Manual medicine and orthopedics

Manual medicine (MM) is a manual medical technique to identify and treat reversible dysfunction especially of the musculoskeletal system. The origins of MM were derived from empirical observations but MM is nowadays based on anatomy, biomechanics and neurophysiology. Besides special training in palpation according to precise topographic anatomic knowledge, the diagnostics of segmental or articular dysfunction are also based on knowledge about afferent convergence of multiceptive neurons located in proprioceptive and nociceptive layers of the brain stem and spinal cord. This leads to activation of motor and sympathetic reactions with the consequence of segmental or regional dysfunction. Manual therapy aims to eliminate noci-afferents as well as to activate inhibitory receptive fields. This can be achieved either by a single high velocity manipulative impulse or by slow-soft rhythmic repetitive mobilization. The special medical education and training in MM is outlined in relation to the Bologna postgraduate concept. As MM is basically used in relation to the musculoskeletal system it should definitely be incorporated into the specialization for orthopedics and traumatology and become part of the examination. In outpatient medicine an orthopedic and trauma surgeon without MM expertise will be inferior to a general practitioner with this expertise.