From the Guidelines
Manual therapy does not cause significant long-term structural changes in tissue. While manual therapy techniques like massage, joint mobilization, and manipulation can provide temporary relief from pain and improved range of motion, the evidence suggests these effects are primarily due to neurophysiological responses rather than permanent tissue remodeling 1. When a therapist applies pressure or movement to muscles, fascia, or joints, the body experiences short-term changes including increased blood flow, temporary reduction in muscle tone, and stimulation of mechanoreceptors that can inhibit pain signals.
Key Points to Consider
- The therapeutic benefits of manual therapy appear to work primarily through the nervous system by modulating pain perception, reducing protective muscle guarding, and potentially triggering the release of endorphins and other pain-relieving chemicals.
- According to the British Journal of Sports Medicine 1, manual therapy should be applied only as an adjunct to other evidence-based treatments, highlighting its role as part of a comprehensive treatment plan rather than a standalone solution for permanent tissue change.
- For lasting improvements in tissue health and function, manual therapy should be combined with appropriate exercise, movement training, and addressing underlying contributing factors rather than relied upon as a standalone treatment for permanent tissue change.
Clinical Implications
- The temporary nature of manual therapy's effects explains why patients often experience immediate relief during treatment that gradually diminishes over time, necessitating repeated sessions.
- Clinicians should prioritize a multifaceted approach to patient care, incorporating manual therapy as one tool among many to achieve optimal outcomes in terms of morbidity, mortality, and quality of life 1.
From the Research
Manual Therapy and Tissue Changes
- Manual therapy (MT) has been shown to evoke complex mechanistic responses across body systems, including molecular, cellular, and physiological processes 2.
- These responses can lead to changes in the tissue, including neurovascular, neurological, and neurotransmitter/neuropeptide changes, as well as biomechanical changes 2.
- However, the evidence for these changes is of varying quality, with moderate quality evidence supporting neurovascular, neurological, and neurotransmitter/neuropeptide changes, and low to critically low quality evidence supporting biomechanical changes 2.
Long-Term Changes
- There is limited evidence to suggest that manual therapy causes long-term changes in the tissue 3.
- Most studies have focused on the short-term effects of manual therapy, and more research is needed to fully understand its long-term effects 3.
- One study found that manual therapy techniques based on soft tissue and neurodynamic mobilizations can be effective in improving pain, physical function, and nerve conduction studies in patients with carpal tunnel syndrome, but the long-term effects of these changes are not well understood 4.
Comparison to Other Therapies
- Manual therapy has been compared to other therapies, such as heat and cold therapy, in terms of its effectiveness in reducing pain and improving function 5, 6.
- These studies have found that manual therapy can be effective in reducing pain and improving function, but the evidence is not always consistent, and more research is needed to fully understand its effects 5, 6.
- Heat and cold therapy have also been shown to be effective in reducing pain, but the evidence for their long-term effects is limited 5, 6.