Manual Therapy or Functional Exercises?
Lately there has been criticism raised against manual therapy and it has sometimes been quite aggressive. Comments have been made that if a Practitioner lays you down on a table the treatment is outdated and ineffective. Functional Exercises are instead being promoted as the answer to everybody’s pain syndromes. Much of this loud criticism is made with comments like “backs don’t go out” and “discs don’t slip” so therefore manual therapy must be ineffective.
First up I would like to assure all Practitioners who use Manual Therapy to alleviate their patients pain syndromes, that there is nothing wrong in your approach.
Let us look at the concept of Functional Exercises:
What is a functional exercise?
A functional exercise is any exercise that is performed with joint centration created by functional stabilization throughout the entire movement.
Joint Centration is the joint position where there is maximum contact of the joint surfaces allowing for maximal loading without straining the surrounding supportive tissues. Joint centration is a brain program, and functional training is therefore not just performing certain “functional exercises” but keeping the joints in functional positions while performing exercises.
We can therefore just look at an exercise to quickly determine if it is a functional exercise or not.
Manual Therapy is often, if utilized correctly, the quickest way to get a person out of pain. It is almost impossible to assess a person’s functional movement patterns when they are in pain. Pain will often distort movement patterns and not allow for an accurate evaluation. How would a squat pattern look for someone with acute back-pain, and if that person cannot squat properly should someone try to teach them how to squat in pain or would it be a smarter solution to get the person out of pain and then assess their movement patterns? A well-structured exercise program can often be very beneficial in the acute stages of back pain, but the movement patterns have to be properly assessed once the pain is gone.
The fact is that the answer to the question of whether we should promote Manual Therapy or Functional Exercises is that the combination of the two is far superior than either approach on its own.
We can illustrate this with a pendulum that just has swung out to one side, but it will turn and come back again.
There is nothing wrong with Manual Therapy if it is combined with a Functional Exercise approach. Manual Therapy on its own is often not enough to create a difference in how the patient moves. The majority of the patients seeking help are in pain because they do not move properly, so if we don’t change how they move, how can we expect them to have lasting improvement.
The answer to the backpain epidemic is however not more or better treatment, but an approach designed to educate people on how to look after themselves better to PREVENT problems. Manual Therapy (and even in certain cases surgery) will always be in demand, but it should not be the aim.
Prevention is much better than cure!
Wouldn’t it be great to have a proper study done comparing the benefits and effects of Manual Therapy versus Functional Exercise regimes? Then just imagine a third group where the two were combined: Manual Therapy to alleviate the pain as quickly as possible, and then assess and implement effective functional training. I bet that after x number of months, while the manual therapy group were still seeing their practitioners every 2 weeks, and the Exercise group were struggling with some basic “non-functional” movement patterns, the combined group would be out squatting and deadlifting.
The Practitioner of the future will have very effective manual skills, and also be trained to assess and correct their patient’s movement patterns with properly executed functional exercises.