Clinical effectiveness of manual therapy as a standalone intervention is really questioned. Manual physiotherapists possess a variety of tools in their toolbox and should decide on the best one for the person sitting in front of him. Manual therapy as part of the conservative management of MSK Pain has a place, a role to play and but our paradigms may require updating. As Mark Kargela said “Manual therapy does not need to die, but it risks committing suicide if it decides to park itself in theory science that is swiftly passing by."

Knowing when ‘not to’ and ' it’s not necessary' is just as important as when it’s indicated.

If you want to learn more about this topic, you can watch Ina Diener's lecture here:

Click here

6 CRITIQUES ABOUT MANUAL THERAPY

1. Manual therapy has no unique specific effects.
Manual therapy is just one of many ways to modulate pain. The mechanical force from manual therapy initiates a cascade of neurophysiological responses from the peripheral and central nervous system, which are then responsible for both the mechanistic and the clinical outcomes. This is the strongest validating feature of manual therapy and the one that has been the most investigated. What is our responsibility? To make this known to our patients.

2. Manual therapy causes as much harm as help.
Many interventions have some minor temporary increased muscle soreness, increased pain, stiffness and tiredness. On rare occasions of serious harm, mostly in cervical manipulations is an incidence estimate of 1 to 2 million manipulations to 13 per million 10,000 patients. The benign adverse events are common and serious adverse events are rare. We should be aware of the contraindications and indications of Manual therapy.

3. Manual therapy leads to patient reliance and low self-efficacy.
Manual therapy doesn't cause low efficacy, individuals with low efficacy are more likely to seek analgesic drugs, passive activities and potentially manual therapies. We can improve our communication with patients and make sure that they don’t depend on us and start taking care of themselves.

4. Manual therapy lacks skills in communication, reassurance and empathy.
Many of the concepts associated with the values of reassurance and empathy, clinical communication, patient alliance and shared decision making is included in OMPT training. Our responsibility is to self-reflect, decide do I have enough knowledge of clinical communication and the psychosocial idea of treating patients?

5. Manual therapists do not take contemporary pain neuroscience education into consideration.
Contemporary pain neuroscience research has been exclusively initiated and published by MSK physiotherapists. Contemporary pain neuroscience forms the basis of modern OMPT training. We should know how to communicate with patients about pain neuroscience education properly.

6. Manual therapy doesn't fit within Value-Based Care.
What is value-based care? It is care that is patient-centered, guideline oriented. It measures the patient's outcomes and it's cost-effective. We should make sure that our manual therapy is patient-centered, guideline oriented and cost effective.
 

If you want to learn more about this topic, you can watch Ina Diener's lecture here:

Click here

Sources:
1. ‘Making sense of contemporary Manual therapy’ lecture by Ina Diener.