MET is commonly used with a wide variety of musculoskeletal disorders in conjunction with mobilization and manipulation. The current literature reveals that MET directed at the lumbopelvic spine significantly reduce pain and disability scores.10 However, this evidence is level C, and further research needs to be performed. This technique is widely used by physical therapists. The overall treatment goal of MET is to restore normal physiologic motion of the joint or affected area.
Joint Mobilization and Manipulation
Physical therapists, along with other practitioners, will commonly refer to a joint as hypomobile, within normal limits, or hypermobile. Joint play is assessed in the physical therapy evaluation to determine whether restriction or pain is present. It is suggested that normal joint play is necessary for pain-free movement of the synovial articulation and, if restricted or absent, voluntary movement will, in turn, become restricted and painful.11,12 The main purpose of mobilization is to improve motion and normalize joint function.
There are five types of joint mobilization. Grades I and II are applied to a patient for the main purpose to decrease pain and muscle guarding. Grades III, IV, and V are provided to increase joint mobility and function with stretch into joint structure. Grade V manipulation is also referred to as high-velocity, low-amplitude (HVLA) thrust. It is proposed that the HVLA has a neurophysiological, nutritional, and mechanical effect on the joint, resulting in increased mobility and decreased pain. The stimulation of large mechanoreceptors helps to decrease pain (according to the gate control theory) on the neurophysiological level.11 Nutritionally, the movement of synovial fluid acts to improve nutrient exchange. Mechanically, with the use of Grade III–V mobilization, capsular adhesions are directly impacted to increase joint mobility. Note that absolute contraindications include malignancy, tuberculosis, osteomyelitis, osteoporosis, fracture, ligament rupture, or herniated disc with nerve compression.
The current research on manipulation and mobilization is extensive. For example, with patients with lower back pain, there is strong evidence that mobilization and manipulation are similar in effect to a combination of medical care with exercise instruction. There is moderate evidence that mobilization and manipulation are superior to general practice medical care and similar to physical therapy in both the short and long term.13
Physical therapists obtain general manipulation and mobilization skills with their DPT degree, but continuing education is always available to those who want to build on their skill level and knowledge. Organizations such as the American Academy of Orthopaedic Manual Physical Therapists (AAOMPT) offer fellowship programs in manual therapy. You can recognize a manual therapy fellow if they have FAAOMPT within their title.
