Manual medicine, one of the oldest healing arts, constitutes that medical discipline in which practitioners apply their hands skillfully in both the diagnostic and therapeutic management of painful neuro-musculo-skeletal disorders and various diseases. Over time, the field of manual medicine has developed and refined its own approaches and strategies through specific, and at times unique, examination and treatment techniques. More recently, various components of the manual medicine armamentarium have been adopted by and integrated into general medical practice, as well as specialties such as Neurology, Orthopedics, Physical Medicine, Rehabilitation, Rheumatology, and Sports Medicine. At present, primarily four professional groups routinely rely on using this form of medicine in patient management, albeit to varying degrees: the allopathic and osteopathic physicians, chiropractors, and physical therapists (Dvořák et al., 2001).

Despite the high number of manipulative procedures performed every year, the number of major complications is rather low. However, when significant complications do occur, they can assume disastrous outcomes. In particular, the classic “thrust techniques,” more recently defined as the mobilization-with-impulse techniques and in the vernacular referred to as the “pop-and-crack maneuvers,” carry an inherently greater risk of potentially severe complications than the low-velocity, low-amplitude soft-tissue approaches. Thus, the techniques that are regarded as particularly risky require the practitioner considering their use to pay special attention to the indications and contraindications, within the context of the entire clinical picture. It seems reasonable to suggest that the high-risk thrusting techniques be performed exclusively by those professionals who have received adequate formal training and who have developed the particular skills necessary to perform them correctly.

In contrast, the non-thrust techniques, recently termed the mobilization-without-impulse techniques and generally referred to as the soft-tissue techniques, represent techniques that have been associated with less risk than the impulse techniques. The non-thrust techniques have found useful application in a number of fields that emphasize the functional components of the neuro-musculo-skeletal system. In particular, this is seen in Physical Medicine and Rehabilitation, and its associated physical and occupational therapeutic management approaches. For any of the manual medicine treatment approaches to be successful, it will be indispensable to obtain a precise understanding of the three-dimensional anatomy, biomechanics, neurophysiology, and pathophysiology of the locomotor system. Clinically, the practitioner is called upon to make as accurate a structural and functional diagnosis as possible before instituting the appropriate treatment technique for the individual patient.

During the past 50 years, and in particular since the 1970s, manual medicine has experienced unprecedented growth and acceptance not only by the general population but also by some of the traditionally orthodox branches of medicine. This increase may in part be attributed to the strong interest by a small group of pioneering allopathic physicians in Europe, who expanded upon the initial teachings by John Menell Sr., M.D. (Mennell, 1951) and some of the techniques brought to Europe by a nucleus of osteopathic physicians and chiropractors trained in the United States. The German term “Manuelle Medizin,” or manual medicine, which describes a series of treatment applications using one’s hands, is now the standard term used for manipulative medicine in most of Europe. The “modern” era can be traced back to the Swiss physician Nägeli (1843–1922), who described a series of “Handgriffe” (hand applications) for cervical manipulations in 1894 (Harris and McPartland, 1996). This was approximately 20 years after the introduction of osteopathy by Andrew TaylorStill, M.D. in the United States. Sollmann (1981) believes that Nägeli had been introduced to osteopathic treatment techniques through some of his Swiss patients who had gone to the United States for treatment.

Professor Robert Maigne of Paris, France, studied under Stoddard and Beal at the London College of Osteopathy, and introduced his exaggeration technique (Maigne, 1964). Another French physician, Arlen, introduced what he refers to as atlas therapy, a technique in which the patient remains in the sitting position (Arlen, 1990).

In the United Kingdom, the physician Cyriax (1904– 1985) (Cyriax, 1984) is arguably the most prominent British figure in Manual Medicine and Rehabilitation (Harris, 1993). John Mennell Sr., M.D. introduced and emphasized the importance of joint play in the examination and treatment of the synovial joints (Mennell, 1951).