03/16/2026
Manual Therapy: a global conversation
Who doesn't love a good double entendre??
Firstly, why "global?"
Manual therapy is a global occupation that uses various different approaches: Japan has shiatsu; China has tuina; Thailand has Thai massage; India has ayurvedic massage; Turkey has hammam; Russia has venik massage; east Africa has rungu massage; Mexico has hakali massage; and the most well known and most ubiquitous style in North America and beyond is Swedish massage. This list isn't exhaustive, but as manual therapy has been around for thousands of years it makes sense that various forms and derivatives can be found all around the world.
The philosophy and application of these modalities will vary in application: some may use broad strokes; some use a hands-on approach only while others make use of both hands and feet; some modalities use techniques more akin to acupressure points; both eastern and western methodologies may incorporate various aspects of energy work. The point being, there is much diversity in philosophy and style depending on where and with whom you find yourself in the world.
Secondly, why a "conversation?"
Consider that different countries speak different languages; think of these languages as different modalities. As languages have regional dialects within them, thus different modalities have various techniques under their umbrella. Take Swedish massage for example, petrissage, effleurage, tapotement, rocking, and vibrations all fall under the heading of Swedish massage. When navigating a particular problem we may defer to a specific modality of choice. Further, we may opt for a specific technique of choice within that umbrella that has demonstrated efficacy in the past.
Why is this important? The more languages we know, the more countries we can visit where communication and acceptance are facilitated. Let's consider going to Mexico and donning our Spanish hat. It is likely that we can communicate in most any part of Mexico under the wide-brimmed sombrero of Spanish. However, if we can converse in either Norteno, Costeno, or Yucateco to name a few regional dialects, then our acceptance increases; this acceptance builds trust. Research in manual therapy shows that trust improves patient outcomes.
Conversing with the body:
Like languages and dialects, certain physiological states and mechanical issues can be addressed with numerous modalities and techniques. However, there will be options that will have either a more comprehensive effect, a longer lasting effect, a faster effect, or facilitate better resolution. Further, if we can recognize the language of the problem, we can select the technique that is most appropriate. If we don't speak the dialect it doesn't mean we can't have a conversation, but some of the message may get lost in translation.
This is why it is important to continue our education by learning new techniques and new modalities: it allows us to travel around the body and speak the language of the given region. English will get you a long way, but what if you find yourself in rural Japan? If we need the Tsugaru dialect of northern Honshu and we don't even speak basic Japanese, then we can't communicate at all. We are left to either gesticulate, guess, act out, or find alternate means to get our message across. This is laborious, time consuming, and often ineffective.
How do we learn to communicate effectively?
With learning any language, in the beginning we only know single words. As we grow and progress we can string words into sentences, turn sentences into paragraphs, and paragraphs into stories. Communication is as precise as the breadth of our vocabulary. The physiological narrative of the body is an unknown history of languages and dialects that require translation. In some ways, we must become corporeal philologists: becoming fluent in various techniques will allow us to interact with differing anatomical problems. The key to fluency is practice.
For those who have had the opportunity to travel, you may have found that knowing a few words in the local language can go a long way in establishing a connection. The body is no different: it will respond more enthusiastically to something helpful and familiar. Conversely, being bombarded with a foreign language, however we choose to express it, is not likely to yield any sort of understanding. It is better to know a few sentences in many languages than to be verbose in only one.
To summarize:
Languages are akin to modalities. Techniques are akin to regional vernacular. The more we travel does not mean the better we can communicate. There must be active participation on the part of the traveler. Similarly, just because we have practiced manual therapy for years it does not mean we can communicate fluently with anatomy. We must continue to learn and apply ourselves with awareness and presence. We cannot be reliant on one modality and expect all anatomical problems to understand it.
We must explore. We must be curious. We must practice the applicability of what we learn. We must strive to increase our vocabulary and seek out new methods of communication. As widely spoken as some languages are, occasionally we may encounter either Swahili or Tagalog, Amharic or Gujarati, Italian or Urdu. The more we can communicate globally, the more understanding we will have. The objective of a technique in manual therapy can be paralleled to the objective of a Japanese haiku:
Haiku: to capture a specific, fleeting moment of insight or emotion, often in nature, through concise and vivid imagery
Manual therapy: to release a specific, accumulated aspect of tension and emotion, through precise application of technique
