Turns Out, Manual Therapy Doesn’t Suck

Top 5 Misconceptions about Manual Therapy:

  1. Manual therapy is passive.
    While traditional models of manual therapy are performed “on” the patient who is frequently lying on a plinth passively, The Mulligan Concept™ of Mobilization with Movement™(MWM) actively engages the patient to move in functional ways while the therapist applies manual therapy forces that allow them to move pain free.
  1. Manual therapy is stretching tight structures or used on hypomobilities.
    While a component of Mobilization With Movement™ is allowing a dysfunctional and possibly tight region of the body to move more freely, the mechanisms of action are multifold. Neurophysiological mechanisms may play a large part in the success of Mobilization With Movement™:Baeske 2016. Click Here to read “Mobilisation with movement: a step towards understanding the importance of peripheral mechanoreceptors.” Physical Therapy Reviews.For more information on the neurophysiological effects of Mobilisation With Movement, check out:Vicenzino B, Hing, W, Rivett D, Hall T. Mobilisation with Movement: The Art and the Science. Chatswood: Elsevier Australia; 2011.
  1. Manual therapy is a treatment.
    Manual therapy is more than a treatment, it is part of the assessment. The Mulligan Concept™ of manual therapy and Mobilization With Movement™ is used as part of a clinician’s clinical reasoning process. It is used as assessment, treatment, and home program. A big component of establishing a therapeutic alliance with a patient, is understanding the patient themselves, and how they respond to things. One aspect of this may be determining if they are a responder to manual therapy. This assessment can help you select your treatment approach more efficiently for that individual patient.A very easy way of doing this is applying a force (MWM) to the patient’s body while they perform the movement they are complaining about, to see if you can render it pain free. Some studies suggest that if patients’ respond positively to this assessment, they are more likely to recover quickly:Cook C. 2012. Can a within/between-session change in pain during reassessment predict outcome using a manual therapy intervention in patients with mechanical low back pain? Manual Therapy (17) 325-329.Cook C. 2017. Does early change predict long-term (6 months) improvements in subjects who receive manual therapy for low back pain? Physiotherapy Theory and Practice (33)9 p 716-724.
  1. Manual therapy develops dependence and the patient will think they need someone else to “fix their problem.” Part of the beautiful thing about the Mulligan Concept of manual therapy is the education of the patient to use self-treatments at home. One example is dysfunction in the UCS with Cervicogenic HA’s. A home self-treatment with a towel was shown to be effective at 4 weeks at 12 months later!Hall T et.al. 2007. Efficacy of a C1C2 Self-sustained Natural Apophyseal Glide (SNAG) in the Management of Cervicogenic Headache. JOSPT 37(3).Video tutorial of the C1 Self SNAG:
  1. Manual therapy produces temporary changes without lasting benefit.
    The Mulligan Concept™ of manual therapy, when indicated, can produce profound and long-lasting results on pain and dysfunction. Many studies have demonstrated this, the most recent of which include:Gogate et.al. 2021. The Effectiveness of Mobilization With Movement on pain, balance and function following acute and subacute inversion ankle sprain – A randomized, placebo-controlled trial. Physical Therapy in Sport, Vol. 48:91-100.The study found that MWM at the distal tib-fib joint was effective at reducing pain, improving balance, improving ROM, and improving disability as measured by the Foot and Ankle Disability Index at 1 and 6 month follow up.This article published last year is also interesting: Nigam et.al. 2020. Long Term efficacy of mobilization with movement on pain and functional status in patients with knee osteoarthritis: a randomized clinical trial. Clinical Rehabilitation 00(0)1-10.

If you are not using Mobilizations With Movement™ in your practice, I think you would really enjoy studying the Mulligan Concept™ and utilizing these evidence-based treatments. Techniques are pain free, establish immediate rapport with your patient for good therapeutic alliance, have immediate and long-lasting results, and can be followed up with taping and patient generated forces to maintain the effect when necessary!