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Reflection: "A Change in Perception"

11/17/2014

1 Comment

 
Regular readers of the Sports Physio blog are well aware that there is definitely at least a dislike towards manual therapy (or what many claim to be manual therapy) with the author of the blog, Adam. He recently put up a post about his frustrations with certain theories of the mechanisms behind physical therapy. The post was well supported with various articles. While the tone of the article is somewhat extreme and definitely opinionated, Adam brings up some very important points, particularly about the lack of any evidence for biomechanical explanations behind manual therapy.
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In our most recent fellowship class with the Manual Therapy Institute, we covered adverse neural tissue tension and manipulations. The instructors recognize that there is a lack of research to support a specific mechanism behind manual therapy, but do have a hard time factoring in studies as proposed by Adam in his blog post. They offer up both biomechanical and neurophysiological explanations for the techniques. To the casual reader, it would appear Adam's post argues against using manual therapy at all, when in reality, it is just arguing against a particular theory of it - the biomechanical one. Towards the end, he recognizes that most of the current research suggests that manual therapy works via the central nervous system. While this may be true, it is a difficult argument to fully support. According to Shirley Sahrmann, it is impossible to prove a neurophysiological mechanism behind the success of manual therapy. Even though some studies may suggest an existing mechanism behind the theory, we are incapable of actually proving it according to her.

Now the theme of the article would suggest that manual therapy has minimal applications. This may prove discouraging to those who have spent thousands of dollars trying to improve their manual skills. This is the point at which I disagree with the author. I have seen significant improvements in patients in which I use manual therapy. Measure a joint's mobility, perform some IASTM, reassess and find changes in ROM. Assess neural tension, perform a manipulation, reassess and find changes in neural tension. Of course this is not applicable to everyone, but it does affect a lot. There are quite a few studies that have shown improvements in patients after manual therapy has been applied (check out our previous post here). Even though we cannot prove why a technique works, should we stop using it if it is successful? That is the message I fear some will take away from Adam's article. Take IASTM for example. With my IASTM training (IASTM Technique), we learn the theory behind the changes are in activation of mechanoreceptors that allow the nervous system to have altered mobility. There is also some theory about cortical remodeling. Adam links to an article that he uses to defend his belief that IASTM has little effect. However, upon closer look, we do not know enough about the individuals selected in the study (possibly slow-responders) and the study's small sample size of 17 participants do not exactly qualify for normalizing to the population. Many that use IASTM, myself included, have seen immediate changes after the manual treatment alone. Now, of course we must reinforce any changes we acquire through manual therapy with some sore of exercise or education to make the patient more independent and lock in the changes. Manual therapy can be an extremely useful tool to accelerate your treatment plan. Be flexible as research continues to come out about manual therapy that might assist your decision making, but don't throw it away just yet.

-Chris
1 Comment
Kev PT
12/3/2014 12:34:56 am

I agree I have used manual therapy to great effect in my practice especially with IASTM. I always test function, strength, pain level with different movements and retest them after IASTM. Unless I am being delusional or my patients are lying to me, majority of the time those same things tested before are improved.

With that being said I have discarded PIVMS as part of my manual therapy tool set

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  • Home
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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 >
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        • 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