A rationale for the treatment of back pain and joint pain by manual therapy.

Manual therapy, with its emphasis on joint movement and exercise, has become increasingly important for the treatment of pain and dysfunction of the musculoskeletal system. The rationale used to explain the success of manual therapy has changed radically in recent years. Early explanations, which included concepts such as adjusting joint subluxations, restoring bony alignment, and reducing nuclear protrusion, have been shown to have no basis in fact. Current biological research shows the value of movement in maintaining the health and strength of collagenous, muscular, and bony tissues and emphasizes the need for joint movement and for relatively high levels of activity throughout the life cycle. The musculoskeletal system thrives on stress and movement and reacts adversely to prolonged rest or immobilization. The problems associated with working or recreational postures involving prolonged loading at or near the limit of joint range of motion are considered together with a rationale for appropriate therapeutic management. Explanations are provided to enable an understanding of the success of intensive physical therapy for chronic back pain and for manipulation in the treatment of the acute painful locked back.