Evidence Based Physical Therapy Articles-Manual Therapy  

The Trap of Manual Therapy

Michael Rinaldi, PT, OCS

In recent times there has been a rise in the practice of manual therapy in the physical therapy profession as many schools of thought and continuing education providers  are putting out their own spin on the subject.  Current thrusts of research are trying to determine what specific type of manual therapy and in what situations are they indicated and most useful. I get the sense that practitioners have gravitated towards the use of manual therapy techniques as they have found that stretching and general exercise programs have become inadequate in the total care of their patient, and that the addition of such skills gives the practitioner a certain edge over other practitioners.  This edge I would suspect in some PTs may be a more egocentrically-based attribute where the PT has a desire to stand out or be special in comparison to his peers. 

Others have simply recognized that patients do better when skilled manual or manipulative therapeutics are introduced into patient management.  All others probably believe that simply laying on of the hands in some fashion assists in patient progression. 

None of this is wrong.

In each scenario if the patient benefits from the intervention, it doesn’t really matter why a PT would use manual therapy.

But here’s the trap.  In many cases a therapist using a great deal of manual techniques (more than 75% of treatment session) does get results and gets them quickly.  Therefore they have the ability to change the patient’s complaint quick.  Why else do people continue with chiropractic?

But are they really changing the problem?

As you consider this scenario you will begin to understand the point.

Your new patient walks in says she’s had therapy at five different places, seen two chiropractors and had massage therapy that left her bruised.  In her previous therapy interventions she went from machine to machine, had modalities, maybe some stretching, and one person that pushed even on her back and even out her hips because she has "one leg longer than the other". 

But for whatever reason she’s carrying around a problem for the last 17-22 years and she’s finally tired of it.  And now she’s in your office in because her physician says “I want you to go see this person, because he/she gets results.  Trust me.”

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