Manual therapy is oftentimes a part of Physical Therapy, however it’s not always everyone’s favorite part!
Almost weekly, we receive phone calls from inquiring potential patients asking if massage is a part of our physical therapy sessions. While we don’t offer 45 minutes of massage, we do incorporate what is known as “manual therapy” or “soft tissue work” into our sessions. To some, this may be exciting, while to others who may have gone through physical therapy before, it may bring back some not-so-pleasant memories.
What is Manual Therapy?
Manual therapy may sound intimidating, but it’s not! In the realm of physical therapy, manual therapy refers to the Physical Therapist’s use of manual techniques within your treatment session, as opposed to a machine. This may include massage, pressure to the joint, or what is referred to as a Grade 5 manipulation.
Why Does Massage Hurt?
We’ve heard it before! As we are working on a patient, we sometimes hear, “Ouch that hurts! Why does that hurt?” While we wish that the manual aspect of physical therapy was more pleasant and relaxing, it may sometimes be uncomfortable.
We asked our physical therapist, Courtney Lee, about what things may cause massage to hurt.
What stage of healing is the patient in? - Depending on when the injury occurred, massage may hurt less or more. Physical therapists categorize injuries as being acute (having occurred 0-48 hours prior), subacute (2-7 days out), or chronic.
Acute - In the acute phase of an injury, the tissues are going through an inflammatory phase and that often includes pain or nociceptors being hyper-stimulated, swelling, tissue damage if it was a trauma. According to Courtney, “In the acute phase, my goal would be to minimize pain and swelling, and prevent an excessively long inflammatory phase (inflammation in and of itself is not a bad thing since our bodies are signaling "HELP!", but prolonged inflammation is not good).”
Subacute – Courtney explains, “In the acute phase, and even beyond, if the area treated is hypersensitive to light touch, then I can use desensitization techniques to try to tell the brain "THIS is normal touch... it's not 'pain'." I use items such as light strokes, cotton balls, a soft washcloth, basically anything that can help re-train our sensory system to distinguish between "pain" and "normal touch." This is good with patients who are post op, around a healthy/healing incision, acute sprains, etc.”
Chronic – Other patients suffering from a chronic condition may still be cycling in and out of an inflammatory stage. “Scar tissue may have laid down over an injury to a muscle or ligament, for example, and say the patient just went back to their regular activities without seeking manual therapy for the injury, the scar tissue now prevents the muscle fibers from contacting/relaxing in their respective parallel plane; or fascial adhesions may occur, thus preventing normal glide of fascia over structures above/below. We can use different methods such as the desensitization techniques used above, and/or fascial gliding to help relieve pain. We can use prolonged pressure to help down-regulate the sensory system, and this can help the tissue regain normal length and then we can introduce a functional movement for that muscle (helllooo, Pilates and other neuro-re ed),” says Courtney.
Our goal at Envision PT is to make sure we have an open line of communication with our patients, and if some aspect of manual therapy is uncomfortable, the treating therapist, would definitely want to know. Everyone’s tolerance to pressure is different. Some people want more, while some do not.