Manual Therapy vs. Massage Therapy

by: Boris Prilutsky

The context, in which word is used, could change its meaning. This happens quite often and it’s enough to look up a word in a dictionary to see a long list of diverse meanings that are specific to different contexts. For example, depending on the context, the phrase “What a jerk!” could mean a reference to an annoyingly stupid person or a bouncing, or thrusting motion. So the usage of a word outside of its common contextual understanding could bring about a major confusion.

A meaning of a technical term is also specific to a micro-social context. Its usage within this context is a convention and therefore is being understood in a specific professional field in the framework of that convention. Thus taking the term out of a micro-social context or bringing it into a wrong micro-social context introduces confusion and leads to miscommunication and unnecessary arguments.

An example of such phenomenon, in my view, is overlaying the term “Manual Therapy” over the micro-social semantic scope of Massage Therapy.

The Latin word manus means hand, and therefore therapy conducted by hands is manual therapy. Technically speaking, massage therapists can call themselves manual therapists because scope of their practice uses quite a bit of soft tissue manipulations done by hands.

In the western methodologies of massage therapy, practitioner mostly use hands. However, during some eastern massage procedures, practitioners use not only their hands. In some cultures massage is conducted by feet. (Maybe in this case they should call themselves pesual or pedisual therapists?)

More importantly, massage therapy doesn’t use the entire gamut of manual therapy manipulations, but only a part of it. For example, a massage therapist cannot administer spinal movement segment/facet joints adjustment/maneuvers, cannot perform massage on carotid artery, etc. (For a more detailed familiarity of the differences please watch the video).

Yet even more importantly, other medical specialists such as physical therapists, osteopaths and chiropractors when using the term “manual therapy” imply something different. If a massage therapist introduces him/herself as “manual therapist” to these specialists, they are likely to interpret this term in the context of their profession, an assumption that would eventually lead to a confusion.

There are specific billing CPT codes pertaining to manual therapy that can only be used by physical therapists, osteopaths and medical doctors. So a massage therapist declaring him/herself as “manual therapist” is not only going to cause a confusion, but such an “imposter” might suffer some legal consequences. Yet even more importantly, other medical specialists such as physical therapists, osteopaths and chiropractors when using the term “manual therapy” imply something different. If a massage therapist introduces him/herself as “manual therapist” to these specialists, they are likely to interpret this term in the context of their profession, an assumption that would eventually lead to a confusion.

If such term substitution is so professionally questionable, why would so many massage therapists nowadays consider this a worthy experiment? The answer is simple – it’s a matter of marketing.

In several latest articles I expressed a concern about the poor state of the massage industry in the present modern market economy and exposed the reasons of why this state is so poor. You are welcome to familiarize yourself with these articles by clicking here. If such term substitution is so professionally questionable, why would so many massage therapists nowadays consider this a worthy experiment? The answer is simple – it’s a matter of marketing.

I am convinced that one of the reasons for such decline is due the attempt of many massage therapists to find the ways to separate themselves from being massage therapist and present themselves in some new quality, give their image “the new fresh look.” Knowing that American consumers are sold on new ideas, inventions, trends, and buzz words, presenting yourself as a member of some trendy “new wave” seems to some as a good idea. Thus “Manual Therapy” is the new buzz word and everybody are trying to jump on its bandwagon.

NOT in our case. In fact, allow me to throw a monkey wrench into a wheel of that bandwagon, because the term “Manual Therapy” is hardly new.
Manual therapy as a comprehensive concept initially was proposed in the former Soviet Union. In 1969 the Professor Kish of Uzhhgorod medical school in the Western part of Ukraine, proposed spinal manipulative techniques. At the time these techniques – spinal segment /facet joint maneuver – were considered significant support to a medical massage procedure. It’s a gentle and very specific to each spinal movement segment manipulation; something between a chiropractor’s adjustment and an adjustment by osteopaths. The Professor Kish called it a “maneuver.”

Professor Kish knew and practiced medical massage, including connective tissue massage, muscular manipulations by means of massage, and other massage disciplines. He taught that there is no substitute to massage therapy, and if adjustment/maneuver is being administered without normalizing myofacial function, then no rehabilitation would be achieved. Most cases of facet joint subluxations are the results of myofascial dysfunction. Therefore only comprehensive rehabilitative approach should be applied.He never claimed to be a pioneer of this type of manual therapy. Quite the contrary, he claimed to be trained in this method in Austria. However, I and many other colleagues from my generation, strongly believed that he was the one who in the end of 60s initiated the manual therapy development.In 1974 I had the privilege to take a class from this, at the time, a very old man. Originally he was a Hungarian national, born in Budapest before the World War I. What I can recall is he graduated from some Hungarian or Austrian medical school. After the World War II, he ended up living in the Soviet Ukraine, city of Uzhhgorod, teaching there in the local medical school.

In the 60s, Bulgarian scientist Dr. Boris Ivanov contributed very significantly to manual therapy. He proposed the clinical approach to the corrections of Biomechanics. In the beginning of the 70s the Eastern European methods of manual therapy, were further developed, by inclusion of post-isometric relaxation techniques, proposed by Czech Republic scientist Dr. Karel Lewitt as well as by Dr.Vladimir Janda. It came out that PIR techniques are much more effective and achieve faster results in cases that require restoration of muscular energy productions due to muscular pathologies within the same muscle.

Previously for this purpose we all used the techniques of massaging under stretching proposed by the Russian physician Manakov. Honestly, in certain cases, even today I am using Manakov’s techniques. But I can assure you that everyone, including every member of the Manual Therapy Association until 1980, knew that soft tissue mobilization by means of massage cannot be substituted.

Toward the middle of the seventies, the methods of manual therapy became so popular in the countries of the Soviet Bloc that “The Manual Therapy Association” was established. Uzhhgorod is located in the Western part of Ukraine, near Slovakian border, historically it was annexed by different countries, which made its international ethnic makeup diverse: Hungarians, Slovaks, Czechs, Germans, Ukrainians and Russians and its cultural and scientific connections international and multilingual. Ultimately, perhaps, because of its close ties to Czechoslovakia, part of which Uzhhgorod was since 1919 and until 1938, or because of the support of famous Czech scientists like Karel Lewitt, the Manual Therapy Association was established in Czechoslovakia.

So, to a large degree, people who became medical professionals were idealistic and ambitious enthusiasts, who “lived and breathed” by what went on in their professional field and dreamed to “change the world” and become well known in the process. Consequently, any new scientific development in the field was immediately known, passionately discussed and attempted to be implemented.Recall that unlike the pattern established in the Western countries, the earnings of doctors and other medical specialists over there weren’t much higher compared to other much lesser prestigious professions. However, despite a relative similarity in earnings of an unskilled worker and a professor of medicine, the later was still a very prestigious occupation. Surely, professor of medicine used to earn a bit more but not significantly.In order to explain why this Association became so popular you have to understand the social climate around mid seventies in the Soviet Bloc countries.

The aforementioned “maneuver” became widely known since professor Kish, well respected in the academies of sciences in the Soviet Union, gave seminars in many large cities. Manual therapy quickly became a new popular trend, a movement everyone wanted to be a part of. Therefore once the “Association of Manual Therapy” was established, in a short time, it became esteemed and many people wanted to be a part of it. At the beginning it was a very positive undertaking. Everybody who was trained and practiced physical methods of treatment, were accepted and association start producing some scientific papers, etc.

However, very soon things changed dramatically. It was not enough to be a medical doctor, osteopath, physical rehabilitator, or medical massage practitioner, well-trained in medical massage and other manual therapy disciplines. The management of Manual therapy Association enforced the rule that in order to be a member of Manual Therapy Association, one must be a neurologist.

No one, including the Association management, could explain or, at least, be polite enough to give a somewhat reasonable explanation as to why a neurologist can administer protocols of manual therapy, including medical massage techniques, safer and better than all listed above medical professionals.

This artificial segregation significantly divided the former Soviet Union community of experts in different manual therapy disciplines. Let’s keep in mind that at that time many Eastern European medical doctors took volunteered training in medical massage, as well as included hands-on massage therapy procedure in their medical practice. We all believed at the time that it was unhealthy and dangerous to establish such ”superiority,” as well as thought it was driven by greed and other special interests. Incidentally, this suspicion turned out to be completely true. Going ahead ourselves and fast forwarding in time, after collapse of the Soviet bloc, the Association immediately started accepting not only neurologists but everybody. In the mid eighties in the Soviet Union such irresponsible policy lead to untrained people declaring themselves manual therapists after taking only a couple of private seminars.

For a long time, the medical and sports massage community carried a great legacy, a very powerful healing methodology, its techniques designed to directly address myofascial dysfunctions, and other abnormal conditions that producing pains, functional disturbances, etc. By dividing massage therapy community the Manual therapy Association damaged it reputation and downplayed its achievements. From the middle of the 80s and on, the reputation and high clinical outcome record of medical massage and other disciplines was damaged. This “adjustment only” approach, in some cases caused significant condition aggravation to the point of crippling patients, speeded up spondylosis developments as well as didn’t produce adequate results.Recall that professor Kish, being an excellent massage therapists himself, stated that the “maneuver” is a supplemental procedure, that should be done in some situations and in addition to massage therapy protocols. However, the people who came to power in the Association deliberately distorted his message and manual therapy was presented and propagated as ultimate solution. As a result many practitioners start believing that “quick fix” like adjustment of facet joint could eminently solve the problem. Physical rehabilitators and other specialty medical doctors trained in medical massage who could legally practice this manual therapy maneuvers, voluntarily abandoned medical massage procedures. Indeed this was a very comfortable excuse to avoid the plethora of sophisticated and labor intensive medical massage methods, requiring much knowledge and efforts to administer. In the middle of the 80s manual therapy “excitement” reached its grotesque apogee, carried by the mob psychology, it triggered bizarre and out of control phenomenon. Thousands “brand new” manual therapy instructors, without appropriate training, clinical experience, etc. started developing ”NEW” methodologies and taught seminars to everyone, who was ready to pay the money to became ”Manual Therapists.”

My professor Alexander Dembo MD. PhD, the widely known and respected professor of medicine, trained as a neurologist and medical massage practitioner, was outraged with the Manual therapy Association wheeling and dealing, left the Association and advised all his students and followers to do the same. Instead he advised us to focus on rehabilitative efforts, which is to normalize function of muscles and fascia, rehabilitative corrective exercise, etc.

Interestingly enough many medical doctors, professors of medicine who used to practice hands-on incorporation of medical massage in their treatments and where members of manual therapy Association, but never called themselves ”Manual therapists.“ They always proudly called themselves “Medical Massage Practitioners.”

So if you are in the process of deciding to switch to a new trendy way of doing things and abandon the old, clinically proven, safe and effective massage therapy methods, please find out whether this “New” is indeed new and remember the bad experience of Eastern Europe. I would propose to learn from that bad experience, and not to repeat it here in the US.

To conclude, surely massage therapy is a manual therapy by definition, but the general public and healthcare professionals know what massage therapy stands for. I am convinced that, in case if one practices therapy by means of massage, the usage of alternative terms to massage therapy is faulty and damaging practice. Massage therapy is a major soft tissue rehabilitative methodology, while stretching, tractions, cupping, etc. should be only be given a supportive role. Other tools are very important components in comprehensive approach for therapy but in no case should be viewed as a substitute, to comprehensive soft tissue mobilization by means of massage.

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