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Year : 2022  |  Volume : 4  |  Issue : 1  |  Page : 83-85

Existence of manual therapy: Is it the brain or the mind? The brighter prospect and the darker truth

Department of Physiotherapy, Capri Institute of Manual Therapy, New Delhi, India

Date of Submission15-Apr-2022
Date of Decision15-Jun-2022
Date of Acceptance27-Jun-2022
Date of Web Publication30-Jul-2022

Correspondence Address:
Dr. Bhini Semwal
William Rise, Leeds, West Yorkshire, United Kingdom

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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ijptr.ijptr_62_22

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In the treatment of musculoskeletal condition, manual therapy is a frequently utilized therapeutic strategy. There is growing evidence for the efficacy of different manual therapy concepts which are into practice. With evolving science and technology, paradigm shifts are blooming, but at the same time, they cannot conceal the importance and existence of older concepts. This article debates on the existence of manual therapy.

Keywords: Manual therapy, Physiotherapy, Profession

How to cite this article:
Semwal B. Existence of manual therapy: Is it the brain or the mind? The brighter prospect and the darker truth. Indian J Phys Ther Res 2022;4:83-5

How to cite this URL:
Semwal B. Existence of manual therapy: Is it the brain or the mind? The brighter prospect and the darker truth. Indian J Phys Ther Res [serial online] 2022 [cited 2022 Nov 29];4:83-5. Available from: https://www.ijptr.org/text.asp?2022/4/1/83/353020

  Introduction Top

The Brain and the mind, are not the same. Thought must be tickling your head by now. Surprisingly, in English Vocabulary, both are the same and can be interchangeably used. Speaking about the topic of interest, i.e., scientifically, they cannot be the same but may be seen sometimes used in researches as synonyms. It has been stated that in science, anything which cannot be experimented within the laboratory and has no physical property does not exist, so GOD and THE MIND do not exist. You will soon know why the author believe that “Manual therapy” is treated more as MIND, despite “Manual Therapies” a humungous contribution to the field of physical therapy.

“Credibility of Manual Therapy at Stake,”[1] “We need to debate the value of manipulative therapy,”[2] “Manual therapist - Have u lost the love feeling,”[3] “Manual therapy is not fashionable anymore;”[4] these titled editorials/articles have recently been published and written by prominent authors who are known for their pen-and-thought processes. As a manual therapist and as a manual therapist Instructor for over a decade, this was thought-provoking and triggered grey matter. The gap between the past and the future generation is always tied to historical ways whether its community, religion, or any profession. One sees the world as it is passed down to generations from its ancestors/history. In physiotherapy, this historical perspective has laid the foundation of knowledge and skills so that students gain competency for basic learning to excel in graduation. But what about facing challenges in the actual world which is changing rapidly. Will the Basic learing will prepare them for diversity? Will it fill the gap between past & present / future? Existence of manual therapy is a question of debate with this historical perspective. Therefore, it is time to reform physiotherapy eduction differently to bridge the gap.[5]

  Debating the Existence of Manual Therapy Top

Professional life requires students to develop the capability to deal with uncertainty, diversity, novelty, and adaptability in future. The greatest example was seen by the world health professionals during the pandemic 2020. Everything was online and no basic knowledge was carried out in the past for quality assessment and treatment in a virtual platform. Hence, idea stands for reforming the education system with the present scenario.

With rapidly evolving fields in medicine there are different challenges on the plate. Where on one side, other health care professionals are denying the credibility of the physiotherapy profession itself, on the other hand within our community, internal conflicts exists, claiming themselves, there concepts the best. This will slowley vanish everthing in near future. Many cochrane studies, systemic reviews and Randomized controlled trials (RCTs) may prove that one concept/treatment is better in respect to other, but never conclude that the latter is not working at all. The results obtained may not be of that significant value because of different confounding factors. Why not to diccuss MCID (Minimal Clinical Improvement Difference) for that treatment, which represents “smallest improvement considered worthwhile by the Patient for that treatment”. This may solve the conflict of proving themselves the best & effective.

RCTs are considered to represent a higher level of evidence, but they cannot be compared to randomly obtained data in practice because the former is conducted in an artificially generated environment. The higher-level evidence suggests that systemic reviews and meta-analysis give a typical conclusion stating “no conclusions can be drawn until further number of quality papers is published” that makes it further difficult to practice evidence-based manual therapy.[6] Further RCTs on manual therapy have inadequate methodology and clinical outcomes. This evidence shows fewer roles on individualized patient care because they must have been documented on heterogeneous population who differ physiologically, anatomically, culturally, socially, and psychologically. Therefore, RCTs should be used as optimal guide to practice.[7]

  Why Manual Therapy Works? A Question of Debate Top

There are existing answers in the theory and will also be coming in the near future, but it is up to us whether to go along with it or to refuse it for one or another reason. Why the effect of mother's touch and her cuddle on the little ones is not the question of debate, probably because every single life in the universe has felt it personally, though it is also the one not has proven or gone through various higher levels of evidence. Again, a sincere reply to all well-wishers standing against the evidence of manual therapy, patients never asked how it works, the important thing for them is that it worked and helped them, they will never ask, which concept you are following, why this? Why not the other? And still, if we want to know the answers, we have to wait and have patience. Remember, “Rome was not built in a day.” We may agree to disagree with this thought and every individual has their preference. We just need to think differently.

Paradigm shift is necessary for any medical, life sciences to change in the perception of how things need to be done, made, and thought about. In recent years, manual therapy holds one's attention in physical therapy; manual therapy is a traditional biomedical method focusing on anatomy, patho-anatomy, and biomechanics. These models would imply that injury diseases and muscle guarding may lead to altered movement patterns, resultant pain, and dysfunction. These dysfunctions may also be because of micro-malalignment in the joint surfaces because of imbalance around the joint. Manual therapy revolves around the correction of these malalignments by different approaches keeping arthrokinematics in consideration.

There is growing evidence for the efficacy of different manual therapy concepts which are into practice. In the meta-analysis, RCTs show results in both the directions, sometimes statistically significant and clinically irrelevant or/and statistically insignificant and clinically relevant.

These approaches have come under scrutiny, partly because of lack of evidence to prove mechanical effects/correction of malalignment and because of advances in other fields as the use of musculoskeletal ultrasound for diagnostic as well as therapeutic purposes.

Paradigm shift existence is necessary, but at the same time, they cannot prove the older concepts not working. The new will be better, overcoming the disadvantages of old, but we must remember when the new was not there this old only worked. Paradigms come with anything; NEW is the better version of OLD, not to make old vanish. “Should evidence or sound clinical reasoning dictate patient care?”[8] A survey on shoulder rehabilitation using manual therapy among physiotherapists having experience for more than 2 years from, India, the United states, Canada, and Middle East countries was conducted. The study shows that 87% of physiotherapists were manual therapists and use different manual therapy concepts. Interestingly, 42% of physiotherapists did not follow evidence-based practice and still 80% of patients responded positively to their treatment. Surprisingly, 78% of physiotherapists modified the manual therapy treatment based on each clinical case.

Few do not believe in manual therapy because they have observed no change and the others do not believe because experimental-based evidence at cellular level is limited, and this is a reason “Manual Therapy was earlier considered as THE MIND.” “Effort is important, but knowing where to make an effort makes all the differences.” Any revolution in physiotherapy/manual therapy the fundamental approach will be always focus on arthokinematics, osteokinematics, kinetics. In short, biomechanics will be the foundation of any concept, and as manual therapists, we should be happy and feel lucky because the biochemical injection cannot correct a biomechanical problem it is only we who can help. And as a physio or better to be called as movement scientist we cannot opt for one tool in our tool box. Embrace the old and appreciate the new dimensions. This is again going to resolve internal conflict and save the profession..

  Conclusion Top

Bio + Psycho + Social is all what a manual therapy model comprises, i.e., Bio (Mechanics), Psycho (Assessment) + Social (communication + Rehabilitation to social life). Even if the name and presentation of manual therapy might change, it will still remain fashionable. Therefore, we manual therapists have not lost anything neither integrity nor feelings, it just we have to work together to win the race, reform our education system, work on skills, work on more global functional assessments and diagnoses, and yes researches which cannot be denied, for a new era.

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Conflicts of interest

There are no conflicts of interest.

  References Top

Oostendorp RA. Credibility of manual therapy is at stake 'where do we go from here?' J Man Manip Ther 2018;26:189-92.  Back to cited text no. 1
Reid D, Cook C, Sizer PS, Froment F, Showalter CR, Brismée JM. Is orthopaedic manipulative physical therapy not fashionable anymore? Lessons learned from 2016 IFOMPT meeting and future directions. J Man Manip Ther 2017;25:1-2.  Back to cited text no. 2
Mintken PE, Rodeghero J, Cleland JA. Manual therapists – Have you lost that loving feeling?! J Man Manip Ther 2018;26:53-4.  Back to cited text no. 3
Karas S, Mintken P, Brismée JM. We need to debate the value of manipulative therapy and recognize that we do not always understand from what to attribute our success. J Man Manip Ther 2018;26:1-2.  Back to cited text no. 4
Barradell S. Moving forth: Imagining physiotherapy education differently. Physiother Theory Pract 2017;33:439-47.  Back to cited text no. 5
Wainwright SF, Shepard KF, Harman LB, Stephens J. Novice and experienced physical therapist clinicians: A comparison of how reflection is used to inform the clinical decision-making process. Phys Ther 2010;90:75-88.  Back to cited text no. 6
Dijkers MP, Murphy SL, Krellman J. Evidence-based practice for rehabilitation professionals: Concepts and controversies. Arch Phys Med Rehabil 2012;93:S164-76.  Back to cited text no. 7
Sizer PS Jr., Mauri MV, Learman K, Jones C, Gill N', Showalter CR, et al. Should evidence or sound clinical reasoning dictate patient care? J Man Manip Ther 2016;24:117-9.  Back to cited text no. 8


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