How Manual Therapy Evolved and Why It Faces Criticism

Ina notes that disability from musculoskeletal conditions rose by 61% between 1990 and 2016, and asks how clinicians can move from fixer to facilitator. She traces the influence of pain models, from the Cartesian model through gate control to the neuromatrix, and the shift that followed Bialosky's neurophysiological framework and the 2012 and 2016 IFOMPT congresses, ending with the federation's new musculoskeletal name. She rejects several criticisms as unfounded: that manual therapy has no specific effects, causes as much harm as help, creates dependency and low self-efficacy, ignores communication and pain neuroscience, or cannot be value-based care. Serious adverse events are rare, mostly after cervical manipulation, while minor soreness is common. Founded criticisms include the lack of ways to pick suitable candidates, short-term effects only, costly guru training, outdated ideas such as subluxations, palpation of spinal movement and SIJ dysfunction, and harmful beliefs passed to patients, since 89% of people with recurrent back pain learned their negative beliefs from clinicians. She warns against overdiagnosis, unhelpful labels and early MRI.