MANUAL MEDICINE (FRSc)
Manual Medicine is a branch of medicine sometimes referred to as physical medicine and it’is the
practice of providing preventive, diagnostic and therapeutic treatment to the patients. Manual
Medicine is not a form of “massage” but a medical practice based on a thorough understanding of
anatomy, physiology, biomechanics, physiology of pain combined with the ability to use the
principles of the Five Regulatory Systems concept (FRSc) and manual proficiency in therapeutic
techniques.
The founder of FRSc is Polish orthopaedic doctor Radosław Skladowski who based on his clinical
observations associated various “types” among patients’ according to the body structure, soft tissues
density and reactivity to particular stimuli along with an individual mechanisms of information
transfer in the body. This is how an original typology was created to facilitate the specifically
dedicated therapeutic approach to an individual “type” of patients. The aforementioned typology is
therefore one of the pillar of a diagnostic triad allowing an effective and safe qualification of the
patient to the specifically targeted treatment.
Manual Medicine applications are wide and diverse. In fact, although its main indication is in
treating musculoskeletal (MSK), it is frequently applied for chronic pain management, postural
problems, visceral disorders (e.g. IBS), and mental health, particularly stress, anxiety and insomnia.
PINOTHERAPY
Pinotherapy is an integral part of Manual Medicine according to doctor Radoslaw Skladowski
known as FRSc (Five Regulatory System concept). It’s highly effective therapeutic approach for
pain management, injuries recovery, supporting the scars treatment, many orthopeadic and
neurological disorders.
Pinotherapy requires pins – brass or steel nails with a pointed tip for a stimulating function over
specific points or zone on the body and a flat tip used for compression techniques without piercing
the skin. A skilfully set stimulus in an appropriate location aims to eliminate pathologies occurring
in one or more regulatory systems. During the treatment the therapist may focus on so called
piezoactive points highly innervated and proprioceptively, muscles and / or fascial compartments
showing disturbance of fluid circulation in their area, zones of the so-called lipodynia manifested by
a marked compaction of the subcutaneous connective tissue. As a result of pathological processes
taking place in individual regulatory systems, there may be e.g. characteristic pain, limited mobility
or a decrease in muscle strength. Pinotherapy through the reactive and / or reflex reversal of
pathological processes creates conditions in the body for regeneration and recovery.
This method is perfect for the treatment neurological and orthopedic disorders, such as myofascial
pain, headache, cervical, thoracic and lumbar spine pain, as well as post-operative and post-
traumatic conditions and restrictions over joint mobility. Pinotherapy can play a role in
desensitizing scar also after caesarean section, in polyneuropathy (peripheral nerve damage
syndrome), in multiple sclerosis (MS), ischemic strokes, Parkinsonism and any neurological pains.
Some techniques may have an indirect positive effect on digestion and hormone balance
DRY NEEDLING
Dry needling is safe, minimally discomforting and often an effective technique for patients with
certain musculoskeletal presentations. Dry needling is performed by skilled and certified in the
procedure physiotherapist using a thin filiform needle to penetrate the skin and stimulate underlying
myofascial trigger points, muscular and connective tissues. Once inserted the needles are
manipulated by the Physiotherapist until a sensation is felt (often a twitch and/or ache associated
with the needle). Techniques vary from inserting the needle and leaving it in for 15 minutes or so
with occasional manipulation.
The way it works is through complex neural pathways and chemical releases in the body. A
simplified explanation follows:
• A local flow of blood is promoted to the injured part for healing.
• The neural pathway that causes pain is inhibited or ‘blocked’ to some extent.
• Endorphins (the body’s natural painkillers) are released to ease the pain and inhibit the pain/
inflammatory cycle.
What is a Trigger Point?
A trigger point is a taut band of skeletal muscle located within a larger muscle group. Trigger points
can be tender to the touch, and touching a trigger point may cause pain to other parts of the body
What is the difference between Dry Needling and acupuncture?
Both acupuncture and Dry Needling use a solid filament needle; however, the uses of a solid
filament needle for acupuncture and Dry Needling are very different. The differences are evident in
the evaluative tools used by the practitioner, the assessment, the application, and the overall
intended goal. Acupuncture is a treatment based on Eastern medical diagnosis requiring training in
traditional Chinese medicine (TCM). The TCM practitioner inserts needles into specific points that
lie along meridians (channels) of the body through which the life force, or “qi” (pronounced
“chee”), flows. The overall goal of TCM acupuncture is to restore normal flow of the life force. In
contrast, Dry Needling is rooted in Western medical philosophy. DN revolves around a practitioner
using a thin filiform needle to penetrate the skin and stimulate underlying myofascial trigger points
and muscular and connective tissues for the management of neuromusculoskeletal pain and
movement impairments.
What is the current evidence regarding the effectiveness of DN?
Numerous studies indicate support for Dry Needling in cases of myofascial pain syndromes,
spasticity as a result of stroke, shoulder pain, golf/tennis elbow, heel pain, jaw pain and many
others.
Why Dry Needling?
In cases when physiotherapist applies dry needling, it is typically technique that’s part of a larger
treatment plan – not solely a treatment on its own. Dry needling are used to release or inactivate
trigger points to relieve pain or improve range of motion. Preliminary research supports that dry
needling improves pain control, reduces muscle tension, and normalizes dysfunctions of the motor
end plates, the sites at which nerve impulses are transmitted to muscles. This can help speed up the
patient’s return to active rehabilitation.
NEURORECEPTOR THERAPY (P-DTR)
Proprioceptive Deep Tendon Reflex (P-DTR) is a unique neurological therapy based on neurology,
biomechanics, neurophysiology, anatomy and profound research, founded by Dr Jose Palomar. It’s a
very gentle, non-invasive, and painless method based on the real time manual effect of particular
sensory receptors on the human body. It works directly with central nervous system and has a
logical scientific explanation for all of its teachings. Unique to P-DTR as a therapy, is and
understanding of the role that sensory nerve endings (‘receptors’) play in the function and processes
of the central nervous system. P-DTR uses receptors as its entry point to understand, assess and
treat all kinds of dysfunction, pain and symptoms that it is possible to experience.
The scope within which P-DTR is capable of operating, can be compared with an analogy with the
computer. Computers contain hardware, software and firmware. An example of the hardware would
be the screen, the keyboard or the speakers. An example of the software would be iOS, Microsoft
Word. An example of the firmware would be the programme that relays information from the on
switch to the hard drive to instruct it to boot up the computer for use. In the human body we can
apply the same analogy. The hardware is the bones, the ligaments, the organs, the nerves and blood
vessels and the physical brain itself. The software is the communication within the CNS (central
nervous system) and its many interconnected functions. The firmware are the primitive reflexes we
are born with as children and some of the autonomic unconscious functions that our bodies perform.
P-DTR as a therapy can be used primarily to treat the software and firmware components of the
above analogy, however it also has an important role to play in treating the causes of some hardware
problems such as chronic degenerative conditions, and also post operatively when changes have
been made surgically to the structure or hardware of the body.
P-DTR efficiently treats a wide spectrum of functional problems and solves musculoskeletal,
gastrointestinal, hormonal, chemical, and emotional dysfunctions. Dysfunction is a physiological
and reflexive disorder that, in most cases, has a compensatory mechanism. The main goal of the P-
DTR treatment is to restore the optimal reflexive activity of the nervous system to a stimulus. This
includes its motor, vegetative, and sensory response, which would result in no symptoms of pain or
discomfort as perceived by the client, optimal range of motion, and accurate appropriate adaptation
to the conditions of the external environment.
VISCERAL MANIPULATION (VM)
VM is an integrative approach developed by world-renowned French Osteopath Jean-Pierre Barral,
to evaluation and treatment of a patient requires assessment of the structural relationships between
the organs and their fascial or ligamentous attachments to the musculoskeletal system. Strains in the
connective tissue of the viscera can result from surgical scars, adhesions, illness, posture or injury.
Tension patterns form through the fascial network deep within the body, creating a cascade of
effects far from their sources for which the body will have to compensate. This creates fixed,
abnormal points of tension that the body must move around, and this chronic irritation gives way to
functional and structural problems
Harmony and health exist when motion is free and excursion is full – when motion is not labored,
overexcited, depressed, or conflicting with neighbouring structures and their mobility. Visceral
Manipulation is based on the specific placement of soft manual forces to encourage the normal
mobility, tone and motion of the organs and their connective tissues. These gentle manipulations
can potentially improve the functioning of individual organs and the structural integrity of the entire
body. Due to the delicate and often highly reactive nature of the visceral tissues, gentle force
precisely directed reaps the greatest results.
Visceral Manipulation relies on the palpation of normal and abnormal forces within the body. By
using specific techniques, therapists can evaluate how abnormal forces interplay, overlap and affect
the normal body forces at work. The goal is to help the body’s normal forces remove abnormal
effects, whatever their sources. Those effects can be global, encompassing many areas of bodily
function.
VM assists functional and structural imbalances throughout the body including musculoskeletal,
vascular, nervous, urogenital, respiratory, digestive and lymphatic dysfunction. It evaluates and
treats the dynamics of motion and suspension in relation to organs, membranes, fascia and
ligaments. VM increases proprioceptive communication within the body, thereby revitalizing a
person and relieving symptoms of pain, dysfunction, and poor posture.
DEEP TISSUE MASSAGE (DTM)
Deep Tissue Massage (DTM) it’s a form of manual therapy following the function of the myofascial
system directly increasing the flexibility and mobility of soft tissues (muscles, fascia, tendons, ect).
It is very popular and the most effective form of therapeutic massage especially for musculoskeletal
disorders such as trigger fingers, carpal tunnel syndrome, rotator cuff injuries, anterior knee pain
and others.
VISCERAL MANIPULATION (VM)
VM is an integrative approach developed by world-renowned French Osteopath Jean-Pierre Barral,
to evaluation and treatment of a patient requires assessment of the structural relationships between
the organs and their fascial or ligamentous attachments to the musculoskeletal system. Strains in the
connective tissue of the viscera can result from surgical scars, adhesions, illness, posture or injury.
Tension patterns form through the fascial network deep within the body, creating a cascade of
effects far from their sources for which the body will have to compensate. This creates fixed,
abnormal points of tension that the body must move around, and this chronic irritation gives way to
functional and structural problems
Harmony and health exist when motion is free and excursion is full – when motion is not labored,
overexcited, depressed, or conflicting with neighbouring structures and their mobility. Visceral
Manipulation is based on the specific placement of soft manual forces to encourage the normal
mobility, tone and motion of the organs and their connective tissues. These gentle manipulations
can potentially improve the functioning of individual organs and the structural integrity of the entire
body. Due to the delicate and often highly reactive nature of the visceral tissues, gentle force
precisely directed reaps the greatest results.
Visceral Manipulation relies on the palpation of normal and abnormal forces within the body. By
using specific techniques, therapists can evaluate how abnormal forces interplay, overlap and affect
the normal body forces at work. The goal is to help the body’s normal forces remove abnormal
effects, whatever their sources. Those effects can be global, encompassing many areas of bodily
function.
VM assists functional and structural imbalances throughout the body including musculoskeletal,
vascular, nervous, urogenital, respiratory, digestive and lymphatic dysfunction. It evaluates and
treats the dynamics of motion and suspension in relation to organs, membranes, fascia and
ligaments. VM increases proprioceptive communication within the body, thereby revitalizing a
person and relieving symptoms of pain, dysfunction, and poor posture.
CORRECTIVE EXERCISE (DNS)
Kiara Physiotherapy provides a combination of manual form of therapy supported by the movement
aspects and corrective exercises based on Dynamic Neuromuscular Stabilization approach (DNS). It
is a manual and rehabilitative approach to optimize the movement system based upon the scientific
principles of developmental kinesiology (DK). The developer of DNS is Professor Pavel Kolar, PT,
PhD, a Czech physician who has been influenced by the “greats” of Prague School of Manual
Medicine. DNS is rapidly gaining attention and acceptance in the sports rehabilitation and
performance arena for both the recovery from musculoskeletal overuse injuries and in injury
prevention.
The purpose of the technique is to promote proper activation and coordination of the neuromuscular
system. This approach compares the stabilization pattern used by a patient with the stabilization
developmental pattern that develops naturally as a result of the typical developmental sequence in a
healthy baby.
Many patients with low back pain do not use their diaphragm and deep stabilizing system properly.
DNS treatments routinely begin with proper training of the diaphragm by normalizing breathing
patterns and restoring the stabilizing function of the diaphragm. Restoring proper function to the
deep stabilizers (core) is important not only for those with chronic lower back or neck related
problems but also is essential to provide a stable base for treatment of peripheral joint issues such as
hip, knee, shoulder, ankle, and foot problems.
In addition to core stabilization, DNS focus on joint centration. Joint centration is established when
the joint surfaces are positioned in a way that provides the greatest joint congruency and the best
mechanical advantage for the muscles that support that joint throughout its entire range of motion.
Restoring proper joint centration allows for optimal use of the muscles to support the joint with
minimal stress to the ligaments, cartilage, and joint surfaces. DNS treatment helps to normalize
joint and muscle function, improve stability, reduce pain, and improve your quality of life.
KINESIOLOGY TAPING
Kinesiology tape is a supporting tool for recovery and prevention purpose which works – when
applied correctly – by lifting the skin from the tissues below it. Everyone has nerve receptors in their
skin, as well as in the deep layers of the fascia, muscles, and other connective tissues. It’s elastic
tape that provides sensory input into an area, but still allows for full range of motion. It was
developed back in the 1970s by Kenzo Kase, a chiropractic doctor, in Japan; instead of using stiff
medical tape, he wanted to create something that mimicked the elasticity of human skin. While it
was used widely by professional athletes, physical therapists, and trainers alike.
When tape is applied, it causes compression or decompression of these areas, allowing it to alter
pain signals to the brain. We can use more tension to turn on or excite a muscle. If someone gets
surgery to repair their ACL, their quad will likely be weak. Taping the quad with maximum tension,
brings those muscle fibers together, essentially causing a contraction (which is what strengthens
your muscles). On the flip side, if someone has plantar fasciitis and is experiencing a lot of tightness
in their calves, taping with limited tension can turn “off” the muscle so the person isn’t receiving
pain signals. Kinesiology tape really does reduce swelling and pain and increase muscle
function.The tape typically lasts for three to five days, even if you shower or swim with it, and the
constant wear is to re-educate the body to perform in a more optimal way.
Depending on the way kinesiology tape is applied, it can be used for a variety of different things
including, but not limited to, muscle inhibition/facilitation, pain relief, decreasing swelling,
proprioceptive stability (helping your muscles provide stability while still allowing for motion), and
tissue decompression.