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The Manual Therapy Solution

What is Manual Therapy? How does it help my back stop hurting? Why are we talking about exercise when I am in pain?  These are some of the most common questions I deal with as a Physical Therapist.  Today, I’d like to make sure you have all the answers. Let’s get started!

When talking about Manual Therapy, most people immediately picture the chiropractic “adjustment”.  However, many different (and often, gentler) forms of MT exist.  MT includes treatments ranging from high velocity thrusts to a typical Swedish-style massage (which unlike most MT, is not covered by insurance).  It can also target trigger points (knots in muscles), muscle spasms, stiff joints, or even a joint in abnormal alignment (out of placed or “locked”).  Each of these disorders typically requires a unique type of MT to be addressed correctly. Imagine a 70-year-old woman with osteoporosis receiving MT compared to a high school gymnast with a crick in her back.  Hopefully, most PTs wouldn’t twist the first lady into a pretzel and do a thrust technique on her first visit!  A thorough understanding of anatomy determines the type of hands-on treatment your therapist will use to get you maximum relief.

So let’s move on to how MT can help when you’re hurting. Studies now show us that the first line of defense in alleviating back pain is MT because of its immediate impact on pain ( In addition, physical therapy that uses MT has been shown to give longer carry over of pain relief, particularly when coupled with active exercise (AE).

This brings us to the other “I don’t get it” question- Why would I exercise when I’m hurting?  It may seem counterintuitive, but muscles and joints typically feel better when they’re moving. Finding the happy medium of exercise gets tricky…Somewhere between “No pain, no gain” and the week-long hospital visit of bed rest your parents’ generation may have grown accustomed to.  Typically, resting to allow the initial inflammatory response to settle down only warrants a few days.  In Physical Therapy, your first visit will be to evaluate and determine what (if any) weakness and/or muscle imbalances crept in during that period of pain and decreased activity.  As we all know, most of us don’t have the core strength these days that our grandparents and great grandparents had when we were a nation of farmers and laborers.  This is why your PT would evaluate not just your back, but also what activities you want/need to get back to.  Remember that 70-year-old woman?  Chances are her exercises would be a smidge different than the high school gymnast!

One last point worth mentioning here is on the subject of what I call the “chiropractic syndrome”. Maybe it’s a social issue or just human nature- most of us are looking for a quick fix when we’re in pain, and that includes me.  Just make it stop hurting!  Many people do get dramatic relief with an adjustment or high velocity thrust. So much so that you can now sign up for a $15 per week program to walk in and get your back cracked. The problem here is that most of the other topics I’ve been talking about in this post never get addressed.  Where is the evaluation and reevaluation to determine the tissue or joint (sometimes tissues and joints) that might be involved? When do the needs/types of activities you’d like to return to get addressed? I’m all for the easy way out if it will last, but if you require weekly treatments to control your pain and are not being educated on how to manage your back pain independently, your treatment lacks some crucial components.