Profession-based manual therapy nomenclature: exploring history, limitations, and opportunities

Figures & data

Figure 1. Timeline of the International Consortium on manual therapies.

Abbreviations: FG, focus group; VC, video conferences.

Figure 2. Qualitative process of collecting and scrutinizing outcomes.

Abbreviations: FG, focus group; MT, manual therapy; VC, video conferences.

Table 1. Scope of practice for manual therapy (MT) professions.

MT Profession	Legal Form	Functional Goals	Primary Focus
Chiropractic	Primary care, direct contact with patients The right and duty to diagnose, including taking or ordering skeletal imaging	Diagnosis, treatment, and prevention of mechanical disorders of the musculoskeletal system and the effects of these disorders on the function of the nervous system and general health	Emphasis on manual treatments, including spinal adjustment and other joint and soft tissue manipulations
Massage therapy	Licensed health profession (USA and Canada)	Maintain, rehabilitate, or augment physical function; relieve or prevent physical dysfunction and pain; and enhance the well-being of the client	Soft tissues
	Licensed, registered, certified, or unregulated (outside USA and Canada)
Osteopathic	(1) Osteopathic physicians: licensed to practice the full scope of medicine (trained in USA)	(1) Diagnose, treat, prescribe medications, perform surgery, and use osteopathic manipulative medicine	Whole person approach
	(2) Osteopathic practitioners: a very heterogeneous group of primary healthcare practitioners with different practice rights (trained outside USA)	(2) Patient-centered care using a whole person approach to all aspects of health and healthy development, principally by the practice of manual treatment
Physiotherapy	Physical therapists/physiotherapists: licensed to practice physical therapy/physiotherapy, functioning as an allied health professional in some countries and as a primary care medical professional in others	Management of neuromusculoskeletal conditions based on clinical reasoning, using highly specific treatment approaches, such as manual techniques and therapeutic exercises	Joints, central and peripheral nervous system structures, myofascial structures, ligamentous/cartilaginous, and lymphatic tissues
Structural integration	Not licensed as a profession in most US states or in the European Union	Improve posture and efficiency of movement in the field of gravity	Fascia

Figure 3. Osseous and nonosseous techniques of the 5 manual therapy (MT) professions.

Abbreviations: OT, osseous techniques; NOT, non-osseous techniques

Table 2. Osseous treatment techniques used by the 5 manual therapy (MT) professions.

Osseous Technique^a	Chiropractic	Massage Therapy	Osteopathic	Physiotherapy	Structural Integration
Manual
Balanced ligamentous tension/ligamentous articular strain			Balanced ligamentous tension/ligamentous articular strain
Compress, hold, and release					Compress, hold, and release
Facilitated positional release			Facilitated positional release
HVLA	HVLA/thrust		HVLA/thrust	HVLA/grade V mobilization
Mobilization	Low-force joint mobilization	Joint movement methods	Mobilization; articulatory; low-velocity, moderate-amplitude	Mobilization grade I-II and III-IV
Muscle energy			Muscle energy	Muscle energy
Osteopathic cranial manipulative medicine			Osteopathic cranial manipulative medicine
Strain counterstrain			Strain counterstrain
Sustained pressure directly into joint gap					Sustained pressure directly into joint gap
Instrument-assisted
Mobilization	Reflex protocol (activator, etc.)
Percussion			Percussion hammer

^aTechniques in italics are used by more than 1 MT profession.

Abbreviation: HVLA, high-velocity, low-amplitude.

Table 3. Non-osseous treatment techniques used by 5 manual therapy (MT) professions.

Nonosseous Technique^a	Chiropractic	Massage Therapy	Osteopathic	Physiotherapy	Structural Integration
Manual
Cranial/balanced membranous tension			Cranial/balanced membranous tension
End-of-session back					End-of-session back
End-of-session cervical-cranial					End-of-session cervical-cranial
End-of-session sacral-pelvic					End-of-session sacral-pelvic
Facilitated positional release		Facilitated positional release	Facilitated positional release
Fascial distortion model			Fascial distortion model
Gliding, stroking, effleurage		Gliding, stroking, effleurage
Kneading, twisting, petrissage		Kneading, twisting, petrissage
Lifting myofascial sheet					Lifting myofascial sheet
Lymphatic		Lymphatic drainage	Fluid/lymphatic
Muscle energy		Muscle energy	Muscle energy	Muscle energy
Myofascial	Myofascial	Myofascial/connective tissue	Myofascial release
Neural mobilization	Neural mobilization			Nerve glide/neural mobilization
Oscillation		Oscillation
Percussion		Percussion
Proprioceptive neuromuscular facilitation	Proprioceptive neuromuscular facilitation	Proprioceptive neuromuscular facilitation
Sacro-occipital	Sacro-occipital
Separating at inter/intramuscular septa					Separating at inter/intramuscular septa
Shear stress/friction		Shear stress/friction
Shearing across collagenous fibers					Shearing across collagenous fibers
Shearing parallel to collagenous fibers					Shearing parallel to collagenous fibers
Soft tissue	Soft tissue techniques		Soft tissue method	Soft tissue mobilization
Spreading from a midline					Spreading from a midline
Static methods: resting/holding		Static methods: resting/holding
Strain counterstrain	Strain counterstrain	Strain counterstrain	Strain counterstrain	Strain counterstrain
Sustained pressure at 1 location					Sustained pressure at 1 location
Sustained pressure at bony attachments					Sustained pressure at bony attachments
Sustained pressure directly into joint gap					Sustained pressure directly into joint gap
Trigger point therapy		Trigger point therapy
Visceral manipulation			Visceral manipulation
Instrument-assisted
Cupping/suction		Cupping/suction
Percussion/vibration		Percussion/vibration	Percussion hammer
Scraping		Scraping
Soft tissue	Soft tissue			Soft tissue

^aTechniques in italics are used by more than 1 MT profession.

Figure 4. General overview of a Mind Map.

Table 4. Examples of interprofessional glossary definitions of manipulation and related terms with multiple descriptions as defined by the 5 manual therapy professions and basic scientists.

Glossary Term and Description^a	Basic Scientist	Chiropractic	Massage Therapy	Osteopathic	Physiotherapy	Structural Integration
Adjustment
(1) A specific directional thrust maneuver or application of forces applied to a subluxated vertebra. (2) This term refers to a wide variety of manual and mechanical interventions that may be high or low velocity, short or long lever, high or low amplitude, and with or without recoil.		X
Force-based manipulation
Force-based manipulations refer to the application of mechanical forces to the outside of the body with therapeutic intent.	X	X	X	X
High-velocity, low-amplitude (HVLA)
An adjustment technique using high-speed and low displacement procedures to target a specific joint		X			X
Also called a thrust treatment method. An osteopathic method in which the restrictive barrier is engaged in 1 or more planes of motion, and then a rapid, therapeutic force of brief duration traveling a short distance is applied within the anatomic range of motion.				X
Manipulation
Therapeutic application of manual force	X	X	X	X
Skillful use of the hands in a therapeutic manner. Massage manipulations focus on the soft tissues of the body and are not to be confused with joint manipulation using a high-velocity thrust.			X		X	X
A passive, high-velocity, low-amplitude thrust applied to a joint complex within its anatomical limit with the intent to restore optimal motion and function and/or to reduce pain.					X
(1) The therapeutic application of manual forces that move a joint quickly beyond its elastic barrier or resistance but not beyond its limit of anatomic integrity.		X
(2) A manual procedure that involves a directed thrust to move a joint past the physiological range of motion without exceeding the anatomical limit.		X
Thrust
The rapid, controlled application of force used to effect an adjustment or manipulation	X	X		X	X
The word thrust is interchangeable with the word manipulation or manipulative. At times, it is expressed as a manipulative thrust, implying the skilled force (energy) imparted to the patient/client by the clinician during the act of a manipulative technique.					X

^aSome professions had multipart descriptions of terms.