Manual therapy as lozenge

I had a sore throat earlier in the year. Thankfully I very rarely get ill, which is just as well as my wife tells me I am a dreadful patient. I always think it quite ironic considering the amount of pain I have been exposed to in my professional life. You’d think i’d have learnt how to be a ‘good patient’ what with all that illness behaviour i’ve been subjected to. Maybe it doesn’t work that way…

Anyway, I had a fever and was in bed for a day. It was taking a while to clear up so I went to see the GP because the front of my throat was swollen and tender. The GP gave me a script for some antibiotics to take if my symptoms didn’t improve in a few days, thinking it might be a bacterial infection.

So as I lay there in my deathbed-febrile state it came to mind to check the NHS website for information on sore throats. Very interesting it was as well…after a list of ‘tips to ease the discomfort’ (avoid smoke, eat cool soft foods) here’s what it said about ‘medicated lozenges’…‘Well!’ I thought. ‘That’ll do for me….I want some of those’. ‘Medicated lozenges‘. Did I care that there ‘isn’t much scientific evidence’? Did I hell. I wanted relief. I wanted it now.

So I got a packet of ‘Strepsils – soothing effective relief for sore throats.’  The back of the honey and lemon coloured packaging speaking to me in a wonderful soothing honey and lemon voice: ‘these are used for the symptomatic relief of mouth and throat infections.’

There were pages of small print and warnings, age restrictions and dosing advice. These things – all 36 of them! – were quite possibly lethal in the wrong hands.

To cut a long story short, i’m really not sure the mighty ‘Strepsil‘ made much of a difference and soon I was recovered and back at work.

But this whole rather inadequate human episode – and I do sincerely apologise for making you think about my adenoids – got me reflecting on our suffering, our pain and on our desire for relief. The Oxford English Dictionary…

Isn’t that interesting? Relief is….Reassurance. Relaxation. Release from anxiety. Alleviation of pain. Something interesting & enjoyable providing a short respite…

Now it wasn’t long before my thoughts turned to our good old friend manual therapy. Why, in this miserable pyrexial and pastille-filled fugue I saw manual therapy as lozenge, and it was an almost perfect vision.

Manual therapy: that part of the treatment when you’re pulling, pushing or twisting the spine. Sometimes fast. Sometimes slow. Let’s remind ourselves: the experimental evidence tells us that in the vast majority of cases, manual therapy offers nothing more than short term effects e.g. pain relief. If it works, then the more you do (and the harder you do it), the longer the effects persist. 

And that’s not all. Apparently, ‘technical parameters don’t affect outcome’. So it doesn’t really matter which bits you push, pull or twist because the effects are non-specific.

Whatever expensive cutting edge lab-machine you’re attached to or whatever highfalutin questionnaire you complete after being squashed, stretched or corkscrewed…you will probably obtain ‘a bit of relief for a short time’.

It’s over. Where manual therapy and pain are concerned it’s probably time to move on. There is nothing more to see here (i’ll hold fire on manual therapy for dizziness and manual therapy for headache for a bit longer).

But have you noticed a fascinating atmosphere surrounding manual therapy? People whisper – barely audibly and in hushed tones – about manual therapy. They check both ways then…’it’s really just a placebo you know‘. I feel like a spy. During the Q&A, after a talk i’m frequently asked ‘so, do you do any hands on at all?’

Here’s a good example. I was teaching up in the North of England last November. Lovely clinic. High ceilings. It was autumn – big brown leaves everywhere. Great group to teach. Wonderful pasta lunches. One of the physiotherapists on the course was involved with a grand orchestral concert on the Friday night.

The next morning he told us ‘the operatic lead hurt her neck. She wasn’t sure if she could go on with the show. They asked me to look at her neck. So I went down to the dressing room and mobilised and snagged her neck. She said it helped and she got through the concert.’

There was an ever so subtle sense of apology in his voice. But why? Surely this is manual therapy’s raison d’être – n’est-ce pas?

So, do I do any hands on?

Of course I do ‘hands on’! If I specialised in sore throats and didn’t sell lozenges, i’d be a bloody fool wouldn’t I? Isn’t that what an expert is? Someone who can manage all eventualities?

Of course most of our work (unless you’re working in A&E) is sub-acute and persistent pain; that’s a completely different paradigm to acute pain and one where we need to tread especially carefully when it comes to the ‘laying on of hands.’ 

But I do see people week in, week out who have acute pain. They may have some fear of movement, but they’re not catastrophising and they’re not anxious or depressed.

They are stuck – literally. Physically. They can’t stand up straight. They can’t move their head and alongside explanation, reassurance and relaxation – relief through manual therapy has an important role to play.

Why, i’ve had people crawl into my room on all fours. I’ve had families five strong or more, drag poor beleaguered relatives into my room whilst they all stand around watching us, like some surreal theatre.

I’ve been called out on home visits and seen people sprawled face down with back pain on their living room floor, a pyjama’d corpse, the anxious neighbour who opened the front door standing over me, clutching the front door key in their sweaty palm, asking me if they ‘can go to work now?’

I’ve even had someone stuck on my treatment plinth for an entire afternoon (and that was after the treatment!). I think we called an ambulance in the end…

These are people in acute distress. They want relief. I give them ‘the lozenge’. We talk about their life, their happiness and their stress. There’s no mention of structural faults, but together we work to understand the true why of their body hurting so, as I hold their body and their mind in my head and my hands.

I like to think that most of the time people leave my room in a better state than when they came in. And yes hopefully reassured, more relaxed and able to function better.

It’s simply manual therapy as lozenge. No more. No less. We should be proud. Let’s stop talking in hushed tones. It works. It has its place. Come on, let’s celebrate it.