What is muscle manipulative therapy?

Muscle manipulation is the alignment of muscles, ligaments, tendons, cartilages, blood vessels, nerves and fibrous tissues that have been pulled out of position by injury. Once they are back in place, the body can heal the area properly.

When tissue is left misaligned, pain persists. In some cases calcium forms around the injured area, which makes later manipulation harder. A practitioner works by feel to locate the injured tissue, then uses their fingers, a Bio Stimulator unit, or both, to bring it back into alignment. Relief can come very quickly, sometimes within minutes of a manipulation.

The work depends on a sensitive feel. You have to know what you are feeling for, and once you have found it, you have to know where the muscle, ligament, tendon, cartilage, blood vessel, nerve or cord belongs. It gives people who have carried injuries for years an option worth trying before more invasive routes. See the injuries and conditions I treat.

Scope of practice

This is manual soft tissue therapy and general education. It is not a diagnosis and not a substitute for medical care. Suspected fractures, complete ruptures, dislocations, head injuries, and any injury involving numbness or loss of power in a limb need assessment by a doctor first.

A therapist's two hands on a limb, thumbs together on the belly of the muscle, running along the fibres to find a tear — Thumbs together on the belly of the muscle, run along the fibres. A tear shows up as a depression under the thumb.

Hatchard's Way

Bill Hatchard called his method Hatchard's Way, and that is the name it is still known by among the people he taught. It is not a brand so much as a way of working: find the injured tissue by feel, put it back where it belongs, and let the body do the healing. Everything below is the anatomy that method rests on.

How muscles work

The word muscle comes from the Latin for mouse. A muscle has a body, which is the muscle itself, and a tail, which is the tendon. The tendon acts as an extension of the muscle and usually attaches to a bone to help raise and lower a limb.

Diagram of a muscle between two bones, labelling the tendon at each end, the belly in the middle, the lengthwise fibres and the cords holding it in position — The body is the muscle, the tail is the tendon. The fibres run lengthwise, which is why it tears lengthwise.

Muscles are small motors that move every part of the body. You cannot talk, eat, breathe or blink without using one. They all produce movement the same way: when they shorten or contract, they pull on their tendons or their attachments to bone, and those bones move. Each muscle is activated by a nerve carrying messages from the brain.

An arm shown relaxed with a long muscle and forearm down, then contracted with a short thick muscle and the forearm raised — A muscle only ever pulls. It shortens, the tendon pulls, and the bone comes with it.

Diagram showing a message travelling from the brain down the spinal cord along a nerve to a muscle, which then contracts — Each muscle is switched on by a nerve carrying the message from the brain.

Two panels showing a pair of opposing muscles: one shortening while the other lengthens to bend the joint, then swapping roles to straighten it — Because a muscle can only pull, they work in opposing pairs. Train one past the other and the weaker one tears.

Muscle fuels

Diagram showing carbohydrate as the primary fuel, fat as secondary and protein as a building block, with red blood cells carrying oxygen through vessels of different sizes — Carbohydrate first, fat second, protein not at all — and none of it burns without oxygen.

Protein is never a source of immediate energy and is a poor substitute during exercise. It is a building block for tissue, and the body has no way to store extra.
Fat is a secondary source of energy, particularly in the later stages of a long effort. It is stored in the muscles, under the skin and around the inner organs.
Carbohydrate is the primary fuel for exercise, stored in the muscles and liver as glycogen. Glycogen and fat are the main fuels muscles burn.

Burning those fuels efficiently takes oxygen, delivered through the bloodstream by red blood cells. This is why muscle toning matters so much. Toned muscles have larger blood vessels, more blood flows through them, and more oxygen reaches the muscle to burn glycogen and fat.

Training properly improves oxygen utilisation on both sides of that equation: the heart pumps a greater volume of blood per beat, arteries and blood vessels enlarge, red blood cell count rises, and the enzymes in your muscles get better at picking oxygen out of the bloodstream.

What limits muscular endurance

Flow diagram of glycogen breaking down to pyruvate, then to carbon dioxide and water with oxygen, or to lactic acid without it — With enough oxygen, pyruvate is breathed off. Without it, lactic acid builds up.

Loss of muscle glycogen, the primary fuel
Loss of fat reserves, the secondary fuel
Low blood sugar
Lack of oxygen
Heat build-up in the muscles
Accumulation of lactic acid

When glycogen is burned it breaks down into pyruvate. With enough oxygen available, pyruvate converts to carbon dioxide and water, which are breathed off by the lungs. Without enough oxygen, it converts to lactic acid instead, which builds up in the muscle and spills into the bloodstream.

Lactic acid impedes muscle contraction and makes movement progressively harder, which is felt as fatigue. At high levels the muscle stops contracting altogether: control goes, and it becomes very painful and may cramp. As soon as oxygen is available again the process reverses and the athlete gets a second wind. The practical lesson is to train and warm up properly so the muscles are toned and well supplied with oxygen.

Ligaments

A ligament is a tough fibrous band attached near the ends of bones where they meet to form a joint. Its main job is to hold those bones together as the joint moves. Some hold so tightly there is very little movement at all; others are flexible enough for the wide range of the elbow, wrist, shoulder, hip, knee and ankle. The vertebral ligaments holding the spine together have a very limited range.

In this therapy ligaments matter enormously, because they hold bones together and keep muscles in their correct position. Ligaments are fixed at both ends, to bone or to muscle, and they have fibrous cords that tear away easily from either. Those tears are what we call sprains, and they always bleed. The work is to put those cords and ligaments back as close as possible to correct alignment. In most cases they re-attach where they were torn from, laying down new cells that close the tear with little scar tissue.

Ligaments can stretch and stay stretched for want of manipulation. This is common after childbirth where the muscles and ligaments of the groin, stomach and lower back are not properly rehabilitated, and the result is ongoing lower back pain and sciatic irritation. Much of that is avoidable with the right treatment and exercise.

Tendons

Tendons are strong fibrous bands attached to muscle at one end and bone at the other. They are very strong and differ noticeably from ligaments in size, shape and feel; with practice you can trace where a tendon continues on from a muscle and attaches to bone.

When a muscle contracts it draws its tendon up, and the bone with it. The calf muscles contracting draw up the Achilles tendon, which runs from the bottom of the calf down the back of the leg to the heel, and that is what pulls the foot down. The same action bends knees, elbows, fingers and toes.

Tendons have a smaller cross-section than muscles, so force is concentrated over less area and they take more strain during exercise. They are also poorly protected, and can rub against bone, ligament and other tendons as they move. They tend to separate from bone or muscle, and occasionally tear right through, usually from a violent muscular contraction. Ruptures are common in sprinting and football, and most common in athletes with tight, inflexible or under-conditioned muscles.

You can usually hear a rupture. There is a loud pop, and the pain is severe enough that the person will not let the limb be examined.

Suspected rupture: go to hospital

If a rupture is suspected, go to hospital so the extent of it can be verified. A complete rupture needs to be stitched back together. A piece of bone torn away with the tendon needs surgery. Manual therapy has a role afterwards, not instead.

Where it is a separation rather than a complete tear, there is internal bleeding at the site that needs to be dispersed as quickly as possible so the cords in surrounding tissue can re-attach to the tendon or bone. Aligning those cords speeds recovery, and within a few days gentle stretching should begin. Daily stretching is the only reliable way to stop it happening again. In running sports the Achilles takes the most force and is pulled or ruptured far more often than any other tendon.

Cartilages

Five stick figures demonstrating hamstring, calf and Achilles, quadriceps, groin and lower back stretches — Lack of flexibility is the main source of muscle and ligament strain. These five cover the groups most often torn.

Cartilages are tough white gristle lining the ends of bones in a joint, protecting them from rubbing together and cushioning shock. They contain no blood vessels or nerves, are fairly brittle, and can be torn or chipped by the stress placed on them. Once damaged, bone can rub on bone, and because the ends of unprotected bones carry a rich nerve supply, every movement hurts. Pressure on nerves is the most common source of pain in the body.

The cartilages most prone to injury are in the knee joint and the spinal column, where they are called discs. Keep the muscles and ligaments around the knee toned and exercised, and do the same for the back, which is what holds the spinal column in position.

Lack of flexibility is the main source of muscle and ligament strain. Stretching is the single most important thing you can do to prevent injury, and mineral levels matter too — cramping often traces back to magnesium.

The Bio Stimulator

One device sits alongside the hands-on work. It does not replace it, and it is not the reason the treatment works — the manipulation is.

A low-voltage current passed through the muscle between two pads placed at opposite ends of it. The impulses make the muscle contract and expand at a set frequency, which stretches the tissue and helps disperse congealed blood left behind by bleeding into the injury. TENS is a long-established and widely used form of physical therapy.

Diagram of a muscle with an electrode pad at each end and current passing between them — Pads at opposite ends of the muscle; the current runs along its length.

Working by feel

Four panels showing how a blood vessel, a tendon, an intact muscle and a torn muscle each feel under the fingers — Each tissue feels different. The tear shows up as a depression under the thumb.

Everything above comes down to feel. Blood vessels are the one structure I treat as genuinely risky, because they do not stretch as much as the others and are more prone to rupture. A blood vessel feels spongy, with tiny concertina ridges along its length, more obvious in the larger ones. Sometimes a throb can be felt. Before feeling for ligaments I probe the area first to locate the blood vessels, because they are not always where the anatomy book says.

Tendons are large, very smooth and usually taut. Press your fingers on a muscle and move down, and you can feel where the tendon starts and trace it to its end. They vary enormously: wide and flat like the Achilles, or round and long, some as thick as a little finger and some like a piece of thread, from a fraction of an inch to over 300 mm.

Muscles are the easiest to recognise, which matters because most sporting injuries are muscular. Nearly all of them cross over or under other muscles, so knowing their shapes is what separates a strain from a tear. Most are shaped like a deflated football bladder, thinner at the ends and wider in the middle, made of fibres that run the length of the muscle rather than across it. That is why they tear lengthwise.

The thigh muscles are the classic example. The rectus femoris looks like a butterfly fillet of fish, in two distinct parts you can feel clearly, and you can feel where it usually tears. Once you know the direction of a muscle, running a thumb along it with very light pressure will drop into the depression of a tear. The limit of the method is depth: an injury to a muscle covered by several layers of other muscle cannot be felt.

Book a treatment

Endeavour Hills, Victoria. Phone is the quickest way to reach me; otherwise send a message and I will get back to you.

Call 0438 106 861

Address, email and enquiry form