Valencia PhysioBlog
By Valencia Physio Physio

The benefits of manual therapy

The topic

The benefits of manual therapy

image of woman with back pain - the value of the McKenzie method

Summary

Key takeaways

  • What is manual therapy ?
  • What are the main benefits ?
  • What is manual therapy for ?

The benefits of manual therapy:

We hear a lot about this concept, but what is manual therapy really? It encompasses many confusing things, and for years I myself had a misconception of the concept.

For a long time I thought manual therapy was just techniques borrowed from osteopathy. At school, we had a teacher who is a physiotherapist and osteopath and who gave us courses in manual therapy. He mainly showed us the manipulations and mobilizations used in osteopathy. It wasn’t until years later that I realized that manual therapy encompassed much more than the techniques we learned at school.

To put it simply, manual therapy encompasses all the manual techniques used by a healthcare professional such as a physiotherapist, osteopath or chiropractor… Manual therapy encompasses many different techniques, such as: massage, mobilization, passive stretching (performed by the therapist while the patient does little or nothing), spinal manipulation, or manipulation of the upper or lower limbs, and many other techniques, as the list is not exhaustive. It’s part of the “hands-on” concept, i.e. the therapist’s hands on the patient’s body. Hands-on is the opposite of hands-off, which means that the therapist does not touch the patient.

What manual therapy is not :

Manual therapy is not a hands-off method, but a hands-on method. So it does not include, for example, the prescription of exercises, or anything to do with communication and exchange between therapist and patient to establish and maintain a therapeutic alliance.

What can Manual therapy do ?

  • Targeting areas of tension
  • Improve mobility
  • Relieve pain
  • Mobilize joints
  • Test range of motion
  • Increase range of motion
  • Improve blood circulation
  • Improve lymphatic circulation
  • Provide relaxation
  • Improve well-being

When is manual therapy used?

It all depends on the therapist’s working method, but at Valencia Physio we like to use this technique to feel the tensions perceived by the patient, to relieve them, and to help reduce their pain and improve their state of health.

Manual therapy is used for a wide range of conditions:

  • Shoulder pain
  • Limited range of motion
  • Neck pain
  • Back pain
  • Tendinopathies
  • Ankle sprains
  • Knee pain
  • Digestive problems
  • Respiratory problems
  • Gynaecological problems such as endometriosis

That said, manual therapy complements hands-off exercise prescription very well, and the two are complementary.

 

By Valencia Physio Physio

The importance of gut health

The topic

From the heart of our cells to our plate

The expert

Anthony Berthou
Micronutritionist

Summary

Key takeaways

  • Omega 3s: where to find them and through what form
  • The deficiencies we most suffer from

Interview Highlights

What types of Omega 3 supplements should we take ?

When we look at food supplements like Omega 3 for instance, we can talk about esterification, purification and so on. And the quality of the process and, above all, the preservation are important – oxidative stress can start to affect these omega-3s, because what makes them so rich, that is the fact that they are highly unsaturated, also makes them weak ; indeed, they are very sensitive to oxidative stress. So when you keep omega-3 capsules for several months, or even several years for some people, it’s a bit like the hot potato effect, i.e. there’s going to be a very significant propagation effect of oxidative stress. In a clinical trial, it was shown that oxidized LDL, i.e. the atherogenic fraction of LDL, increases the risk of cardiovascular disease. In fact, oxidized omega-3s can accentuate the risk, whereas non-oxidized omega-3s tend to reduce it.

And unfortunately, we’re not legally obliged to mention the oxidation rate, what we call the TOTOX index (the lipid peroxidation index from a laboratory), i.e. normally this index must be less than 5 to really have very low oxidation. But this index is sometimes measured by laboratories, and that’s fine. So it’s not because it’s not compulsory that some laboratories don’t do it. Some do, to their credit. Now, the question is, is it done when the product leaves the factory? Is it done after six months’ storage? Is it done after ten months’ storage? And if your storage is at room temperature, etc., unfortunately… these compounds oxidize very quickly. That’s why I recommend, first and foremost, taking the freshest omega-3s possible. We don’t have much control over that, because it simply depends on when they’re produced. But in any case, when you buy them, keep them in the freezer. Because, in fact, even in the refrigerator, in the fridge, oxidation continues.

Which foods can provide us with Omega 3 ?

Little oily fish. Unfortunately, whether it’s salmon or other fish, there have heavy metals… And it’s true that today, if we stay with the salmon story, there’s methylmercury, but there are also other compounds, because they’re fatty fish, and they’ve accumulated these compounds over the course of their own lives. And when we recommend sardines, macros, anchovies, small fish, we have fewer cumulative effects, so we’ll have fewer of these compounds. They’re also present in walnuts from Périgord or Grenoble.

What are the deficiencies we suffer the most from ?

Fortunately, deficiencies are rare today. In Western countries, etc., not all or most of us are deficient in certain micronutrients. On the other hand, we can be deficient. In other words, a deficiency is in the intermediate zone between an optimal status and the preamble to a deficiency if it is maintained over time. And here, in fact, we have a fraction of the population who may be prone to it. Classically vitamin D, not because it’s a dietary problem, simply because we’re no longer sufficiently exposed to natural light: we’re always indoors, as Pierre Rebi said: “we live in boxes, we sleep in boxes, we move around in boxes”, and unfortunately, we lack vitamin D. So it’s unfortunately in relation to our lifestyle. This vitamin D is synthesized from the sun’s UVB rays, and so we need exposure to light to have sufficient vitamin D status, particularly during the period from spring to autumn, to build up reserves for the period when we have less exposure.

And we can see that around 80% of the population today has a deficit in relation to official standards. And if we were to raise the minimum level of deficiency a little, we could have even more people. The same applies to magnesium. We’re talking about 80% of the French population, because on the one hand, the micronutritional density of the foods we eat is falling. We eat a lot of ultra-processed foods. These are often referred to as “empty calories”, because they provide a lot of calories and few micronutrients. On the other hand, we have a lifestyle where we’re often stressed. We also live in an environment, a society where we’re a little stressed all the time in transport, and so on. As magnesium is very important for all energetic enzymatic reactions, whether cognitive or physical, we can greatly increase our magnesium requirements. So, on the one hand we increase it, on the other hand we have less intake, which means that mathematically we end up with a major deficiency.

Podcast Episode

Additional Resources

  1. Link one
  2. Link two
By Valencia Physio Physio

Addressing Shoulder Pain – which physio can help rotator cuff injuries?

The topic

Addressing Shoulder Pain - which physio can help rotator cuff injuries?

The expert

physio and shoulder injuries, rotator cuff injury and rehab
Dr Angela Cadogan
Physiotherapist and shoulder specialist in New Zealand.

Summary

Key takeaways

  • Rehab for shoulder is unique from other injuries
  • Patient pain is very high
  • Focus should be on functional usage without increasing pain

Interview Highlights

What is the role of physiotherapy before a rotator cuff surgery ?

“The role of physio before rotator cuff surgery is different from other types of surgery ; for instance, for knee joint replacement surgery, you’ll work at gaining quadriceps strength, but it doesn’t seem to quite work that way with rotator cuff tears. In my experience and with the surgeons who I work with in my local area, very often the reason that they are operating is that the patient has high levels of pain and ongoing weakness because of their rotator cuff tears. So I often find that those patients, if you try and make them exercise more, it just increases their pain and increases their irritability and weakness.  

What are the recommended exercises for shoulder pain?

That really depends on the condition. And it also depends on what you are defining, how you’re defining exercise. The term “exercise” covers such a huge range of things. It covers stretching exercise. It covers isometric exercise. It’s motor control. It’s eccentric. It’s concentric. It’s heavy load. It’s light load. It’s scapula, it’s cervical spine etc…

What are the recommended exercises for stiff shoulders ?

With stiff shoulders, at the start, stiffness is greater than pain. But once the pain levels settle, and the patient is more stiff than they are painful, stretching is the best exercise for those patients, followed maybe by strengthening. But very rarely have I ever seen a patient who remains weak and functionally limited after they regain their range of motion, so they tend to return to normal functional activities without a lot of exercise once they regain range of motion.

What are the recommended exercises for unstable shoulders ?

For the unstable shoulder, working on the rotator cuff activation by targeting specifically the rotator cuff in terms of its co-contraction function is efficient. Its ability to work right through the range of motion, particularly right through internal and external rotation, and then its ability to develop force rapidly is a priority for rehabilitation. With high velocity exercise training. So you’re essentially trying to retrain the rotator cuff to maintain stability of the humeral head and react under high speed and unpredictable circumstances. 

What are the rotator cuff pain ?

I know a lot of patients with a rotator cuff disorder that have had a lot of rotator cuff strengthening exercises. Most of the time, the reason they see me is because they are sore, and the exercise is making them worse. So, for that group of patients, if we look at the irritable rotator cuff disorders, because the massive and inoperable are a slightly different group, but if you’ve just got a small and irritable rotator cuff tear, then again, once the pain and irritability has settled, it’s more about functional strengthening for me. If you try and target that torn, irritable rotator cuff with long specific high load exercise, you’re just going to make it sore.

So, what do those people need to be able to do?
They need to be able to lift their arm up forwards in front of them. And they need to be able to externally rotate their arm.

So for me, it’s about the functional training in those positions in a way that is not aggravating their symptoms.

It doesn’t necessarily have to be pain free, but as long as it’s not making their pain any worse, then it doesn’t matter what muscles they’re using to do that. But if they can regain flexion and regain external rotation, that is going to be functional for them.

What about the acromio-clavicular disorder ?

The AC joint group needs to work on the scapula. Their scapula must be working well with good force coupling really for those AC joint conditions. So that’s probably broadly how I would approach exercise in those different patient groups.

Podcast Episode

Additional Resources

  1. Link one
  2. Link two
mark laslett kinedit interview mckenzie physio | valencia physio
By Valencia Physio English, Physio

Episode 26 – Mark Laslett & McKenzie method

 Mark Laslett is a New Zealand-based lower back pain clinical specialist and physiotherapist.

Mark has published numerous research articles on lower back pain, and during our podcast  interview he describes how he treats patients with both acute and chronic pain (pain that has been there for a long time.)

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mark laslett kinedit interview mckenzie physio | valencia physio

The McKenzie Method

Mark tells us about the McKenzie approach, which he uses on a daily basis. This approach consists of centralizing pain at one level of the spine (cervical, thoracic, lumbar) through repeated movements. These movements can be flexion, extension or what he calls the lateral shift, which is a kind of sideways glide.

These movements are extremely easy to perform and very accessible, and there are several variations, depending on each person’s abilities.

 

Ian's Story

A pain that has centralized means that it has gone the other way round; for example, a referred sciatica pain that goes down the leg, sometimes even to the little toe, will gradually work its way up to the back, only to become a very localized pain, the size of a thumb.

Mark tells us about a patient, Ian, he saw at the practice. Ian had been in pain every day for 8 years. Ian’s job as a salesman required him to drive for 8 hours a day, and because of his pain, he had to stop every hour or even every 30 minutes to lie on the ground outside, whether it was snowing, hailing, raining, summer or winter.

Ian arrived at Mark’s office in agony. He’d been suffering from back pain for 8 years.  After a long, detailed and thorough interrogation, Mark asked him to perform several repetitions (in flexion). At the end of the session, Ian was almost pain-free. His pain had centralized and almost disappeared. He continued to do his flexion sets in the weeks that followed, and Mark still sees him to make sure everything’s okay. For several years now, Ian has been doing very well and is pain-free. In Ian’s case, it was the flexion movement that provided the solution. Sometimes it’s extension, or lateral shift, depending on the person and their pain.

Alternatives to the McKenzie Method

For some people, the McKenzie method doesn’t work, the pain isn’t centralized, and so other treatments may be proposed to the patient: medication, epidural, injections etc. The physiotherapist may refer the patient to a surgeon, or a doctor for further treatment, and in all cases support the patient in maintaining functional capacity and coping with pain.