Manual Therapy Cults

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 

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Reference:
Holmes, James A (1996). Be Not Content to Sleep and Feed. Physical Therapy Journal. 76(6), 664-666. doi: 31 Mar 
     2014.