In discussions with academic faculty peers, I often am asked, “Why do you you teach so much manual therapy?” I ask them, “Why don’t you teach more?” To be clear, I teach manual therapy because, when added to a full complement of evidenced, clinical reasoned treatment, there is ample evidence that is effective. WHY it is effective is up for debate and several scholars have covered this in excellent key notes and literature. Some offer placebo as a reason, but in actuality placebo is present in all medical treatment…even placebo.
We learn and practice sound anatomical and biomechanically informed, evidenced based manual therapy treatment. We learn it in a safe manner and apply it with other care, not as a stand alone treatment. The art of manual therapy, particularly in the spine, is not only knowing how to do it, but when, on whom, and perhaps most importantly when not to use it. Precautions and contraindications should be observed and its use in pediatrics is limited and in the very young dangerous, unnecessary, and potentially catastrophically harmful.
The evidence for manual therapy, particularly of the spine shows that is: reduces pain, increases range of motion, improves function, improves exercise tolerance, and as a proper adjunct, improves patient outcome measures and satisfaction. It does not, as a stand alone treatment, “cure the patient” or (considering COVID) enhance your immune system, prevent disease, or lessen nervous system “interference.” There simply is no high quality evidence for this anywhere for which I am aware. We share manual therapy with other professions. We share spinal mobilization with other professions. Each of us can use this tool for the benefit of our patient. As Physical Therapists we must be the ones that use it based on evidence, in a very safe manner, on the appropriate patients, for the correct reasons, and in conjunction with our knowledge, the best available evidence, and our patients’ expectations.