Evidence-Based Manual Therapy Techniques for Massage Therapists

How to maximize Manual Therapy Techniques' effectiveness.

The world of manual therapy is full of techniques. But are all manual therapy techniques created equal? How does a massage therapist evaluate the techniques they choose? To maximize their effectiveness, therapists must align their techniques with the Principles of Critically Informed and Evidence-Based Manual Therapy. Below are some guidelines to help massage therapists make well-informed decisions.

Recommended course: Orthopedic Manual Therapy of the Lower Body

Principles of critically informed and evidence-based manual therapy

• The “no pain, no gain” strategies that many hands-on therapists use are outdated and ineffective.
• The term “deep tissue work” implies achieving results by applying more pressure and force, and nothing could be further than the truth.
• Research shows that fascia and muscle tissue respond best when approached by using methods that employ the person’s neurology, physiology, and movement. (SALT, 2022)
• Mere force cannot make a muscle relax and lengthen. Only slow, patient pressures and stretches can avoid triggering more contractile responses in the muscles. (Juhan, 2023)
• Remember, too much pressure applied too fast can damage tissue.

Psycho-social factors of evidence-based manual therapy

• Create emotional safety for the client. Reassure them they can heal/recover. Reassurance helps decrease their stress, anxiety, and fear.
• Pain (both chronic and acute) often causes the amygdala to go on high alert, arousing sympathetic arousal.
• “The amygdala plays an important role in emotional-affective aspects of behaviors, stress integration, and related disorders such as anxiety, depression, and addiction, as well as pain modulation.” (Neugebauer et al., 2020)

Practical manual therapy techniques: Pin and rock

Warm the tissue using the pin and rock technique. A gentle pin and rock is an extremely effective way to warm the tissue and prepare it for deeper work. Rocking creates a parasympathetic (rest and repair) response in the nervous system.

Why is rocking so effective in stimulating a parasympathetic response? It’s intimately connected to the first nerve to become active in the human fetus: the vestibular nerve. The vestibular nerve registers movement. For most people, gentle rocking evokes deep breathing and a calmer state. Use gentle pin and rock often during a massage therapy session. It is useful as a warm-up and to reset the nervous system before or after the active release/deeper tissue work.

Recommended course: Orthopedic Manual Therapy of the Cervical Spine

Practical manual therapy techniques: Strain/counterstrain

Always begin manual therapy work with the muscle in a shortened state. This manual therapy technique uses the principles of positional release (also known as strain/counterstrain).

“When the body is put into positions of comfort through shortening of a tight or locked-short myofascial structure, it reduces the signaling of the stretch reflex thereby interrupting the pain-spasm-pain cycle. Over time a healthy resting length of the tissue is restored promoting better strength, performance, and function.” (PRTi, 2023)

“Strain/counterstrain has positive effects by increasing range of motion and improving functional status in patients with chronic low back pain.” (Ahmed et al., 2021)

• Release the muscle in all its states: short, neutral, and stretched.
• Pin and move (active release technique). The client performs active movement while the practitioner is pinning a particular place within the structure.
• Release the muscle from different positions when possible: supine, side-lying, prone (not necessarily in that order).
• Pin and move (active release technique) is an extremely effective way to separate fascial adhesions and clear trigger points.

Active release technique

“A single session of active release technique is better as compared to muscle energy technique to improve hamstring flexibility and range of motion. Therefore, active release technique can be used with conventional techniques in a clinical setting.” (Khan et al., 2021)

According to Gangwar and Sharma (2022), active-release therapy was effective in many muscular and skeletal disorders, such as frozen shoulder, plantar fasciitis, trigger thumb, upper crossed syndrome, hamstring tightness, and trapezius pain. Active release techniques showed notable improvements in pain, range of motion, functional disability, and quality of life in musculoskeletal disorders.

When a massage therapist uses an active release technique, the client experiences:

• Novel sensory information
• Increased proprioception
• Becoming more somatically aware

Putting manual therapy techniques into practice

Manual therapists from all disciplines who understand the principles of safe, intelligent, and evidence-based bodywork will be able to deliver more effective treatment so that those who suffer from musculoskeletal conditions have a better chance of achieving a pain-free state.

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This article was written by Peggy Lamb, MA, LMT, BCTMB.