Manual therapy: process or product?
Four pages on PainSci cite Silvernail 2012: 1. Pseudo-Quackery in Physical Therapy 2. Science versus Experience in Musculoskeletal Medicine 3. Reassurance for Massage Therapists 4. How much evidence is enough?
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,” Long et al, Spine (Phila Pa 1976), 2004.
- “The effectiveness of manual physical therapy and exercise for mechanical neck pain: a randomized clinical trial,” Walker et al, 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,” Deyle et al, Physical Therapy, 2005.
- “A comparison between two physical therapy treatment programs for patients with lumbar spinal stenosis: a randomized clinical trial,” Whitman et al, 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?,” 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:
- Topical glyceryl trinitrate (GTN) and eccentric exercises in the treatment of mid-portion achilles tendinopathy (the NEAT trial): a randomised double-blind placebo-controlled trial. Kirwan 2024 Br J Sports Med.
- Placebo analgesia in physical and psychological interventions: Systematic review and meta-analysis of three-armed trials. Hohenschurz-Schmidt 2024 Eur J Pain.
- Recovery trajectories in common musculoskeletal complaints by diagnosis contra prognostic phenotypes. Aasdahl 2021 BMC Musculoskelet Disord.
- Cannabidiol (CBD) products for pain: ineffective, expensive, and with potential harms. Moore 2023 J Pain.
- Moderators of the effect of therapeutic exercise for knee and hip osteoarthritis: a systematic review and individual participant data meta-analysis. Holden 2023 The Lancet Rheumatology.