Localised manual therapy treatment has a preferential effect on the kinematics of the targeted motion segment

Tuttle, Neil Alan; Evans, Kerrie; Rocha, Clarice Sperotto dos Santos

doi:10.1016/j.msksp.2021.102457

Cited by 2 publications

(1 citation statement)

References 25 publications

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“…To support technique specificity, comparative data must repeatedly and reproducibly show superiority of outcome from specific MT interventions over non-specific MT, which is consistently not observed [71][72][73]. Some studies have demonstrated localised effects of targeted interventions [74] but there appears to be no difference in outcome related to: the way in which techniques are delivered [75]; whether technique selection is random or clinician-selected [41]; or variations in the direction of force or targeted spinal level [76]. Conversely, there is evidence that non-specific technique application may improve outcomes [77][78][79].…”

Section: Technique Specificitymentioning

confidence: 99%

A modern way to teach and practice manual therapy

Kerry,

Young,

Evans

et al. 2024

Chiropr Man Therap

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Background Musculoskeletal conditions are the leading contributor to global disability and health burden. Manual therapy (MT) interventions are commonly recommended in clinical guidelines and used in the management of musculoskeletal conditions. Traditional systems of manual therapy (TMT), including physiotherapy, osteopathy, chiropractic, and soft tissue therapy have been built on principles such as clinician-centred assessment, patho-anatomical reasoning, and technique specificity. These historical principles are not supported by current evidence. However, data from clinical trials support the clinical and cost effectiveness of manual therapy as an intervention for musculoskeletal conditions, when used as part of a package of care. Purpose The purpose of this paper is to propose a modern evidence-guided framework for the teaching and practice of MT which avoids reference to and reliance on the outdated principles of TMT. This framework is based on three fundamental humanistic dimensions common in all aspects of healthcare: safety, comfort, and efficiency. These practical elements are contextualised by positive communication, a collaborative context, and person-centred care. The framework facilitates best-practice, reasoning, and communication and is exemplified here with two case studies. Methods A literature review stimulated by a new method of teaching manual therapy, reflecting contemporary evidence, being trialled at a United Kingdom education institute. A group of experienced, internationally-based academics, clinicians, and researchers from across the spectrum of manual therapy was convened. Perspectives were elicited through reviews of contemporary literature and discussions in an iterative process. Public presentations were made to multidisciplinary groups and feedback was incorporated. Consensus was achieved through repeated discussion of relevant elements. Conclusions Manual therapy interventions should include both passive and active, person-empowering interventions such as exercise, education, and lifestyle adaptations. These should be delivered in a contextualised healing environment with a well-developed person-practitioner therapeutic alliance. Teaching manual therapy should follow this model.

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