Living in the great State of Colorado, USA, has been interesting the past few years. It was not too long ago that we voted as a State, to allow each county to legalize marijuana for private use and for distributors to do so under scrutiny and taxation by the State. As I travel domestically and internationally to teach therapy concepts, Colorado’s laws are always a hot topic to discuss, and of course, discredit or educate the misconceptions and distortions of the truth. Topics like “Pot is legal everywhere in the state, you can toke and drive, if you are carrying more than the federal law will allow on an interstate you are still OK because of state laws, you can still consume and work because state law precedes employer policy or regulation etc. All of these are mistruths. Developed by hearsay and passed down from person to person. But by far, the biggest topic is one of Marijuana being the “gateway drug”. This is the idea that consumption originally is harmless and fun. But over time, it leads to experimentation with other drugs, addiction, dependency, altered thought process, and crime. All of these arguments have two sides, but it got me thinking about my profession. Perhaps manual therapy is the “gateway drug” of physical rehabilitation?
There is debate currently on the effect of manual therapy and its place in rehabilitation medicine. In fact, several research articles have called into question the efficacy of various manual treatments. Some of the “powers that be” have continually argued that manual medicine takes second fiddle to exercise, rest, or even the placebo effect. So why continue with manual medicine techniques?
Any treatment of choice, but especially manual rehabilitation techniques, were always (in my opinion), meant to be a treatment accelerator! A way to get short-term, immediate improvements that were enhanced by pain modulation by-products, self-empowerment by the client, and return of functional movement. Now of course, I have seen some tremendous immediate results over the years that required nothing further. But, most often, it has provided a gateway to move on to other procedures more quickly than without.
Too often I read research papers that, in methodology, are inherently biased and not clinically applicable. Structured to mandate that a specific technique or treatment be repeated for a set number of repetitions and sessions to determine an outcome/effect. I always end up asking myself “who would do the exact same thing for 4-6 visits regardless of outcome or result?” The reality of clinic practice is that there are far too many factors (controllable and non-controllable) to expect that the situation or environment is the same each time you see a patient. As an example, if we apply a manual based treatment, and there is a noticeable positive or negative outcome, doesn’t it stand to logic that the next step is some type of progression or advancement? In contrast, if there is a neutral or negative result, why would doing the same thing again make sense here? Published research has given us significant insight into the vast array of physiologic changes that happen after manual medicine and other treatments. But why stop there? Maximize those short-term results by enhancing movement patterns, empowering the patient, performing functional activities or even non-specific exercise. Start moving again!
There should not be a battle between current research and past models of applied therapy. Individuals who insist on swinging the pendulum to the opposite side are just as likely to see failures and pushback as their predecessors. Lorimer Moseley was recently quoted at the recent IFOMPT meeting in 2016 as saying “…the biopsychosocial model rejects the biomedical model because the medical model is not concerned with the person. But it does not reject the role of structural, biomechanical and functional disturbance of body tissue as potentially powerful drivers of protection.”
Embracing the middle of a multi-modal therapy approach has always seen success because it places the patient interest first….psychology, empathy, hands on care, movement, pain.
We should stay open…to staying open!
Stop condemning other models of therapy. Rather, I employ my colleagues to accept that just because we either don’t know how something works, or don’t understand how another practitioner explains something, doesn’t mean the procedure is useless. As long as we are critically assessing and re-assessing our patients and having success, …in the end…it worked for that individual and changed their life in a positive way. If we aren’t having success, move on, try something else, be willing to be open…to being open. EVERY model of therapy, no matter what the basis or theory is, fails for someone.
Chad Cook was once quoted, “I am a manual therapist, but first and foremost, I am a physiotherapist.” Well said, Sir. Sometimes we do not need understand exactly how we make success, but rather that we focus on simply have successes with individual patients again and again!
Written by Eric M. Dinkins
Edited by Mark Thomson