How Does Manual Therapy Work? (Part 3 of 3 blogs)
Manual therapy is an effective treatment for musculoskeletal conditions and is backed by research. How manual therapy works is still not fully understood. In this blog I will outline some likely mechanisms. These mechanisms can be broken down into 3 broad categories.
- Biomechanical Effects.
- Neurophysiological Effects.
- Patient Beliefs and Expectations.
The first category is biomechanical effects and they include:
- Improved range of motion or reduced stiffness.
- Improved spinal intervertebral disc diffusion/hydration.
A physical therapist’s assessment that restricted motion of a specific joint may be contributing to your pain or loss of function will often guide them toward using manual therapy techniques. After manual therapy treatment, a physical therapist will often re-assess that motion to help determine the effectiveness of the manual therapy treatment.
The second category is neurophysiological effects and they include:
- Reduced pain/ hypoalgesia.
- Improved muscle activation.
- Changes in skin conductance.
- Changes in skin temperature.
Pain reduction with manual therapy is believed to be from nervous system stimulation. There are peripheral nerves responses, spinal cord responses, and brain responses. Localized joint motion produced with manual therapy techniques stimulates the nervous system at the peripheral nerve and spinal cord level to block pain from being perceived by the brain.
With technological advancements including functional MRI’s of the brain we are gaining new insight into some of the central nervous system responses. The sympathetic nervous system has been shown to be stimulated by the mid-brain (dorsal periaqueductal grey matter) in response to manual therapy. The activity of the mid-brain blocks pain perception by the brain. Also, the brain itself is now considered changeable via neuroplasticity and can be positively influenced by physical therapy by using manual therapy, exercises, and education.
The third and final category is patient beliefs and expectations and they include:
- Placebo (Positive) & Nocebo (Negative) Effects
- Therapeutic Alliance / Provider-patient interaction
>80% of patients surveyed expected that hands-on manual therapy would provide relief of symptoms, prevention of disability, and improvement of activity level and sleep. This is often where the art and science of physical therapy work together. By providing the most appropriate and evidenced based manual therapy treatments that match a patient’s expectations for care, a positive therapeutic experience can yield a positive therapeutic alliance between a physical therapist and a patient. Other physical therapy treatments such as patient education and exercise are more likely to be adhered to due to this alliance and patient outcomes are improved.
The biomechanical and neurophysiological effects of improved motion, improve disc hydration, reduced pain, and improved muscle activation are often short term and temporary. Because manual therapy effects are often short term and temporary, it is important to include appropriate education and exercise in order to have improved long term outcomes. Manual therapy, education, and exercise should be used as part of a comprehensive, multi-modal physical therapy plan of care that is tailored to an individual patient based on their impairments in order to ensure the best patient outcome possible.
If you are having pain and/or limited function, please call OSI Physical Therapy to make an appointment.
Steve Schneider, PT, MS, PT, CMPT.