How it Works – A Deep Dive into the Science of Manual Therapy

To tell this story properly, we have to start at the beginning.  The body is made up of cells, tissues, organs, and organ systems.  

The cells live within a structural framework of protein fibers called the matrix which they spend their lives building and maintaining. You can think of it as a scaffold around the cells that holds them all together, provides some degree of structural continuity, and is in a constant state of modification – being broken down and rebuilt in response to the mechanical forces the matrix is subject to.  The matrix is made of a few different types of structural proteins, the most abundant of which is collagen.

Different types of cells build different matrices, producing different tissue types.  Ligament and tendon matrices are very dense, with tightly packed layers of collagen fibers, aligned along the lines of mechanical force. Bone is similarly dense and infused with calcium phosphate crystals which give it its rigidity, allowing it to resist compressive forces.  Other tissues like muscle tissue and epithelial tissue like glands and mucus membranes have much looser matrices that allow for flexibility, extensibility and elasticity.  The tissues are organized into functional units called organs.

Organs are held together by connective tissue structures of varying density and strength. Many of these are familiar to us because of the frequency of their injury: the meniscus and ligaments of the knee, the rotator cuff of the shoulder, the intervertebral discs of the spine…  

These large sturdy structures are responsible for transmitting and managing tremendous amounts of mechanical force and absorbing a great deal of kinetic energy and dissipating it through stretch and elastic recoil.  But all of the body’s tissues are subject to mechanical forces and kinetic energy and the tissues must have flexibility and resilience to dissipate this energy.  If they didn’t, we would never survive all the bumps and crashes we are subject to in our childhood.

When the body encounters a sudden large external mechanical force like a fall, or being hit, or a whiplash injury, it may be unable to completely absorb that force in the stretch and elastic recoil of the connective tissues. This is when tissue damage occurs.  

In some cases, the mechanical forces may focus on a large structural element such as the ACL ligament of the knee or the radius bone of the arm and result in a fracture or a tendon or ligament rupture. In other cases, those forces may be absorbed by softer more flexible fascial structures such as the mesentery which holds the small intestine together or the ligaments that suspend the liver from the diaphragm.  Inertial forces absorbed by these broad soft tissue structures results in multiple widespread microscopic tears of the collagen matrix.  Those tears will heal in just a couple days, so such an injury may be written off as inconsequential. However, the inflammation caused by those tears causes adhesions to form between the connective tissue layers, some of which may persist after the injuries heal.  These adhesions result in loss of motion in the tissues.  The person may experience symptoms such as vague soreness which usually resolves after a few days.  Again, we think nothing of it.

But as the decades roll by, we continue to collect more adhesions and restrictions in our vital soft tissues and the compensatory distortions in our musculoskeletal frame accumulate. That is why we tend to get stiffer as we age.  We may lose mobility in a shoulder for example, due to restrictions in the brachial plexus or the suspensory ligaments of the lung.  The body is smart, it knows that if the shoulder moves too far it could overstretch and irritate the lung or or the nerve plexus, which is definitely not a good idea.  The body will wisely give up shoulder mobility to protect the lungs and nerves.  But we try to force the shoulder through its full range, stretching it which irritates the joint and causes pain.  The more we try to force it, the worse it gets.  We go pay someone to stretch it and rub it, which undermines the body’s carefully laid compensation.  And we have the audacity to call it a “bad shoulder!”  The fact is, that shoulder is doing the best it can to compensate for the deeper restriction.  If we can identify the deeper vital tissues that are stuck and successfully correct those, the shoulder can go back to its normal function.

Think on this.