The Demonization of Manual Therapy

Dr. Chad E. Cook, an American physical therapist, recently wrote “The Demonization of Manual Therapy” on a German publication, Muskuloskelettale Physiotherapie, referring to manual therapy’s systematic and thorough criticism in recent years.

The full article is available here https://www.thieme-connect.com/media/10.1055-s-00049852/202103/supmat/10-1055-a-1499-5262-s01.pdf

You all probably have read and even supported the “critical thinking” bloggers or internet gurus, with a reason that we need to be thinking critically. As Cook said, “In medicine, when we do not understand or when we dislike something, we demonize it”.  At the end, many will believe that manual therapy has low efficacy, just a placebo, had temporary pain-reducing effects, lead to a waste of time and money. At the end of the day, these popular blogs, which are not always true, led to the attack of manual therapy.

Cook outlined 8 of those demonisation, and dispelled them:

• Manual Therapy has No Unique Specific Effects

The exercise proponent said that there is no unique mechanism of manual therapy and thus should not be used. However, many studies have indicated that manual therapy influences pain modulation. And indeed, many rehabilitation interventions do not have a unique mechanism.

• Use of Manual Therapy Leads to Patient Reliance and Dependency and Subsequent low Self-Efficacy

Since manual therapy is a passive treatment, it could lead to dependency and the patient cannot attain his/her healing capacity. To be evidence-based, there are no studies to date that demonstrate that MT leads to lower patient self-efficacy

• Manual therapy provides only Short-Term Changes

This is true, but it does not mean it is not effective. Rapid changes in symptoms at the start of therapy are associated with a good prognosis. Being pain adaptive means a person has the ability (endogenously, within their body), to modulate pain without the help of medical interventions.

• Manual Therapy Techniques are based on Outdated, Inappropriate Philosophies that were derived to Support a Guru’s Theories

Sadly this is true. Philosophies must adapt to emerging evidence and divorce themselves of dated concepts

• Manual Therapists lack Skills in Communication, Reassurance, and Empathy

This is a load of BS

• Manual therapy does not fit within Value-Based Care

Similarly patient-centeredness is the centre of manual therapy

• Manual Therapy Causes as Much Harm as Help

There are side effects, but mostly related to soreness in muscles, increased pain

There is no one single best treatment, as most what Cook called shared mechanisms, “regardless of what approach you use, there seem to be shared responses in which everybody responds quite similarly; the outcomes are essentially the same no matter which treatment was applied.”

And of course this will not change the perception of the belief.