Can you just massage my back?

This has been a hot topic in the rehab community, but I'm not sure how much of it has made its way to the lay person. Every healthcare provider that you choose will have their own unique approaches to treating different conditions. Some may have more of a hands on approach and sprinkle in some movement, whereas others may have the opposite. It's based on a few things including educational background, current philosophy for treating, influence of peers and role models, past experiences, and what setting they practice in. Occasionally, you may read articles saying one method is better than the other, but it's hard to separate active and passive therapies in practice.

It makes it difficult for the consumer to figure out what will help them solve their problem. I just read an article today in a prominent journal produced by Journal Of Orthopaedic & Sports Physical Therapy (JOSPT) titled "The Active Future for the Passive Therapist" by David A. Nicholls, PhD. In the article, Dr. Nicholls describes the evolution of public and professional perception on those that perform manual therapy. This can include soft tissue mobilizations/massage, joint mobilization or manipulation, and many "passive" therapies. He described how the demand for therapies evolved over the years with popular trends and fascination with technology developed. These days some high profile providers even brought a hammer and chisel back to the treatment table (look up

The conversation has always been: WHAT WORKS BEST?

Here's how I boil it down: basically, it depends on where you're starting in your rehabilitation and where you want to be. Initially, manual therapy can be helpful to improve pain, joint mobility, reduce guarding and muscle tension, bring awareness to the body, and more. It always depends on the source of the pain, because sometimes manual therapy can worsen symptoms. Like I said earlier, it's hard to separate both active and passive therapies. For the sake of simplicity, the key is not to stay there forever and learn that you will eventually have to transition to a more active plan.

So, what does the transition to an active plan look like? You may continue to integrate some manual or "passive" therapies to keep your symptoms under control, but you will find that integrating exercises to build strength, endurance, and restore movement quality will benefit you greatly in the long run. Not to mention you will also want to learn how to manage your particular symptoms independently as soon as possible! Interestingly enough, Dr. Nicholls attaches trends in therapy with each generation citing how in the 1950's polio was rampant and passive therapies were heavily relied upon including ultrasound versus the 1970's which emphasized more personal responsibility and health care choice.

The follow through really starts looking good when your symptoms are resolving and you are able to get back to previous exercise, more normal daily mobility (like getting out of bed or bending forward), and thinking about your pain and symptoms less frequently. Even as early as the first visit, your therapist should be able to show you techniques on how to perform any warm up and self mobilization work. This is the big moment where you have more opportunities to get away from the constant "feel good" treatments like massage, and develop autonomy in your programming.

In summary, there is a time and place for most treatments and it's never appropriate for treatments to be written off because they are more passive. Sometimes, that will be the key to helping someone get out of the hole, so to speak, allowing for the active therapies to take place. Look for an honest and genuine discussion with your healthcare provider about the way they plan on intervening. If you have any specific questions on this, never hesitate to reach out.


This blog was written by Dr. James Babana, PT, DPT

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