Manual therapy: process or product?
Three articles on PainSci cite Silvernail 2012: 1. Pseudo-Quackery in the Treatment of Pain 2. Science versus Experience in Musculoskeletal Medicine 3. Reassurance for Massage Therapists
PainSci commentary on 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 wherever possible.
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.
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:
- No long-term effects after a three-week open-label placebo treatment for chronic low back pain: a three-year follow-up of a randomized controlled trial. Kleine-Borgmann 2022 Pain.
- Exercise and education versus saline injections for knee osteoarthritis: a randomised controlled equivalence trial. Bandak 2022 Ann Rheum Dis.
- Association of Lumbar MRI Findings with Current and Future Back Pain in a Population-based Cohort Study. Kasch 2022 Spine (Phila Pa 1976).
- A double-blinded randomised controlled study of the value of sequential intravenous and oral magnesium therapy in patients with chronic low back pain with a neuropathic component. Yousef 2013 Anaesthesia.
- Is Neck Posture Subgroup in Late Adolescence a Risk Factor for Persistent Neck Pain in Young Adults? A Prospective Study. Richards 2021 Phys Ther.