A Brief History of Manipulative Therapy

  • Spinal manipulation appears to have had parallel developments in many parts of the world where it was used to treat a variety of musculoskeletal and spinal disorders. It was widely practised in many cultures - the shamans of Central Asia, the sobadors in Mexico, and by bone-setters in Nepal, Russia and Norway to name but a few.

    With regards to Western manipulation historical reference to Greece provides the first direct evidence of spinal manipulation around 400BCE, or even earlier.
    Hippocrates (400-385BCE), often called the father of modern medicine, was the first to describe spinal manipulation - using gravity in the treatment of scoliosis (essentially by tying the patient to a ladder and tipping them upside down).
    Galen (131-202 CE), a noted Roman surgeon provided evidence for the use of spinal manipulative techniques including standing or walking on the dysfunctional spinal region. In the Middle East Avicenna (known as the doctor of doctors) from Baghdad (980-1037CE) included descriptions of Hippocrates' techniques in his medical text The Book of Healing.
    A Latin translation of this book was published in Europe and influenced future scholars such as Leonardo Da Vinci.

  • Modern Medicine and Spinal Manipulation
    The renaissance in modern medicine began with Andreas Vesalius who in 1543 described the detailed anatomy of the human body.
    References to spinal manipulation continued until the 18th century when it fell out of favour, possibly due to the danger inherent in manipulating a spine weakened by TB, a disease of epidemic proportions at the time.

    Thus spinal manipulation continued to be rather a 'dark art' practised mainly by bone-setters and village healers leading to a paradox developing by the 19th century whereby the established medical profession largely expressed disdain for the spinal manipulators, whilst having to accept their undeniable popularity amongst the general populace.

  • Chaos Within Allopathic Medicine: A Breeding Ground for Alternative Philosophies
    To fully understand how modern manual medicine arose one must view the status of medicine in North America at the turn of, and during, the 19th century.
    In spite of huge strides forwards in scientific investigation, medicine had changed little.
    Hippocrates and Galen would have approved of the philosophy and logic at the time - observe and use what helps, and avoid what does harm. However it must be remembered that such logic was based on symptoms.
    This led, for example, to Benjamin Rush concluding that the best way to tackle a fever was to 'bleed' the patient. This resulted in the patient going from hot and flushed to cold and pallid - clearly the first step towards being cured, it would have appeared to a physician at that time. His approach was lauded throughout Europe and North America to the degree that probably the foremost journal in medicine today - The Lancet - is named after the instrument used in the 'bleeding' procedure.

    In 1800 medicine medicine was called the withered arm of science. Physicians were discouraged from quantifying medical data and against this backdrop alternatives to the traditional medical model could germinate and flourish.

  • Andrew Taylor Still
    Born in 1828, Still was the son of a physician and a Methodist minister. He suffered from chronic headaches and noticed that after falling asleep with his head wedged between the roots of an oak tree his headaches were completely relieved.
    From this original observation, along with others, he developed a theory whereby the bodies health could be maintained using a combination of manipulative therapy and magnetism (magnetism in this case being generated by the therapists body - a concept derived from the work of the Austrian physician Franz Anton Mesmer).
    In clinical practice Still called himself the lightening bone-setter, and in 1892 he established the American Osteopathic College in Kirksville.

  • Daniel David Palmer
    Born in Canada in 1845 Palmer was a 'natural healer' interested in the effects of magnetism on the bodies continuing health.
    Whilst working in this field he was consulted by a builder who had gone deaf after lifting a heavy object and subsequently hearing a pop in his neck. Palmer noticed that a vertebra appeared to be out of alignment, and thrust upon this vertebra, reportedly bringing about an immediate improvement int he patients hearing.
    The seed of chiropractic adjustment was sown.
  • Mennell and Cyriax
    The birth of modern physiotherapy can possibly be said to originate with the work of these two families. In the UK the ideas discussed above were largely met with scepticism by the medical establishment.
    However James Mennell (1880-1957) a medical officer at St Thomas' Hospital and a physical therapist named Edgar Cyriax (1874-1955) eagerly endorsed them.

    Their work was carried on by their respective sons - John Mennell and James Cyriax. Cyriax the younger qualified in medicine at St Thomas' in 1929 and became passionate in his chosen field. When asked if he believed in God he replied "I believe in Orthopaedic Medicine."
    His greatest gift to the physiotherapy profession is his Textbook of Orthopaedic Medicine Vol 1, originally published in 1954. In this book he laid the foundation of a method of logical, clinically-reasoned, differential diagnosis which he called 'selective soft tissue tensioning testing.'
    This was what he most wanted to be remembered for. Eminently quotable: "Every patient contains a truth - the (clinician) must adopt a conscious humility, not towards the patient, but towards the truth concealed within the patient;"
    "All pain has a source. All treatment must reach the source. All treatment must benefit the lesion." His private consulting suite was visited by many high-profile figures of his generation including Enoch Powell, John Profumo, Oswald Mosely and the actor Anthony Quinn. He thrived on hard work but always remained somewhat outside the mainstream.
    He scoffed at the idea of clinical trials and would expound "If you want proof that it works just ask my patients."
    He passed away in 1985 and is buried in Hampstead Cemetery. He is sorely missed by large sections of the physiotherapy community today.