Manual Therapy and Touch

Introduction: The physiotherapy approach to musculoskeletal pain is currently pointing more towards a hands-off management of patients by education and exercise therapy. However, hands-on techniques still represent a core element of musculoskeletal physiotherapy practice appreciated by patients and widely taught in educational program and clinical professional development training.

Purpose: This professional issue explain why hands-on techniques may be considered a specific form of touch and outlines the importance of having a deep and wider understanding of their action mechanisms. Three aspects of the human touch, namely analgesic, affective and somatoperceptual are considered in light of the current literature.

Implications: The view of hands-on techniques as a specific form of human touch implies a change of perspective. Primarily, manual therapy techniques are based on the physical properties of the delivered stimulus (requiring knowledge of anatomy, biomechanics and neurophysiology) as well as on the emotional properties that emerge from the sympathetic contact established with the patient. Secondarily, the manual therapists should develop relationship and communicative skills allowing this kind of touch to emerge. Thirdly, accordingly with this new perspective, the study of the multifaceted mechanisms of action of hands-on techniques requires a multidisciplinary team of researchers including specialists apparently far from the clinical field. Finally, the recognition of the therapeutic value of touch as one of the most qualifying professional acts of physiotherapists is needed and guarantees patients of its best evidence-based delivering.

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