It’s a common experience in clinics everywhere: you walk in to see a new therapist, and you’re excited to have a hands on treatment. The problem is, in your 45 minute appointment, they spend 20 minutes just figuring out what’s wrong. You want to scream, “I’ve just told you what’s wrong! Just fix it! Stop wasting my time!” and the frustration kicks in. You feel as if they’re being over-cautious in a litigious world, or that they’re not very good at what they do, and so they’re fluffing about. You’re so exasperated that you can’t quite even appreciate the treatment itself. Why do they do it?

The benefit of hands-on

Whether it’s for the pain relief, increased freedom of movement, or simply dusting away some of the metaphorical cobwebs of your body, manual therapy is a fantastic way to help you feel better. Some manual therapies, such as Relaxation Massage are effective simply because of the touch they provide. Your nerve endings are stimulated, the skin friction brings blood to the surface, the warmth is amazing, your brain floods with oxytocin and you feel happy and calm. These therapists need to assess, but relatively minimally. For other manual therapies though, such as Myotherapy, it’s not primarily the touch that’s helpful, it’s the type of touch.

Myotherapy translates to “muscle therapy”, but it could more accurately be called neuromusculoskeletal therapy, because Myotherapists treat the nerves, muscles, joints and connective tissue that holds us together. With so many structures that can be treated, the therapist couldn’t possibly treat all of those things in every location in just one session. And what would be the point of doing that, anyway? I’ve never yet paid a plumber to fix a pipe that isn’t broken, and I’m not likely to. Treating structures that aren’t problematic is not only a waste of money, but in a body with limited ‘healing resources’, you don’t want to direct your immune and repair cells to a location they’re not needed, instead of into places that are.

Underlying knowledge

Manual therapists have some interesting pieces of information that you might not know. One is that you can change how your nervous system is aware of and responds to certain areas of the body. If you try to do this in too many places though, it becomes ineffective. Two, is that you can improve stuck or painful movement by physically assisting the joint to move. This improvement can sometimes be reduced if you move the joint back in the opposite direction or in too many other directions. Three, is that inflammation isn’t always bad. In fact, a little bit of inflammation (caused by certain pressures, movements, etc) can be very helpful to healing and recovery. The problem isn’t inflammation, it’s too much inflammation. All of this knowledge guides us towards ensuring our treatment is specific and targeted. Too much treatment, like most things, is not good.

So, the average manual therapist is thinking very strategically about your session. What techniques will have the greatest impact without the risk of over-treating? Sometimes this seems a little like Jenga to me; it’s a balancing act and you have to get it just right, or risk causing flare-ups (or worse). Making it even more complex is that the location of your pain isn’t always where the problem stems from. Plenty of therapists have made the mistake of just treating the sore spot, and not looking at the actual cause. That’s great for the therapist’s income at first, but nobody raves about the practitioner who couldn’t fix you. Keeping you coming back for more treatment does not a solid practice make.

Tailoring Treatment

Assessment is one of the most vital parts of your session. In fact, any therapist who isn’t assessing you isn’t doing their job. Using targeted assessment, the therapist can check on the root cause of your problem; see if other structures are involved; investigate how serious the problem has become; and ensure that it’s nothing more sinister than what it appears to be. Your safety is their concern, absolutely, but it’s actually about ensuring that they get it right so that you get the most benefit for your money. Great assessment means that the therapist can often give you brilliant results by actually doing very little. Novices keep throwing darts at a dart board until they stop hitting the wall; the master knows that their one dart will hit the bullseye before they throw.

Next time you see a new practitioner, realise that the greatest therapists are often doing the most thorough assessments, to ensure that the treatment they do is tailored specifically to you. A whole session of treatment from one therapist might be far less effective than just a few techniques from the next. Judge a therapist by their assessment rather than their treatment, and you’ll likely get better results.

This article provides general information and is not intended to constitute advice. All care is taken to ensure information is accurate and relevant. Please see your Practitioner for health treatments and advice.