Tan, G., & Duan, Z. (2006). Pilot study of HT and progressive relaxation for chronic neuropathic pain in
persons with spinal cord injury. Journal or Holistic Nursing.24(4), 231-240.
• Weymouth, K. & Sandberg-Lewis, S. (2000). Comparing the efficacy of HT and chiropractic adjustment in treating chronic low
back pain: A pilot study. HT Newsletter, 00(3), 7-8.