Is manual therapy getting pushed to the side?

Both Dave and I have just had the honour of attending The International Federation of Orthopaedic Manipulative Physical Therapist (IFOMPT) conference in Glasgow this month.  The five day conference brought together an array of highly respected academics and clinicians as a means to present current evidence in the field of musculoskeletal physiotherapy.  The conference rightly gave a large amount of time to the current research within pain science.  With the increasing evidence of patients belief systems and changes with neural chemistry manifesting as drivers to persistent pain there is an increasing move away from using manual therapy techniques into the management of chronic pain patients.

Although researchers including Lorimer Moseley and Anna Schmid presented exceptional research on the evolving picture surrounding pain science there  was one manual therapist that simply ‘stole the show’.  Brian Mulligan was presented with the Geoffrey Maitland Award for the advancement of clinical practice in Orthopaedic Manipulative Physical Therapy at the IFOMPT Conference.  On receiving his award Brian voiced his concerns our profession is losing its skill mix whilst universities are reducing their manual therapy programmes particularly as we step into more of a biopsychosocial field.  Following his award Brian provided impromptu teaching sessions over 2 days which were highly motivational and crowded with clinicians.

Such prestigious conferences may lead clinicians to reflect upon their own practice, in particular where we are heading as a profession in the management of persistent musculoskeletal pain.  I have absolutely no doubt the Biopsychosocial approach is the way forward in management, the term itself indicates the complexity and multifaceted dimensions of pain but I also have concerns we are excluding the biological component and what can be achieved with manual therapy techniques.  Jull & Moore (2012) have previously raised the question whether the pendulum swung too far in favour of the psychosocial domain?  Personally I think this is the case.  I found Brian Mulligans lectures refreshing, highlighting the point it is acceptable to explore mechanical influences with your hands irrespective of time frames.  In essence Manual therapy has a role with our patients!   It’s getting our patients to understand the context of the applied manual therapy whilst addressing psychosocial drivers which can be the challenging part….

Congratulations to Brian on his well-deserved award and for pushing the manual therapy approach.

To make an appointment with a physiotherapist in East Grinstead or Horsham, the clinic details are here. Alternatively you can book an appointment online here.

Jull G, Moore A. (2012) Hands on, hands off? The swings in musculoskeletal physiotherapy practice. Manual Therapy;17(3):199-200.

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