A Good Response To: “Manual Therapy Sucks”
Not too long ago, we did a post about how manual therapy actually works (as opposed to many of the narratives offered in continuing education).
While we know manual therapy can be a very helpful component in helping people dealing with pain, we still see some opposition to this once in a while.
We see people making some bold statements like:
“manual therapy sucks” or
“exercise is the only thing that works.”
In reality, neither of these things are true but using both in treatment will likely give you better outcomes than just one as a singular intervention.
Putting The Human Back In Human Touch
For the past few years, the manual therapy field has paid a lot of attention to the biopsychosocial aspects of pain management.
However, it almost seems like manual therapy has taken a back seat to other interventions like exercise (which I’m a big fan of using in treatment).
But is this the best approach for us to take?
A great new paper¹ outlines several reasons why it is still REALLY important for us to use and incorporate manual therapy into treatments and fortunately, there are a number of things I never thought of.
Firstly, think about the aspects of your clinical encounter when a patient comes to see you, especially when it’s the first time.
Usually, we would start with some orthopedic tests and a good conversation. Part of what is happening during this time is demonstrating your clinical competence
Your hands-on movement of an injured area shows not just that you know what you’re doing, but it also demonstrates compassion and humanizes the treatment for the person receiving it.
This also helps us set up treatment boundaries where we find out what the person is comfortable with while creating a safe space. While it is very important for us to set up our clinical encounter with people to create that safe space (and to show your clinical competence) there are some other really important aspects to touch that are invaluable in helping a person with pain.
Ever hit your shin on the side of a coffee table and then rub it incessantly like Peter Griffin in family guy (obviously after you’ve sworn at the table!)?
Well, there’s a reason we do this because touch feels really good!
There is a pain modulation that happens with touch that feels good. While there are other techniques we use that do things like distraction to take attention away from a painful area, good touch actually helps to downregulate pain signals through various fibres and pathways that are mediated at the brainstem.
When touch is delivered in a therapeutic setting, it prepares the brain for touch which stimulates C-Tactile fibres which set things up for a positive therapeutic experience. This promotes positive feelings like safety and relaxation while also reducing things like avoidance behaviours and stress.
Now because this is an empathetic touch it helps remove some of the psychosocial barriers that contribute to a person’s pain experience.
We have seen over the past few years how when a person dealing with persistent pain can experience a misrepresentation of how their body actually feels and what it experiences.
Turns out a therapist’s touch can help in this regard as well.
Just by putting our hands on people, we can help to change a person’s body perception by helping to reorganize mental representations of their body. This helps a patient be able to discriminate between safe and threatening stimuli while also showing how their body isn’t damaged.
This also helps to reduce stress, anxiety, and avoidance behaviours around pain.
Does This Mean Our Touch Is Enough?
There are certainly times when someone just needs a good old delicious feeling massage and there is certainly NOTHING wrong with that.
If we have those people (say nurses or other first responders for example) who aren’t necessarily dealing with an injury and are using us as part of a wellness plan, then by all means give them that delicious massage.
However, when we have those individuals who are dealing with an injury say from a car accident, workplace, sports, or some other type of injury we need to incorporate more than just hands-on into the treatments.
We still need to follow the best guidelines for MSK care and provide education, reassurance, movement…and of course some massage. While a lot of what we do in treatment is communicating with our hands, our communication verbally is still a really important part of the therapeutic experience. This paper ¹ points out how this should also be a responsibility of educators and students alike to veer away from the biomechanical constructs of communication to include the person’s emotional experiences as well when we talk to them. While I will always be an advocate to include exercise and movement into our treatments, it doesn’t mean we need to abandon manual therapy (as some would like to promote) and strictly adhere to an exercise-only program. It’s quite the opposite. To be a better therapist and have better outcomes with our patients, let’s not throw the baby out with the bathwater as it were, let’s include education, movement, and massage. The more well-rounded we are as therapists and the more well-rounded our delivery, the better it is for the people who come to see us. As for those who say manual therapy sucks…well…this paper proves that wrong. There is still a really important place for that delicious feeling massage.
- Geri T, Viceconti A, Minacci M, Testa M, Rossettini G. Manual therapy: exploiting the role of human touch. Musculoskeletal Science and Practice. 2019 Dec 1;44:102044.
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