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Manual medicine, such as chiropractic or manual osteopathic care, may also be an important part of the integrative approach to low back pain. Both systems of medicine have developed highly specific forms of diagnosis and treatment. In addition to standard orthopedic and neurological testing, manual medicine includes a general assessment of the structure of the body and of how the body moves. These are based on palpation (use of touch in the diagnostic process) and analysis of the musculoskeletal system including joint range of motion, muscle restriction, spinal alignment and other structural problems. Applied kinesiology, the study of movement, may be used to assess how the muscles are working and to identify any imbalances. Muscular tensions will be identified and the practitioner may attempt to infer improper drainage of the lymphatic system. Although lymphatic drainage cannot be physiologically evaluated unless there is a clear physical sign of a problem (called lymphedema) or a special diagnostic test is performed, this inference is sometimes made to help develop a therapeutic plan that incorporates an integrative approach.
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