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The Hidden Utility of Manual Therapy

If you’re on #PTTwitter, you know that there is a growing population of people who are NOT fans of manual therapy. Then again, maybe it’s just in my feed. I can never tell. It’s so echoey in there.

Either way, in this episode, I’m not going to talk about the relative efficacy of manual therapy & the literature surrounding that question. It’s been done. & quite well at that.

I want to talk about manual therapy from a slightly different perspective. I want to talk about a utility of manual therapy that rarely gets talked about, but which can be a tremendous asset in our practice.

I’ll start by talking about my journey with manual therapy, how my beliefs and approach have evolved over time, and finally how & why I choose to use manual therapy at this point in time.

My Manual Therapy Story

I was taught manual therapy from a very biomechanical perspective in PT school. At that point in time, my ‘why’—the reason that I chose to use manual therapy—was to correct biomechanical faults.

Then I started residency and shifted drastically away from a biomechanical model. The neurophysiological effects of manual therapy became more of my focus. My ‘why’ at that point was to provide input into the system, essentially to change people’s symptoms.

After residency, I went through a phase where I slowed way down on my use of manual therapy due to fears of lowering patients’ self-efficacy. My ‘why’ when I did choose to use it was to provide hope. To show that symptoms can be changed.

But I found that I had to shift gears a lot, vacillating between a very hands-off approach with some people and a very hands-on approach with others. It felt disjointed.

Then I went through fellowship training and was guided toward a new perspective, which is where I’m resting these days.

I want to lead you through my current reasoning process surrounding manual therapy, asking what & why at every phase of what we do.

The Person

People come to us for a wide variety of reasons. Not everyone who comes to us wants a thorough examination followed by a specific plan of action that includes exercises and lifestyle modifications.

  • Some people just want advice

  • Some people just want to be listened to

  • Some people want to know that they’re safe doing what they’re doing

But… many people do want (& expect) the thorough exam & specific plan.

The Examination

For the people who want the specific plan, one of the key purposes of the examination involves getting a sense of what might help their symptoms to improve.

The process essentially looks like this: