Laurie's Blogs.
Jan 2020
What kind of manual therapy do you start with?
This past weekend, I was teaching my Advanced Manual Therapy for the Canine Spine course here in Calgary. (It’s my favourite course! I think the information is a real game changer in rehab practice!) Anyways, I was asked a question. “Do you do soft tissue work before doing the mobilizations?” Good question. Good enough for a blog post topic! So here we go!
I remember back when I was treating humans, and there were a few times when the patient had gone for a massage before coming for physio, and the patient complained that they felt worse. Now, I’m not saying that massage is bad. No way! I get a regular massage. However, what was particular about the patients for whom massage made them worse, is that they had disc issues.
What happens with a disc issue? The pain at the disc and/or inflammation of the adjacent nerve creates a facilitation to the epaxial muscles supplied by that nerve root. That muscle spasm isn’t primary. It’s not the root of the problem. It’s in response to pain and inflammation, and in with those conditions, the nervous system becomes hyper-excitable. As such, not only does efferent messaging go awry (thus causing the facilitated muscles), but the afferent messaging is also skewed! So, it’s a viscous cycle. Muscles are tight because the nerves are inflamed or hyper-excitable. Applying stimulus to the muscles sends signals back to the central nervous system via inflamed or hyper-excitable nerves, which results in the central nervous system inappropriately signaling the muscles to turn on instead of relax. (Okay, this is my simplified explanation of the process… but it’s the one I’ve been using for years.) All to say, that if I suspect the issue to be discogenic, then I’d not use a soft tissue technique until the disc, nerve, or spinal inflammation was better sorted.
Secondly, mobilizations and/or manipulations have a neuromodulatory effect (inhibiting nociceptors and mechanoreceptors) resulting in a reduction of pressure within the joint and efferent outputs from the joint. This helps to normalize the tone and activation soft tissues adjacent to the joint. From my way of thinking, then why not do the mobilizations first?
That’s how I view it anyways. I’ll do my soft tissue techniques afterwards. In my hands, that’s when they do well. But… you may have a different experience, and I’d love to hear it if you do! Really, (outside of the presumed disc lesion…), I don’t think there is a wrong answer, soft tissue first or mobs/manips first. Please feel free to send me a note back to let me know! If I get enough feedback, I’d love to share the responses!
