Manual therapy

Manual therapy is a branch of physiotherapy. However, it requires the therapist to complete additional training. Manual therapy has a long history, reaching back to the ancient world and specifically ancient China, where certain manual techniques were already used to treat back pain. Indeed, chiropractic and osteopathy arose from this early form of manual therapy.

The major focus of manual therapy is the treatment of functional diseases of the locomotor apparatus. Therefore, it is limited to muscles, joints and nerves. However, manual therapy is not only a specialized form of therapy but also serves diagnostic purposes. After the cause for discomfort is identified, therapy is usually performed by means of mobilisation to restore unrestricted movement and to ease pain.

In order achieve this the therapist applies special manual techniques using different approaches of mobilisation. A distinction is made between traction, translatoric gliding and soft tissue treatment. Traction means the joint is being stretched to relieve it from pressure. This eases the pain and also increases the mobility of the joint. Translatoric gliding is used to restore the joint to its former state of mobility and to extend its range of movement. Soft tissue treatment consists of various stretching and relaxation techniques. Gentle stretching is used to lengthen the muscles in order to adapt them as well as possible to the improved range of movement of the joint. The different techniques can be used to treat various joints, as well as intervertebral joints. This type of therapy usually doesn’t cause pain and is used together with therapeutic exercises. Ultimately, the goal is to strengthen the muscles in order to take pressure away from the joints. Manual therapy is an inherent part of classic physiotherapy, which means the costs will be covered by the statutory health insurance companies.


The primary goal of physiotherapy is the treatment of patients with restricted functionality or activity. Damage resulting from shortened groups of muscles or an imbalance of muscles often causes significant pain over a prolonged period of time.

Sports-physiotherapy is a specialized branch of physiotherapy. The sports-physiotherapist combines his or her knowledge of sports and the body to achieve optimal rehabilitation results after injuries. Sports-physiotherapy also comprises providing support during competitions and prophylactic treatment, for instance in cases of muscle or ligament weakness. In many of those cases, taping is used to reduce the maximum pressure these structures are subjected to and to avoid injuries.

Sports-physiotherapy has been the subject of significant changes during the last couple years. For many years, sports-physiotherapists used almost entirely passive methods of treatment, such as massages, electrotherapy or ice, to the point where the athlete was free of pain. In this case the athlete was - and unfortunately still is - considered “cured” and sent back to continue with their team or competition training.

The step from rehabilitation to competition training was often too great and therefore quickly led to health problems recurring!The lack of knowledge made it impossible for the therapist to analyse the specific type of sport-related-stress the patient was subject to, as well as for the coach to put together an individual program with regards to the physiology of wound healing. This gap is now closed by the qualified sports-physiotherapist.

He or she analyses and documents the specific type of sport-related-stress the patient is subject to and develops a completely individual rehabilitation plan, tailor-made for the athlete in question. This ensures that - upon the completion of rehabilitation - the athlete can use their full potential to push for their limits according to their discipline.

Medical training therapy

This type of therapy is used to partially or completely restore the restricted freedom of movement of a person. The kind of therapy used here is movement that basically means training. In the course of this, methods are used which increase strength and endurance and improve coordination.

Usually, during the early phase of rehabilitation, while under the guidance of a physiotherapist, the patients learn the necessary exercises so they are able to make the initial movements after an injury or surgery. Medical training therapy is a useful supplement to this exercise program. Together with the physiotherapist, coordinated training programs using therapeutic devices, which can also be found in gyms, are being developed.

Functional Movement Screen

The Functional Movement Screen consists of seven motion tests that put your spine, shins and also hand, knee and ankle joints in particular to the test in terms of mobility and stability. This research method is recognized in the U.S. since 1998. As a graduate of the FMS training course, I find out about your fitness and your biomechanical deficits that have to be considered or even fixed.

By means of the FMS, we safely look for biomechanical deficits and pain areas. Your progress will later be determined in the so –called Re-Test. Deficits may be for example: limited mobility of a shoulder, a shortened muscle, a lack of stability of your spine or asymmetries in the bodily frame. Even in case you think you can do sport exercises normally, it may be that you accommodate pain by so-called pain compensatory movements which falsify your exercises making them less efficient. As a result, your locomotor system may be strained inappropriate which leads to further problems. The FMS is a basic method for examination out of which many possible forms of treatment derive.

Further details: Functional Movement Systems website

Training optimization

My understanding of training optimization is you reaching your training goals using science-based services that specifically cater to your needs. The result is maximum efficiency and success. In the course of this you will establish your individual goals (from reaching performance optimization to losing weight) while I support you on your path. Furthermore, I put together training schedules with regards to professionals or those interested in sports, taking medical aspects into consideration.

Myofascial therapy

“Myo” stands for muscle while a “fascia” is a structure of connective tissue that surrounds muscles, joints, ligaments, nerves and tendons. Very often, chronic stress and injuries of the affected muscular structures are the reason for a “myofascial pain syndrome”.

They cause a functional disorder of the connective link between nerves, tendons, bones and muscles leading to a taut band or a painful “trigger point” within the muscle. At the transition from muscle to tendon, densifications of the connective tissue can be observed, as well as loss of elasticity, torsion of single strands or adhesion between the muscle layers.

These disorders are not always characterized by local pain but can often cause a transmission of pain to other remote regions. The individual muscles act as a link in a chain, running through the whole body, connected by fascial connective tissue (sheath). This is how deeply located trigger points or adhesions within the muscles of the forearm can cause tennis elbow or shoulder problems. Chronic cramps located in the lower leg can potentially possibly lead knee joint or lumbar spine disorders.

The concept of treatment comprises an effective and manipulative method of treatment of the myofascial tissue suitable for numerous indications:

  • Sprains
  • Stiff shoulders
  • Neck- and back pain
  • Tennis elbow
  • ankle or knee joint discomfort
  • perennial injuries of athletes

Craniomandibular therapy (mandibular joint therapy)

Craniomandibular dysfunctions are caused by a malposition of the skull (cranium) and the jaw (mandibula). When compared to specialized doctors, who are often incapable of thinking outside the box, the physiotherapist’s holistic approach, e.g. using manual therapy, gives them an advantage when dealing with symptoms such as facial pain, vertigo, cervical spine problems and even tinnitus and headaches. All aspects concerning the patient have to be considered to completely understand the clinical picture of craniomandibular dysfunction (CMD).

Cracking in the mandibular joint during eating or when the mouth is opened, teeth grinding at night and stress related clenching of the teeth are possible signs for craniomandibular dysfunction. It is currently believed that stress is one of the main causes for teeth grinding. Furthermore, imbalances, such as chewing finger nails or pens, excessive use of chewing gum, pressing lips together, sucking in of cheeks, sucking, sleeping on stomach or frequently holding the head in a bad position, can cause an overburdening of the muscles of mastication or the mandibular joint or lead to an unnatural position of the jaw. This can result in tenseness and pain, which are also transmitted to other regions of the body, such as the neck muscles, back and pelvis - regions far from the actual location of the cause. Imbalances of the muscles or the joint can also be caused by malpositions after accidents, such as hits on the chin, whiplash injuries, prolonged opening of mouth at the dentist or intubation anaesthesia. A bad sitting posture (crooked body posture) changes the state of tension of the muscles, therefore resulting in possible imbalances.


  • Restoration of restricted mobility
  • Optimization of muscle tension disorder
  • Pain reduction

Mulligan Concept

The Mulligan Concept is named after its founder, Brian Mulligan, a physiotherapist from New Zealand. It is a manual therapy concept that was developed from practice for practice. This method is a structure-and joint, gentle way to integrate active movement into classic manual therapy. The term “mobilisation with movement” originated from this method.

The Mulligan Concept is also gaining increasing importance in Germany. Acting as a supplement to manual therapy, the Mulligan Concept comprises examination and treatment techniques for the spine and joints of the extremities. “Mobilisation with Movement” (MWM) is used in cases of restricted movement or joint pain. In the course of this, the therapist executes an additional supportive move while the patient actively moves the joint in the direction where pain is caused or movement is limited. At the end of the active movement, the patient or the therapist can apply excessive pressure in the direction of the limited movement for maximum success of the treatment.

In his concept, Brian Mulligan assumes that even a minimal malposition of the opposing parts of the joint can be the cause of limited movement or movement related pain. The combination of passive mobilisation and the patient's active movement corrects this malposition. In the course of this, the therapy is always adjusted to the individual situation of the patient. For example, if limited movement of the joint only occurs in a sitting position, it is treated while the patient is in that same position. This means functional treatment in a provoking position.

The principle of treatment is being free of pain

Scientific research proves that there is a connection between being free of pain and functional improvement. The major advantage of this new method of treatment is that it immediately takes away the pain. As a consequence, the patient can perform their exercises free of pain. This prevents the imminent chronification of pain and restores the balance of biochemical processes in the brain. The patient regains self-consciousness with regards to his own movement.

Numerous studies have shown the positive effect of MWM on a neurophysiologic level. The Mulligan Concept is considered to be state-of-the-art pain treatment, especially for the treatment of tennis elbows.

Further information: Mulligan Concept

Osteopathic techniques

What is osteopathy?
Osteopathic medicine mainly serves the purpose of detection and treatment of functional disorders. Diagnosis and therapy are characterized by specific manual osteopathic techniques. The use of osteopathic medicine requires exact knowledge in the field of anatomy and physiology. The principles of osteopathy comprise the integrity of the human body, the interdependence of structure and function and the self-regulating forces of the body.

How does osteopathy work?
Our body continuously coordinates all vital functions. Very often we are not aware of most of this mobility. This includes the pulsing bloodstream, rhythmic respiratory movement, the autonomous work of digestive organs, the stream of body fluids and finally the movement of muscles, tendons, joints and connective tissue. The limitation of movement of individual structures of the body influences their function. Changed mobility is a sign for a functional disorder of a structure. The body does not always use pain or other discomfort to indicate functional disorders. Our organism can adapt and has the ability to naturally relieve some “disorders”, such as bad posture, stress related tenseness or even injuries. In such cases, the impaired functions are carried out by other body structures, leading to functional disorders “shifting” and influencing other regions of the body. But if the body reaches its limit of adaption (“In the past I easily could take this!”) just a small amount of physical or psychological influence can cause strong, disproportional reactions, possibly in a totally different region of the body. For example, airflows or a clumsy move can provoke lumbago. So the “solution” for discomfort often cannot be found where the pain is located.

It is here, if not before, where the role of the osteopath starts. The osteopath can feel functional disorders that are characterized by limited motion by using their sensitive and trained hands and help the body to repair functional disorders by manually removing the limitations of motion. Therefore, the osteopath helps the body to heal itself by freeing and supporting our self-healing capabilities through restored mobility, which, in turn, helps to restore the normal function of the disordered structure. Their exact anatomy and physiology knowledge enables them to go past the symptoms for the causes of discomfort and put every disorder and its treatment into context within the body as a whole.

Where osteopathy is applied
You are in good hands with your osteopath. He can help with many types of discomfort or diseases. Naturally, the osteopath cooperates with doctors and therapists when necessary and also uses other diagnostic and therapeutic methods. Osteopathy can be used with virtually every functional disorder of the body, even when it has already existed for a longer period of time. There are no limitations regarding age. Every kind of living tissue can be treated with osteopathy. It is possible to treat diverse, even chronic tenseness and injuries of the skeleton and its associated muscles and ligaments, such as disc herniation, lumbago, injuries after accidents and mandibular joint problems. Occasionally, it is also possible to treat tinnitus, digestive problems (excluding tumours or ulcerations), incontinence and premenstrual discomfort. Babies and children with problems resulting from traumata at birth or even earlier are typical osteopathy patients.

LNB Pain therapy by Liebscher & Bracht

How das LNB Pain therapy function?

The treatment


The first step to successfully treat the pain is the anamnesis. The LNB therapists spend substantial amount of time to explain you the treatment process. The therapist compile the pain history based on the doctors’ reports, x-ray photographs, diagnosis etc. The therapist records your pain condition and locates the exact pain point and asks when and in which situations the pain occurs in especially strong way. We want to understand, when and where the pain emerges. After the anamnesis, the LNB therapist can start with the treatment with pain point pressure.

Pain point pressure

With the pain point pressure developed by Liebscher & Bracht, the misprogramed muscle tension will be eliminated. Your therapist treats you naturally and causatively with his/her hands. Via imposing pressure on the alarm-pain receptors discovered by Liebscher & Bracht, the pain points are being influenced, so that the bio-logical information switch to the brain arbitrates. The deadlocked pain mode will be resolved by the pain point pressure, the muscular-fascial break-even will be established and the pain will be eliminated completely or significantly reduced most of time within a few minutes.

Bottleneck stretching

Via bottleneck stretching according to Liebscher & Bracht, the active and passive stretch stimuli, reinvigoration and activation impulses are set. Those are exercise and movement forms, which support the effects of the pain point pressure and program in the brain in the long-lasting way. The bottleneck stretching are the integral part of the therapy providing for the freedom from pain to be preserved and enabling the pain-free healthy life in movement. The LNB therapist guides the patient thoroughly through the exercises. Detailed instruction ensures that the exercises can be performed easily at home. With the help of LNB-pain free-DVD the bottleneck exercises can be followed step-by-step.

Treatment- and success control

The pain condition achieved by the treatment can be discontinued in the long run. The maintenance of the pain reduction or even the further improvement of the pain condition depends substantially on the regular performing of the bottleneck exercises. It might well be that you get the muscle soreness after the first treatments. However, it is a positive signal of the body that the muscles are reactivated. Under some circumstances the bruises might appear on the treated areas, which is totally normal by certain types of connective tissue.

Sports massage

In general, massage is the manual working of the surface of the body and muscles for healing purposes. It also remotely and generally affects the organism as a whole.

Massages are, first and foremost, circulation enhancing measures. They improve blood circulation by opening capillary vessels (the smallest vessels). Furthermore, they cause stasis products, metabolic waste products and residua from bleedings to be transported away. The sports massage is an addition to the classical massage with classical techniques and additional techniques utilised in harmony. It meets the needs of the athlete, as well as the individual problems during exercising.

  • Massages prior to competitions

    In the world of sports, it is an inherent part of the competition to prepare and warm-up the muscles.

  • Revitalization massages

    This type of massage should be applied after physical exertion to increase the transport of metabolic waste products and to support recovery in the medium term. In this case, massage techniques with deep impact and techniques that support the backflow are recommended.

Kinesio Taping

More than 20 years ago, K. Kaze from Japan invented the Kinesio Taping Method, together with its associated taping materials. It has subsequently evolved into a complex medical concept of treatment. The internationally employed term Medical Taping Concept comprises Medical Taping, Cross-Links, Lymph-, Meridian- und Acupuncture-Taping. These types of therapy are either used independently or in combination. An elastic sticking plaster has been developed for Europe that can be applied quickly and easily. This specific kind of taping has a stimulating effect on muscles, joints and the lymphatic and nervous system.

The elastic tape can be worn for a couple of days without causing negative skin reactions. It has a stimulating or relaxing effect depending on how it is applied. This positively influences static and dynamic coordination. Furthermore, in cases of lymphostasis, the Medical Tape Concept reduces pressure in the affected tissues, which in turn causes an acceleration of the lymphatic stream and quick regeneration. The irritation of specific receptors in our skin activates the body's own pain damping system. The stimulation of receptors in our joints causes a better feeling of movement. Another advantage of this method: The full extent of mobility is preserved!

Dynamic Taping

What is Dynamic Tape?

Dynamic Tape is a different tool for a different job. It is made from very different materials, has completely different physical properties and is used very differently to rigid athletic tapes or the colourful kinesiology tapes that are often seen. Dynamic Tape is a highly elastic tape which stretches in all directions and has very strong recoil properties. It can be laminated together to increase this power. It stretches much further and does not have a rigid end point like kinesiology tapes. This design and the unique, visco-elastic properties allow it to work like a bungee cord by acting on the levers of the body aiming to provide a deceleration force, absorb load and reduce the work on injured tissues. Once deceleration is complete, the energy is stored as elastic potential energy and then reinjected back into the system to assist movement as shortening commences. In this way it may assist the work of weak, injured or overloaded muscles or may be used to change movement patterns by pulling the body in one direction or resisting it in another. This may be useful for improving technique in sport, assisting gait in a child with cerebral palsy or assisting the grasp of someone who has suffered a stroke. In simple terms it provides strong mechanical assistance to reduce the work on injured tissues, assist weak muscles or improve movement patterns while still allowing full range of motion even when performing complex, multi-planar movements like those required in sport or work. This is very different to the primary neurophysiological approach described by kinesiology tapes where they aim to lift the skin to create space in order to take pressure off pain sensitive structures, to increase the circulation or to effect muscle activity via the input into the nervous system through the skin. Powerful neurophysiological and circulatory effects are seen with Dynamic Tape and this is a nice bonus however our clinical reasoning is based on a sound evaluation of the anatomy and biomechanics to determine which tissues are overloaded and the movement faults that are contributing to this. Dynamic Taping is then applied to address this. Tissues do not fail because of pain, they fail because of load. Dynamic Taping aims to absorb load extrinsically thereby reducing the load that the body has to dissipate intrinsically. Furthermore, in many cases pain is not even present and if it is, it does not correlate well with the amount of tissue damage. Dynamic Taping may be used to assist someone with a foot drop post stroke or to correct someone’s golf swing. A focus on movement, function and load allows us to get effective results.

How does Dynamic Tape work?

There are mechanical mechanisms and physiological mechanisms. These are intertwined however they are separated here to aid in the explanation. The mechanisms proposed draw on a large body of research and knowledge pertaining to anatomy, biomechanics, pathophysiology, pain and taping. Any proposed effects are reliant on a sound clinical reasoning process to determine the aim of taping and then correct application. Mechanical Mechanisms: When Dynamic Tape is applied properly it is like having a spring or strong rubber band pulling on the levers of the body. In this way it may help to:

  • decelerate motion
  • absorb load (load is a major driver of tendinopathy as demonstrated in research by Soslowsky et al, Docking et al but will also impact function e.g. the force of gravity acting on a foot in someone with foot drop increasing the risk of them catching their toe.
  • reduce the work of muscles (that would normally do the above)
  • change movement patterns by pulling the body one way or resisting it in another
  • allow muscle to generate force effectively by bringing it into a better position (i.e. improve the length-tension relationship). An example is the scapula.
  • change the orientation of a joint (add a rotation or a glide) to allow it to function in a position of ease (e.g. Mulligan techniques)
  • provide strong postural correction and resist unwanted movements (e.g. loss of lumbar lordosis with McKenzie extension regime)
  • offload the soft tissue to reduce pressure pain thresholds and tissue 'stiffness' as observed with ‘box’ offload taping (Hug et al, 2014) to reduce compressive loading
  • augment force closure by creating compression with circumferential type applications

Physiological Mechanisms:

Dynamic Taping is primarily concerned with managing load, movement and function. Corresponding changes in pain are often observed. There may also be direct effects on the pain, circulatory, proprioceptive and motor control systems although there is no clear consensus at this stage due to a lack of homogenous studies that investigate the same subjects, same techniques, same outcome measures etc. This can be said for many aspects of manual therapy including taping for many parts of the body and all taping approaches. A number of mechanisms may be involved including:

  • Non-opioid mediated analgesia - a sympathoexcitatory effect is often observed and may be suggestive of a non-opioid mediated analgesia similar to that seen with some manual therapy techniques (e.g. as demonstrated in studies on Mulligan lateral glide of the elbow or Elvey lateral glide of the cervical spine with subjects with tennis elbow).
  • A reduction in pressure pain thresholds and improvement in circulation by manually gathering all of the soft tissue together and holding it there with the recoil of the Dynamic Tape. This creates a soft, spongy area which reduces pressure on irritated structures and decreases firing of sensitised peripheral nociceptors (Hug et al, 2014 have shown changes in stress on the muscle tissue with 'box' unloading technique to the quadriceps). This has not been investigated with respect to Dynamic Tape to our knowledge although some previous taping applications e.g. McConnell diamond box has been shown to improve pain free grip strength and pressure pain thresholds in tennis elbow subjects (Vicenzino)
  • Normal afferent input - providing normal afferent input may have a modulating effect on the pain experience. Due to its constant but variable stimulation to the skin, approximation of the joints and varying stretch on the muscle (occurs as the tape is placed on the body with the muscle in a short position and with tension on the tape such that when the muscle is lengthened, the tape tightens significantly, compressing the tissues) a lot of mechanical stimulation occurs.
  • This compression (or reduction of compression in offloading techniques) may also have an effect on the motor control system via altered input from golgi tendon organs or muscle spindles. Research on facilitation or inhibition of muscle is inconclusive at this stage and it may be that different muscles are affected differently and may also respond differently in the presence or absence of pain or tissue damage.
  • Beliefs, expectations, past experience and many other factors have a profound effect on the pain experience. A reduction in the perception of threat may result in a lessening of the pain experience.
  • Similarly, sensory signalling from the periphery is also heavily involved in the pain experience. A reduction in load or firing of sensitised structures will also effect the pain experience.
  • Improvements in circulation - the mechanism is not well understood but research is demonstrating a reduction in tissue stiffness when all the soft tissues are gathered up manually and held in place by tape. This may then result in more patent small vessels which can remove fluid more readily.

Dry Needling

"Dry needling" is an effective addition to manual trigger-point therapy. In the course of this, the trigger-point, which is responsible for the current discomfort, is precisely punctured with a thin needle without medication (hence the term “dry”). As a result, tenseness is reversed, local blood flow enhanced and local inflammatory reaction decreased. «Dry needling» is used for sports-physiotherapy, orthopaedic rehabilitation and in treating pain syndromes. Various studies have shown that it is not necessary to inject substances into the trigger-point to cause healing. It is the precisely executed puncture itself that does the job. This is where the term «dry needling» originated from.

«Dry needling» has been used in Switzerland since 1996 and is being systematically introduced to specialized personnel. When «dry needling» is used, the trigger-points are punctured with thin single-use needles. This technique has almost nothing to do with acupuncture, apart from the same tool being used. The puncture of the skin can barely be felt. Hitting the trigger-point causes a quick but massive contraction of the taut band where the trigger-point is located. This localized twitch can be a slightly unpleasant experience but is absolutely necessary for the intramuscular stimulation (IMS). In spite of the discomfort, many patients prefer «dry needling» over manual therapy. However, it is possible to treat myofascial discomfort with surface «dry needling», the afferent stimulation of the surface or the manual techniques of trigger-point therapy, if a patient has problems with intramuscular «dry needling».

Physiokey-therapy (SCENAR-medicine)

SCENAR therapy (self-controlled energo-neuro-adaptive regulation method) is a vegetatively balancing, holistic therapy method that is performed without pain on the skin surface. A targeted administration of bipolar pulses causes physical reactions, to solve the blockages, control loops harmonize and help restore the vegetative balance.

The physiokey can be used for patients of all ages with a variety of different kinds of problems. This handy device stimulates the self-regulation by biofeedback-controlled impulses. The influence on the autonomic nervous system, and thus on the body's adaptation and regulation processes strengthen the immune system and show the body to heal itself on a path. The goal of therapy is a rapid pain relief and functional improvement. The initial combination of two established methods of therapy, it is simultaneously possible over the so-called "Key-phoresis" to produce a modified form of iontophoresis. Thus, the use of externas (ointments) is more efficient, they can more quickly and effectively overcome the skin barrier and enter the body to significantly accelerate the healing process (eg. inflammation)!

About 80% of patients take after treatment perceive an obvious change in their symptoms. The users report an improvement in the state of tension of the muscles. In the case of a plurality of patients, the rapid decline of soft tissue swelling was observed. The reason for that is probably a rapid lymphatic flow by the special pulse technology.

The adaptive-regulatory mode of action of physiokey is generated by constant skin and tissue resistance measurements. Thus each signal individually adapts to the respective body situation. Nature and duration of therapy will be regulated by the patient himself. The influence on the autonomic nervous system, and thus on the body's adaptation and regulation processes strengthen the immune system and show the body to heal itself. Because of these functional possibilities of the physiokey it is also possible to do scar tissue balancing.