Manual Therapy?
nothing to lose but pain
Massage lowers the levels of stress hormones and relieves muscle tension.
Do you have chronic neck or back pain? Does your neck, back, or large joints pop, crack, catch, give out or lock up on you? Do certain positions make your pain better or worse? Does your pain come and go, especially with certain activities or movements? Are your shoulders or hips lower on one side? Do you have problems with just one of your feet or one knee?
If the answer is yes, then you may have a mechanical/structural problem causing your pain. In other words, your spine or joints may not be in proper alignment. To correct the problem, you need some form of manual therapy or manipulation.
Unfortunately, your doctor may not know about this treatment. MDs have very little training to recognize, diagnose, or treat misalignment problems. As a result, many conventional treatments and surgeries are performed that are not beneficial because the actual underlying problem is misalignment, which is not addressed. It is regrettable because these can be some of the easiest problems to correct.
In fact, besides spine problems, many people don’t realize that foot, ankle, or knee problems can be caused by spine misalignment, which places unequal pressure on one side of the lower body. Most doctors simply treat the joint, but do not address the underlying cause, resulting in recurrent problems.
If you have any of the symptoms listed above and/or conventional treatments have not helped, it is worth your while to see a manual therapist, but there are many different types and forms of manual therapy, which can be quite confusing.
First, there are two basic types of manual therapy: osseous (involving bones, joints, ligaments) and soft tissue (muscle, fascia, tendons).
For osseous conditions, chiropractic and osteopathic manipulation are the most familiar. Chiropractic is the most common, usually involving a high velocity thrust maneuver (‘popping’ the spine), although there are other techniques such as using an activator or special tables or machines to move the spine elements. Research has shown that chiropractic is beneficial primarily for acute (recent) injuries and pain as well as for headaches caused by neck problems (called cervicogenic headaches). You should obtain initial improvement within six to twelve treatments for such conditions. If not, further testing or another therapy should be considered.
Chiropractic has not been proven to be beneficial for chronic neck and back pain, although some patients do respond well. Many patients, however, may obtain relief for only a few hours or days. If this occurs, a different type of manual therapy or another type of treatment should be considered. You should be wary of chiropractors who require pre-payment or who tell you that it will take dozens of treatments or numerous months before you obtain benefit. Chiropractic has also not been proven beneficial for treating non spine-related medical conditions. Although side effects and complications are rare, chiropractic should be avoided in certain spinal conditions, such as ruptured discs.
For chronic neck and back pain, osteopathic techniques may be a better choice. Although some high velocity thrusting is occasionally performed, osteopathic manipulation is usually gentler, using resistance techniques to move structures into correct alignment. These types of adjustments may require more time, often 45 minutes to an hour.
Osteopathic includes additional techniques such as cranial-sacral work and myofascial release and is indicated for rib and pelvic dysfunctions, as well as TMJ syndrome. In general, osteopathic techniques should provide initial benefit within two to eight treatments although occasional additional adjustments may be necessary for maintenance every few months or yearly.
The main problem with osteopathic is that there are very few practitioners. Osteopaths or physical therapists perform only 4% of osseous manipulation; chiropractors perform the other 96%. In fact, most osteopaths do not perform manipulation. A small percentage of chiropractors are trained in osteopathic techniques.
For any type of osseous manipulation, it is also advisable to obtain treatments close together if possible (a few days apart), especially when starting treatment. If the treatments are performed too far apart, the spine can go back out of place and the practitioner must start over.
For soft tissue manipulation, therapeutic (healing) massage is the treatment of choice, but there are numerous forms of massage, including Shiatsu, Swedish, Sports, Trigger Point, as well as acupressure, reflexology (using acupressure points on the feet) and Chinese massage (called Tui Na). Different types help different conditions and you simply need to find the type that helps you the most. Massage has been studied extensively and benefits a variety of conditions in addition to pain. It is even beneficial in helping premature infants mature more rapidly. Studies show that massage increases levels of serotonin, a chemical substance in the brain that is low in many conditions, such as depression. It also lowers the levels of stress hormones and relieves muscle tension.
The problem with massage is that its benefits are most often only temporary. Nevertheless, it can reduce pain symptoms and help you feel better, so it is worthwhile.
There are a few other types of manual therapy, categorized as bodywork. These techniques use various combinations of manipulation but also attempt to re-balance and/or re-program the body. Such techniques include Rolfing, Feldenkrais, Alexander, and Trager. Each requires specialized training to be a practitioner and can be very effective in treating and resolving difficult spine, joint, and muscle conditions.
The experience and skill of the practitioner is very important in obtaining benefits from any manual therapy. Make sure the practitioner is certified, especially in the more complicated or aggressive forms of therapy. It always helps to ask others who have found benefit from a particular practitioner.
Manual therapy definitely can be very beneficial for many musculo-skeletal conditions and should be considered before undergoing invasive injections and surgeries. Since these therapies can provide beneficial results in a short period, you have nothing to lose but the pain.
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"Manual Therapy?
nothing to lose but pain"
authored by:
Dr. Altshuler graduated magna cum laude from Duke University in 1972, and received his medical degree from the University of Oklahoma School of Medicine in 1976. A board certified Internist since 1979, he founded the Balanced Healing Medical Center,...
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