The Modernisation of Manipulative Therapy
PainSci summary of Zusman 2011?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.
A strong indictment of the persistent use of “passive movement” in physiotherapy, and the disappointing reasons for it: a “now obsolete, structure-based ‘bio-medical’ model” which has “been shown flawed or at least irrelevant.” Unfortunately, the language of the paper is tortuous and clunky, especially the bizarrely overuse of scare quotes and parentheticals. However, I agree completely with its substance, and share the author’s frustration with the state of physical therapy: “The profession needs to be seen to be taking the mature stance afforded by its modern science-based training.”
original abstract†Abstracts here may not perfectly match originals, for a variety of technical and practical reasons. Some abstacts are truncated for my purposes here, if they are particularly long-winded and unhelpful. I occasionally add clarifying notes. And I make some minor corrections.
Research indicates that, despite physiotherapists’ comprehensive training in the basic sciences, manipulative therapy is still dominated in the clinical setting by its original, now obsolete, structure-based “bio-medical” model. This is further inexplicable in the light of evidence that not only the underlying “philosophy” but also several of the fundamental requirements of the clinical process itself which has the structural-mechanical model as its basis, have been shown to be flawed or at least irrelevant. The apparent inability of the profession to fully abandon outmoded “concepts” (and embrace the acknowledged science-based “best practice” biopsychosocial model) may have potentially undesirable consequences for both patients and therapists engaged in the management of (chronic) musculoskeletal pain and disability.
related content
These three articles on PainScience.com cite Zusman 2011 as a source:
- PS Save Yourself from Low Back Pain! — Low back pain myths debunked and all your treatment options reviewed
- PS Your Back Is Not Out of Alignment — Debunking the obsession with alignment, posture, and other biomechanical bogeymen as major causes of pain
- PS Pseudo-quackery in Chronic Pain Care — A field with a large gray zone between overt quackery and evidence-based care in musculoskeletal medicine
