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5 Myths of Manual Therapy

1. Posture and biomechanics don’t matter. (most of the time)

Treatments that focus solely on trying to correct posture or faulty biomechanics are doomed for failure. The majority of biomechanical faults seen are the result of being in pain and not the cause of it. To change posture or biomechanics is not always a practical or advisable strategy. An evidence based approach would see us changing our treatment focus. Education about the source of your pain and what that means to your recovery, increasing movement capacity and gentle manual techniques to decrease pain sensations would be provided to point you in the right direction.

2. Bones do not go out of place.

A common belief held by many manual therapists. Bones and joints do not ‘go out!’ If they do it is a medical emergency. The sensation of bones being out of place or not moving properly is usually your nervous systems response to a perceived threat to the area. Something has occurred to sensitize the area and your body is now protecting it. This can be brought on by any number of factors and although it can be extremely painful, it is easily treatable by massage, chiropractic or physiotherapy treatments.

3. Fascia doesn’t need ‘releasing.’

Fascia is a very thick and robust connective tissue that provides important structural support to our body. It is commonly believed by many manual therapists that fascia needs to be pulled, stretched and ‘released’ in order to get pain relief and restore function. However, there is no evidence to show that this is even possible! Research has shown continually that fascia cannot be altered or changed for any length of time, and even if we could change it why would we want to? The human body undergoes more stress and strain in our daily lives than we could ever exert on it in therapy. If fascia was so easily manipulable the functioning of the human body would be in constant distress as it could not even withstand mild exercise or physical work.

4. Trigger points are not a problem in your muscles.

There has been much debate over what trigger points are and whether they even exist! All manual therapists and patients can agree that there are obviously palpable tender points in soft tissues. Traditional explanations of trigger points are that they are a hyperirritable tender point in the muscles or fascia. The problem with trigger points is that their existence has never been proven, only hypothesized. In cadavers, dissections, or anesthetised patients no trigger points can be found. A more likely explanation is that they are referred pain from peripheral nerve inflammation. Treatments that focus on pressing at an inflamed nerve are not likely to work. A slow, gentler approach that is less painful and incorporates simple movements can be more effective at alleviating symptoms.

5. More pain is not more gain.

A painful treatment to fix painful problems is rarely effective and is not supported by evidence. When in pain, the nervous system is sensitized and the last thing it needs is more pain, as this will make the pain worse in the long term. Treatments need to address the origin of the pain and be comforting to the nervous tissue. If a treatment hurts, let the therapist know because it is likely doing more harm than good.