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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 central 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 risk factors 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. Prior work demonstrating the effects of friction type massage on rodent tendons seemed potentially promising, but has yet to shown any significant human evidence in its favor. 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.