The Manipulative Prescription

The Manipulative Prescription

In the practice of medicine, it is essential that an accurate diagnosis be made before the institution of either curative or palliative therapy. When a therapeutic intervention is indicated, particularly when using pharmacotherapeutic agents, a specific and accurate prescription must be written. No self-respecting physician would make a diagnosis of throat infection and write a prescription for an antibiotic.

Diagnosis (DX)—Throat infection

Prescription (RX)—Antibiotic

The physician would seek to identify the infectious agent, either bacterial or viral, causing the throat infection. When a specific infectious agent responsive to antibiotic therapy is identified, a specific prescription would be written for the antibiotic agent. The prescription would identify the antibiotic to be used, the strength of each dose, the number of doses per day, and the duration of therapy.

In manual medicine, it is common for practitioners to be lax in their specificity for the structural diagnosis and prescription of the manual medicine intervention to be applied. Too often, a diagnosis is made of somatic dysfunction, and manual medicine is the prescription, such as:

DX—Somatic dysfunction

RX—Manipulative treatment

In manual medicine, it is just as important to know the location, nature, and type of somatic dysfunction before a specific manual medicine therapeutic intervention is prescribed. The same elements are needed for a manual medicine prescription as for a pharmaceutical agent. One wants to be specific about the type of manual medicine, the intensity, the frequency, and the total length of the treatment plan. Therefore, the manipulative prescription requires an accurate diagnosis of the somatic dysfunction to be treated and a specific description of the type of manipulative procedure, the intensity, and the frequency.

Manipulative therapeutic procedures are indicated for the diagnostic entity somatic dysfunction or the manipulable lesion.


Somatic dysfunction is impaired or altered function of related components of the somatic (body framework) system: skeletal, arthrodial, and myofascial structures and the related vascular, lymphatic, and neural elements.


  • Joint blockage

  • Joint lock

  • Chiropractic subluxation

  • Osteopathic lesion

  • Loss of joint play

  • Minor intervertebral derangements


In defining somatic dysfunction, one uses three elements:

“A” for asymmetry of form or function of related parts of the musculoskeletal system.

“R” for range of motion, primarily alteration of motion, looking at range, quality of motion during the range, and the “end feel” at the limit of movement.

“T” for tissue texture abnormality with alteration in the feel of the soft tissues, mainly muscle hypertonicity, and in skin and connective tissues, described as hot/cold, soft/hard, boggy, doughy, and so forth. Most of the tissue texture abnormalities result from altered nervous system function with increased alpha motor neuron activity maintaining muscle hypertonicity and altered sympathetic autonomic nervous system function to the skin viscera, and vasomotor, pseudomotor, and pilomotor activity.

Oct 30, 2018 | Posted by in GENERAL & FAMILY MEDICINE | Comments Off on The Manipulative Prescription

Full access? Get Clinical Tree

Get Clinical Tree app for offline access