Manual therapy: process or product?
PainSci summary of Silvernail 2012?This page is one of thousands in the PainScience.com bibliography. It is not a general article: it is focused on a single scientific paper, and it may provide only just enough context for the summary to make sense. Links to other papers and more general information are provided at the bottom of the page, as often as possible. ★★★☆☆?3-star ratings are for typical studies with no more (or less) than the usual common problems. Ratings are a highly subjective opinion, and subject to revision at any time. If you think this paper has been incorrectly rated, please let me know.
Selected quotes:
Published trials of an impairment-based manual therapy approach where the treatment is provided by highly-trained clinicians using manual therapy in the context of a systematic, hypothesis-based clinical reasoning process have consistently shown large effect sizes in validated outcome measures relative to other interventions.
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Manual therapy is not, as is sometimes believed, simply the application of manipulative techniques for the treatment of painful problems. A manipulative procedure is not the same as a manual therapy approach, just as extension exercises do not represent the MDT approach. The manual therapy approach is a ‘process’ of care centred on a reasoning model, not a ‘product’ consisting of one or more manipulative techniques.
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Anyone can show a patient a few press-ups or twist someone’s spine. It takes a skilled and well-trained clinician to use a systematic reasoning model to arrive at the appropriate treatment decision, and that clinical process leads to the positive results seen in published randomized trials. These are results that last and produce meaningful improvement in our patients’ lives — using low cost, low risk, non-invasive care.
related content
- “Does it matter which exercise? A randomized control trial of exercise for low back pain,” Audrey Long, Ron Donelson, and Tak Fung, Spine (Phila Pa 1976), 2004.
- “The effectiveness of manual physical therapy and exercise for mechanical neck pain: a randomized clinical trial,” Michael J Walker, Robert E Boyles, Brian A Young, Joseph B Strunce, Matthew B Garber, Julie M Whitman, Gail Deyle, and Robert S Wainner, Spine (Phila Pa 1976), 2008.
- “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,” Gail D Deyle, Stephen C Allison, Robert L Matekel, Michael G Ryder, John M Stang, David D Gohdes, Jeremy P Hutton, Nancy E Henderson, and Matthew B Garber, Physical Therapy, 2005.
- “A comparison between two physical therapy treatment programs for patients with lumbar spinal stenosis: a randomized clinical trial,” Julie M Whitman, Timothy W Flynn, John D Childs, Robert S Wainner, Howard E Gill, Michael G Ryder, Matthew B Garber, Andrew C Bennett, and Julie M Fritz, Spine (Phila Pa 1976), 2006.
- “The use of RCT's in manual therapy--are we trying to fit a round peg into a square hole?,” Steve Milanese, Manual Therapy, 2011.
These three articles on PainScience.com cite Silvernail 2012 as a source:
- Pseudo-Quackery in the Treatment of Pain — The large, dangerous gray zone between evidence-based care and overt quackery in musculoskeletal and pain medicine
- Science versus Experience in Musculoskeletal Medicine — The conflict between science and clinical experience and pragmatism in the management of aches, pains, and injuries
- Reassurance for Massage Therapists — How ethical, progressive, science-respecting massage therapists can thrive in a profession badly polluted with nonsense
This page is part of the PainScience BIBLIOGRAPHY, which contains plain language summaries of thousands of scientific papers & others sources. It’s like a highly specialized blog. A few highlights:
- Effectiveness of customised foot orthoses for Achilles tendinopathy: a randomised controlled trial. Munteanu 2015 Br J Sports Med.
- A Bayesian model-averaged meta-analysis of the power pose effect with informed and default priors: the case of felt power. Gronau 2017 Comprehensive Results in Social Psychology.
- The neck and headaches. Bogduk 2014 Neurol Clin.
- Agreement of self-reported items and clinically assessed nerve root involvement (or sciatica) in a primary care setting. Konstantinou 2012 Eur Spine J.
- Effect of NSAIDs on Recovery From Acute Skeletal Muscle Injury: A Systematic Review and Meta-analysis. Morelli 2017 Am J Sports Med.