Manual Therapy for a Healing Touch

Manual therapies are some of the oldest types of treatments in the field of medicine. They are found in all regions of the world and are used to help alleviate pain and correct dysfunction. Touch has a long history as a natural component of healing and health maintenance. Today, we have many more options for treatment of musculoskeletal ailments, such as neck and low back pain. So, who performs these manual treatments, and how are they best incorporated into modern medical management?

Manual therapy can be provided by many types of practitioners including physicians, chiropractors, physical and occupational therapists, massage therapists, and others. All of these practitioners use a “hands-on” approach to the musculoskeletal system and can even target visceral organs as well.¹ There are certain nuances that differentiate the approaches of these manual health providers. For example, osteopathic physicians provide osteopathic manipulative therapy (OMT) which targets bony structures, soft tissues and visceral organs. Chiropractors primarily focus on the use of spinal manipulation to treat musculoskeletal conditions and can also provide manual therapy to peripheral joints and soft tissues. Physical and occupational therapists incorporate soft tissue and joint mobilization, myofascial release, and muscle energy techniques into their exercise-based treatment sessions. Finally, massage therapy treats soft tissue structures, such as muscles and fascia, and encompasses many types including acupressure, deep tissue, Swedish massage, reflexology, decongestive lymphatic therapy and myofascial release.²

Several theories exist regarding the mechanism that underlies manual therapies. Depending on the mode of treatment, there may be release and relaxation of tight muscles, increased circulation, disruption of fibrotic adhesions and greater joint range of motion.³ The receptors that conduct pain may also be altered through the use of manual therapies with the release of endorphins (aka “feel good hormones”).⁴ So, does it work? There are many studies examining whether manual therapies are effective in the treatment of musculoskeletal disorders. In our monthly journal club, we discussed a review of randomized controlled trials on the effectiveness of physical therapy including manual treatments for carpal tunnel syndrome which found moderate evidence for manual therapy to reduce symptoms in the short term and midterm.⁵ While the body of literature on manual therapy is growing, much of the research shows variable benefits which leads to the conclusion that more research is still needed in this area.

Manual therapies, such as OMT, physical therapy, and massage, can be a beneficial part of a comprehensive treatment program that also includes education, lifestyle modification and individualized exercise programs. While there is no consensus on the frequency or duration of manual treatments, it is likely best to allow the body to respond and adjust before another treatment is performed. Repeating treatments before the full benefit or lack of response is determined may cause an unnecessary continuation of treatment. While manual therapies are generally safe, there are circumstances where it is important to avoid high velocity manipulations, such as cancer or infection of the bone, spinal deformity, severe diabetes or vascular disease, and joint or ligamentous laxity.⁶

Contact our team at Desert Spine and Sports Physicians so that we can help guide you through a multi-disciplinary treatment program for your musculoskeletal pain or injury. We focus on the whole person rather than just the problem area to get you back into the game!