5 Mechanisms of Manual Therapy vs 5 Myths
Manual therapy is an umbrella term encompassing a variety of “hands-on” techniques utilized by many different professions. Hundreds of different certifications/courses exist that incorporate some form of performing these passive interventions with the mindset that these techniques are specific and will “fix” someone’s pain. 5 Mechanisms of Manual Therapy by Cameron Faller
Given the lack of long term success with only transient changes, many clinicians have challenged the beliefs of the narrative behind what manual therapy can actually do.
Research has never supported the theories that joints can be put back into place, that muscles can be released or lengthened, or that even clinicians have the reliability of detecting certain faults/detecting the tissue “causing” someone’s symptoms.
Instead, research supports that manual therapy with the right contextual factors has a significant neurophysiological response to potentially decrease symptoms and improve mobility for a temporary time.
An article written by Bialosky et Al in 2009 described the concepts behind this neurophysiological response and why some patients respond well to manual therapy techniques.
👉The joints/muscles involved will undergo transient biomechanical effects supporting improved mobility for a short time
👉Top down inhibition will occur via decreased activation of the supraspinal regions responsible for central pain processing
👉For local tissues, you may see a reduction of cytokines and release of endogenous cannabinoids in the periphery
👉Temporal summation or conditioned pain modulation may decrease spinal activity via the dorsal root ganglion
👉Overall hypoalgesic effect via increased production of dopamine given the interaction of touch, relaxation, and other contextual factors
This is not an argument of whether manual therapy should be performed or not; that is a whole different topic in itself. This is simply a narrative challenging the current framework which a lot of manual therapists rely on and to better provide an understanding for the patients of what our hands-on techniques are actually doing.
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