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Home » Blog » Manual Therapies Make Space

Manual Therapies Make Space

Posted by Matt on Mar 10, 2016 in Blog, Featured | 0 comments

At this point there is very little (if any) compelling evidence that massage or other manual therapies can heal, fix, or cure anything. I’m not saying that manual therapies are ineffective or unwarranted, but research thus far shows that manual care alone produces only short term changes. Despite their short term nature, these changes can be extremely valuable if leveraged correctly. This understanding can help set reasonable expectations and produce more favorable outcomes for everyone involved.

Making Space

I like to conceptualize the effects of hands on care as “making space.” People who seek massage or other manual therapies are typically having some kind of unpleasant experience they would like to distance themselves from, overcome, or adapt to. Because the application of skilled touch can provide short term pain relief, improvements in mood, reduced muscular tension, and improved range of motion, manual therapies can often create a sort of buffer from some of the factors that influence these experiences.

Making Space as Time Takes its Course

A great deal of common aches, injuries, stiffness, and other stressors will get better over time without intervention. While the nature of different conditions certainly influences the recovery period of these events, even some rather complicated disorders improve at about the same rate with or without treatment. The goal of manual therapy here is not to alter healing, but to make the natural process feel easier and more comfortable.

Making Space for Change

It can be difficult to make changes in your life when you’re stressed, depressed, and in pain. Sometimes even a little bit of distance from these experiences can help you sleep better, think more clearly, and get a better perspective of what might be contributing to your current circumstances. Using this space to reflect upon your habits, beliefs, and behaviors is a wonderful way to make changes in your life. In this way manual care may help to facilitate the ability to change, but it is the changes a person makes on their own that lead to lasting improvements.

Similarly, manual therapies in physical rehabilitation can frequently provide pain relief and increased freedom of movement, which are helpful to get people moving with more comfort and confidence. These effects are valuable to demonstrate that symptoms can be changed, which can alleviate fears, strengthen the therapeutic alliance, and open the door for conversations about other factors and activities that can be modified to create further change. And research does suggests that physical therapists who employ manual therapy within a systemic reasoning process often achieve superior outcomes for their patients even in the longer term. However, manual care does not make any lasting changes to the body on its own. The true value in rehabilitative medicine is most commonly found in movement and behavioral interventions that provide changes to the local tissues and/or the nervous system, and can be done at little cost without the continuing reliance on a health care provider.

Making Space When Change Isn’t Possible

Our collective knowledge of the medical sciences is the best it has ever been, but there are (unfortunately) still a number of diseases and disorders for which there is no known effective treatment. Other conditions may have available treatments, but are so demanding that they preclude other activities. While it’s imperative that appropriate medical care and self-management strategies are provided for the people who are affected, these people are often stressed, tired, and in pain and can improve their quality of life with additional care. Skilled touch can safely be applied to cancer patients, those with chronic conditions, as palliative care, and much more. Having some space can allow these people to confront their challenges with increased flexibility and renewed fortitude. Even though the relief from touch is temporary, it can make a world of difference and its value should not be underestimated.

Making Space as Risk Management

Stress, anxiety, and depression are all present in the development and maintenance of numerous types of pain, injuries, and chronic conditions. Current research suggests that interventions targeting many of these mood-related psychosocial factors can mitigate the prevalence and course of at least some of these conditions, and that manual therapies [massage in particular] consistently demonstrate positive effects across many of the same mood-related dimensions that have been identified as modifiable risk factors. Similar stress buffering effects from social touch have already been well established in other primates. So,while it hasn’t been studied directly, it is both plausible and possible that receiving some sort of regular hands on work could reduce the risk of developing some types of pain, injuries, and/or other conditions.

Exercise also shows similar effects in mood-related experiences and offers a great deal of additional health benefits, so the importance of regular physical activity and other healthy habits must be stressed. However, it has been my experience that some of the people who are the most physically active (like athletes) could use a bit of extra time to decompress and do nothing. Maybe a chance to rest helps manage the loads imparted on a person’s body or maybe the effects of exercise combine with the effects of manual care for a greater total benefit. Additionally, athletes who receive hands on care often report their activities of choice feel easier and/or they fatigue less quickly. This may influence the risk of injury because a good deal of injuries are associated with impaired focus and fatigued conditions. It’s very important to note that although these ideas are derived from related research, they’re still purely speculative for the time being. For whatever the reason, a great deal of people across domains seem to report similar experiences of being more resilient when receiving regular hands on care.

Risks

Manual therapies as whole carry exceptionally little risk of physical harm, especially when compared to a great deal of other treatment methods. Though manual care does not carry the dangers associated with many medications or invasive procedures used for similar conditions, manual therapies can still have the potential to convey messages of false hopes, incorrect beliefs, and dependence. This is a particularly dangerous and costly combination that has people running to their provider of choice every time they have something go slightly awry for fear of catastrophe. People who seek manual care are likely those who will see the most benefit from it, but this can make it easier for the same people to become trapped in a dependent relationship with providers. Additionally, many with difficult persistent conditions can spend a great deal of time and money on practitioners who promise to fix, cure, or heal them with no lasting results. These risks are real and serious, but can be addressed with appropriate education and honest conversations.

Caveats and Future Considerations

I should note that there is some very interesting research that is being done with animal models and in vitro on the mechanical and cellular effects of certain manual therapies. Some of this work demonstrates effects on scarring, adhesion, and inflammatory mediators. However, it’s important to understand that in vitro studies and animal models often do not translate into similar results in humans.  I am watching eagerly to find out what influence (if any) manual therapies might have in the healing and prevention process.

Closing Thoughts

Touch is healthy and beneficial for a great deal of people for wide variety of reasons, but we must also understand its risks and limitations. Massage and manual therapies are not applicable to all situations, nor should we expect any single method of care to be. However, when manual therapies are used responsibly by well informed providers, clients, and patients there is a great potential for the reduction of human suffering.

References:

A Meta-Analysis of Massage Therapy Research

A meta-analytic review of the hypoalgesic effects of exercise

A note to the musculoskeletal physiotherapist

A Process model in Manual and Physical Therapies: beyond the structural model

Adverse events and manual therapy: a systematic review

Adverse Events of Massage Therapy in Pain-Related Conditions: A Systematic Review

Analgesic effects of manual therapy in patients with musculoskeletal pain: a systematic review

Are depression, anxiety and poor mental health risk factors for knee pain? A systematic review

Balancing “hands-on” with “hands-off” physical therapy interventions for the treatment of central sensitization pain in osteoarthritis

Can anxiety damage the brain?

Clinical effectiveness of manual therapy for the management of musculoskeletal and non-musculoskeletal conditions: systematic review and update of UK evidence report

Common link functional somatic central sensitisation

Comparing the Effects of Self-Myofascial Release with Static Stretching on Ankle Range-of-Motion in Adolescent Athletes

Course and prognostic factors for neck pain in the general population: results of the Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders

Deep friction massage to treat tendinopathy: a systematic review of a classic treatment in the face of a new paradigm of understanding

Deep transverse friction massage for the treatment of lateral elbow or lateral knee tendinitis

Depression and anxiety as major determinants of neck pain: a cross-sectional study in general practice

Depressive Symptoms, Anatomical Region, and Clinical Outcomes for Patients Seeking Outpatient Physical Therapy for Musculoskeletal Pain

Does nonsurgical treatment improve longitudinal outcomes of lateral epicondylitis over no treatment? A meta-analysis

Effect of Physical and Academic Stress on Illness and Injury in Division 1 College Football Players

Enhanced Therapeutic Alliance Modulates Pain Intensity and Muscle Pain Sensitivity in Patients With Chronic Low Back Pain An Experimental Controlled Study

Exercise for depression

Exercise for treating fibromyalgia syndrome

Exercise therapy for chronic nonspecific low-back pain

From acute musculoskeletal pain to chronic widespread pain and fibromyalgia: Application of pain neurophysiology in manual therapy practice

Hands on, hands off? The swings in musculoskeletal physiotherapy practice

Immediate effects from manual therapy: much ado about nothing?

Impact of Psychological Factors in the Experience of Pain

Individual expectation: an overlooked, but pertinent, factor in the treatment of individuals experiencing musculoskeletal pain

Influence of symptoms of depression and anxiety on injury hazard among collegiate American football players

Long-term changes in musculoskeletal pain sites in the general population – The HUNT study

Lessons from a trial of acupuncture and massage for low back pain: patient expectations and treatment effects

Manipulation Does Not Alter the Position of the Sacroiliac Joint – A Roentgen Stereophotogrammetric Analysis

Manual therapy and exercise for neck pain: A systematic review

Manual Therapy: Process or Product?

Manual therapies in myofascial trigger point treatment: a systematic review

Massage induces an immediate, albeit short-term, reduction in muscle stiffness

Massage therapy has short-term benefits for people with common musculoskeletal disorders compared to no treatment: a systematic review

Mechanotherapy: how physical therapists’ prescription of exercise promotes tissue repair

Mental Health Has a Stronger Association with Patient-Reported Shoulder Pain and Function Than Tear Size in Patients with Full-Thickness Rotator Cuff Tears

Nonspecific Treatment Effects in Pain Medicine

Opioids for chronic noncancer pain: A position paper of the American Academy of Neurology

Pain relief by touch: A quantitative approach

Patient expectations of benefits from interventions for neck pain and resulting influence on outcomes

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Psychosocial factors and risk of chronic widespread pain: An 11-year follow-up study—The HUNT study

Psychosocial Factors and Sport Injuries: Meta-analyses for Prediction and Prevention

Psychosocial influences on low back pain: why should you care?

Reciprocal Relationship between Pain and Depression: A 12-Month Longitudinal Analysis in Primary Care

Resistance training in musculoskeletal rehabilitation: a systematic review

Sports massage: A comprehensive review

Strength training alone, exercise therapy alone, and exercise therapy with passive manual mobilisation each reduce pain and disability in people with knee osteoarthritis: a systematic review

Symptoms of Depression and Risk of New Episodes of Low Back Pain A Systematic Review and Meta-Analysis

On the (f)utility of pain

The burden and determinants of neck pain in the general population: results of the Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders

The effectiveness of soft-tissue therapy for the management of musculoskeletal disorders and injuries of the upper and lower extremities: A systematic review

The Effects of Manual Therapy on Connective Tissue

The effects of self-myofascial release using a foam roll or roller massager on joint range of motion, muscle recovery, and performance: a systematic review

The frictional properties at the thoracic skin-fascia interface: implications in spine manipulation

The Influence of Expectation on spinal manipulation induced hypoalgesia – an experimental study in normal subjects

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The Modernisation of Manipulative Therapy

The Role of Descending Modulation in Manual Therapy and Its Analgesic Implications: A Narrative Review

The Role of Psychosocial Processes in the Development and Maintenance of Chronic Pain

The social role of touch in humans and primates: Behavioural function and neurobiological mechanisms

The traditional mechanistic paradigm in the teaching and practice of manual therapy: Time for a reality check

The Value of Massage Therapy in Cancer Care

There’s Something About Passive Movement…

Three-Dimensional Mathematical Model for Deformation of Human Fasciae in Manual Therapy

Touch inhibits subcortical and cortical nociceptive responses

Understanding and Approach to Treatment of Scars and Adhesions

Why do ineffective treatments seem helpful? A brief review

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No information here is intended to diagnose, treat, or cure any medical condition. I am not a doctor, dietitian, or physical therapist nor do I claim to be. Please seek immediate medical attention from a licensed health care professional for all medical conditions.

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