The Modernisation of Manipulative Therapy

Max Zusman

.

DOI: 10.4236/ijcm.2011.25110                

Abstract

Research indicates that, despite physiotherapists’ comprehensive training in the basic sciences, manipulative (currently “musculoskeletal”) therapy is still dominated in the clinical setting by its original, now obsolete, structure-based “biomedical” model. This is further inexplicable in the light of evidence that not only the underlying “philosophy” but also several of the fundamental requirements of the clinical process itself which has the structural-mechanical model as its basis, have been shown to be flawed or at least irrelevant. The apparent inability of the profession to fully abandon outmoded “concepts” (and embrace the acknowledged science-based “best practice” biopsychosocial model) may have potentially undesirable consequences for both patients and therapists engaged in the management of (chronic) musculoskeletal pain and disability.

Keywords

Manipulative Therapy, Chronic Pain, Biopsychosocial Model, Passive Movement

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	N. Ali and D. Thomson, “A Comparison of the Knowledge of Chronic Pain and Its Management between Final Year Physiotherapy and Medical Students,” European Journal of Pain, Vol. 13, No. 1, 2010, pp. 38-50. doi:10.1016/j.ejpain.2008.02.005
[2]	G. D. Maitland, “Relating Passive Movement Treatment to Some Diagnoses,” The Australian Journal of Physiotherapy, Vol. 3, 1974, pp. 129-135.
[3]	J. Hickling and G. D. Maitland, “Abnormalities in Passive Movement: Diagrammatic Representation,” The Australian Journal of Physiotherapy, Vol. 16, No. 1, 1970, pp. 13- 31.
[4]	G. D. Maitland, “Vertebral Manipulation,” Butterworths, London, 1986.
[5]	G. D. Maitland, “The Problems of Teaching Vertebral Manipulations,” The Australian Journal of Physiotherapy, Vol. 9, No. 3, 1963, pp. 79-81.
[6]	B. C. Edwards, “Manual of Combined Movements,” 1st Edition, Butterworth-Heinemann, Oxford, 1992.
[7]	F. M. Kaltenborn, “The Spine: Basic Evaluation and Mobilization Techniques,” Olaf Norlis Bokhandel, Oslo, 1989a.
[8]	G. D. Maitland, E. Hengeveld, K. Banks and K. English, “Maitland’s Vertebral Manipulation”, 7th Edition, Elsevier, Edinburgh, 2005.
[9]	G. D. Maitland, “Evolution of the Maitland Concept,” Proceedings of the International Federation of Orthopaedic Manipulative Therapists 5th International Conference, Vail, 2 June 1992, p. A6.
[10]	B. C. Edwards, “Manual of Combined Movements,” 2nd Edition, Butterworth-Heinemann, Oxford, 1999.
[11]	F. M. Kaltenborn, “Manual Mobilization of the Extremity Joints,” Olaf Norlis Bokhandel, Oslo, 1989b.
[12]	A. Gross, J. Miller, J. D’Sylva, S. J. Burnie, C. H. Goldsmith, N. Graham, T. Haines, G. Br?nfort and J. L. Hoving, “Manipulation or Mobilisation for Neck Pain,” The Cochrane Library 1, Cochrane, 2010.
[13]	C.-Y. Ho, G. Sole and J. Munn, “The Effectiveness of Manual Therapy in the Management of Musculoskeletal Disorders of the Shoulder: A Systematic Review,” Manual Therapy, Vol. 14, No. 6, 2009, pp. 463-474. doi:10.1016/j.math.2009.03.008
[14]	M. W. van Tulder, B. Koes and A. Malmivaara, “Outcome of Non-Invasive Treatment Modalities on Back Pain: An Evidence-Based Review,” European Spine Journal, Vol. 15, Supplement 1, 2006, pp. S64-S81. doi:10.1007/s00586-005-1048-6
[15]	J. E. Bialosky, M. D. Bishop, D. D. Price, M. E. Robinson and S. Z. George, “The Mechanisms of Manual Therapy in the Treatment of Musculoskeletal Pain: A Comprehensive Model,” Manual Therapy, Vol. 14, No. 5, 2009, pp. 531-538. doi:10.1016/j.math.2008.09.001
[16]	F. Wellens, “The Traditional Mechanistic Paradigm in the Teaching and Practice of Manual Therapy: Time for a Reality Check,” 2010. www.physioaxis.ca
[17]	R. L. Aquino, P. M. Caires, F. C. Furtado, A. V. Loureiro, P. H. Ferreira and M. L. Ferreira, “Applying Joint Mobilization at Different Cervical Vertebral Levels does Not Influence Immediate Pain Reduction in Patients with Chronic Neck Pain: A Randomised Clinical Trial,” The Journal of Manual & Manipulative Therapy, Vol. 17, No. 2, 2009, pp. 95-100. doi:10.1179/106698109790824686
[18]	A. Chiradejnant, C. G. Maher, J. Latimer and N. Step- kovitch, “Efficacy of ‘Therapist-Selected’ versus ‘Randomly selected’ Mobilisation Techniques for the Treatment of Low Back Pain: A Randomised Controlled Trial,” Australian Journal of Physiotherapy, Vol. 49, 2003, pp. 233-241.
[19]	O. Krouwel, C. Hebron and E. Willett, “An Investigation into the Potential Hypoalgesic Effects of Different Amplitudes of PA Mobilisations on the Lumbar Spine as Measured by Pressure Pain Thresholds,” Manual Therapy, Vol. 15, No. 1, 2010, pp. 7-12. doi:10.1016/j.math.2009.05.013
[20]	J. M. Ngan, D. H. Chow and A. D. Holmes, “The Kinematics and Intra- and Inter-Therapist Consistencies of Lower Cervical Rotational Manipulation,” Medical Engineering & Physics, Vol. 27, No. 5, 2005, pp. 395-401. doi:10.1016/j.medengphy.2004.10.009
[21]	M. A. Seffinger, W. I. Najm, S. I. Mishra, A. Adams, V. M. Dickerson, L. S. Murphy and S. Reinsch, “Reliability of Spinal Palpation for Diagnosis of Back and Neck Pain: A Systematic Review of the Literature,” Spine, Vol. 29, No. 19, 2004, pp. E413-E425. doi:10.1097/01.brs.0000141178.98157.8e
[22]	S. J. Troyanovich, D. D. Harrison and D. E. Harrison, “Motion Palpation: It’s Time to Accept the Evidence,” Journal of Manipulative and Physiological Therapeutics, Vol. 2, No. 1, 1998, pp. 568-571.
[23]	A. Dilley, S. Odeyinde, J. Greening and B. Lynn, “Longitudinal Sliding of the Median Nerve in Patients with Non-Specific Arm Pain,” Manual Therapy, Vol. 13, No. 6, 2008, pp. 536-543. doi:10.1016/j.math.2007.07.004
[24]	M. L. Ferreira, P. H. Ferreira, J. Latimer, R. D. Herbert, C. Maher and K. Refshauge, “Relationship between Spinal Stiffness and Outcome in Patients with Chronic Low Back Pain,” Manual Therapy, Vol. 14, No. 1, 2009, pp. 61-67. doi:10.1016/j.math.2007.09.013
[25]	S. George, J. E. Bialosky, M. D. Bishop, M. E. Robinson and D. D. Price, “Effects of Manual Therapy on Pain Perception in Individuals with Carpal Tunnel Syndrome,” Journal of Hand Therapy, Vol. 21, No. 4, 2008, p. 428. doi:10.1016/j.jht.2008.07.024
[26]	E. van Trijffel, R. J. van de Pol, R. A. B. Oostendorp and C. Lucas, “Inter-Rater Reliability for Measurements of Passive Physiological Movements in Lower Extremity Joints is Generally Low: A Systematic Review,” Journal of Physiotherapy, Vol. 56, No. 4, 2010, pp. 223-235. doi:10.1016/S1836-9553(10)70005-9
[27]	M. W. Coppieters and A. M. Alshami, “Longitudinal Excursion and Strain in the Median Nerve during Novel Nerve Gliding Exercises for Carpal Tunnel Syndrome,” Journal of Orthopaedic Research, Vol. 25, No. 7, 2007, pp. 972-980. doi:10.1002/jor.20310
[28]	T. Tulberg, S. Blomberg, B. Branth and R. Johnsson, “Manipulation does Not Alter the Position of the Sacroiliac Joint. A Roentgen Stereophotogrammetric Analysis,” Spine, Vol. 23, No. 10, 1998, pp. 1124-1128. doi:10.1097/00007632-199805150-00010
[29]	A. J. Threlkeld, “Effects of Manual Therapy on Connective Tissue,” Physical Therapy, Vol. 72, No. 12, 1992, pp. 893-902.
[30]	H. Chaudhry, R. Schliep, J. I. Zhiming, B. Bukiet, M. Maney and T. Findley, “Three-Dimensional Mathematical Model for Deformation of Human Fasciae in Manual Therapy,” Journal of the American Osteopathic Association, Vol. 108, No. 8, 2008, pp. 379-390.
[31]	J. K. Ross, D. E. Bereznick and S. M. McGill, “Determining Cavitation Location during Lumbar and Thoracic Spinal Manipulation: Is Spinal Manipulation Accurate and Specific?” Spine, Vol. 29, No. 1452, 2004, pp. 1452- 1457. doi:10.1097/01.BRS.0000129024.95630.57
[32]	P. Moss, K. Sluka and A. Wright, “The Initial Effects of Knee Joint Mobilisations on Osteoarthritic Hyperalgesia,” Manual Therapy, Vol. 12, No. 2, 2007, pp. 109-118. doi:10.1016/j.math.2006.02.009
[33]	D. A. Skyba, R. Radharkrishnan, A. Rohlwing, A. Wright and K. A. Sluka, “Joint Manipulation Reduces Hyperalgesia by Activation of Monoamine Receptors but not Opioid or GABA Receptors in the Spinal Cord,” Pain, Vol. 106, No. 1-2, 2003, pp. 159-168. doi:10.1016/S0304-3959(03)00320-8
[34]	A. Wright, “Hypoalgesia Post-Manipulative Therapy: A Review of a Potential Neurophysiological Mechanism,” Manual Therapy, Vol. 1, 1995, pp. 11-16. doi:10.1054/math.1995.0244
[35]	M. Zusman, B. C. Edwards and A. Donaghy, “Investigation of a Proposed Mechanism for the Relief of Spinal Pain with Passive Joint Movement,” Journal of Manual Medicine, Vol. 4, 1989, pp. 58-61.
[36]	M. Zusman, “Mechanisms of Musculoskeletal Physiotherapy,” Physical Therapy Reviews, Vol. 9, No. 1, 2004, pp. 39-49. doi:10.1179/108331904225003973
[37]	H. Pohl, “Changes in the Structure of Collagen Distribution in the Skin Caused by a Manual Technique,” Journal of Bodywork & Movement Therapies, Vol. 14, No. 1, 2010, pp. 27-34. doi:10.1016/j.jbmt.2008.06.001
[38]	M. Zusman, “There’s Something about Passive Movement…,” Medical Hypotheses, Vol. 75, No. 1, 2010, pp. 106-110. doi:10.1016/j.mehy.2010.01.049
[39]	S. E. Hartman, “Why do Ineffective Treatments Seem Helpful? A Brief Review,” Chiropractic & Osteopathy, Vol. 17, No. 10, 2009. http://www.chiroandosteo.com/content/17/1/10
[40]	A. R. Daykin and B. Richardson, “Physiotherapists’ Pain Beliefs and Their Influence on the Management of Patients with Chronic Low Back Pain,” Spine, Vol. 29, No. 7, 2004, pp. 783-795. doi:10.1097/01.BRS.0000115135.19082.97
[41]	G. D. Maitland, E. Hengeveld, K. Banks and K. English, “Maitland’s Vertebral Manipulation,” 6th Edition, Elsevier, Edinburgh, 2001.
[42]	W. E. Fordyce, “Back Pain in the Workplace,” IASP Press, Seattle, 1995.
[43]	J. D. Loeser, “Complementary Therapies in Rehabilitation,” APS Bulletin, Vol. 7, No. 4, 1997, July-August.
[44]	C. Maih?fner and B. Vill, “Functional Pain Syndromes,” European Journal of Pain, Vol. 13, 2009, p. 1096.
[45]	E. A. Mayer and M. C. Bushnell, “Functional Pain Syndromes: Presentation and Pathophysiology,” IASP Press, Seattle, 2009.
[46]	C. J. Woolf, “Pain: Moving from Symptom Control towards Mechanisms-Specific Pharmacologic Management,” Annals of Internal Medicine, Vol. 140, No. 6, 2004, pp. 441-451.
[47]	J. Kruger, “Patient Referral and the Physiotherapist: Three Decades Later,” Journal of Physiotherapy, Vol. 56, No. 4, 2010, pp. 217-218. doi:10.1016/S1836-9553(10)70001-1
[48]	S. R. Woby, N. K. Roach, M. Urmston and P. J. Watson, “The Relation between Cognitive Factors and Levels of Pain and Disability in Chronic Low Back Pain Patients Presenting for Physiotherapy,” European Journal of Pain, Vol. 11, No. 5, 2007, pp. 869-877. doi:10.1016/j.ejpain.2007.01.005
[49]	M. Zusman, “Instigators of Activity Intolerance,” Manual Therapy, Vol. 2, No. 2, 1997, pp. 75-86. doi:10.1054/math.1997.0288
[50]	M. Zusman, “Associative Memory for Movement-Evoked Chronic Back Pain and Its Extinction with Musculoskeletal Physiotherapy,” Physical Therapy Reviews, Vol. 13, No. 1, 2008, pp. 57-68. doi:10.1179/174328808X251948
[51]	S. Brookfield, “Clinical Reasoning and Generic Thinking Skills,” In: J. Higgs, M. A. Jones, S. Loftus and N. Christensen, Eds., Clinical Reasoning in the Health Care Professions, Elsevier, Amsterdam, 2008, pp. 65-75.
[52]	D. R. Kaufman, N. A. Yoskowitz and V. L. Patel, “Clinical Reasoning and Biomedical Knowledge,” In: J. Higgs, M. A. Jones, S. Loftus and N. Christensen, Eds., Clinical Reasoning in the Health Care Professions, Elsevier, Amsterdam, 2008, pp. 137-148.
[53]	M. V. Hurley and L. M. Bearne, “Non-Exercise Physical Therapies for Musculoskeletal Conditions,” Best Practice Research Clinical Rheumatology, Vol. 22, No. 3, 2008, pp. 419-433. doi:10.1016/j.berh.2008.01.001
[54]	E. Lederman, “The Fall of the Postural-Structural-Biomechanical Model in Manual and Physical Therapies: Exemplified by Lower Back Pain,” CPDO Online Journal, 2010, pp. 1-14. www.cpdo.net
[55]	D. A. MacDonald, G. L. Moseley and P. W. Hodges, “The Lumbar Multifidus: Does the Evidence Support Clinical Beliefs?” Manual Therapy, Vol. 11, No. 4, 2006, pp. 254-263. doi:10.1016/j.math.2006.02.004