Manual Therapy
What is manual therapy?
Manual therapy comes in many forms and when used appropriately, can provide a variety of helpful results.
The term ‘manual therapy’ can include a range of techniques which a clinician such as a physiotherapist, osteopath, manual therapist or alternative therapist may use.
Joint ‘mobilisation.’ Physically moving the bones or tissues which form a joint in a slow and rhythmic motion with the intension of improving the joint’s ability to move or to reduce the feeling of stiffness or resistance when the joint moves. This is commonly performed on vertebra of the mid- and lower-back, wrists and ankles.
Joint ‘manipulation.’ A short and rapid movement applied to a joint. By tensioning the soft tissues around a joint and compressing the joint in a fast and direct motion, the natural gasses which rest in the joint space may be squeezed and forced out with a ‘popping’ sensation. This is the same result as is had by ‘cracking’ your knuckles. This has the effect of temporarily reducing the pressure in the joint which may improve the mobility of the joint until the joint naturally refills with gas.
Do I need manual therapy?
Manual therapy can be a helpful tool in many cases. However, it is important that when you see a physiotherapist or other clinician, that you are fully aware of the intended outcome of the sort of techniques listed above.
Much has changed in the past decade in our understanding of the direct physiological and physical impact of manual therapy, and so it is important that we do not overstate the impact or expected outcome of using various forms of manual therapy.Â
Here are a few myths that have been busted over the past decade:
Manual therapy can be performed accurately on specific tissues.
It has long been stated that clinicians have the ability to perform specific techniques on specific tissues, joints or bony structures. However, research in the past decade has investigated this very question by asking a number of clinicians to perform the same technique on a mannequin with a pressure gauge and labelled landmarks which were not visible to the clinicians. The study found that no two clinicians performed the same technique in the same way. This study has since been repeated and found the same result which has cast significant doubt over the ability for clinicians to be accurate or specific when applying manual therapy techniques.
Manual therapy and massage can improve range of movement or flexibility
Techniques such as ‘back cracking’ high velocity manipulations can, for a very short time improve joint mobility by squeezing gas out of a joint space and reducing the pressure and resistance acting on the soft tissues which cover the joint. However, this is rarely the route cause of pain or injury and therefore should only be used as an adjunct to therapy to help people feel better as part of a focused approach to rehabilitation or conditioning. These techniques should not be over-represented and be used as the primary treatment method. This is as much because of the effect they have physiologically as it is because the results are very short lived.
Manual therapy and massage can improve joint or physical alignment.
The notion that humans have a correct or can be ‘incorrectly’ aligned is false. We are all shaped differently and are all asymmetrical to an extent. For example, it is normal to have one leg longer than the other, to have some degree or curvature of the spine, for our pelvises to tip forwards. There is also no evidence that things like this cause pain or dysfunction and many people live with normal anatomical differences like these without pain. Therefore, using manual therapy to treat these findings, is likely to not get to the route of your issue, nor would it be effective in doing so if they were your issue.
Can manual therapy help me if I’m in pain?
Yes, absolutely. Even though these techniques are not long term solutions to pain or injury, they have been found and proven to have profound effect on people’s experience of pain and can be a valuable tool for reducing pain and reducing the feeling of discomfort when moving.Â
Some of the expected benefits from these types of manual therapy techniques are:
Pain relief:
Albeit short term, the benefit of therapeutic touch can be profound on a person’s experience of pain, reduce the pain of movement and offer a valuable window in which better quality movement can be achieved. This can be used to perform mobilising exercises, strength exercises and other forms of rehabilitation.
Improved quality of sleep:
Improving a person’s experience of pain and movement can be highly beneficial in helping them achieve better quality of sleep which can be a big milestone in pain and injury management. Poor sleep can be a significant driver of pain, nothing feels good when we’re sleep deprived! Getting as much good quality sleep as you can when you’re in pain can be one of the most helpful steps in making progress in the early stages of rehabilitation and manual therapy can be helpful in providing this opportunity.