Dedicated to holistic health excellence.


Mailing Address:

767 River Road
Mexico, ME 04257

Office Locations:

767 River Road
Mexico, Maine 04257

184 Webster Street
Lewiston, Maine 04240

Please call for an appointment.

Integrated Manual Therapy . . . 1

Manual Therapy Techniques . . . 2

Strain & Counterstrain . . . 1

Myofascial Release Technique . . . 2

Muscle Energy Technique . . . 3

Visceral manipulation Technique . . . 3

Manual Lymph Drainage . . . 3

Cranial Osteopathy or Craniosacral Therapy . . . 4

Advanced Therapeutics

Specializing in Chronic & Acute Pain

Tammy R. Mawhinney, LMT

Integrated Manual Therapy — Newsletter No. 1


Integrated Manual Therapy refers to a group of therapeutic techniques, many of which were developed by osteopathic physicians. These techniques address the different systems within the body and treat the problems found within each system.

Integrated manual therapy uses a multiple systems approach in which each system is assessed, differentially diagnosed, and treated with the most appropriate combination of techniques. Patient evaluations are performed using general observation of movement patterns with walking. A history intake is performed, asking about previous injuries, illness, disease, ailments, and habits. Static postural evaluation is also observed looking for forward head posture, protracted shoulders, locked knees, flat feet, and so on. Range of motion of the applicable area is assessed. Palpation techniques are utilized to evaluate tender points, stiffness of joints,

The systems assessed and treated with manual therapy include:

  • Connective Tissue or Fascial System
  • Muscular System
  • Visceral System
  • Nervous System

The techniques or modalities that are the basis of manual therapy include:

  • Fascial Release
  • Strain Counterstrain
  • Manual Lymph Drainage
  • Muscle Energy Technique
  • Visceral Manipulation
Advanced Therapeutics Newsletter   p.2

Manual Therapy Techniques

Much of manual therapy is comprised of direct and indirect techniques. Direct techniques like muscle energy load the direction of movement toward the least mobile, most restricted, most limited area. At the muscle barrier a technique is performed, and the result is a change of the position of the barrier, closer to normal range of motion. Indirect techniques, like strain / counterstrain or positional release therapy, unload or ease the tissue or structure in the direction it most wants to go. The tissue is moved away from the barrier, on one or more planes. The distortion is therefore exacerbated and the problem is exaggerated. The result would be a "release" phenomenon when the soft tissues "let go" allowing increased range of motion past the original barrier.

Strain and Counterstrain or Positional Release Technique

Strain counterstrain or positional release therapy is an indirect technique developed by Lawrence Jones D.O. in the early 1950's. It is a technique for removing spasm from the muscle and fascial system. The spasmed muscle is held in a passive contracted state for ninety seconds. This engages the myotatic reflex arc placing the muscle spindles within the muscle in a slackened position. Thus the nerve stimulation from the muscle spindle to the spinal cord is reduced, stimulation from the spinal cord to the muscle is also decreased allowing elongation and relaxation of the muscle. Tender points help determine which muscles require counterstrain. When the tender point is not present, as with some chronic pain and or neurologic patients, the mechanical model is used. If the position is held for two or three minutes a fascial release will occur. Thus we know that by holding a muscle in a nonresistant contraction we can attain relaxation and elongation of the muscle, and if we continue to hold a fascial release will occur. In recent years this technique has been further developed in include arteries, veins, organs, and lymph vessels.

A person's health can be judged
by which they take two at a time . . .
stairs or pills

Joan Welch

Myofascial Release Technique

Myofascial Release Technique addresses the continuous, contiguous connective tissue systems. There are both direct and indirect techniques for fascia that afford good results. The direct technique is a highly interactive stretch that requires feedback from the patients body to determine the direction, force, and duration of the stretch and to facilitate maximum relaxation of the fascial tissue. Myofascial release or myofascial stretching recognizes that muscles cannot be isolated from fascia. All parts of the body are covered by fascia down to individual muscle fibers. Therefore all "fascial stretching" is also stretching of muscle fiber. The indirect fascial release technique also requires feedback from the patients body. The area in question is assessed to determine where an adhesion or lesion is located. The area is then sandwiched between the hands and gentle three planer stretch is held, in the direction of ease until a release occurs. An image that works well when performing this technique is that of a large over ripe tomato with an objective of reforming the inside without damaging the skin. These techniques work well over large areas.

Advanced Therapeutics Newsletter   p.3

Muscle Energy Technique

Muscle Energy Technique or reciprocal inhibition was developed by Fred Mitchell Sr. D.O. in the late 1950's. It is a direct technique for addressing joint mobility and restoring articular balance in the skeletal system. The pelvis, spine, neck and peripheral joints, such as shoulders, knees, and ankles can all be assessed and treated with this technique. To apply this technique, the joint being treated is stacked on three planes in the least mobile direction, to the muscle barrier. The muscle barrier is the point at which the muscle fibers just start to tighten. A gentle unilateral isometric contraction is applied by the patient for six to eight seconds. After the six to eight seconds joint mobility will have improved and the muscle barrier will have changed. The joint is then restacked and the whole procedure is repeated three times. The result is increased joint mobility and better articular balance of stiff joints. The result is better posture with increased range of motion and less pain.

Visceral Manipulation Technique

Visceral Manipulation was developed by Jean-Pierre Barrel, D.O. in the 1970's and has been further developed by others since. It employs both direct and indirect techniques. The method is designed to locate and treat specific areas of deep fascial restriction within the chest, abdominal, and pelvic cavities. Good palpation skills and knowledge of anatomy are critical for identifying and treating problem areas. The procedure is based on specific placement of soft manual forces to the area of dysfunction to encourage mobility, tone, and motion of the viscera and their connective tissues. This manipulation can improve the function of the individual organs, the system that the organ functions within, and the structural integrity of the entire body. This technique addresses the mobility and motility of organs or viscera. Visceral mobility refers to movement of the organs in response to voluntary movement, or movement of the diaphragm with breathing, etc. Visceral motility refers to the inherent motion of the organs themselves. All organs should function without any restrictions. Any restriction, fixation, or adhesion to another structure implies functional impairment of the organ and a loss of range motion in the body.

Manual Lymph Drainage

Health is not simply the
absence of sickness

Hannah Green

Manual Lymph Drainage was developed by Emil Vodder, PhD. in the 1930's and has been further developed by others since. The lymphatic system is part of the immune system and works indirectly with the circulatory system. Blood leaves the heart through the arterial system and returns through the venous and the lymphatic system. Arterial blood contains oxygen, nutrients, and hormones. It diffuses through the capillary walls and becomes the interstitial fluid that provides needed substances to cells. Waste is moved through lymphatic vessels in the form of lymph and is returned to the venous blood system where it is filtered out and removed. It is when the interstitial fluid enters a lymph vessel, that its name changes from interstitial fluid to lymph. In effect the lymph system fine tunes the drainage of the interstitium and thus works to evacuate wastes and excess fluid and substances from the interstitial environment. If the lymph did not regain this fluid, the body would develop major edemas (swelling), become toxic, and death would occur. Manual Lymph Drainage is designed to encourage the flow of lymph back into the venous system. The lymph system circulates about two liters of lymph a day. Manual lymph drainage can elevate lymph evacuation to twenty or thirty liters a day.

Advanced Therapeutics Newsletter   p.4

 Restrictions in the skull
 can cause headaches
 and body pain.

Cranial Osteopathy or Craniosacral Therapy

Cranial Osteopathy was developed by William Sutherland, D.O. in the 1930's. It is used to assess and treat restrictions in sutural joint (joints where he bones in the skull meet) and to synchronize cranial impulse rhythms. Cranial impulse rhythms are subtle movements of the skull that occur by the production, circulation, and reabsorption of cerebral spinal fluid as it is manufactured in the brain. Cerebral spinal fluid circulates through the central nervous system, nourishing the brain and spinal cord. Restrictions in the skull can cause severe head aches and body pain. This technique has been used successfully to treat migraines, vertigo, TMJ, etc.

These restrictions in the skull can cause sever head aches and body pain. John Upledger, D.O. further developed this to include the meninges (the covering of the brain and spinal cord.

A complicated problem may be evaluated one system at a time, differentially diagnosed and treated with the appropriate modality.

Some of the benefits of integrated manual therapy are:

  • Removal of muscle spasm
  • Normalization of fascial tension
  • Improved joint mobility
  • Increased circulation
  • Reduced swelling
  • Decreased pain
  • Increased strength
  • Improved quality of life

Advanced Therapeutics

Tammy R. Mawhinney, LMT

767 River Road
Mexico, ME 04257


184 Webster Street
Lewiston, Maine 04240

Call for an initial evaluation to find out how Advanced Therapeutics can change your life.

Newletter No. 2   To the Top

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