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Manipulative and Body-Based Therapies

by Steven Rosenzweig, MD

Manipulative and body-based therapies treat various conditions through bodily manipulation. These therapies include chiropractic, massage, rolfing, reflexology, and postural reeducation.


In chiropractic, the relationship between the structure of the spine and the function of the nervous system is seen as key to maintaining or restoring health. The main method for correcting this relationship is spinal manipulation. Chiropractors may also provide physical therapies (such as heat and cold, electrical stimulation, and rehabilitation strategies), massage, or acupressure or recommend exercises or lifestyle changes.

Chiropractic is being actively studied. Problems treated by chiropractic include low back pain, various headache disorders (although effectiveness is not always clear), neck pain, and pain caused by compressed nerves.

Past clinical trials have shown chiropractic to be as effective as conventional medical treatment in providing short-term relief of low back pain. Conventional medical practice guidelines include chiropractic as a treatment option for sudden low back pain that persists despite measures people take on their own. Treatments continued beyond 3 months may not provide added benefit. The usefulness of manipulation for conditions not directly related to the musculoskeletal system has not been established.

Serious complications resulting from spinal manipulation, such as low back pain, damage to cervical nerves, and damage to arteries in the neck, are rare. Other side effects may include discomfort, headache, and fatigue, which usually disappear within 24 hours. Spinal manipulation is not recommended for people who have any of the following:

  • Osteoporosis

  • Symptoms of neuropathy (for example, loss of sensation or strength in one or more limbs)

  • Previous spinal surgery

  • Stroke

  • Blood vessel disorders

Massage Therapy

Massage therapy is the manipulation of body tissues to promote wellness and reduce pain and stress. It involves a variety of light-touch and deep-touch techniques, from stroking and kneading (as used in Swedish massage) to applying pressure to specific points (as used in Shiatsu, acupressure, and neuromuscular massage). Massage therapists claim to help the musculoskeletal, nervous, and circulatory systems of the body. Other healing effects of massage include the benefits of caring and human touch, basic needs that are unmet in the lives of many people.

Massage has been shown to be helpful in the following:

  • Relieving pain, such as that caused by back injuries, muscle soreness, fibromyalgia, and anxiety

  • Treating fatigue, pain, nausea, and vomiting in people with cancer

  • Helping the brain, nerves, and behavior of low-birth-weight infants develop normally

  • Preventing injury to the mother’s genitals during childbirth

  • Relieving chronic constipation

  • Controlling asthma

Massage may lower stress and anxiety.

Precautions for massage therapy and other therapies that involve forceful manipulation include the following:

  • Bare skin should not be massaged in people who have infectious or contagious skin diseases, open wounds, burns, high fever, or tumors.

  • Massage can cause bruising and bleeding in people who have a low platelet count or a bleeding disorder.

  • Massage should not stress bones affected by osteoporosis or cancer that has spread to the bones (metastatic cancer).

Structural Integration

Structural integration is based on the theory that good health depends on correct body alignment. It is a form of deep tissue massage that is typically done over a series of sessions. Correct alignment of bone and muscle is achieved by manipulating and stretching the fibrous tissue that surrounds certain body organs (fascia), such as muscles. The effectiveness of structural integration has not been scientifically proven.


In reflexology, manual pressure is applied to specific areas of the foot that are believed to correspond to different organs or systems of the body. Stimulation of these areas is believed to eliminate the blockage of energy responsible for pain or disease in the corresponding body part. Reflexology may help relieve anxiety in people who have cancer.

Postural Reeducation

Postural reeducation uses movement and touch to help people relearn healthy posture, move more easily, and become more aware of their body. The therapies involved seek to release habitual, harmful ways of holding the body by focusing on awareness through movement. The effectiveness of postural reeducation is not clear.