A PROCESS APPROACH IN MANUAL AND PHYSICAL THERAPIES BEYOND THE STRUCTURAL MODEL – FORUM

(with tongue firmly in cheek) Is osteopathy just a ‘glorified cuddle’ then? ;)

Very interesting read. I bang on about exercise being of little value if not functional or relevant to real life but can definitely see where many of the conventional rehab exercises I prescribe could be replaced by more truly ‘functional’ ones relevant to an individuals daily activities.
My mind gets stuck though at the thought of not needing to address structural obstacles as well as implementing more process oriented activities…

I read the article in my lunch, then spent the afternoon telling my patients that my structural treatment was just opening a window of opportunity for themselves to continue their ‘healing process’ before they next see me! They liked that idea a lot. Not sure that’s exactly what the article was referring to, but it helped them understand a little more. So for that, big thanks!

MT techniques?

The power of touch is evident in the lack of satisfaction patients feel when they have ‘hands-off’ therapy. I feel compliance and perception of change, from the patients perspective is always greatly enhanced when some form of manual therapy is combined with advice / exercise etc.

I agree with the idea that PSB factors may not be able to explain why someone suffers with LBP – the body has a great capacity for adaptation. I’m interested to know what Eyal thinks about when there are several PSB factors present concurrently whether there is point at which the biological reserve is used up and symptoms develop?

Do you think this type of approach would be better for treating chronic pain conditions such as FM? The published research would appear to suggest that the structural manual therapy approach to treating FM is not as good as the physical exercise and empowerment route, and so to me it would seem to be a better approach….

rather than saying the structural model is defunct, is it not a case of the process approach ‘absorbing’ the structural model into a wider and more holistic model? surely, some MT seek to help facilitate adaptive change as well as alleviation of symptoms and that by helping the patient to relate these changes in symptoms with functional and psychological process we help to repair and recovery?

Definitely theres a gap between structural approach and what a vast amount of patients need to gain a full resolution… I am currently treating a client with a very stubborn chronic shoulder. Structural approaches have gotten him so far, but will certainly sit down with him and work out a more process approach as we seem to have hit that stagnation stage. Definitely will broaden the approach I take in these sorts of cases particularly.
In general, as discussed above I feel the power of touch along with the power of simply ‘being heard’ plays such a huge huge role in what we achieve. All great food for thought, so to speak.

With FM (and other similarly chronic conditions also) does a heck of a lot of a patients state not come down to how in control of their progress (or perhaps lack thereof) they feel? Process approach I’d imagine in that case is simply a case of empowering the patient within their limitations, whether pain or function are technically improving or not?

Ah I see what you mean. Now that really is one to think about! Especially when so many ‘processes’ are at play in this condition!

MT ( manual therapy ? – general hands-on) or should we go back to MT (manipulative therapy ? – implying skilled more specific hands-on interventions). I wonder if patients or their nervous systems (maybe parasympathetic – sympathetic sensorimotor – not structural/biomechanical) do know somehow the difference.

Very true. I had a patient recently whose symptoms presented very much like an acute rib dysfunction might. Structurally there was some very mild ‘stuff’ worth working on, but I strongly feel it was the discussing the grief and stress she’d been under for many years, culminating in recent significant health issues, and allowing her to feel she could physically move through the pain she felt without risk to either MSk or systemic health that made the difference. In hindsight I suppose it was a process approach of sorts involving gradually introducing her previously normal ADL’s which got her moving through that pain which resolved as she went. Fear was a huge factor in it all, which all the structural approach in the world would never make a dent in.

But then yep… what of the cases where the repair process has gone askew and become a chronic presentation as mentioned by lumac. Can that be expected to change without some good breaking down of aberrent tissue? Wouldn’t we then end up like it appears many exercise based Physios seem to be where patients are diligently following a graded exercise program but their body is doing the movements all arseways due to structural restriction/dysfunction? Arseways being highly technical and proper terminology of course :)

And heck, in those cases patients tend to feel so warm and fuzzy by the time they leave i’ve literally gotten some osteopathic hugs ;)

Thank you for your time and a thought provoking article Eyal.