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Manual Therapy Cults

4/3/2014

1 Comment

 
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Next Tuesday I will presenting a Journal Club on the different manual physical therapy "cults" that exist in our practice. I did not choose the word "cult" nor do I think that this term is appropriate. "Cult" has a negative, even evil connotation, that makes the cult-ee seem close-minded and against all other practices. A simpler, more optimistic word may be "brand,"(which manual therapy brand is one associated with) but for the sake of today's writing, I will stick with cult.

When discussing different manual cults, I think it is important to look back into the beginnings of this name game in PT practice. In a 1996 Physical Therapy Journal editorial entitled, "Be not content to Sleep and Feed," author James Holmes defends the "cult" of manual therapy against therapeutic exercise and passive modalities for the treatment of low back pain. Around this time, there was much controversy regarding the proper management of low back pain patients. Many patients were not improving with therapeutic exercise and the use of passive modalities. In response, some therapists turned to manual therapy. At this time, there was limited evidence toward the efficacy of manual therapy treatments. This change in practice did not go unforeseen. The traditional therapists started classifying manual therapy as a cult. In the editorial he writes: "reconsider chastising manual therapists as cultists...our methods await research validation...and our patients are better served as a result of the emergence of manual therapy."
        
Holmes was right in defending manual therapy, but what is more interesting is that manual therapy in itself was viewed as a cult. Now each branch of manual therapy is its own cult: Maitland, Kaltenborn, Active Release Technique, IASTM, etc. As human beings, we have tendency to classify ourselves based on our training. The question one needs to ask, "is it bad to be identified with a certain brand of manual therapy?" I do not think so as long as I am not solely utilizing that one system. Each "cult" has its unique positives and negatives, but the truth is that our research is not strong enough to place a patient in only 1 cult. Be open-minded and ready for change. Humans are too unique and individual to place all of one's training into 1 type of practice. It is best to have an eclectic approach, where we consider evaluation and assessment techniques from various schools of though.

-Jim 

Reference:
Holmes, James A (1996). Be Not Content to Sleep and Feed. Physical Therapy Journal. 76(6), 664-666. doi: 31 Mar 
     2014.
1 Comment
Paul
4/4/2014 05:48:55 am

maybe a better term would be "guru" education or training. I think as the evidence and available research of various manual therapy techniques evolves with need to step away from the guru philosphies seen especially in the continuing education world ( i.e Paris, Maitland, etc) and reach a common understanding of what techniques are best suited to various clinical situations.

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  • Home
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    • About Insider Access
  • Online Courses
    • Hooper's Knee
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    • Return to Sport Essentials Course
  • Resources
    • Newsletter
    • Business Minded Sports Physio Podcast
    • Day in the Life of a Sports PT
    • Residency Corner
    • Special Tests >
      • Cervical Spine >
        • Alar Ligament Test
        • Bakody's Sign
        • Cervical Distraction Test
        • Cervical Rotation Lateral Flexion Test
        • Craniocervical Flexion Test (CCFT)
        • Deep Neck Flexor Endurance Test
        • Posterior-Anterior Segmental Mobility
        • Segmental Mobility
        • Sharp-Purser Test
        • Spurling's Maneuver
        • Transverse Ligament Test
        • ULNT - Median
        • ULNT - Radial
        • ULNT - Ulnar
        • Vertebral Artery Test
      • Thoracic Spine >
        • Adam's Forward Bend Test
        • Passive Neck Flexion Test
        • Thoracic Compression Test
        • Thoracic Distraction Test
        • Thoracic Foraminal Closure Test
      • Lumbar Spine/Sacroiliac Joint >
        • Active Sit-Up Test
        • Alternate Gillet Test
        • Crossed Straight Leg Raise Test
        • Extensor Endurance Test
        • FABER Test
        • Fortin's Sign
        • Gaenslen Test
        • Gillet Test
        • Gower's Sign
        • Lumbar Quadrant Test
        • POSH Test
        • Posteroanterior Mobility
        • Prone Knee Bend Test
        • Prone Instability Test
        • Resisted Abduction Test
        • Sacral Clearing Test
        • Seated Forward Flexion Test
        • SIJ Compression/Distraction Test
        • Slump Test
        • Sphinx Test
        • Spine Rotators & Multifidus Test
        • Squish Test
        • Standing Forward Flexion Test
        • Straight Leg Raise Test
        • Supine to Long Sit Test
      • Shoulder >
        • Active Compression Test
        • Anterior Apprehension
        • Biceps Load Test II
        • Drop Arm Sign
        • External Rotation Lag Sign
        • Hawkins-Kennedy Impingement Sign
        • Horizontal Adduction Test
        • Internal Rotation Lag Sign
        • Jobe Test
        • Ludington's Test
        • Neer Test
        • Painful Arc Sign
        • Pronated Load Test
        • Resisted Supination External Rotation Test
        • Speed's Test
        • Posterior Apprehension
        • Sulcus Sign
        • Thoracic Outlet Tests >
          • Adson's Test
          • Costoclavicular Brace
          • Hyperabduction Test
          • Roos (EAST)
        • Yergason's Test
      • Elbow >
        • Biceps Squeeze Test
        • Chair Sign
        • Cozen's Test
        • Elbow Extension Test
        • Medial Epicondylalgia Test
        • Mill's Test
        • Moving Valgus Stress Test
        • Push-up Sign
        • Ulnar Nerve Compression Test
        • Valgus Stress Test
        • Varus Stress Test
      • Wrist/Hand >
        • Allen's Test
        • Carpal Compression Test
        • Finkelstein Test
        • Phalen's Test
        • Reverse Phalen's Test
      • Hip >
        • Craig's Test
        • Dial Test
        • FABER Test
        • FAIR Test
        • Fitzgerald's Test
        • Hip Quadrant Test
        • Hop Test
        • Labral Anterior Impingement Test
        • Labral Posterior Impingement Test
        • Long-Axis Femoral Distraction Test
        • Noble Compression Test
        • Percussion Test
        • Sign of the Buttock
        • Trendelenburg Test
      • Knee >
        • Anterior Drawer Test
        • Dial Test (Tibial Rotation Test)
        • Joint Line Tenderness
        • Lachman Test
        • McMurray Test
        • Noble Compression Test
        • Pivot-Shift Test
        • Posterior Drawer Test
        • Posterior Sag Sign
        • Quad Active Test
        • Thessaly Test
        • Valgus Stress Test
        • Varus Stress Test
      • Foot/Ankle >
        • Anterior Drawer
        • Calf Squeeze Test
        • External Rotation Test
        • Fracture Screening Tests
        • Impingement Sign
        • Navicular Drop Test
        • Squeeze Test
        • Talar Tilt
        • Tarsal Tunnel Syndrome Test
        • Test for Interdigital Neuroma
        • Windlass Test