Common Concerns About Manual Therapy in Orthopedic Treatment

Questions related to manual therapy?

Hello Dr.
Chen, I recently underwent manual therapy at a physical therapy clinic and have two questions to ask:
1.
After the treatment, my old injury, which has been bothering me for over a decade, has become more painful.
Is this phenomenon common? Can I continue with manual therapy?
2.
During the treatment, I was lying flat on the bed holding a soft pillow, exhaling forcefully, while the therapist applied their full body weight on me.
My spine made popping sounds during this process.
Is this type of manipulation dangerous? Could it lead to paralysis after a few sessions?
Thank you, doctor.

Niming, 30~39 year old female. Ask Date: 2019/12/19

Dr. Chen Yongxue reply Orthopedics

First of all, I am not aware of the reason (diagnosis) for your visit to "manual therapy," nor do I understand which specific treatment you are referring to.
I suggest that you directly consult a rehabilitation physician for clarification.
Thank you.

Reply Date: 2019/12/19

More Info

Dear Patient,
Thank you for your questions regarding manual therapy in orthopedic treatment. It’s important to address your concerns, especially since you have experienced increased pain after your sessions and have questions about the safety of the techniques used.

1. Increased Pain After Manual Therapy: It is not uncommon for patients to experience increased discomfort or pain following manual therapy, especially if they have chronic injuries or conditions that have not been addressed for a long time. This phenomenon can occur for several reasons:
- Inflammatory Response: Manual therapy can stimulate an inflammatory response in the tissues, which may lead to temporary discomfort. This is similar to how one might feel sore after a workout, as the body is adjusting and healing.

- Tissue Mobilization: If the therapist is mobilizing tight or restricted tissues, it can lead to soreness as those tissues are being stretched or manipulated. This is often a sign that the therapy is working to release tension and improve mobility.

- Underlying Conditions: Chronic injuries may have underlying issues that need to be addressed. If the manual therapy is targeting these areas, it may initially exacerbate pain before leading to improvement.

It is essential to communicate with your therapist about your pain levels. They may need to adjust their techniques or the intensity of the treatment. Continuing manual therapy can be beneficial, but it should be done with caution. If the pain persists or worsens, it may be wise to take a break and consult with your healthcare provider to reassess your treatment plan.

2. Safety of Manual Techniques: The sound you describe, often referred to as "cavitation," occurs when gas bubbles in the synovial fluid of the joints collapse or form during manipulation. While this sound can be alarming, it is generally not indicative of harm. However, the forceful nature of the technique you described raises some concerns:
- Forceful Manipulation: If the therapist is applying significant pressure on your body, it is crucial that they are trained and experienced in these techniques. Improper application can lead to injury, including muscle strains or, in rare cases, more severe complications.

- Risk of Injury: While serious complications like paralysis are extremely rare, they can occur, particularly if there is an underlying condition that has not been diagnosed. It is vital to ensure that your therapist is aware of your medical history and any pre-existing conditions.

- Communication is Key: Always communicate your comfort level during treatment. If you feel pain or discomfort that seems excessive, inform your therapist immediately. They should be able to modify their approach to ensure your safety and comfort.

In conclusion, while manual therapy can be an effective treatment for orthopedic issues, it is essential to approach it with caution, especially if you have a history of chronic pain. Always consult with your healthcare provider if you have concerns about your treatment or if you experience significant changes in your symptoms. They can help guide you in making informed decisions about your care.

Wishing you a smooth recovery and better health,
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