8/2/2019 Flynn 2004 - MT Editorial
1/3
Manual Physical Therapy: MovingBeyond the TheoreticalTimothy W.
Flynn, PT, PhD, OCS, FAAOMPT1
T
his special issue of the Journal is dedicated to the topic of
manual physicaltherapy. The growing body of evidence supporting the
effectiveness of manualphysical therapy1,2,4,6,7,10,12,16 for a
wide variety of patient populations makes this atimely and
important topic. The variety of patient populations addressed in
thisspecial issue highlights the diversity of conditions for which
manual physical
therapy should play a role in evidence-based patient management.
Like many aspects ofpractice, however, there appear to be barriers
hindering the integration of the evidencesupporting manual therapy
into the decision-making processes of practicing clinicians and
thecurricula of programs educating physical therapists.5,17 These
barriers need to be identifiedand dismantled.
Perhaps the greatest barrier blocking a wider and more
consistent integration of manualtherapy into physical therapy
practice and education is the language we choose to use. All
toooften our terminology is specific to a particular paradigm of
manual therapy, creating aprofessional tower of Babel, leading to
confusion and an inability for intraprofession and
interprofession communication. The terminology employed by
particular schools of thoughtoften has the effect of intimidating
the uninitiated and creating an illusion of specificity thatcannot
be supported by the evidence. For example, an impairment in
extension range of
motion might be labeled an FRS dysfunction, PA hypomobility,
down-slope restriction, closingdysfunction, TP right, etc,
depending on the particular paradigm used. Each term
generallydescribes the same impairment, but the terminology
employed creates a perception ofdifferences that are actually
without distinctions.
Well-intentioned clinicians all too often allow their particular
model to become reality andexpend great effort in learning and
subsequently defending the theory underlying the system,instead of
focusing on the evidence supporting manual physical therapy
interventions. Recentresearch has questioned the validity of many
theories underlying manual therapy. Yet evidencefor the
effectiveness of manual therapy is also prevalent. For example, an
assessment ofsegmental mobility restrictions, or end play, is
advocated by many manual therapy paradigms,based on a theoretical
model proposing the effectiveness of manual therapy as determined
by
a reduction of movement restrictions identified by manual
assessment at specific joints. Haas
et al
11
recently reported on the reductions in neck pain experienced by
patients when cervicalmanipulation was performed at the cervical
segment identified by the clinician, based on anassessment of joint
mobility, versus cervical manipulation performed at a randomly
selectedcervical segment. No differences in pain reduction were
noted between the 2 approaches.This finding certainly questions the
veracity of the theory that clinicians can identify specificjoint
mobility restrictions, and the theory that the benefit of
manipulation is related primarilyto reducing joint restrictions.
However, it does not change the fact that randomized trials
haveprovided evidence supporting the superior effectiveness of
manual physical therapy forpatients with neck pain.12 Recent
studies examining manual therapy techniques in thethoracic and
lumbar spine have raised similar questions regarding the ability to
direct a
1 Associate Professor, Department of Physical Therapy, Regis
University, Denver, CO.
Journal of Orthopaedic & Sports Physical Therapy 659
G
UEST
ED
ITO
RIAL
Journal of Orthopaedic & Sports Physical TherapyOfficial
Publication of the Orthopeadic and Sports Physical Therapy Sections
of the American Physical Therapy Association
8/2/2019 Flynn 2004 - MT Editorial
3/3
12. Hoving JL, Koes BW, de Vet HC, et al. Manual therapy,
physical therapy, or continued care by ageneral practitioner for
patients with neck pain. A randomized, controlled trial. Ann Intern
Med.2002;136:713-722.
13. Kulig K, Landel R, Powers CM. Assessment of lumbar spine
kinematics using dynamic MRI: aproposed mechanism of sagittal plane
motion induced by manual posterior-to-anterior mobilization.
JOrthop Sports Phys Ther. 2004;34:57-64.
14. Manipulation in First Professional Physical Therapist
Programs: An Academic Faculty Workshop.Denver, CO: Regis
University; 2004.
15. Ross JK, Bereznick DE, McGill SM. Determining cavitation
location during lumbar and thoracic spinalmanipulation: is spinal
manipulation accurate and specific? Spine. 2004;29:1452-1457.
16. Struijs PA, Damen PJ, Bakker EW, Blankevoort L, Assendelft
WJ, van Dijk CN. Manipulation of thewrist for management of lateral
epicondylitis: a randomized pilot study. Phys Ther.
2003;83:608-616.
17. Turner PA, Whitfield TWA. Physiotherapists reasons for
selection of treatment techniques: across-national survey.
Physiother Theory Pract. 1999;15:235-246.
J Orthop Sports Phys Ther Volume 34 Number 11 November 2004
661
G
UEST
ED
ITO
RIAL
