The importance of Human Touch

Hands-on Treatment by Dr. de Smidt

The physiotherapy approach to musculoskeletal pain is currently pointing more towards a hands-off management of patients by education and exercise therapy. However, hands-on techniques still represent a core element of musculoskeletal physiotherapy practice appreciated by patients and widely taught in educational program and clinical professional development training. (Geri et al 2019)

In my 30 year experience, patients that seek out a physical therapist for musculoskeletal pain expect hands-on treatment in addition to education and exercises. When I perform hands-on treatment with my patients we are establishing “Therapeutic Alliance”, the cornerstone of the BPS model. Am I exploiting human touch? No I’m using one of the most trusted ways of establishing trust, so I can better educate my patients and get them to understand the value of exercise treatment. I see a lot of patients that have been seen elsewhere prior to coming to see me. It surprises me every day when I hear that other physical therapists do not even touch their patient. Not during the evaluation and not during treatment!

Can I achieve the same result without touching my patient? Maybe. But why? Do we want to become just like the physicians who we mock because they do not touch their patients? Hands-on treatment has many more advantages than disadvantages. Yes, patient might get dependent on getting hands-on treatment; but proper education on why we use Manual Therapy to begin with. Yes, its a passive treatment; but if it allows them to be more effective and more efficient in the exercise portion of the treatment isn’t that worth the 10-15 minutes we spend on manual therapy?

Does everyone need Manual Therapy? No, a good physical therapist should know what the best treatment method is for each individual patient. The research shows support for manual therapy, especially the combination of exercise with manual therapy. That should be the core of our profession. We are not chiropractors. We are not personal trainers. We are not massage therapists. We are physical therapists!

Research (Louw et al 2017) showed that if we use Pain Neuroscience Education instead of biomechanical explanations for Manual treatments we get better results. Pain Science Education was never intended as a hands-off treatment.


“Manual Therapy and Pain Science Education should go hand-in-hand”. No pun intended.


Geri, Viceconti, Minacci, Testa, Rossettini. Manual therapy: Exploiting the role of human touch. Musculoskelet Sci Pract. 2019 Jul 25:102044. doi: 10.1016/j.msksp.2019.07.008.

Louw A, Nijs J, Puentedura EJ. A clinical perspective on a pain neuroscience education approach to manual therapy. J Man Manip Ther. 2017;25(3):160–168. doi:10.1080/10669817.2017.1323699


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