If I had six hours to chop down a tree, Iʼd spend the first four hours sharpening the ax.
Exercise is an important part of the rehabilitation and so-called maintenance program. As a practice, itʼs analogous to practicing a musical instrument. A broken E string on a violin will effect ones ability to play their music.
Good manual therapy is akin to tuning the instrument. The stretch and strengthen approach is limited in that one can only condition the existing movement capacity, i.e. one may play all the notes except E. This is where stretching is applied.
However, if a protective mechanism is causing the lack of flexibility or decreased range of motion, then any gains will be nominal and hard-won (effortful). Additionally, it is likely that one becomes accustomed to a fairly low plateau, and or the benefits will be transient.
Protective mechanisms are at the root of many pain and limited movement patterns.
Some properties of protective mechanisms are
• Easily irritated, or sensitive to particular stimuli
• Frequently generates a cascade of influence, referred pain, postural compensation
• Posture reflects a dynamic process, as well as body position.
• Posture reflects our adaptive responses
Manual therapy seeks the origin of these postures or those things that the person is
Treatment of these dysfunctional patterns usually alleviates pain and restores mobility that is readily maintained. In the case of low back pain, it is often found that sacral movement is compromised.
This may be from abdominal surgery, faulty ankle or knee mechanics; or stored trauma from a fall, whiplash, or old concussion, etc.
The quality of interaction during treatment is important, with a good interface, the therapist is granted deeper access to the body, this improves the depth and scope of the treatment exponentially.