ExerciseIt is generally believed but not rigorously tested that exercise, even when it causes pain, shortens periods of pain.RelaxationApparently contradictory to exercise, relaxation is intended to correct abnormal postures.Deep massageIt is intended to break tissue free from constriction.Manipulation, osteopathy and chiropracticeThe most organized of complementary therapies, manipulation, osteopathy and chiropractice are designed to force tissue in abnormal locations into a normal position. They use escalating force to achieve this end. Evidence is lacking that the abnormal location existed in the first place and that normality is restored. A large number of so-called trials have been carried out but they are so far uniformly unsatisfactory. The most common problem if one therapy is compared with another is that the differences are so obvious to the patient. For example, chiropractors organized an elaborate trial in which randomly assigned patients received either chiropractic therapy or a course of hospital physiotherapy, and the chiropractic patients did better. But the chiropractic patients were given a series of treatments in the private offices of practitioners who knew their profession was on trial. The other patients went without fanfare to receive routine physiotherapy by unchallenged practitioners who gave fewer and shorter sessions. No wonder chiropractice appeared superior.In another recent analysis of various types of physiotherapy matched against so-called placebos, the only significant result was that the longer the treatment lasted, the better was the outcome. This result applied equally to the designated therapies and their placebos. Whatever the placebo component may be, there is no doubt that these therapies, like many of those we have considered, produce some tissue damage.*59\219\2*
