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Massage, Traction, and Manipulation

Background

Various forms of massage, traction, and manipulation have been used in medicine throughout the world for several thousand years. Each modality represents an approach to treatment of the musculoskeletal and other systems sought by a steadily increasing number of people, despite a relative dearth of quality, evidence-based research supporting their isolated use. Research on each of these modalities continues, but they are all united by a longstanding variable, the concept of touch.

In the 1940s, Spitz reported on children’s home infants who, though otherwise healthy and well cared for, failed to thrive and often died in the absence of being held or touched. Kunz and Krieger additionally defined and taught the principles behind the related concepts of healing and therapeutic touch in the 1970s.

Although there is no consensus on the complete physiology of massage, traction, or manipulation, it is generally accepted that these treatment approaches involve more than just the interaction of mechanical forces and human anatomy. There is a long history of touch as a natural, essential component to healing and health maintenance.

Each of these treatments has some scientific support to back its use in certain cases or conditions, and from a logical perspective, one can assume that some middle ground exists for the application of massage, traction, or manipulation in a carefully assessed and controlled manner within the medical paradigm. Each of these treatment approaches also carries some potential risk, but given the estimates of use worldwide and the rare reports of direct or indirect side effects related to these therapies when they are performed correctly and under proper circumstances, the risks appear to be minimal, with the treatments offering potential benefits for patients.

From an osteopathic perspective, manipulation is not intended to be a standalone treatment; rather, it is meant to be a component of the overall treatment strategy for a given patient. Indeed, current research on manipulation seems to support this use, and further research must be done on a variety of conditions to determine the best approach or combination approaches that will most effectively and safely aid the patient’s recovery. The same concept should be applied to the investigation of massage and traction to determine how best to use these treatments in the complete medical care of a patient.

Because physiatry has embraced the “team approach” since its inception, combining the administration of an appropriate thorough history and physical examination with the use of a variety of physician and nonphysician practitioners, manipulative modalities, and treatments is not a new concept. This strategy is well accepted and has been shown to be effective for many types of patients.

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