Reconceptualising manual therapy skills in contemporary practice

Abstract

With conflicting evidence regarding the effectiveness of manual therapy calls have arisen within some quarters of the physiotherapy profession challenging the continued use of manual skills for assessment and treatment. A reconceptualisation of the importance of manual examination findings is put forward, based upon a contemporary understanding of pain science, rather than considering these skills only in terms of how they should "guide" manual therapy interventions. The place for manual examination findings within complex, multidimensional presentations is considered using vignettes describing the presentations of five people with low back pain. As part of multidimensional, individualised management, the balance of evidence relating to the effectiveness, mechanisms of action and rationale for manual skills is discussed. It is concluded that if manual examination and therapeutic skills are used in a manner consistent with a contemporary understanding of pain science, multidimensional patient profiles and a person-centred approach, their selective and judicious use still has an important role.

‘I just don't have the tools’ - Italian osteopaths' attitudes and beliefs about the management of patients with chronic pain: A qualitative study

“…Through critical self-reflection on biomechanical theories and models which are thought be be central to an osteopathic approach, [39,40], practitioners should appraise the value and plausibility of their dominant approaches and practice paradigms that guide their clinical work as well as to better reconceptualise and expand the rationale of the therapeutic effects of the osteopathic manipulative treatment (OMT) in patients with musculoskeletal related chronic pain [29,60]. This would enable the development of more person-centered framework, that may help osteopaths to enhance their confidence and competence in the identification of obstacles to healing, outside the "joint" [30,47].…”

Immediate effects of cervical mobilisations on global perceived effect, movement associated pain and neck kinematics in patients with non-specific neck pain. A double blind placebo randomised controlled trial

“…Cervical mobilisations -low velocity passive oscillatory movements 3 , are frequently used to treat neck pain 4,5 , but their effectiveness has been questioned by recent systematic reviews [6][7][8] . The heterogeneity of participants in randomised controlled trials (RCT) has been suggested as an explanation for the lack of positive findings as an effect in a subgroup of patients may be diluted by the absence of an effect in others 9,10 . Evidence suggests that treatment outcomes with cervical mobilisations are improved when their application is based on patient subclassification [11][12][13] .…”

Inter-and Intra-Examiner Reliability of Supraspinatus Muscle Tendon Palpation: A Cross-Sectional Study by Ultrasonography

“…Palpation is an inherent and basic skill of health professionals, particularly manual therapists who base their diagnosis and treatment in a clinical environment [1]. Thus, palpation abilities are still critical in physical testing [2,3].…”