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The therapeutic effect of touch

Hands-on techniques in a broader perspective

  • Hands-on techniques are more than biomechanical actions
  • Pain reduction by touching
  • Manual techniques as means of communication

Hands-on manual techniques are more than biomechanical actions to eliminate disorders in muscles and joints: touching is a way of communicating, with which a therapist can reduce pain, transfer emotions and evoke more body awareness in the patient. The authors argue for a revaluation of hands-on techniques and the therapeutic value of touch.

Touch as communication

This broader perspective on human touch means that manual techniques are more than just tools to fix the patient's body: they offer the possibility to communicate with (the brain of) the patient, just like words do. A therapist can alter the meaning of a verbal message by variations in the tone and strength of voice and speaking rate. The message the therapist transmits with their hands can be influenced by variations in handhold and the intention with which the patient is touched. The authors describe this short but powerful in this statement: “it is not therapeutic if it is not sympathetic.”

Education

This broader perspective also has consequences for physiotherapy teachers: they must educate their students about the broad therapeutic possibilities that are offered by touch. Students should not only learn to execute manual techniques properly, but also to take the emotional aspects of physical contact into account. 

Expertise 

Finally, the authors call on professional physiotherapy organisations to promote the therapeutic value of hands-on techniques and to claim them as their specific – albeit not exclusive – expertise. Touching someone is a therapeutic action, which relies on specific biomechanical, neurophysiological and psychological principles. The close physical contact between physiotherapist and patient should be preserved to specifically trained and registered professionals, according to the authors.

> From: Geri, Musculoskelet Sci Pract 44 (2019) 102044 . All rights reserved to Elsevier Ltd. Click here for the online summary. Translation by Casper Martens

Expert opinion by John Bos, MSc.

In the article the authors stand up for the value of therapeutic touch. The article argues the importance of hands-on treatment and forms a critical (very plausible) counter-sound for the dominant hands-off approach in physiotherapy, in which physical touch has evolved to an action that is ‘not-done’. This counter-sound is a relief for daily physiotherapy practice in the unbalanced hands-on/ hands-off debate and is a confirmation of the intuitive feelings of many physiotherapists about the value of physical touch in patients suffering from pain. As author of this expert opinion I want to urge every colleague to read this article, because the postulated message touches upon the individuality of everyday physiotherapy directly. In addition, reading this article is very useful because it provides physiotherapy with a powerful theoretical-biological framework about the multiple supposed effects of therapeutic touch. 

Almost every physiotherapist will agree that a diagnostic exploration of physical aspects is an important core value of physiotherapy. In patients with suffering from pain, this exploration is characterised by making physical contact, accompanied by an exploration of the painful spot. This contact contributes to the trust relationship between the physiotherapist and the patient in a general sense. Generally, with this the chance of therapeutic success also increase, especially when the expectations of the patient about diagnostics are met. When the patient expects the opposite, NOT touching the painful spot can easily result in a feeling that ‘it is between the ears’, and with that disappointment and less confidence in the physiotherapist, or even disillusionment and anger. 

From a therapeutic perspective the targeted use of physical touch is also of tremendous value. Touching and movement (exercise) are the two non-verbal main ingredients of physiotherapy. Tactile and tactful touching does something to people. First, it confirms the feeling that you are there as a (fellow) human being and that you have a body that needs serious investigation. The painful body requests attention. Second, it gives the feeling that the other one (the physiotherapist) is there for you, makes sincere contact and tries to feel along with you. This reliefs the feeling of suffering. Third, it modifies the body image, modulates the painful sensation, and creates physical confidence. 

Touching is a crucial foundation of the physiotherapeutic relation (it strengthens the relationship) but it also potentially is a powerful therapeutic effect that can be pursued with varying focus. The physiotherapist lets ‘their hands speak’ through touching. Therapeutic touching consists of two components: a biophysical component and a (multiple) perceptual component. In patients suffering from pain, the physiotherapist can direct therapeutically on cognitive, affective and biological aspects of pain perception just by touching.

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