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. 

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. 

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.
Melanie Clarke
Melanie Clarke
2023-02-22
We’ll be forever grateful to Chews, the guys are the absolute BEST IN CLASS when it comes to a fully tailored recovery plan. Our son is a young elite competitive acrobatic gymnast who sadly had a high impact fall at gymnastics dislocating and fracturing his elbow and needed surgery, for a gymnast that trains many hours over 4 days week it was devastating blow, especially with GB competitions coming up. Once out of cast (wk 4 post opp) we started 2 x weekly physio sessions with Richard Saxton (who specialises in child’s physio), he was thorough, diligent and his amazing assessments fully supported the coaches at our sons gym to help build a safe recovery plan. The sessions with Richard and Sanford were fun, engaging and they took great care to help improve full mobility and strength. At week 7 post op our son was doing skills we thought would have taken 4mths to achieve, by week 10 he was back to full impact training, even our hospital follow up with the senior elbow consultant was blown away by the physio support we’d had and the rapid recovery. If it wasn’t for Chews we 100% would not be back training this quickly and not have had the reassurances it was safe to do so…..we’ve definitely found a physio for life. Thank you from the bottom of our hearts Team Chews. From Mel & JJ x x
Ruth Shearn
Ruth Shearn
2023-02-21
Have waited a few months post-treatment to write a review - just to be certain! Quite simply, I can't recommend these guys highly enough. I went to them with two badly damaged knees (miniscus tears). Having had three arthroscopes over the years, I was completely resigned to needing surgical intervention again. The Chews team had different ideas. After showing me the latest research findings, they assured me my knees could be rehabilitated without a scalpel. I had just a handful of sessions with them and am delighted to report that, six months on, my knees are great! I'm running 5k twice a week (don't laugh, I loathe running and am no spring chicken) without any pain and have taken up tennis. Everyone at Chews is passionate about their subject, knowledgeable, reassuring and friendly. I wouldn't go anywhere else.
Dave Stuart
Dave Stuart
2023-02-06
I have had a chronic back condition to varying degrees for many years which more recently has forced me to have weeks off work at a time. I was recommended Chews Health by a colleague having tried other physios in the past. However, I always felt that something was missing from the plan. My back muscles would on occasion go into spasm, or my disk to impinge on my nerve, affecting my mobility and effectively setting me back to square one. I came to Chews health a bit wary and was considering surgery due to how much my back was affecting my quality of life and mental health. It has not been a straight forward recovery, but i have made significant progress through having a thorough history taken, my ongoing concerns listened to, and being provided with a clear explanation of not only the exercise plan but additionally explaining why my body was responding in varying ways. This has educated about my condition and provided me with the tools to self manage my condition more effectively should it deteriorate again.. It has not been plain sailing, but I have absolute faith in Jack and his team.
lobo
lobo
2023-01-09
I had to attend Chews Health for help with pain in my elbow and they have been a fantastic help. I am now back to 100%.
The S
The S
2023-01-05
I can thoroughly recommend Chews Health physio. Sessions from diagnosis to rehabilitation are stimulating as well as therapeutic. Jack’s holistic, insightful approach goes beyond fixing the initial problem - he builds the confidence and self-knowledge to help maintain fitness and avoid strains and niggling injuries in the future. His message that the body needs exposure to regular challenges has inspired my journey towards optimum health.
Sam Butler
Sam Butler
2022-12-21
Excellent physiotherapy. After ACL and meniscus surgery I contacted Chews Health to find out about how they could help me feel more confident about returning to more intense sport after my injury. I felt listened to and we worked on a series of different of exercises that tested my knee. Very helpful and I now feel much more confident in my abilities.
feralie Bennett
feralie Bennett
2022-11-23
I saw Richard Saxton for a chronic pain in my achillies. 2 visits, with massage and exercises: clear concise instruction, both written and verbal to do at home were realistic & adapted for my ability - I now no longer require pain relief & can walk the dogs pain free & even manage a few hills. A follow up call to review my progress was also appreciated. The clinic was clean & well equipped. Would highly recommend.
Philip Conroy
Philip Conroy
2022-11-16
When I had severe back pain I was seen within 24 hours. The problem was resolved after 3 weeks of physiotherapy and exercises. I subsequently took up the annual gym membership package which includes regular reviews by the Physiotherapists. I feel this has benefitted me greatly as I had no previous experience of gyms and ensured I was using the equipment in the correct manner. At all times the staff have been very friendly and professional.
Maureen Morris
Maureen Morris
2022-11-10
Helped me tremendously. Lovely people - everyone very very supportive.
Cecilia Wright
Cecilia Wright
2022-10-31
I had been suffering from plantar fasciitis for some months and went Chews Health in the summer for shockwave treatment, after my podiatrist said she had heard good reports about it. Until then I had been resting, exercising it, icing it, using insoles etc., none of which had made much difference. I booked six treatments at the start (recommended) and by the time of the last treatment It was hardly noticeable, so much better! I’ve had two further treatments over the last month, just to be on the safe side, and I’m doing some exercises now to build up the strength in my calf and foot. Chews Health comes with heartfelt recommendations from me, they are friendly, very knowledgeable and best of all - they have fixed my sore foot!