If I had a dollar for every patient that was shocked or a little disappointed when they did not receive a massage during our session, I would be enjoying the view of the Cayman Islands, instead of Northeast Ohio in December.
There is unfortunately an expectation by patients when going to physical therapy that we will be doing a lot of manual therapy and we are able to fix you with our hands. This article will go into why I do not prioritize manual therapy in my treatment.
BORING RESEARCH
I am not going to link the studies because I do not want to find them. You are more than welcome to fact check me on these if you are so motivated. Anyways, based off current research we know a few things about manual therapy.
We aren't doing what we think. Often times, we tell patients we are breaking up scar tissue/adhesions, putting out of place joints back, or fixing asymmetries. This is just simply untrue.
It is not specific. Meaning I could perform a manipulation at the L3/L4 level of your lumbar spine. Not only am I probably not at the L3/L4 level, but it doesn't matter if I was. We could perform the manipulation at any lumbar level and get the same benefit.
Its benefit, if any is short term. Any increase in mobility, decrease in pain or symptoms is short term at best.
Is is not skilled. Expert clinicians vs new grads often have the same outcomes when performing manual therapy. Expert clinicians often disagree on what they think they are feeling within 6 cm. That is a lot of space to be wrong or disagree.
It tends to create dependence on the physical therapist. Over reliance on manual therapy feeds the misconception that patients NEED manual therapy to get better; however, the research points toward empowering patients toward self management vs dependence.
MY OPINION
I think all of the above is a factor, however, one can also acknowledge that research design is inherently flawed especially when dealing with a dynamic system like the human body. So while the research is helpful and gives us a glimpse I do not think it is a 100% truth.
All of that being said, I prefer to use manual therapy as a last resort rather than the star of the show. I will always prefer an active approach to therapy compared to laying on a table; it is called PHYSICAL therapy no less.
Many of the proclaimed benefits of manual therapy like increased blood flow, improved range of motion, decreased pain can also be achieved with movement and exercise. Not only are the mechanisms similar, but we are empowering our patients to be independent and capable of rehabbing themselves. We should be serving as more of a guide helping you along your way rather than a gatekeeping magician with all the secrets to your healing.
SUMMARY
So yes, occasionally I will dust off the old manual therapy gloves if I was necessary or helpful for that patient. However, I am not a massage therapist - I am a physical therapist, and I will always prioritize an active approach because I truly believe movement is medicine. My goal is for 95% of my patients to have left with a good sweat and a good pump.