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Manual Therapy doesn’t suck!



Manual Therapy sucks!!!

I read about that in a blog called “The Sports Physio” . It sounds very impressive and has some correct points, but at the same time is an unfair generalization. So I would like to make some interesting points too.

I am often asked if manual therapy or just manual (in the daily slang) is suitable for “everything”, or if I am using Kaltenborn, Maitland, or any other approach or concept.

Well, life circles around, and some people probably get dizzy.  But does manual therapy really suck?  Are we all who teach manual therapy a group of physiomafia? Are we selling bullshit to our students?  If yes, there must be something rotten in the kingdom of Denmark (don’t worry, I am not getting too Shakespearian).

So allow me please to say, that manual therapy DOESN’T suck at all!!!

This is because manual therapy is NOT about :

  • putting discs back in place
  • rotating vertebrae clockwise or counterclockwise
  • getting an ACL- operated athlete back in the field in one month post-operation
  • cracking bones
  • straightening scoliosis with my bare hands (although I would love to be able to do so)
  • lengthening short legs
  • pissing on electrotherapy
  • “I have long time experience and this is my opinion” (according to my experience)

Manual therapy is mostly about:

  • Training physios to use the available scientific knowledge in their daily practice
  • Combining clinical experience that is obtained through scientific knowledge  and not through theories that only exist in the brain of their founders
  • Making physios use their brain in an open minded process and try to find their limits of knowledge too.
  • It is not an indefinite idea !!!

Declaring that manual therapy sucks, is quite similar to declare that physiotherapy is just ultrasound and hotpacks, or like medicine is merely cortisone injections. So in my opinion if a physio is using this quote, it is either because he wants to draw attention to himself or has no idea what he is talking about whatsoever.

Has anyone or any other concept apart from MT an effective way to mobilize a stiff joint? Maybe there is an “open sesame”  or “close sesame” technique that I am not aware of.

Maybe we should ask ourselves: are we changing from “bone movers”  to   “bone talkers”?
Are we shifting from hands on for everything to hands off for everything?
 I hope not.  I think that there is a danger of losing common sense. We do have to learn how to palpate, we do have to touch our patients and use our hands, but at the same time we do have to be humble and careful on how do we explain the mechanisms of our techniques. We are all using the same techniques as always, but the explanations are dramatically changed and we have to deal with it.

We have to be able to talk scientifically but simply to the public without perpetuating their agony, their stress and their dependence from us to “fix” them.

Let us not forget that one of the invaluable tools that Manual Therapy’s clinical reasoning algorithm offers, is the screening of red flags and the constant reassessment of symptoms, that protects us (therapists) and the patient from useless and danger ongoing therapy sequences.

So we need to find the correct procedures to pick the appropriate approach for each patient because (as expected) not all patients are suitable for hands on treatment, not all patients are suitable for manips, of course we have to bring education for patients to everybody’s level of understanding and culture. Sometimes we may have to use U/S because our patient feels comfortable with it and this will help him trust us giving us the possibility to move to a more scientific treatment later on.

We may also have to massage our patients as human touch has a very positive effect. It is not about what we use, but it is about why we use it. But in the end of the day our main goal as physios is to bring our patients as soon as possible to active training and therefore restoring function and improving quality of life.

So manual therapy doesn’t suck at all dear colleagues. As long as it doesn’t narrow our perspective, as long as it don’t make us committed to systems and concepts, as long as we are ready to doubt ourselves and finally as long as we use reflexion to achieve metacognition with the available scientific knowledge and clinical skills, manual therapy will be the answer for all musculoskeletal dysfunctions.

Long live manual therapy

1sakellariouKonstantinos Sakellariou PT, OMT