Manipulation, Traction, and Massage

Abstract This chapter looks at the techniques for performing manipulation, traction, and massage and the medical literature to support their use. The manipulation section includes information on high velocity low amplitude (HVLA)/thrusting, muscle energy, myofascial release, counterstrain, and craniosacral techniques. There have been a large number of research projects completed on the use of manipulation, mostly with the HVLA form, but often they were done with small numbers, different outcome measures, or different frequency/length of treatment. However, spinal manipulation is an extremely common treatment provided to millions of Americans each year. Massage is most often performed with classic Swedish techniques including effleurage, petrissage, or tapotement, but may also be done with less commonly known techniques such as lymphatic drainage, Feldenkrais, Rolfing, acupressure, or others. There are a lot of small clinical studies for the use of massage in a large variety of musculoskeletal and other medical diagnoses, most of which show short-term beneficial effects but limited long-term changes in the treatment outcomes. The traction section focuses on the differences between utility and success of different cervical traction equipment with primary indication for use with cervical radiculopathies. In contrast, there is limited success with most types of lumbar traction, other than inversion traction, due to difficulties in maintaining the forces directed to the spine. All of the treatments in this chapter can be performed alone but will have more beneficial effects when combined with appropriate exercise regimen.