The research surrounding manual therapy is difficult to consume due to the high variability in it’s methodology. Below is an outline of a couple studies that we have used for this episode. With the citation there are bullet points that have been selected from reviewing the research regarding the general topic of manual therapy. Clearly this is not an exhaustive list but merely a selection of different viewpoints.

In the end the patient focused model comes down to three main factors which we must never forget. First, we must utilize evidence-based practice in order to make sure we are providing high quality level of care. Second, the use of our own experiences and anecdotal evidence is key because there is much that has not been researched and validated yet. Third, patient goals must be at the forefront of our decision making processes when determine which type of intervention we should be applying.

Mancini, F., Nash, T., Iannetti, G. D., & Haggard, P. (2014). Pain relief by touch: a quantitative approach. PAIN®, 155(3), 635-642.

Mancini, F., Beaumont, A. L., Hu, L., Haggard, P., & Iannetti, G. D. D. (2015). Touch inhibits subcortical and cortical nociceptive responses. Pain, 156(10), 1936.

• The analgesic or pain reducing effect of touching a sore or painful body part is a common everyday practice, but it’s underlying mechanisms are debated and difficult to determine
• It has been proposed that touch of a painful area reduces activation of spinal sensors in the brain and spinal cord.
• The main findings of this study indicate that touch to a painful area actually suppressed experiences of pain produced in the brain.

Chaudhry, H., Schleip, R., Ji, Z., Bukiet, B., Maney, M., & Findley, T. (2008). Three-dimensional mathematical model for deformation of human fasciae in manual therapy. The Journal of the American Osteopathic Association, 108(8), 379-390.

• Fascia is a dense fibrous connective tissue that connects muscles, bones, and organs, forming a continuous network of tissue throughout the body.
• Several forms of manual therapy, including myofascial release, are said to change or alter the fascial mechanical properties and to help relieve stresses.
• Used a mathematical model to determine if forces applied in manual therapy are sufficient to produce tissue deformation in human fascia.
• It was found that for the plantar fascia a normal load of 8359 N was needed to produce 1% compression and 1% shear forces. That comes out to 1,800 pounds of force

Clar, C., Tsertsvadze, A., Hundt, G. L., Clarke, A., & Sutcliffe, P. (2014). Clinical effectiveness of manual therapy for the management of musculoskeletal and non-musculoskeletal conditions: systematic review and update of UK evidence report. Chiropractic & manual therapies, 22(1), 12.

• Manual therapy consists of a wide variety of techniques which is part of the reason that it is difficult to perform quality systematic reviews.
• Overall, there was limited high quality evidence for the effectiveness of manual therapy. Most reviewed evidence was of low to moderate quality and inconsistent due to substantial methodological and clinical diversity.

Bialosky, J. E., Beneciuk, J. M., Bishop, M. D., Coronado, R. A., Penza, C. W., Simon, C. B., & George, S. Z. (2018). Unraveling the mechanisms of manual therapy: modeling an approach. journal of orthopaedic & sports physical therapy, 48(1), 8-18.

• Because there is so much conflicting evidence regarding manual therapy based on the wide variety and definitions of manual therapy and the fact that it is difficult to perform high quality randomized and blinded controlled trials it is difficult to determine the true effect of manual therapy.
• The understanding of manual therapy currently is that a transient, mechanical stimulus to the tissue produces a chain of neurophysiological effects and mainly chances the signaling and neurology of the perception of pain and activation of painful nerve impulses.