Manipulative and Body-Based Practices
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.
Bowen technique: Gentle massage of muscles and tendons over acupuncture and reflex points.
Chiropractic manipulation: Adjustments of the joints of the spine, as well as other joints and muscles.
Craniosacral therapy: Form of massage using gentle pressure on the plates of the patient's skull.
Feldenkrais method: Combination of stretching, exercise, and yoga to teach new patterns of movement and to improve posture and breathing.
Massage therapy: Assortment of techniques involving manipulation of the soft tissues of the body through pressure and movement.
Osteopathic manipulation: Manipulation of the joints combined with physical therapy and instruction in proper posture.
Reflexology: Method of foot (and sometimes hand) massage in which pressure is applied to "reflex" zones mapped out on the feet (or hands).
Rolfing: Deep tissue massage (also called structural integration).
Trager bodywork: Slight rocking and shaking of the patient's trunk and limbs in a rhythmic fashion.
Tui Na: Application of pressure with the fingers and thumb, and manipulation of specific points on the body (acupoints).