Detailed guides to painful problems, treatments & more

Manual therapy gets them coming back for more

 •  • by Paul Ingraham
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Weekly nuggets of pain science news and insight, usually 100-300 words, with the occasional longer post. The blog is the “director’s commentary” on the core content of a library of major articles and books about common painful problems and popular treatments. See the blog archives or updates for the whole site.

When people accuse me of being too skeptical or negative — an almost daily occurrence — I can confidently reply that I’m actually a rather moderate skeptic. Exhibit A? The notorious Adam Meakins, a UK physiotherapist and exuberantly foul-mouthed gadfly to his profession. And a smart one. In this Facebook post, Adam is at his bitchy best, and I mostly agree with him on this. (And to clarify right up front, by “manual therapy” he means “hands-on techniques for fixing people.”)

I’ve said it before, and I’ll say it again and again... manual therapy is a low value, unskilled, non specific intervention that anyone can learn to do in a few simple lessons!

No manual therapy technique requires years of training or practice to perfect, and it certainly doesn’t need to be applied by clinicians who are trained to diagnose and make autonomous clinical decisions and judgements!

Manual therapy belongs in the service industries being given at a reasonable cost by technicians not in healthcare being given at a premium by diagnosticians!

Those thoughts were shared with this image …

I think the most important caveat comes from a comment on his post by our mutual pal Phil Greenfield: “What takes skill and time to learn and develop is listening and being kind.” Ayuh.

I also want to add that anyone who spends time with patients needs to have enough training and skill to recognize red flags and know how to refer on, and that’s not nothing (but it’s also got nothing to do with the largely useless “toolkit” of manual therapy).

Further reading: the comments on his Adam’s are just as good as the post itself. Lots of interesting discussion there, recommended.