Thursday Thoughts: Sensation and Awareness Are Requirements for Manual Therapy

image from http://www.afortlauderdalechiropractor.com

It's amazing what can be done under anaesthesia - you can be cut open and repaired all without sensation, perception of threat or pain.

Upon waking, of course, knowledge of procedure being done and some inflammatory soup may make for some varying levels of pain and discomfort. So I have a few questions for you

Have you ever fallen asleep during a massage?
What are your thoughts on manipulation under anaesthesia?
Why do you think manual therapy even works?

Falling asleep during a massage

If you haven't fallen asleep during a massage, you have never had the distinct feeling of missing out on a really pleasurable experience. Maybe you wake feeling more relaxed, but that could just be a function of actually getting rest in a nice environment. Either way, you probably would not get the same effect and feeling from just sleeping than after a massage, otherwise you would not be paying for a massage in the first place. You would just sleep.

MUA

Insurance companies tend to only cover procedures that are not considered experimental and investigational. (Whether or not the covered service is actually effective is another thing). The one that I worked for had me do a lit review on MUA. It turns out there are very few studies on its effectiveness. One of the researched protocols had several sessions of MUA to the spine, followed by 4 weeks of biweekly manipulations. Tough to say that any results of that protocol actually were from "realigning or breaking adhesions" while anesthetized, if the patients also received several weeks of regular manipulations while awake. Also, there are those points about

not being able to reposition bones
move them and have them stay in place
being out of place in the first place, or having structural associations actually related to pain

Why Manual Therapy Even Works

Where am I even going with this post? I was having a great discussion with my good friend and colleague, Nelson Adrian from TherAdvance. We were talking about how frustrating it was to have people still believe in pathoanatomy and how both of us have changed our thinking. When I met him 3 years ago, he was using realtime US to test the effects of IASTM on tissue changes and mobility. He found that it temporarily changed superficial tissues only in all cases, no matter how many hard they pushed. In a few cases, you can actually see the EDGE Mobility Tool in the US image. He now uses those same studies/videos to show that deep tissue changes are NOT happening with a large amount of force. Even in the short term.

More interestingly, he did a pilot study with local anaesthesia applied to one forearm and not applied to the other. A few minutes of IASTM was performed on each side. Only the side that had actual sensation of skin stimulation had increased mobility of the wrist.

Apparently, Robert Schleip has also performed similar pilot studies using local anathesia and STM to the lumbar spine. The group without perceived sensation of skin stimulation from the STM did not have any significant changes in mobility, while the group that perceived the sensation did. Unfortunately, both of these are just unpublished pilot studies, but in lieu of what we know of Modern Manual Therapy, it makes perfect sense.

We are NOT deforming fascia, breaking up scar tissue, or aligning bones with manipulation. The forces required to do so are much greater than what we apply with instruments or our hands. If anyone out there wants to do a similar study for their capstone, or has students that would be willing to do more than just a pilot study, that would be great! Contact me below.

Remember, even US works when it's off, most likely because the patient is aware (sight and skin stimulation) that something is happening. There is an expectation and also input to the CNS. Thoughts? Chime in below or on the facebook page!

Interested in live cases where I apply this approach and integrate it with pain science, manual therapy, repeated motions, IASTM, with emphasis on patient education? Check out Modern Manual Therapy!

Keeping it Eclectic...