Manual Therapy includes all hands-on treatments, including massage, manipulation, chiropractic, physical therapy or acupuncture. To a certain extent the human body is mechanical, and like any mechanical thing with joints and hinges, sometimes something gets stuck, and sometimes you just need to help it get unstuck. Here are some of the main types of manual therapy.
Massage is the manipulation of superficial and deeper layers of muscle and connective tissue using various techniques, to enhance function, aid in the healing process, decrease muscle reflex activity, inhibit motor-neuron excitability, promote relaxation and well-being, and as a recreational activity. Medical studies show that massage does reduce chronic neck and low back pain, and is helpful to prevent headaches and migraines.
A recent study demonstrated that massage can reduce muscular pain from over exercising, and the circulation is increased for at least 72 hours after the massage therapy. For neck pain, one-hour sessions two or three times a week appear to be best, according to Karen Sherman, senior scientific investigator at Group Health Research Institute in Seattle. There are many different types of massage and finding a therapist with an approach that benefits your condition is important.
Spinal manipulation has its roots in traditional medicine and has been used by various cultures for thousands of years. Hippocrates, the "father of medicine" used manipulation, as did the ancient Egyptians and many other cultures. Spinal manipulation gained recognition by mainstream medicine during the 1960s.
When added to ‘best medical care’, spinal manipulation reduces chronic back pain and improves back function. Large medical studies indicate spinal manipulation/mobilization is effective in adults for: acute, subacute, and chronic low back pain; migraine and cervicogenic headache; and cervicogenic dizziness. Manipulation/mobilization is effective for several extremity joint conditions; and thoracic manipulation/mobilization is effective for acute/subacute neck pain.
In North America spinal manipulation is performed by chiropractic (DC), osteopathic (DO) and naturopathic (ND) physicians, and to a lesser extent by physical and occupational therapists. Chiropractors probably perform 90% of the low back manipulations in this country and they often use the term “adjustment” in place of manipulation which is a reflection of their specific philosophy. Dr. Andrew Still, the founder of osteopathy stated his belief in the efficacy of manipulation by comparing it to massage with the following statement:
“Massage is like the warm poultice of the nurse;
manipulation is like the keen scalpel of the surgeon.”
Acupuncture is the stimulation of precisely defined, specific acupoints along the skin of the body involving various methods such as the application of heat, pressure, or laser or penetration of thin needles.
Classically, in clinical practice, acupuncture is highly individualized and based on philosophy and intuition, and not on controlled scientific research. The number and frequency of acupuncture sessions vary but most practitioners don't think one session is sufficient. In the United States, acupuncture typically lasts from 10 to 60 minutes. Sometimes needles are left in the ear for up to 3 days.
In recent years acupuncture has been the subject of many studies. Acupuncture increases endorphins and is effective for chronic low back pain and works even better when added to other therapies. Acupuncture is also used extensively for headaches, neck pain, bursitis, arthritis, shoulder pain and tendonitis.
Physical therapy involves the treatment of medical problems, illnesses, or injuries that limit the ability to move and perform functional activities. Physical therapists use specific exercises, manual therapy, education, manipulation and other interventions.
A 2012 systematic review found evidence to support the efficacy of spinal manipulation administered by physical therapists to patients. The same review found that physical therapy spinal manipulation seems to be safe and improves the outcome for individuals with low back pain.
In this country it is standard practice for orthopedic surgeons to refer to physical therapists and those two professions tend to work together very closely. Physical therapists generally have better insurance coverage than chiropractors and most take medicare and medicaid.
Who can help my pain the most?
There is no easy answer to that question. Most chronic pain patients would benefit from any of the therapies discussed above. But which one would help the most? The one you are willing and able to go to. If we send you to a chiropractor and your insurance won’t cover it and you can’t pay out of pocket, you aren’t going to get any benefit. What's the use of sending you to an acupuncturist if you are afraid of needles and won’t go?
How much benefit will I get from manual therapy?
Acute pain is easier to treat than chronic pain and is outside the scope of this article. For patients with chronic pain, which is much more difficult to treat, a well selected course of manual therapy should produce at least a 10% reduction in pain, with 20-30% being more typical and 50% not unheard of. Almost all patients with chronic pain will benefit significantly from manual therapy and the focus should be finding a manual therapist that you can see periodically. In most cases, manual therapy will not replace the need for pain medicine or aerobic exercise, but will help you to feel much better, have less pain and experience a higher quality of life.