MANUAL THERAPY

WHAT IS MANUAL THERAPY?

Very simply manual therapy is the practice of using your hands to affect body tissues. This includes anything from simple massage to advanced organ manipulation. Like all things, there are degrees of sophistication within the field of manual therapy as well as  levels of mastery ranging from novice to artist. Because manual therapy  by definition is such a broad field, you will undoubtedly see manual therapy touted by most physical therapists, chiropractors, massage therapists and even athletic trainers. As you’re surfing for answers to your unique problem how can you know if manual therapy is right for you? Let me try to provide an explanation in more detail of what manual therapy is, give you some case examples to further demonstrate and tell you why the therapists at Inner Bridges provide a unique level of training and mastery in the field of manual therapy. If in the end you’re still not sure if manual therapy can help you, just give us a call or shoot us an email and we’ll do our best to help you figure it out.

MANUAL THERAPY: FROM NUTS AND BOLTS TO FLUID AND FLOW

Nuts & bolts

Training in manual therapy begins with working with body tissues as if they are nuts and bolts. The basic tenants are to use force to loosen what is tight, and use exercise to strengthen what is loose. This is a musculoskeletal approach which means the practitioner is focused on muscle, fascia and joints. The training that goes with this level of intervention includes massage therapy, joint mobilization/manipulation and stretching techniques. Nowadays folks are additionally using tools like the Graston technique or even foam rollers to apply these same rudimentary concepts of ‘use force on what is too tight and strengthen what is too loose’. Though there is of course an array of sophistication and skill one can attain at these methods, the foundational concepts do not change for these nuts and bolts approaches.

fluid &flow

As a practitioner, the more you work with the body and the more trained your hands get, the more you can come to appreciate the incredible intelligence of the body. You start to notice that sometimes when you try to push or force the body, the more it pushes back. A muscle or joint you stretched on Tuesday is right back to tight on Thursday. Have you experienced this as a patient? Have you had a massage or stretching session that felt amazing right after but a day or week later, all you had to show for it was some bruising? It starts to feel like the ‘force what is too tight’ approach is disregarding all the body’s innate wisdom. You come to realize that sometimes what we feel as ‘tight’ or ‘stuck’ is something the body did on purpose to protect itself. As a manual therapist it is our job to figure it out and to do that, you have to first let go of the nuts and bolts view of the body and recognize that the body is so much more about fluid and flows.

The body is between 60-70% water. We’ve all heard this right? But do we really understand what this means? When you look at the body it doesn’t look like water, it looks like nuts and bolts. What I think we forget is that under the right conditions, like pressure and temperature, water can take shape. Picture a water balloon; the more full it is the more those suckers feel like a rock when they hit you on a hot summer day. The cells of the body are basically water balloons. Organs and muscles are just groups of water balloons separated by thin membranes. The body is basically made up of a water balloon around a bunch of water balloons surrounded by other water balloons. Can you start to visualize this?

When practitioners start to appreciate the true fluid nature of body tissues it changes the way they work with these tissues manually. They start to have a greater appreciation and understanding of the relationships between tissues and tissue systems and begin to understand why bodies do what they do when things start to go bad.  These are the practitioners that seek out more advanced training in manual therapy.

Just as with nuts and bolts approaches, there are lots of fluid and flow approaches that have been developed to work with the body on the basis of this understanding. The primary tenants of these approaches are ‘the more specific you are, the less force you need’ and ‘if you don’t get a lasting result, you’re missing something’. These approaches go beyond the musculoskeletal system to include other body systems like blood vessels, neural tissue, lymph nodes, organs, and even emotions. Some relatively well know examples of the types of methods that live in the fluid and flow category include lymphatic drainage, craniosacral therapy and myofascial release. These approaches are more subtle because, in general, they are working with the body, not against it, and they are focused on treating the cause of a symptom not just the symptom itself. Like the nuts and bolts methods, there is a wide range of training and skill that practitioners can achieve within the field of fluid and flow methods ranging from beginner to expert.

HOW TO KNOW WHAT IS RIGHT FOR YOU?

I realize how difficult it can be for you to figure out what you need to do to get better. This can be increasingly difficult if you have already tried some things and either not had positive results or you’ve gotten worse. It can also be a challenge to know how long you can expect for it to take for you to get better. Here is a quick guide to help you get a general sense for if you may benefit from manual therapy, how long it will take for you to get better,and how to choose the right therapist or therapy team for your specific needs.

when is manual therapy the best choice

Manual therapy is the ideal therapy for pain, nerve damage, injury recovery, complex joint or spine problems, loss of range of motion, foot issues and complicated multisystem problems. Manual therapy can also be excellent for developmental delay in children, sensory issues, headaches, dental problems, persistent muscle weakness, joint degeneration, autoimmune conditions, chronic fatigue and poor sleep but may require a mulitdisciplinary approach including occupational therapy, educators, primary care, naturopaths, dentists etc. Problems like fractures, simple sprains, acute surgical recovery, simple sports injuries, strength and endurance training and other acute and/or mild problems can be addressed with more traditional physical therapy.  If you have been in a car accident manual therapy, physical therapy or chiropractic can all be helpful and you should choose the modality based on your level of health prior to the accident and the severity/complexity of your symptoms, choosing manual therapy for the more persistent problems.

A good measure for how long it could take for you to get better is to consider the cause, severity and chronicity of the problem. In general, problems that are relatively new, are less severe and have an obvious origin (i.e. a fall) are easier to treat than problems that have been going on for a long time, are more severe or are of unknown origin (i.e. neck pain that came on gradually for seemingly no reason). Here are some examples to help illustrate this point.

PATIENT CASE EXAMPLES

Example 1: Low Back pain

For a new or recent mild problem of obvious origin, you might get all the help you need from a pure nuts and bolts musculoskeletal approach provided by a more traditional physical therapist. For Example, a 42 year-old woman that sits all day for work is newly experiencing some mild to moderate low back pain but is otherwise healthy and has had no history of back pain. It is very common to start to experience some low back pain and stiffness from sitting at your job all day. This is usually caused by straightforward muscle imbalance that increases the compression force on your low back joints and discs. This problem can often be easily addressed by stretching muscles that have gotten tight from sitting, strengthening muscles that have become weak from sitting, and the provision of education and training so that it doesn’t happen again.

Example 2: Knee pain

A 56 year old male twists his knee playing tennis. He has no injury history in the knee and had a film taken to rule out any soft tissue tears or bony fractures. After a few weeks of rest he is still having pain and can’t straighten his knee all the way. This is likely from a strained hamstring. It is very common for folks to play sports without the proper training or conditioning. Using muscles in ways they are not accustomed to or conditioned for will often result in an overuse strain. This can be easily addressed by a traditional physical therapist who will likely do gentle hamstring stretching and massage, quadriceps strengthening, hot and cold treatments and if needed, athletic taping.

Example 3: Hip pain

Often problems are not as straight forward as these two cases. For problems that have been going on for a long time, you are unable to manage on your own, are severe or worsening and/or you are unsure what has caused it, you will need a more comprehensive approach (fluid and flows). Often times in these cases there are multiple variables that have contributed to the condition causing symptoms to develop slowly over time. For example, a 47 year old man has left hip pain. The pain started 10 years ago as a mild stiffness or ache. He has tried massage, chiropractic and stretching with a traditional physical therapist (nuts and bolts) to manage the problem but recently these strategies have stopped being as effective and the pain has been increasing. A manual therapy evaluation finds 3 variables contributing to this problem; flat feet, an old right knee injury from basketball, and poor tailbone positioning from an old fall on the ice. These variables all affected the left lower extremity position and slowly overtime led to hip compression, muscle imbalance, connective tissue shortening and strained joint mechanics. Manual therapy is an excellent option for this patient and it will likely take 6 months of weekly treatments to address all the variables to fully fix the problem.

Case 3: the whole enchilada

Sometimes problems require more than one discipline to fix the problems. Consider a 39 year old woman with complaints of headaches, fatigue, and low back pain. A manual therapy evaluation reveals severe nigh-time jaw clenching, a pelvic compression reflex and significant inflammation of the abdominal organs. Upon questioning the patient also reports a car accident 15 years ago with a whiplash injury, a long history of anxiety, a strained labor and delivery of her now 8 year old son and a long history of constipation. This patient will need manual therapy to address the poor neck mechanics contributing to her clenching and headaches and the pelvic compression reflex resulting from her strained labor and delivery. She will also likely need to be evaluated for her constipation which may be contributing to both the low back pain and headaches, and possibly need help finding a psycho therapist to help her work through some of her anxiety which is likely driving the jaw clench. It could take 6 months to a year to coordinate and deliver the therapies needed so she can start enjoying life again.

WHY CHOOSE INNER BRIDGES?

Hopefully you now have a better idea of what you need for your unique problem. If you feel like manual therapy is the right route for you, let me tell you why you should choose us. It’s simple really; we’re the best. The team at Inner Bridges is extremely skilled and experienced, we take the time to make sure you understand what is happening in your body and what we intend to do to fix it, we work closely with the best practitioners in other disciplines that the Boston area has to offer, we are highly dedicated to helping you find solutions to your problems. Here’s what you can expect when to or your loved one comes to Inner Bridges Physical Therapy & Wellness. We hope to be helping you soon.