Manipulative and Body-Based Practices: An Overview

Written by National Center for Complementary and Alternative Medicine

Do alternative therapies such as chiropractic manipulation, massage therapy, reflexology or rolfing really improve your mental health? Here's what the science says.

On this page

• Introduction
• Scope of the Research
• Summary of the Major Threads of Evidence
• Definitions
• For More Information
• References

Introduction

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Under the umbrella of manipulative and body-based practices is a heterogeneous group of CAM interventions and therapies. These include chiropractic and osteopathic manipulation, massage therapy, Tui Na, reflexology, rolfing, Bowen technique, Trager bodywork, Alexander technique, Feldenkrais method, and a host of others (a list of definitions is given at the end of this report). Surveys of the U.S. population suggest that between 3 percent and 16 percent of adults receive chiropractic manipulation in a given year, while between 2 percent and 14 percent receive some form of massage therapy.^1-5 In 1997, U.S. adults made an estimated 192 million visits to chiropractors and 114 million visits to massage therapists. Visits to chiropractors and massage therapists combined represented 50 percent of all visits to CAM practitioners.² Data on the remaining manipulative and body-based practices are sparser, but it can be estimated that they are collectively used by less than 7 percent of the adult population.

Manipulative and body-based practices focus primarily on the structures and systems of the body, including the bones and joints, the soft tissues, and the circulatory and lymphatic systems. Some practices were derived from traditional systems of medicine, such as those from China, India, or Egypt, while others were developed within the last 150 years (e.g., chiropractic and osteopathic manipulation). Although many providers have formal training in the anatomy and physiology of humans, there is considerable variation in the training and the approaches of these providers both across and within modalities. For example, osteopathic and chiropractic practitioners, who use primarily manipulations that involve rapid movements, may have a very different treatment approach than massage therapists, whose techniques involve slower applications of force, or than craniosacral therapists. Despite this heterogeneity, manipulative and body-based practices share some common characteristics, such as the principles that the human body is self-regulating and has the ability to heal itself and that the parts of the human body are interdependent. Practitioners in all these therapies also tend to tailor their treatments to the specific needs of each patient.

Scope of the Research

Range of Studies
The majority of research on manipulative and body-based practices has been clinical in nature, encompassing case reports, mechanistic studies, biomechanical studies, and clinical trials. A cursory search in PubMed for research published in the last 10 years identified 537 clinical trials, of which 422 were randomized and controlled. Similarly, 526 trials were identified in the Cochrane database of clinical trials. PubMed also contains 314 case reports or series, 122 biomechanical studies, 26 health services studies, and 248 listings for all other types of clinical research published in the last 10 years. On the other hand, for this same time period, there have been only 33 published articles of research involving in vitro assays or employing animal models.

Primary Challenges
Different challenges face investigators studying mechanisms of action than those studying efficacy and safety. The primary challenges that have impeded research on the underlying biology of manual therapies include the following:

• Lack of appropriate animal models
• Lack of cross-disciplinary collaborations
• Lack of research tradition and infrastructure at schools that teach manual therapies
• Inadequate use of state-of-the-art scientific technologies

References