Manual Therapy in Neuro Rehab

Manual therapy has gotten a lot of heat over the last few years as more and more evidence has emerged about its efficacy and mechanisms. 

Personally, I have no problems with it, and think many of the plethora of techniques available such as sports massage or dry needling can be a great tool for any therapist to use as part of a rehab process. However, my problem with manual therapy begins not with the techniques, but with the way therapists communicate with their clients about those techniques and how they work.

In my practice, I’ve always leaned more heavily on movement and exercise interventions to help those I work with to achieve their goals. That being said, on the odd occasion, I will use manual techniques if I believe that they’re the right tool for the person in front of me at that point in time.

Typically, this is when short term pain relief is needed to help the client move better, or more easily participate in the higher yielding interventions of exercise therapy. Additionally, within neuro rehab specifically, manual techniques can be a low hanging fruit entry point to helping someone’s nervous system relearn how to sense or move parts of their body independently again.

In multiple sclerosis, this may be beneficial when dealing with spasticity, in which descending inhibitory signals that tell muscles to ‘switch off’ are compromised, resulting in increased muscle tone and spasms. Trying to actively move through these spasms can be counterproductive, as you try to fight uncontrolled tension with yet more tension, often leading to worsened symptoms. This is where using manual therapy, such as massage or passive stretching (especially when combined with the Neubie device) can facilitate greater muscle relaxation, making it easier for patients to move and exercise. 

Moreover, in some cases of motor neurone disease (MND), muscle cramps and chronic pain can significantly contribute to worsening mobility over time. Whilst exercise therapy forms the majority of my interventions when working with those living with MND, manual therapy can again provide short term pain relief, leading to short term improvements in movement and quality of life.

However, this is the key point. Any improvements gained from manual therapy have to be communicated for what they are - short term. This doesn’t make them bad or useless, it just honestly frames their utility to clients as part of a wider treatment plan.

If your goal is to reduce pain long term, improve your movement, return to sport after injury or improve independence with a neurological condition, you’re best off focusing 90% of your attention on the interventions that are going to create long term changes in your brain and body. Exercise therapy, behaviour change, sleep and nutrition management, among many more. Manual therapy can be the 10% that helps you along the way, but be cautious of any therapist that claims that they can fix your chronic ailment with an acute remedy alone.

“The desire for safety stands against every great and noble enterprise.”

- Tacitus

Rehab is a great and noble enterprise with potentially life changing outcomes. The short term relief of manual therapy is the safety that will keep you from it if not used wisely.