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Manipulative therapy has known a parallel development throughout many parts of the world. The earliest historical reference to the practice of manipulative therapy in Europe dates back to BCE. Over the centuries, manipulative interventions have fallen in and out of favor with the medical profession. Manipulative therapy also was initially the mainstay of the two leading alternative health care systems, osteopathy and chiropractic, both founded in the latter part of the 19th century in response to shortcomings in allopathic medicine.
With medical and osteopathic physicians initially instrumental in introducing manipulative therapy to the profession of physical therapy, physical therapists have since then provided strong contributions to the field, thereby solidifying the profession's claim to have manipulative therapy within in its legally regulated scope of practice. Historically, manipulation can trace its origins from parallel developments in many parts of the world where it was used to treat a variety of musculoskeletal conditions, including spinal disorders1. It is acknowledged that spinal manipulation is and was widely practised in many cultures and often in remote world communities such as by the Balinese 2 of Indonesia, the Lomi-Lomi of Hawaii 3 — 5 , in areas of Japan, China and India 3 , by the shamans of Central Asia 6 , by sabodors in Mexico 7 , by bone setters of Nepal 8 , 9 as well as by bone setters in Russia and Norway With respect to manipulation in ancient Western civilizations, those areas around the Mediterranean provide the most logical basis for the practice to exist.
However, there is no direct evidence of such practice in any documents of communities such as Babylon, Mesopotamia, Assyria, and even Egypt Historical reference to Greece provides the first direct evidence of the practice of spinal manipulation. The detail in which this is described suggests that the practice of manipulation was well established and predated the BCE reference In his books on joints, Hippocrates — BCE , who is often referred to as the father of medicine, was the first physician to describe spinal manipulative techniques using gravity, for the treatment of scoliosis.
In this case, the patient was tied to a ladder and inverted The second technique he described involved the use of a table with various straps, wheels, and axles enabling traction to be applied. Hippocrates noted that this treatment should be followed by exercises. Claudius Galen — CE , a noted Roman surgeon, provided evidence of manipulation including the acts of standing or walking on the dysfunctional spinal region 1.
In 18 of his 97 surviving treatises, Galen commented on the works of Hippocrates, with many illustrations of his manipulative techniques, which, even today, are frequently seen in medical texts The design of the treatment table used by Hippocrates and his methods of manipulation survived for more than years. Avicenna also known as the doctor of doctors from Baghdad — CE included descriptions of Hippocrates' techniques in his medical text The Book of Healing.
A Latin translation of this book was published in Europe influencing future scholars such as Leonardo Da Vinci and contributing greatly to the emergence of Western medicine at the end of the Middle Ages While nobody questions these early origins of manipulative therapy, it is from the 19th century onwards that manipulative therapy has at times become an area of contention between the various professions involved in its practice.
To truly understand the role manipulative interventions play within the professions of medicine, chiropractic, osteopathy, and most notably physical therapy, knowledge of the history of manipulative therapy within these various professions is required. Therefore, the goal of this paper is to introduce the reader to the history of manipulative therapy within the various professions with the intent of fostering increased inter-professional understanding and hopefully decreasing the current controversy as to which professions can justifiably lay claim to the practice of manipulative therapy based on historical arguments.
The renaissance in medicine began with Andreas Vesalius, who in described the detailed anatomy of the human body Hippocrates' manipulative procedures again appeared in the 16th-century writings of Guido Guidi and Ambrose Pare. In Pare, the famous French military surgeon who served four successive kings of France, advised the use of manipulation in the treatment of spinal curvature 16 , In , Friar Thomas, in his book The Complete Bone Setter , described manipulative techniques for the extremities and in with a Latin version in Johannes Scultetus included descriptions of Hippocrates' manipulative methods in The Surgeon's Storehouse 1 , It would appear that physicians and surgeons tended to abandon the general acceptance of spinal manipulation by the 18th century.
The reason for this is not completely clear but may have been the ineffectiveness of indiscriminate use or the danger involved in manipulating a spine weakened through tuberculosis, a disease of epidemic proportions in certain locations at this time 19 — Thus, manipulation once again tended to become the domain of the village healers in various areas of Europe and Asia. These bonesetters had undoubtedly passed on the traditional healing arts since time immemorial, long before formal recognition of the medical profession, but now they were far more visible within society.
By the 19th century, a clinical paradox was developing. A significant portion of the established medical profession expressed disdain for the bonesetters and their practices and did their best to run them out of business 1. At the same time, however, they had to recognize just how popular these bonesetters had become to the general populace. It was suggested by James Paget, one of the most famous surgeons of the time, that doctors would do well to observe bonesetters and learn from them what is good but, at the same time, avoid what is bad.
However, it appears that the medical community still did not appreciate the benefits of joint manipulation A notable exception of the time was a physician named Wharton Hood who, under the guidance of a bonesetter, became skilled in the practice of manipulation and concluded that it was both beneficial and safe. In , he published a technical manual on manipulation of the extremities in the Lancet itself 24 , By , manipulation was again evident in medicine. It was the topic of meetings and papers, and the first book had been written on the subject Bonesetting was the main topic at the annual meeting of the British Medical Association's section on surgery.
March 26 and Fox 27 both viewed manipulation favorably but continued to refer to it as bonesetting. Perhaps the greatest change in views by the medical establishment at this time was that manipulation could actually be consistently effective. Dramatic success in their hands should cause us to enquire as to the reason. And so it seemed that without a suitable champion within the medical profession, spinal and peripheral joint manipulation would forever remain the domain of the bonesetters. However, by the end of the 19th century, certain events unfolded that would irrevocably change the way manipulation was viewed and practised around the world.
To fully understand how modern manual medicine arose, one must view the status of medicine in North America at the turn of, and during, the 19th century. In spite of huge strides forward in scientific investigation, medicine had changed little. Hippocrates and Galen would have applauded the philosophy and logic of this time, i. However, it must be remembered that this logic was based on symptoms.
After all, the patient went from being hot, flushed, and delirious to being cold, pallid, and euphoric, in the eyes of physicians of that time clearly the first step to a cure. His approach was lauded throughout the Americas and Europe to the point where the instrument used to perform bleeding i.
At the same time, while being a modernistic technique, it also satisfied the Hippocratic-Galenic view that disease was caused by internal imbalances of the humors and bodily fluids Thanks to the writings of Hippocrates, physicians of the day were discouraged from embracing the study of mathematics to objectively quantify medical data.
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In fact, although science had discovered methods of measuring temperature and blood pressure in the early s, medicine would not utilize such techniques until , some years later. Around the same time, the stethoscope would be discovered and the hitherto taboo practice of human dissection was to ascertain that the body was made up of several discrete types of tissues.
But before that renaissance would occur, the medical profession in North America was to endure an ignominious reputation among the general populace 31 , Worse still, the oftentimes harmful and ineffective results of their treatments made many physicians doubt their own purpose 32 , As might be expected, the brutal experience of the American Civil War — led to advances in surgical technique.
Unlike their European counterparts, American universities provided a poor environment in which to produce well-trained physicians. The admission requirement was most often the student's ability to pay the tuition fee. Following graduation, most educated physicians interested in further education were forced to travel to Europe especially Germany to study in an environment where the evolution of scientific medicine was truly underway. The real advancement of North American medicine was primarily due to these motivated individuals who returned home to begin the daunting task of replacing the prejudices of theology 35 with the discipline of scientific enquiry.
In 19th-century North America, the profession of medicine was clearly in disarray and disrepute. It is from this backdrop that one can clearly see how alternative philosophies to the classic medical model could not only germinate but also justifiably gain public trust and support. Born in , Andrew Taylor Still was the son of a physician who was also a Methodist minister. He was influenced by his father to go into medicine.
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He felt the education to be boring and uninspiring and he seemed well aware that the medical approach of the day e. Interestingly, although Edward Jenner had introduced inoculation to the world in , it would be another 40 years before it gained general acceptance, even in Britain.
It is believed that Still's children had contracted spinal meningitis. His children almost certainly had very little chance of survival but he did not know that, neither did he accept it. This tragic event was the final straw that would divorce him from standardized medicine. Although he maintained his licence to practise medicine, it was only to facilitate the development of his new ideology As a child, Still had suffered from chronic headaches.
He had noted one day, while falling asleep with his neck wedged between the roots of an oak tree, that his headaches were completely relieved. Using this and other experiences, he began to slowly conceive of a theory whereby health could only be maintained and, therefore, disease defeated, by maintaining normal function of the musculoskeletal system. Apart from manipulative techniques, he also incorporated the idea of magnetism.
Unlike the magnetic therapies of today, this magnetism was thought to come from within the therapist's body, a concept primarily derived from the Austrian physician Franz Anton Mesmer, the man who was incorrectly given credit for the introduction of hypnotic therapy, or mesmerism. Mesmer definitely saw the potential of using the human spirit to treat patients and if there were anything that would stimulate a religious healer like Andrew Still, this was it.
Not surprisingly, many of Still's earlier papers related to a primal religious study between God and the Devil. Of course, this would do little to encourage acceptance from the established medical community. This, coupled with his unpopular belief that manipulation could cure disease, would ensure that he was denied access to established medical schools to teach his philosophies and techniques.
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However, his drugless, non-surgical approach to the treatment of disease rapidly gained acceptance among the general public. He soon found that he was unable to treat the growing numbers of patients and decided he would have to train others to help him in his work. In , he was confident enough in his beliefs that he established the American Osteopathic College in Kirksville, Missouri.
This would become known in Osteopathy as the Law of the Artery. As Still's methods continued to grow in popularity, more colleges were opened and by the time of his death in , 3, Doctors of Osteopathy had been graduated. Today, 20 colleges of osteopathic medicine boast an enrolment of nearly 10, students As osteopathy evolved, much of the growing body of scientific knowledge being embraced by the rapidly changing medical profession was also taught in osteopathic colleges.
This parallel growth has led to osteopathic physicians enjoying equivalent legal and professional practice rights as medical physicians, at least in the United States. However, there was, and perhaps still is, a philosophical chasm between the two professions.
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In , Still detailed in his autobiography 37 how manipulation could cure disease. In one chapter, he described how cervical spine manipulation could cure, among other things, scarlet fever, croup, diphtheria, and whooping cough. How many of today's osteopaths continue to adhere to such claims is not known, but instructional manuals in the teaching of cranio-sacral therapy and visceral manipulation suggest that the number may be significant. Interestingly, it would be an osteopath who would ultimately influence the British medical system and indirectly establish physical therapy there within the arena of manipulative therapy.
Unlike Still, Daniel David Palmer's entry into the field of healthcare was not born of privilege or family. Born in Canada in , Palmer had parents who were forced to immigrate to the United States in search of work. Palmer and his younger brother remained in Canada as factory workers until when they rejoined their family.
Palmer was well educated and an avid reader of all things scientific unlike many physicians of the day , especially with regard to the healing arts. However, the celebrated event that would launch chiropractic suggests that he must have had exposure to spinal manipulation. This would seem to contradict Palmer's claim to being the first practitioner to perform such a technique Also, Palmer stated in his book, Chiropractic Adjustor 39 , that he learned about manipulation from the work of a medical practitioner named Jim Atkinson, whose work 50 years earlier propounded similar, if not the same, principles as the new healing art of chiropractic It is also reasonable to assume that Palmer, with his thirst for increasing knowledge, would have had communication with Andrew Taylor Still, whose practice was but one day's drive away in Kirksville, Missouri.
Thus, the seed of the chiropractic profession was sown. Palmer began to reason that when a vertebra was out of alignment, it caused pressure on nerves. He further reasoned that decreasing nerve impulses would surely affect visceral function leading to disease the Law of the Nerve. As occurred earlier with Still, Palmer's views brought the wrath and disdain of the medical community. Undaunted, he continued to develop his innovative approach in both theory and practice.
One of his patients, a minister, is credited with providing his newly formed philosophy with a name. By , 15 people had been graduated. In , one the graduates was Palmer's son Bartlett Joshua or B. A year before his graduation, B. Palmer would see his father, and hundreds of other chiropractors, prosecuted for practising medicine without a licence. In fact, D. A year later one of Palmer's graduates was charged with practicing medicine and osteopathy without a license in Wisconsin.
In a landmark decision, the jury found that Shegataro Morikubo, DC, was innocent on the basis that he was not practising medicine, surgery, or osteopathy. He was practising the distinct healing art of chiropractic. While his father began an educational tour of the West Coast, B. Palmer began to administrate more and more of the college's financial and educational activities. During the s, B. Palmer intelligently used the mass media of the day, i.
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This would only intensify medical opposition and by all accounts it was the younger Palmer's resourcefulness that enabled the profession to survive into the 20th century. The G. Bill at the end of World War II enabled thousands of returning soldiers to bolster the ranks of the chiropractic profession. This influx seemed to provide an impetus that would propel the chiropractic profession to today's status where it boasts 35 schools and colleges worldwide and, in the Western world at least, it is second only to the medical profession as a primary care healthcare provider.