Updating the Mechanism of Action for Laryngeal Manual Therapies

Laryngeal manual therapy (LMT), developed as a treatment for muscle tension dysphonia since the 1980s, traditionally focused on reducing laryngeal muscle tension through physical manipulation. This approach was thought to directly improve voice function by altering the laryngeal area. However, recent insights suggest this view is limited.

Contemporary research indicates that LMT’s effectiveness stems from a combination of factors, not just physical manipulation. This multifactorial understanding reflects a shift in the field, emphasizing the need to consider a broader range of influences – beyond just the physical – in explaining how LMT works and its impact on vocal disorders.

Walt Fritz, with thirty years of experience in manual therapy, has noted a widespread similarity across different models and modalities in the field. While each approach claims to be effective for specific tissues and pathologies, he observes that, in practice, clinicians across these various methods tend to perform tasks that are fundamentally similar.

He wrote an article in Current Opinion in Otolaryngology and Head & Neck Surgery, titled “The mechanism of action for laryngeal manual therapies: the need for an update.” Walt discusses this issue. While unlikely to revolutionize manual therapy education alone, it aims to encourage researchers to broaden their perspectives, acknowledging the multifaceted impact of touch and thereby enhancing and diversifying treatment models.

A holistic view

Historically, the focus of manual therapy was on the precise technique, how the therapist’s hands could physically manipulate and heal. However, recent studies are challenging this narrow view, leading in a broader understanding of the complexities involved. It’s not just about the mechanics of touch; it’s about the entire interaction between the therapist and the patient.

Researchers in the field, like Kolb et al., are calling for a major overhaul in how manual therapy is taught. They emphasize the need to include wider mechanisms – the emotional, psychological, and contextual factors that play a crucial role in therapy. Bialosky et al. propose a multifaceted model that considers various influences, from the nervous system to emotional responses.

The osteopathic perspective, highlighted by Baroni et al. and Cerritelli et al., sheds light on the importance of touch in fostering self-regulation and enhancing the patient’s own healing abilities. Geri et al. bring attention to the emotional impacts of compassionate touch, suggesting that therapy’s effectiveness might also lie in the emotional connection and empathy established between therapist and patient.

This shift in perspective signifies a monumental change. It suggests that the effectiveness of manual therapies like Laryngeal manual therapy might be as much about the therapeutic relationship, the way the treatment is contextualized, and the overall environment as it is about the specific technique used.

As we move forward, this evolving understanding challenges both researchers and practitioners to deepen their appreciation of touch therapy’s complexities. It opens new doors to enhancing treatment effectiveness, not just in voice disorders but in a wide range of conditions, recognizing the power of touch as a tool for holistic healing.

Summary

Evidence from the literature has introduced a broad tapestry of factors that may contribute to the efficacy of manual therapy. To better understand the effect and mechanism of action touch-based interventions have on a patient’s voice and to potentially improve outcomes, it is necessary to  integrate biomechanical, neurophysiological, psychological, interoceptive, contextual, patient-centered, and holistic approaches for effective treatment.