In manual therapy, practitioners use their hands to put pressure on muscle tissue and manipulate joints in an attempt to decrease back pain caused by muscle spasm, muscle tension, and joint dysfunction (Spine Health, 2006).
Often discussions of MT (Manual Therapy), focus specifically on the ‘manual’ part of MT – the use of a practitioners’ hands with the intent to effect beneficial change in some part of a patient. However, MT is not just the application of a technique but an entire ‘process’ for patient management based on a reasoning model. MT involves not only aspects related to the interventions; for example, passive movement of a joint, but consistent with other complex interventions also includes surrounding issues related to patient management (e.g., the diagnostic process, patient/practitioner interaction, movement re-education, advice and cognitive–behavioral factors, among others) which are often influential factors for clinical improvement in patients with musculoskeletal pain (NCBI, 2015).
The International Association for the Study of Pain defines pain as “…unpleasant sensory and emotional experience that is associated with actual or potential tissue damage or described in such terms.” That definition continues: “Pain is always subjective. Each individual learns the application of the word through experiences related to injury in early life”. This suggests that as clinicians, we should not question patients perception or nature of pain, rather acknowledge that it is an individual unique experience; that is, the individual has the last word as to whether he or she is in pain or not, and what the nature and amount of his or her pain is (NCBI, 2015).
The optimal dose is also a consideration. Time per session, number of sessions, and number of weeks are all important factors for therapists and patients. Knowing the optimal treatment sessions has obvious implications on cost-effectiveness, but probably also has an impact on the effectiveness of manual therapy (BMJ Journals, 2004).
Nearly all types of manual therapy have been shown to elicit a neurophysiological response that is associated with the descending pain modulation circuit; however, it appears that different types of manual therapy work through different mechanisms. For example, while massage therapy appears to elicit an oxytocin response, spinal manipulation does not. For some therapies, such as manipulation, a minimal amount of force may be required for an analgesic effect, but whether a minimum force is required for descending inhibition to occur does not seem to be the case, as touch and placebo alone can trigger a descending inhibitory response (Hindawi, 2015).
A study was done to investigate the effectiveness and safety of manual therapy interventions on pain and disability in older individuals with chronic low back pain (LBP). Effectiveness was determined by extracting and examining outcomes for pain and disability, with safety determined by the report of adverse events. All trials were of good methodologic quality and had a low risk of bias. The included studies provided moderate evidence supporting the use of manual therapy to reduce pain levels and alleviate disability (NCBI, 2017).
Another study had a variety of conditions to treat: 13 musculoskeletal conditions, 4 types of chronic headache and 9 non-musculoskeletal conditions.
Additionally, brief references are made to other effective non-pharmacological, non-invasive physical treatments. Spinal manipulation/mobilization is effective in adults for: acute, subacute, and chronic low back pain; migraine and cervicogenic headache; cervicogenic dizziness; manipulation/mobilization is effective for several extremity joint conditions; and thoracic manipulation/mobilization is effective for acute/subacute neck pain. Spinal manipulation is not effective for asthma and dysmenorrhea when compared to sham manipulation, or for Stage 1 hypertension when added to an antihypertensive diet. Massage is also effective in adults for chronic low back pain and chronic neck pain (NCBI, 2010).
One study had a look at the combination of receiving manual therapy with active exercise for 8 therapy sessions over a four to eight-week period. The participants were also instructed to complete specific active exercises assigned to them by a skilled physical therapist. These participants displayed a greater decrease in pain immediately following treatment when compared to the other group. They also displayed less physical disability following treatment when compared (Students 4 Best Evidence, 2014).
Overall, it seems certain versions of manual therapy can be effective as forms of pain relief.
We are pleased to have Manual Therapy here at Omnia Lifestyle in Guildford. If it sounds like something you could benefit from please visit us at 54 Chertsey Street, GU1 4HD. We are situated next to Guildford Spice and at the top of the road you should be able to see the pub, The Guildford Tup. Click the link here to find us on Google Maps. https://bit.ly/2YZhfoJ
Spine Health (2006) Manual Physical Therapy for Pain Relief [Online] (Last updated 13 January 2006) Available at: https://www.spine-health.com/treatment/physical-therapy/manual-physical-therapy-pain-relief [Accessed 16 May 2019]
NCBI (2015) What effect can manual therapy have on a patient’s pain experience? [Online] (Last updated 5 November 2015) Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4976880/ [Accessed 16 May 2019]
BMJ Journals (2004) British Journal of Sports Medicine [Online] (Last updated 1 December 2004) Available at: https://bjsm.bmj.com/content/38/5/521 [Accessed 16 May 2019]
Hindawi (2015) The Role of Descending Modulation in Manual Therapy and Its Analgesic Implications: A Narrative Review [Online] (Last updated 29 November 2015) Available at: https://www.hindawi.com/journals/prt/2015/292805/ [Accessed 16 May 2019]
NCBI (2017) The Effectiveness and Safety of Manual Therapy on Pain and Disability in Older Persons With Chronic Low Back Pain: A Systematic Review. [Online] (Last updated 25 October 2017) Available at: https://www.ncbi.nlm.nih.gov/pubmed/29079255 [Accessed 16 May 2019]
NCBI (2010) Effectiveness of manual therapies: the UK evidence report [Online] (Last updated 25 February 2010) Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2841070/ [Accessed 16 May 2019]
Students 4 Best Evidence (2014) Sorting Crayons: is manual therapy an effective treatment for low back pain? [Online] (Last updated 7 January 2014) Available at: https://www.students4bestevidence.net/sorting-crayons-is-manual-therapy-an-effective-treatment-for-low-back-pain/ [Accessed 16 May 2019]
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