Manual therapy of the
Manual therapy in infants is not comparable to
the thrust-type manipulation conventionally used in adults.
Treatment of infants involves gentle impulse manipulation, without
rotation or sudden application of force.
Two commonly used methods are Atlas Therapy
according to Arlen, and Therapy according to Drs. Gutmann
Techniques vary, and the results achieved by an individual doctor
are more closely related to their individual style of treatment
than to the certificates that they hold.
- Atlas Therapy according to Arlen
involves the atlas alone, and is effective in a single direction
only. Treatment often needs to be repeated.
- Therapy according to Dr. Gutmann,
as modified by Dr. Biedermann, involves the entire
head joint between the base of the skull and C3, and the impulse
is applied in three directions (ie. left/right, forwards/backwards
and in the direction of possible rotational malpositioning
of the vertebra).
This second technique as applied to
adults is called "HIO", as in Hole In
One, therapy, since one impulse addresses the complete
Adults and children are not physically manipulated in the
same way, but although the therapy technique differs, analysis
of the problem is similar (patient history, physical examination,
A moderate lateral pressure is applied to the
upper neck, just below the back of the head.
Improvement in the range of movement of the head
and neck is demonstrable directly after treatment. Various other
functions can also be affected via the reflex centre in this
area, which influences muscle control and, for example, sleep
An immediate improvement of balance and a relatively
rapid relaxation of the muscles involved in maintaining posture
are often a consequence of treatment. It is thought that manipulation
alters the stimulation of the numerous sensory receptors in
the neck which are important for posture.
The treatment is fundamentally pain-free, but
babies don't particularly like it, even during the diagnosis
stage. However, it is obvious that no great pain is involved
as babies rapidly calm down afterwards (mostly the moment they
are given back to their mother/father).
In contrast to older techniques, these modern
therapeutic methods do not result in significant movements of
the vertebrae involved.
This type of treatment is consequently low-risk, assuming that
it is performed properly, and can be used even for young infants.
Because perception and control are significantly affected, however,
treatment should not be performed too often.
In most cases, babies only need a single treatment.
According to Dr. Biedermann, a maximum of 15% of infants require
a second treatment within the first year. In order to allow
the body time to adjust after therapy, other "stimulating"
treatments should be avoided for a period of 2-3 weeks, such
as vaccinations, other intensive medical investigations, osteopathy
or physiotherapy. This adjustment period varies from patient
to patient, and is partly dependant on the extent of the problem
and the age of the patient.
After this pause, physiotherapy needs can be evaluated, and
where necessary adjusted to suit the current developmental stage
of the patient.
A routine check-up is advisable when the child
reaches three years of age, and again before starting school.
This allows for early identification of poor motor skills or
perception problems, avoiding the risk of oversight during normal
Brief relapses, for example during an infection
or a growth spurt, do not require a new visit to the specialist.
It may be that a child falls back into old habits for a short
Once freedom of movement has been established,
the child's body is usually able to cope with minor challenges.
After major falls or anasthaesia it may be sensible to have
a checkup, if symptoms recur and persist for longer than 1-2
Babies from families with a history of spinal
problems such as scoliosis should be regularly monitored. This
can usually be achieved via a physiotherapist and general practitioner,
so that visits to the specialist can be restricted to 1-2 times
Manual therapy does not replace other forms of
therapy, but provides a starting point from which occupational
therapy (Ergotherapie), physiotherapy, INPP therapy or psychomotor
therapy can be provided more efficiently. Manual therapy optimizes
biomechanics (joint and muscle function) and central control.
Manual therapy of the
head and neck for adults
Treatment of older children and adults takes longer,
because the vertebrae are usually fixed into their positions
and not so open to re-setting. Again, it is again important
to avoid using manual therapy too frequently, since the body's
response to an improved head joint position needs time and patience.
Daily treatments have now been abandoned by most atlas therapists.
Depending on the diagnosis, the time between treatments may
be several weeks to months.
In addition to corrections to the head joint,
the pelvic joint and the rest of the spinal column are assessed
and treated as necessary. Various techniques may be used, for
example osteopathy, particularly "soft tissue techniques"
such as myofascial release or muscle energy technique.
Manual therapy of the
cervical spine can help with:
- Neck pain
- Balance problems
- Movement difficulties (spasticity, Parkinsons)
- Chronic backache
- Slipped discs
- Ringing in the ears (tinnitus)
A routine examination of the head joint
in babies (as is carried out for the hip joint) could potentially
help very many people in reducing headaches, back pain and even
certain behavioural problems in later life.