Manual therapy has a reputation for being, well, manual. Hands-on. The use of one person's hands (and the occasional elbow) to help another person feel better.

We can all visualise what a massage consists of, and also perhaps what a visit to a physiotherapist, osteopath or chiropractor might look like.

But there are times when hands-on treatment should take a back seat.

Is hands-on treatment effective?

There is much criticism nowadays of hands-on therapy, as when scrutinised by modern research methods, it seems to offer little value to the recipients. Massage doesn't really make people looser, and spinal manipulation certainly does not re-align joints that have "popped out".

The argument, therefore, is to stick to methods based on education and encouraging self-care. There is some logic here, and this is where BackPain.online sits.

But remember, BackPain.online is made by real-world clinicians, who treat people with their hands within a broader framework of also giving advice, education and rehab.

The real-world argument

Ask the clinicians behind BackPain.online why they use hands-on methods, and they will talk to you about the variety of patients. People are not what researchers would like to think.

Clinical research tries to even out the variations that exist between people by using large groups to standardise cause and effect. In the real world, however, everyone is different. So different people need different combinations of input.

While research might say that massage does not effectively loosen muscles, in individual cases, it can do. Similarly, working to help the shape of a spine can help, but only when considered and subsequently delivered on a case by case basis.

The synthesis of these two camps of thought, to touch or not, is to conclude that there is a place for manual therapy, but only when justified in each individual case.

A more useful tool?

Where hands-off therapy has value, is in its ability to be deployed universally.

There is no requirement for justifying the use of education since at one level or another, everyone needs to know what's going on.

Similarly, advice can be given to every person in pain, and this extends to offering rehabilitation to patients coming back from injury.

But wait...

We need to ensure that patients get the correct education, advice that is relevant, and rehabilitation that suit their needs and demands.

Not as simple as it sounds...

While therapy without contact can clearly be seen to have value, there still lies the same hurdle as with manual therapy. Choosing the right tool for the right job.

To help us structure our plans, we should shelter under the umbrella term of management. 

Management can include hands-on therapy if you're face to face and there is a need for it. 

in contrast, management should always include education and advice appropriate to the patient and their condition. 

The winner?

Management wins. 

It occupies the higher ground of being the overarching strategy, not just an available tactic.

In the example of back pain, allow your management of the condition to be central to your thinking, and add elements to it that are necessary and appropriate. Perhaps that includes hands-on treatment.

No plan survives the battlefield, so remember to adapt, switch tactics, and listen for feedback.