If close to ten rounds of manual therapy have left the pain no different from the start, reviewing the treatment method itself comes before adding more sessions. In most cases the reason it has not worked is not that the body is unsuited to this approach, but that one of three conditions was missing: diagnosis of the cause, adjustment on the day, and combined treatment.
If the pain is unchanged even after all 10 sessions, the first step is to look back at what was actually done during those 10 sessions. This article covers the conditions that decide the effect of manual therapy, along with the standards for choosing a place that can be trusted.
Was the cause of the pain found accurately?
Manual therapy is a method in which a therapist works on the joints and muscles by hand, but the key is not the fact that hands are used. It lies in what those hands are guided by. Repeatedly pressing only the painful area without a clear basis rarely produces more than momentary relief, and the effect lasts only when the process restores alignment on the basis of a medical diagnosis.
The body is connected as a single axis from the head down to the pelvis, so problems in the neck, the back and the pelvis affect one another in sequence. It is not unusual for shoulder pain to have its cause in the neck, or for lower back pain to start from the pelvis. When loosening the painful spot brings relief only for that moment, it is because the starting point was not addressed.
- Forward head posture and straight neck — when the head stays pushed forward for a long time, this becomes the point where the back begins to round
- Rounded back — acts as the middle link that passes the strain starting in the neck down to the pelvis
- Pelvic misalignment — the place where misalignment carried down from the neck and back finally arrives and shows up as pain
Was treatment adjusted to the condition that day, and were other treatments combined?
Last time it may have hurt to bend forward at the waist, while today the pain may be less. The opposite can also happen, with a discomfort that was not there before appearing in a particular movement. The state of the muscles differs between a day after poor sleep and a day after proper rest, so the pain and movement need to be checked again at every visit and the intensity and area adjusted accordingly.
If the cause of the pain is tangled up with inflammation, nerve irritation or even muscle weakness, trying to improve it through hands-on release alone is unlikely to be the answer. Depending on the condition, pain sometimes has to be controlled first with medication or injection, and in other cases exercise has to be combined to correct weakened muscles.
What are the standards for choosing a place that can be trusted?
If a patient is laid on the treatment table straight away without proper examination and assessment, treatment begins without the cause being known. From the first visit, posture analysis and physical examination should establish where the problem lies, and the intensity and goals should be set while the response on the day is checked in real time.
In a study that divided patients with chronic lower back pain into three groups and compared them over 12 weeks, among the group that did exercise alone, the group that added taping and the group that added hands-on treatment, the group that exercised after manual therapy showed the largest improvement on every measure. The result changes depending on how the order of recovery is designed.
- Which movement brings out the problem — identifying the motion that triggers pain narrows down the area responsible
- Which area to approach first — the standard for deciding what has to be dealt with first among several problems
- Movements to avoid — identifying in advance the motions that could make the condition worse
- Setting intensity and goals — deciding the treatment intensity and direction afresh according to the response on the day
