Manual Therapy Doesn't Do What I Thought It Did!

Manual therapy doesn't do what I thought it did and probably not what a lot of people think it does either.

Does it really matter if the explanation is correct?

For me, that's a tricky question. Yes, to a point it matters. As therapists, I think we have a responsibility to give explanations that reflect the best evidence we have. But for many people receiving treatment, the exact explanation isn't the most important thing. What does matter is that we don't create the belief that someone needs manual therapy to get better.

For years, manual therapy including massage has been explained as a way to remove toxins, break down scar tissue, get rid of those dreaded "knots", increase circulation or even "iron out" tight muscles to correct a physical problem.

While it's true that massage slightly increases blood flow to the skin (that's why your skin goes red), that's probably not the reason people feel better afterwards. We aren't melting tissue, breaking up knots or physically changing muscles in the way we once believed.

Instead, it's becoming increasingly clear that manual therapy is interacting with one of the body's most important systems, our nervous system. Our nervous system is constantly taking in information and deciding whether we are safe or whether we need protecting. Pain is one of the ways it protects us, but pain isn't always a sign that damage is occurring. Sometimes the nervous system becomes overprotective, particularly if pain has been around for a long time.

This is where I think manual therapy has an important role.

Rather than trying to "fix" tissues, manual therapy may help provide the nervous system with reassuring information. Combined with movement, it can be an opportunity to show the brain that a movement or position is safe again. As the nervous system becomes less protective, movement can become easier and less painful.

This is one of the reasons I like to combine massage with movement whenever it's appropriate. That movement might be something you're doing yourself or something I'm guiding you through. It doesn't have to be big or difficult especially if you've been living with pain for a long time. Often, small, comfortable movements are exactly what's needed.

Of course, not every massage needs to involve movement. If your goal is simply to relax and unwind, then a relaxing massage is exactly what you need. There are no hard and fast rules because every person is different, every nervous system is different, and every treatment should be tailored to the individual.

For me, manual therapy is less about changing tissues and more about creating an opportunity for the nervous system to feel safe enough to move with more confidence again.

Now to the idea of how much pressure we really need and whether massage has to hurt to work! That's a rabbit hole I'm not going to disappear down today, so we'll leave that for next time...