Can Manual Therapy Alone Offer Sustainable Pain Relief?
Manual therapy is a term used to describe most techniques Chartered Physiotherapist do with their hands. There are techniques which are taught to us 'Physio’s' at University which take a lot of practice to perform correctly and effectively.
- joint mobilisation and manipulation
- soft tissue release techniques
Joint manipulation techniques are the ones which give a satisfying cracking noise. The noise itself is thought to be the nitrogen gas coming out of solution within the fluid which bathes the joints – a bit like opening a can of coke. It’s not the noise however which determines if the techniques will be successful but more likely, the force and direction of movement with which it is applied.
So, what type of physical problems respond best to manual therapy techniques?
There is a general perception that Physiotherapy is all about hands on treatment and this is the way to fix everything. However, this is not necessarily the case.
Let’s take someone with back pain for example
Manual therapy is more likely to offer relief if there is a physical restriction to movement which is often associated with pain and a loss of function. The term ‘mechanical’ back pain is used to describe a situation where the pain comes on with a particular movement, or on getting into a certain position and then eases when one moves out of this position. Normally the movement concerned is restricted in terms of how 'much' movement is available, as well as the quality or ‘smoothness’ of the movement.
In this situation manual therapy can be useful to facilitate a greater ‘range’ and quality of movement while at the same time providing an ease in pain symptoms. There is a catch though. As good as manual therapy can be, the effects in restoring movement have been found in research studies to be temporary. As a result, we need to look at manual therapy as a way of facilitating behavioural change, that is providing pain relief and restoring movement while at the same time addressing what caused the problem to begin in the first place.
In this way the chances of longer lasting, if not permanent relief, are much more likely. In addition the movement restored with manual therapy may be maintained with therapeutic exercise – which is why we physio’s keep harping on about doing your exercises!
‘But my Chartered Physiotherapist also likes to use medical acupuncture, why is this?’
The reason is that clinically we find medical acupuncture or dry needling techniques (painless if done properly) help reduce muscle activity or ‘tension’ which can allow for better manual therapy to be applied to the underlying joints. For this reason we often start with acupuncture in preparation for manual therapy and ultimately exercise. The foundation of effective treatment begins with a thorough assessment and diagnosis of the problem at the outset. Following this and with a clear understanding of the pathology, an integrated approach leveraging a combination of manual therapy, medical acupuncture and therapeutic exercise such as Pilates, is more often than not the best approach to effective and sustainable pain relief.