Daily Maestroism

DM #681

Wednesday, April 4th, 2018

DM #681: My feelings on manual therapy.
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As always, I’m hyper-aware of the pendulum swinging too far, and this DM is my attempt at making sure my pain science peeps don’t let things go too far.
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Manual therapy ABSOLUTELY has its place. Manuals therapy ABSOLUTELY “works”. The discussion we need to be having is ‘how’ exactly it’s helping, not whether or not it helps at all.
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Potential physiological effects (fascial decompression, fascial glide, lymphatic/circulatory changes) aside, manual therapy allows us to communicate with the nervous system. Not only does it allow us to speak to different receptors within the tissue, it gives us a way to make that patient’s nervous system feel SAFE; and that, my friends, is everything.
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You want more mobility? Make the nervous system feel safe. You want more strength? Make the nervous system feel safe. You want to learn a new movement pattern? MAKE THR NERVOUS SYSTEM FEEL SAFE.
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When we hear/say that someone has ‘bad hands’, if we break that down, what we’re really saying is that that person did not make us feel safe. Our nervous system felt threatened. We did not believe in their capabilities and/or their intentions. It’s no surprise that that treatment didn’t “work”.
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So, while I am by no means trying to breed dependency or state that our treatments should focus around manual therapy, simply asking that we don’t throw the baby out with the bath water. There is absolutely a time and a place for manual therapy. Communicating with the nervous system, aka connecting with the locals, is not a bad thing. The questions is what kind of connections are being formed, and will they ultimately allow for bigger, more meaningful steps.
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