ROLE OF JAMES MANNELL IN MANUAL THERAPY

 INTRODUCTION; An Insight to Mennell’s Role in Physical therapy and Manual therapy

      The European physician educated their physical technician in manual therapy. Dr. James Mennell taught manipulation to Physician and Physical Therapist.

        Mennell is most known for developing and instructing therapists and physician worldwide. His system of Orthopedic Medicine emphasized clinical diagnosis and conservative management by way of mainly friction massage, exercise, manipulation and infiltration. Therapists and physicians were also educated in manual therapy at the BRITISH SCHOOL OF OSTEOPATHY as of 1920. James Mennell introduced the term Manual Therapy(MT)

        Between 1912 and 1935, Mennell served as the medical officer lecturing on massage therapy at the Training school of St Thomas’s Hospital. Undoubtly influenced by his medical predecessors Paget, Hood, and Jones, Mennell was engrossed in the use of physical means, including manual therapy, in the treatment of musculoskeletal dysfunction.

                  In 1917, the same year Littlejohn was opening the British School of Osteopathy, Mennell published his text PHYSICAL TREATMENT BY MOVEMENT, MANIPULATION AND MASSAGE. It seems more than likely that the therapist under his tutelage would have been instructed in his methods even prior to the text’s publication.

        Assisting him in his courses at St Thomas’s was a physiotherapist named Edgar Cyrix who studied Remedial Gymnastics and Massage and also studied and practiced Manipulative Therapy. In 1903 he published his own text on manual therapy based on the principles of James Mennell.

MENNELL’s CONTRIBUTION TO THE WORLD OF PHYSIOTHERAPY

1. In his published text Mennell clearly detailed how symptoms of thoracic spine origin can closely mimic true visceral symptoms.

• He thus cautioned against accepting the relief of pain through spinal manipulation as being equated with a cure of organic disease.

• He clearly advocated the use of spinal manipulation only following through examination including medical diagnostics and laboratory tests if necessary, that differentiated visceral from spinal symptoms.

• Employing differential diagnosis techniques to indicate the use of spinal manipulation would become a common denominator in both clinical practice and the teaching philosophy of Mennell.

• By the late 1890’s he was teaching therapists in the United Kingdom on how to perform spinal and extremity joint manipulations.

• James Mennell wrote a number of books on massage and manipulation. The most successful was;
• THE SCIENCE AND ART OF JOINT MANIPULATION vol.1
• THE SPINE AND EXTREMITIES vol.2

• Mennell also wrote “THERE IS NO MAGIC IN JOINT MANIPULATION, when relief of symptoms occurs it must be within the laws of anatomy, physiology and pathology. If existing laws do not cover the proven clinical facts, then those laws must be extended”.

• While some of his techniques may appear to be physically challenging many were not and used the principle of leverage

• He used then ‘new’ technology of Radiology to gain a better insight as to how normal and dysfunctional joints moved.

• Mennell was the first to used radiology to see what the techniques achieved. He was also the first to show that the manipulative “crack” causes a gas to form in the joint seen as a shadow on the radiograph.

He also proposed;

• Soft tissue differentiation
• Popularized the term ‘end feel’
• Trained physiotherapists
• Pleaded for emphasis first on evaluation and then treatment

Below I’ve mentioned a section from the published text

 JOINT MANIPULATION (UPPER EXTREMITY) by James Mennell on

February 17, 1933

   Our profession may be blamed and abused because we have not in the past made use of the art of manipulation more freely in our ministrations to the public. But critics forget that one of the most important functions of a registered body of qualified medical practioners is to shield the public from harm. No doubt many people in the past had to abandon tennis or football because of minor injuries that might have been remedied by manipulation, but this is a relatively small price to have paid, if, by our caution, we have saved others from loss of limb and possibly of life.

If however we can offer a rational explanation of what we do when we mobilize a joint , then the treatment rests on a scientific basis, and the remedy  in skilled hands, becomes safe and free from the terrible abuse and risks that so often surround administration by unqualified hands

 If we are able to treat a patient scientifically, the first essential is accurate diagnosis, and if we are called upon to make a diagnosis of any joint lesions, we must be in the first place study the movements of joint. Unfortunately, the knowledge to be gained from the ordinary anatomy text-book is altogether inadequate when we are asked to form a diagnosis of a joint lesion. From this source, for example, we learn nothing as to the movement which can be performed at joints and which are normally not under voluntary control. Yet it is, often enough, the examination of these movements that reveal the nature of these lesions within the joint, and thus points to read the cure.

MOVEMENTS OF METACARPOPHALENGEAL JOINTS—these offer an admirable study in this respect. The movements of flexion and extension are not hinge movements, for the base of phalanx glides over and round the head of the metacarpal. It will be found that throughout the movement one point on the metacarpal is always equidistant from one point on the phalanx, and these two points must of necessity be represented by the attachments of the lateral ligaments. With the metacarpal attachment as center and the ligaments as radius, the points of attachment of the ligaments to the phalanx describe a circle. The ligaments are not equally taut throughout the whole range. That this is so shown by the study of those movements that are not under voluntary control.

The first law f all osteopathic and bone-setting manipulations is , whenever possible , to apply tension. This we are free to do with all the force in our power, but only if we pull in the long axis of fibers of the lateral ligaments while using the ‘’ golf-club grip’’ . comparatively little force is safe if applied with leverage, or at an angle to the line of the fibers in ligament; very little will strain them.

As a result of tension on a normal finger it is possible to pull the joint surfaces apart. any loss of elasticity in the ligament can thus be tested, or adhesions within them can then be broken down.

A second movement which is not under voluntary control is the antero-posterior movement of the phalanx on the metacarpal. this has nothing to do with flexion and extension, it is pure antero-posterior movement. Again there is no leverage, and so the movement can be performed with vigor.

Rotation of the phalanx on the metacarpal is again not under voluntary control, and is performed by bending the distal part of the digit into a hook, and rotating the proximal bone in both directions. Now we are using leverage, so that far greater caution is needed.