Introduction to manipulation.

The art of manipulation was known to Hippocrates and the physicians of ancient Rome, and has passed down a long line of medical manipulators and bonesetters to present day practitioners; osteopaths, physiotherapists, chiropractors and manipulating physicians and surgeons. Osteopathy and chiropractic, unlike physiotherapy, at present remain outside orthodox medical practice in the UK The subject has always been contentious, often acrimonious, with much factional and interprofessional rivalry, but in the late 20th century the practice of manipulation is finally achieving scientific respect- ability through the application of biomechanical principles and recent advances in neurophysiology, together with a serious attempt to prove efficacy through controlled randomized clinical trials. Thus osteopathy and chiropractic may yet be extended a guarded welcome into the orthodox medical fold. This paper will describe briefly the terminology used in manipulation and discuss patient assess- ment, indications for treatment and the common manipulative techniques. A review of present knowledge of the physiological effects of manipu- lation will accompany a discussion of clinical outcomes based upon data from clinical research.