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Manipulative and Body-Based Practices

by Steven Rosenzweig, MD

Manipulative and body-based practices include chiropractic, massage therapy, postural reeducation, reflexology, and structural integration.


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


Chiropractic provides short-term relief of low back pain, but continuing adjustments may not provide additional benefit. Thus, the usefulness of chiropractic for chronic back pain is unclear. Chiropractic is sometimes useful in treating headache disorders (although data are inconsistent) and nerve impingement syndromes; it has also been used to treat neck pain. The usefulness of manipulation for conditions not directly related to the musculoskeletal system has not been established.

Possible adverse effects

Serious complications resulting from spinal manipulation (eg, low back pain, damage to cervical nerves, damage to arteries in the neck) are rare. Spinal manipulation is not recommended for patients with osteoporosis or symptoms of neuropathy (eg, paresthesias, loss of strength in a limb). Whether it is safe for patients who have had spinal surgery or stroke or who have a vascular disorder is unclear.

Massage Therapy

In massage therapy, body tissues are manipulated to promote wellness and reduce pain and stress. The therapeutic value of massage for many musculoskeletal symptoms and stress is widely accepted. Massage has been shown to help relieve the following:

  • Muscle soreness

  • Pain due to back injuries

  • Fibromyalgia

  • Anxiety, fatigue, pain, nausea, and vomiting in cancer patients

Massage therapy is reported to be effective in treating low birth weight infants, preventing injury to the mother’s genitals during childbirth, relieving chronic constipation, and controlling asthma.

Massage can cause bruising and bleeding in patients with thrombocytopenia or bleeding disorders. Therapists must avoid putting pressure on bones affected by osteoporosis or metastatic cancer.


This variant of massage therapy relies on manual pressure applied to specific areas of the foot; these areas are believed to correspond to different organs or body systems via meridians. 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 patients with 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 manipulation that is typically done over a series of sessions. Correct alignment of bone and muscle is achieved by manipulating and stretching muscles and fascia. The efficacy has not been proved.

Other Therapies

Several lesser known therapies are used in various cultures. They include cupping, scraping (eg, coining, spooning), and moxibustion. Some of these therapies result in lesions that may be mistaken for signs of child abuse. These therapies are thought to stimulate the body’s energy and to enable toxins to leave the body.


This therapy is used in traditional Chinese medicine and in Middle Eastern, Asian, Latin American, and Eastern European cultures. The air inside a cup is heated, often using a cotton ball soaked in alcohol, then ignited. The heated cup is immediately inverted and placed on the skin. The resulting vacuum sucks the skin partway into the cup, which may be left in place for several minutes. Cupping has been used to treat bronchitis, asthma, digestive disorders, and certain types of pain; however, no research has verified its efficacy. Cupping may redden or burn the skin.


This therapy involves rubbing an implement across lubricated (oiled or wet) skin, usually on the back, neck, and shoulders. Coining uses a coin; spooning uses a spoon. These therapies are used to treat the common cold, influenza, muscle pain and stiffness, and other disorders. Coining results in linear red marks; spooning results in ecchymosis.


Dried moxa herb (a mugwort) is burned usually just above but sometimes directly on the skin over acupuncture points. The herb may be in the form of incense sticks. This therapy is used to treat fever, digestive problems, and pain due to injury or arthritis. Moxibustion can result in circular burns (which resemble burns from cigarette tips) and vesicobullous lesions.

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