Is There a Difference Between a Manual Therapy Approach and a Pain Modified Approach?

Manual therapy (MT) comes in all shapes and sizes - mobilisation, manipulation, mobilisation with movement, soft tissue massage, instrument assisted massage, muscle energy techniques, pointy elbows pressed into flesh and more. Patients (often) love it, and it's a popular treatment modality with therapists.

Debate rages, and myths and misconceptions surround MT. Is MT evidence-based? Could the time we spend performing MT be better spent elsewhere? How does MT work? Is it worth using if treatment effects are short lived? Is it just used as revenue raising by therapists, while creating reliance on passive therapies? Which patients may benefit from MT, and which patients you should steer away from MT?

In this podcast, clinical researcher, physical therapist and Professor at Duke University, Prof Chad Cook, we discuss the evidence around MT, myths and misconceptions, how MT works, and using your clinical reasoning to decide when and how to utilise MT.

You'll discover:

• What is the current evidence around MT
• What are the arguments for and against manual therapy?
• How does MT work - potential mechanisms
• Does MT break up scar tissue or adhesions, correct biomechanical dysfunction or joint alignment?
• How to explain MT to your patients
• How to identify pain adaptive and non pain adaptive patients, and why this is important regardless of the treatment
• How to use clinical reasoning with MT
• How to select MT techniques
• How many sessions of MT should patients receive?
• Does MT cause harm and patient reliance?
• How to identify and change patient treatment expectations

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• Infographics by Clinical Edge

• Prof Chad Cook at Duke University

• Twitter - @ChadCookPT

• Book - Orthopaedic Manual Therapy

• Bialosky et al. 2009. The Mechanisms of Manual Therapy in the Treatment of Musculoskeletal Pain: A Comprehensive Model.

• Bialosky JE, Bishop MD, Penza CW. Placebo mechanisms of manual therapy: a sheep in wolf's clothing?. journal of orthopaedic & sports physical therapy. 2017 May;47(5):301-4.

• Cook et al. 2014. Is there preliminary value to a within- and/or between-session change for determining short-term outcomes of manual therapy on mechanical neck pain?

• Cook et al. 2013. Early use of thrust manipulation versus non-thrust manipulation: a randomized clinical trial.

• Cook et al. 2012. Can a within/between-session change in pain during reassessment predict outcome using a manual therapy intervention in patients with mechanical low back pain?

• Cook. 2011. Immediate effects from manual therapy: much ado about nothing?

• Deyle et al. 2005. Physical therapy treatment effectiveness for osteoarthritis of the knee: a randomized comparison of supervised clinical exercise and manual therapy procedures versus a home exercise program.

• Goss et al. 2004. A Cochrane review of manipulation and mobilization for mechanical neck disorders.

• Learmann et al. 2014. No Differences in Outcomes in People with Low Back Pain Who Met the Clinical Prediction Rule for Lumbar Spine Manipulation When a Pragmatic Non-thrust Manipulation Was Used as the Comparator.

• Rubinstein et al. 2011. Spinal manipulation therapy for chronic low back pain.

• Schneider et al. 2014. Derivation of a clinical decision guide in the diagnosis of cervical facet joint pain.

• Traeger et al. 2018. Effect of Intensive Patient Education vs Placebo Patient Education on Outcomes in Patients With Acute Low Back Pain.