Manual Therapy and Chronic Pain

Manual therapy is a form of specialized therapy that's delivered via the therapist's hands, as opposed to using a device or machine. The practitioner will use their hands to exert pressure on the various affected or related muscles and manipulate the joints to decrease instances of chronic pain and muscle spasms or joint dysfunction.

However, it is important to understand that there are various types of manual therapy. Many practitioners will use a combination of manual therapies during a single session. The therapies used may have overlapping effects or techniques but will have different names.

In this article, we'll go over how manual therapy works to ease chronic pain.


Massage therapy


Most people reading this may already be familiar with massages. It is medically defined as a healing modality that uses the body's own processes for repair, renewal, and well-being.


Massage has been a part of every system of medicine in history across the globe. It has been around for at least 5000 years. In the US, massage therapy has been abandoned at the advent of managed care primarily because nurses, instead of being tasked with massaging patients, are bogged down with documentation as opposed to direct patient care.


Therapeutic massage has multiple benefits. From a physical and biomechanical perspective, deep tissue manual therapy brings blood flow, which has healing mediators, into the soft tissue. The manual manipulation breaks up or softens scars in muscle tissue and in the surrounding fascia. Massage can deter the scar from binding or restricting the contraction of the muscle. It also strips some of the tiny nerve endings that cause the sensation of pain, so they are no longer sending a pain signal to the brain.


Massage therapy has also been found to decrease pain perception in 10-20% of people for up to 18 hours (if you have a good meditation practice and parasympathetic activation, this can be much longer if not indefinite). Touch massage helps to biochemically dampen the pain fiber transmission. The pain and temperature fibers, the light touch fibers, vibratory sense, and the proprioception fibers are all within one nerve sheath. If the therapist overstimulates a certain fiber it will decrease the firing or transmission through the other fibers. Therefore, light touch and/or vibration techniques in pain regions will decrease the transmission through the pain fibers.


In addition to the positive physical effects of massage, there are also other benefits. Most massage environments are calm and soothing from a sensory standpoint (visual, auditory, tactile, and sometimes olfactory through aromatherapy), which can increase parasympathetic tone, consequently positively affecting pain sensations.


A few subsets of massages include:

a. Craniosacral therapy – Referred to as CST, it is a gentle hands-on technique. It uses light touch to examine the movement of fluids and membranes around the central nervous system. By relieving tension in the central nervous system, a CST therapist can create the feeling of well-being, eliminate pain and boost immunity.


b. Myofascial releases/trigger point release – It is a type of physical therapy used to mainly treat myofascial pain syndrome. For those who don't know, myofascial pain syndrome is a chronic pain disorder caused by tightness and sensitivity in the myofascial tissues. These are tissues that surround and also support the muscles in the body.


c. Yin massage – The Yin Yang Touch massage, or Yin Massage, is a method that applies the principles of the opposites in Chinese theology. The yin and yang massage requires that the practitioner has knowledge of the various areas of the body that are yin and those that are yang. The two sets of qi (energy force), i.e. those of the therapist and the patient, are working together. The modality is mainly making informed use of how they both interact.

d. Thai massage – Interestingly, even though it's called "Thai massage," it originated in India. Since then, it has been around for roughly 2500 years. It was originally regarded as being a healing art. Today the Thai massage includes inspiration from Ayurvedic and even traditional Chinese medicine. Unlike most western style massages, it does not require the patient to lie on the bed for the massage while the therapist applies oil on the body and kneads all the pressure points. Instead, the patient lies on a mat fully clothed while the practitioner uses a series of stretching, rocking, and pulling techniques to help promote relaxation and relieve tension. It also improves flexibility and overall blood circulation. That's why it is also often referred to as assisted yoga.


Osteopathic Manipulative Treatment (OMT)

Osteopathic manipulative treatment, referred to as OMT, is a hands-on technique that is used by an osteopathic physician to first diagnose, treat, or even prevent injury or illness. An OMT practitioner will move the patient's muscles and joints, which includes techniques like gentle pressure, stretching, and resistance.


OMTs also receive training that enables them to understand the musculoskeletal system, which is a series of nerves, bones, and muscles in the body. The advanced training provides practitioners, or DOs as they are referred to, with an understanding of the body's interconnected system and how one affects the other.


In situations, OMT can complement and even work as a substitute to surgery or drugs, which brings an important dimension to standard care.


Benefits of Using OMT

OMT helps people of all ages and genders. The treatment, amongst other things, is highly successful at easing pain, improving mobility, and promoting healing. While it is mainly used to treat muscle pain, it can also help patients with asthma, migraines, sinus issues, menstrual pain, and carpal tunnel syndrome, to name a few.


Physicians using OMT will mainly apply a certain amount of force or pressure to various regions of the body. The techniques can help with:


  • Treating tissue abnormalities and structural issues.

  • Relieve joint misalignment and restriction.

  • Promote and improve blood flow.

  • Restore muscular and tissue balance.


Using OMT for Pain Relief

It is important to understand that there are many types of chronic pain. There are numerous treatment options, from medication to using a hands-on technique like OMT, which has been clinically proven to offer relief from instances of low back pain.

Various clinical studies have over the years shown that OMT is an effective alternative to medication and various other therapies.


Chiropractic Techniques


Chiropractic techniques are practiced under the premise that the body has an innate ability to heal itself as long as fluid and signals can flow freely through to the brain via the spinal cord out into the peripheral nerves to all the organs, tissues, and cells.


Causes of spine malalignment: Physical trauma, ingested toxins, and mental state. Chiropractors use X-rays and postural observations as well as palpation for assessment of spine alignment. A variety of hands-on techniques and manipulations are listed below:

a. HVLA

b. Low-velocity manipulation, especially for craniocervical junction and upper cervical spine

c. Craniopathy

d. Heat

e. Electrical stimulation

f. High-frequency ultrasound

g. Sacro-occipital techniques.


Physical Therapy


Traditional physical therapy is primarily focused on optimal movement patterns to promote health and biomechanical imbalances. Physical therapy focuses on joints, ligaments, tendons, bursa, etc. with awareness of mechanical forces of compression, tension, or shear.


A physical therapist is trained to take care of patients regardless of which phase of healing they might be in. Therapists will work with patients from initial diagnosis through to preventive stages of recovery and restorative stages. It can also be a standalone option or be part of a larger treatment scheme.

Some patients may be referred to a physical therapist if a doctor sees that it will help their patient. However, many patients seek the help of a therapist on their own.

Regardless of how a patient may come to start visiting physical therapy, they can expect the following:

  • Start with undergoing a full physical exam which includes their health history and certain testing procedures. The therapist will also examine their posture, flexibility, and movement. In addition to their muscle and joint motion performance.

  • Patients will receive a clinical diagnosis, a care plan, and a prognosis. The therapist will set both short and long-term goals for their patients.

  • Physical treatment or therapy and intervention are based on the therapist's assessment and diagnosis of the issue as well as their level of training.

  • Get self-management recommendations to perform at home.

Patients will often have to train with a physical therapist, often performing various exercises which they are then to repeat at home. The goal is to help with function, circulation, and healing.


Conclusion

Manual therapy is one of the best ways to treat chronic pain. However, there are many choices out there, which can be confusing. That said, the best way is to leave it up to a professional to find what methods of treatment will work best for you based on your particular ailments and biomechanics. So, start with visiting a pain management expert to discuss your condition, get a diagnosis, and then work with the recommended manual therapist to determine the best way forward.