‘Bodywork’: (some of) what it is…and what it is not

It is no wonder consumers and providers are confused about who and what a bodyworker is/does. Bodywork is pretty nebulously defined on Wikipedia as “any therapeutic or personal development technique that involves working with the human body in a form involving manipulative therapy, breath work, or energy medicine. Bodywork techniques also aim to assess or improve posture, promote awareness of the ‘bodymind connection’ which is an approach that sees the human body and mind as a single integrated unit, or to manipulate the electromagnetic field alleged to surround the human body and affect health.” Elsewhere on the internet, bodywork comprises a host of forms and definitions, making it difficult for someone seeking care to determine the appropriate type of care for themselves or their child. For example, this definition on a blog by the Acupuncture Massage College: “Bodywork Therapy is a term that broadly refers to manual therapies that utilize non-physical principles or energetic anatomy. For example, reflexology is considered a bodywork therapy, because it claims to work by clearing the blockage of the body’s energy through [massaging] particular zones of the feet.” As you can see by these definitions, it would be difficult to determine whether a provider of ‘bodywork’ would be performing manual therapy at all, as working with ‘energy’ could comprise techniques such as Rolfing or reiki. Body work may be used to describe different types of massage, craniosacral, craniofacial, myofascial, chiropractic, or osteopathic work. These are not types of work typically covered in traditional medical or allied healthcare education programs, therefore may sometimes be referred to as “alternative” treatments. 

Physical therapy is NOT just ‘bodywork’.

As you can see, ‘bodywork’ is an umbrella term which can refer to a wide range of approaches that seek to influence bodily tissue, either directly or indirectly. Manual therapy falls under this category, and therapists are providers of manual therapy interventions, thus making them ‘bodyworkers’...I suppose. 

However, therapy encompasses a range of evaluative and treatment techniques, some of which definitely do not fall under the term bodywork, and some that do. However using the term bodywork to describe therapy may not be accurate, and definitely vice versa. 

What is manual therapy?

Manual therapy is hands-on care in which providers manipulate the skin, soft tissues, and/or joints. These interventions influence the nervous system. These influences are associated with changes in inflammation, spasm, range of motion, as well as central nervous system pain control. These influences may be associated with information processed by the body which may cause it to alter its “output” or physiological response, such as skin temperature, heart rate, hormones, endorphins, and neurotransmitters, muscular activity, and psychological responses.

While hands-on treatment in general may elicit a multitude of physical and psychological responses, it has been stated that effective manual treatment relies on an expertise in the anatomy, biomechanics, and neurophysiology involved in achieving the desired outcomes. And when combined with movement as an emphasized part of the treatment plan, outcomes are certainly enhanced, such as when this treatment approach is used as part of therapy treatment. Plus, a majority of these techniques are easily instructed to caregivers, making it accessible and reproducible, reducing reliance on a specialized provider.

Hands-on treatment may be best used as PART of a comprehensive, multifaceted therapeutic approach, and not necessarily as a standalone. Moreover, the emphasis should be on the benefits of physical contact, rather than the treatment itself. This highlights the need for patient/caregiver education regarding how to achieve the touch-based effects of manual therapy without the presence of and reliance on the clinician/practitioner.  When providing manual therapy, it helps if the provider explains the very specific reason (i.e. “You appear to be responding to extension-biased movements. I am going to give a little added pressure here while you move to see if it changes things more quickly, which will help to confirm that direction of preference.” Or in the case of my pediatric clients, “Your baby is going to respond BEST to YOUR touch. Here is the way to do what I am doing, and what you are looking/feeling for.”).

Therapy is more than manual

Manual therapy is not the only way to influence tissues. Movement is a huge part of therapy. We work on structure, but within the context of function. So we use therapeutic movement to make the most of the structure we influence using manual therapy. The tissues need to experience movement into their new available space, and compensatory patterns need to be trained out. In with the new, out with the old. Without the movement piece, we may slip right back into old patterns.

Ideally, therapists show measurable improvements as a result of treatment. In order to do so, we may use normed, standardized assessments in combination with subjective (what the client reports) and objective (things we can measure) assessment techniques in order to establish baselines off of which to track progress. However, it can be important to also take into account client self-assessment and our own clinical judgment to determine progress. Not all providers need to be able to demonstrate objective outcomes for their care. 

There are a multitude of different approaches, techniques, and offerings to choose from with respect to addressing an individual’s needs. The most important thing is choosing an approach that makes you feel comfortable, that you see objective and measurable progress with, and most importantly, that feels safe and comfortable.  An important aspect of this last part is the relationship with the provider. The practitioner-client relationship has a significant impact on the response to the approach, regardless of the method applied. Therefore, choose a provider you feel you connect with, who understands not only the anatomy, biomechanics, and neurophysiology, but also you and your needs.

Sources:

1. J Orthop Sports Phys Ther 2018;48(1):8–18. doi:10.2519/jospt.2018.7476  https://www.jospt.org/doi/full/10.2519/jospt.2018.7476

2. https://en.wikipedia.org/wiki/Bodywork_(alternative_medicine) Accessed 7/27/22.

3. https://www.amcollege.edu/blog/understanding-massage-bodywork-asian-therapies

4. Manual therapy: Exploiting the role of human touch. Musculoskeletal science and practice.  Vol 44, 2019.