Reflection: "A Change in Perception"

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.

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