Thursday, November 18, 2010


In recent years, there has been an upsurge of interest in mobilisation and manipulation of the peripheral
and spinal joints .
There have been a multitude of articles andbooks written by doctors, physiotherspists, lay manipulators
and anyone who has, or thinks he has, a knowledge of the subject.
Manipulation, for many years, was shunned by the medical profession and anyone who even attempted to
manipulate, whether it be to the peripheral or spinal joint, was immediately branded as a quack.
Why this was so is mystifying, because, if the history of manipulation is studied, it will be found it has its
roots as far back as 400 BC, where orthodox medicine, as we know it had its beginning.
The first known description of manipulation was given by Hippocrates whose ideas were the basis of
modern medicine.
Hippocrates advocated that the patient be given a steam bath and then placed prone, bound to a board, and
traction applied by assistants, pulling on head and feet . While this was being done, the physician would
press sharply on the affected area, or sit on the back and bounce up and down or even stand on the back .
However, the procedure most favoured was, while the patient was prone and still in traction, to put a board
in a cleft in the wall to act as a lever and then place it across the patients spine and press downwards . These
maneuvers were performed on a couch more primitive than those used today, but certainly similar .
Hippocrates influence was still evident in 200 AD when Galen described a method of manipulation for
dislocated discs while the patient was in traction .
In the early years of the 10th century, an Arab physician Abu'All ibn Sina, wrote a treatise on traction, illustraing
the Hippocrates method .
This treatment was still being used centuries later . Spinal traction was described by a Spanish-Arabian
physician in the early 14th century, and by a Turkish physician later in the same century.
In the 16th century, an Italian doctor known as Vidius Vidio, also followed Hippocrates, and indeed
organised the medical faculty of the day using the earlier illustrations. His methods were more refined but
were essentially that of the great master .
Ambroise Pare, recognised as the greatest surgeon of renaissance times, included a chapter on vertebral
dislocation in his works. He also described traction and pressure as advocated by Hippocrates .
Volume 2, 1978-79
After the mid 17th century, when Johan Schultes recommended similar treatment, little more was written
of manipulation for two hundred years'until the bone setters became known for their remedies .
Through the centuries, people practised cures on each other because physicians were not commonly
available . Some developed special skills . In places as far apart as Central Europe, Mexico and Japan,
Gypsies, Indians and Jiu-jitsu exponents respectively, used a form of manipulation to relieve back injuries .
The most primitive method was stamping on the back, and it was thought that certain women had special
gifts. An Emeror's physician in 400 AD wrote:
"A woman who has given birth to twins shall stamp on the painful kidneys and
that person shall be cured".
In 1211, a further refinement was reported, the twins had to be boys!
In 1662, in Norway, during a lawsuit about witchcraft, a woman gave evidence on the method she had been
using to cure back ache. Since she was three she had trodden on sufferers from rheumatism, and when
she grew up she found she could treat effectively with her hands.
People in different countries had their own particular beliefs . In Norway, the operator must be a first-born
child, and in Ireland a seventh child . In Scotland those born feet first possessed remarkable healing powers .
The first published description of the bone setter craft was made by a Dr . Wharton Hood in the late 1800's.
He was taught by a bone setter who owed his father a debt of gratitude. Dr. Hood said that the knowledge
gained was very important in preventative and curative treatment .
These people were named "bone setters" because they believed they were putting small bones back into
place . They were mainly farmers and blacksmiths and, being very jealous of their art, would not freely
discuss it . Their knowledge was, therefore, passed from father to son only.
One of the first practitioners documented was very small, ugly lass called Sarah Mapp. She was quite fat,
very bad tempered, but quite a competent manipulator, and royalty of the day used her services . She
acquired fame in the 1730's but was much criticized by the medical profession of the times . She lost her
supporters and died a pauper.
Perhaps the best known bone setter in modern times was Sir Albert Baker who learnt his art from his
cousin, John Atkinson (no relative of mine). For years, he offered to demonstrate and teach doctors
manipulation but they refused until 1916 when they finally agreed to publish his work in the Medical
Journal, and his skill was recognised openly by eminent members of the profession .
In 1922, he was knighted, much to the upset of many doctors throughout England .
Andrew Still (late 19th century), an American, was responsible for the introduction of Osteopathy. He
believed that the body had within itself the power to control all diseases . He also considered that anatomical
lesions caused physiological malfunction . e .g . Dislocation of the hips is a frequent cause of diabetes .
The Journal of the Hong Kong Physiotherapy Association
All this on todays standards seems very primitive, but when we consider the doctors of that day used bark
and opium for diabetes, and vinegar for smallpox, we realise the limitations of their knowledge .
In 1892, still joined an Edinborough doctor named William Smith to form the first school of osteopathy
and in 1900, the first Osteopaths were granted a full licence to practice medicine in some states in America .
Since this time, of course, the standard has improved until today, the Ostoepaths and doctors in U .S .A . have
equal standing .
During the same period, Chiropractics developed . At first they were "magnetisers" . A man called Daniel
Palmer in Iowa in the United States was convinced that he had powers of magnetism and started a business
which lasted ten years . He gained some knowledge of manipulation and replaced subluxated vertebrae .
Palmer's first patient was a negro who, for seventeen years, had been completely deaf after an injury to his
neck, Palmer found a "subluxation" which he adjusted and the patient recovered .
He opened his first Chiropractic school with a solicitor called Carver in 1897. Palmer not only manipulated
the spine but also the limbs. Carver later took over the school and taught the Carver method of Chiropractic
. These chiropractors were known as "mixers" .
Palmer's son then started his own school but only manipulated the spine . This was the "Palmer Method of
Chiropractic" and its exponents were called "straights" . The terms "mixers" and "straights' . are still used
to this day.
Chiropractors have gained a lot of recognition in America but with differing stateslaws, the situation is
confused .
A little known branch of Chiropractic is Naprapathy and was started in Chicago in 1903. These
practitioners believed that the ligaments become contracted and pull the vertebrate together, causing
diseases like gallstones, for example, by restricting nerves and blood vessels .
During the 19th century, the medical profession began to look at manipulation as a means of curing backache
and other discomforts of the spine and limbs .
Oscillatory tecniques were first recommended by Recamier in 1838 for treatment of Torticollis . Manual
vibration was intensively employed by Kellgreen, a Swedish physiotherapist working in London at the turn
of the century . These techniques have been adopted and improved on by modern therapists such as
Maitland and Grieves .
Since the turn of the century, there have been many men who have put respectability into the fine art of
manipulation . John Mennell practised in London as did Drs . Edgar and James Cyriax, father and son, and
Dr. Main in France, to name a few.
Volume 2, 1978-79
About 1950, Freddy Kaltenborn became interested in manipulation and after graduating as a physiotherapist,
went to U.K . to study under Mennell, Cyriax and Stoddart, and also attended .the school of
Osteopathy in London . After this, he returned to Norway to teach his new found art to his colleagues.
Cyriax followed to conduct the first examination in manipulation in Norway.
In 1970, Dr . Cyriax, Freddy Kaltenborn and sixteen physiotherapists from seven countries met on 20th
April with the intention of forming a special interest group which was the beginning of the International
Federation Of Manipulative Therapists . (I .F .O .M .T .)
In 1973, the first seminar and congress of I .F .O.M .T . was held in the Canary Islands. Here the first examination
and assessment of standards were held . The second seminar was also in Gran Canary and 1977 saw
the third seminar of I .F .O .M .T . in Vail in Colorado, and anyone who has read the proceedings of the
scientific week will realise the high standards achieved .
This has been a resume of the history of manipulation from Hippocrates to the present date .

References : Manipulation : Past and Present.
Eiler H. Schiotz.
James Cyriax .
The Journal of the Hong Kong Physiotherapy Association

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