Howdy, i’m a second year DPT student and this semester we are taking manual therapy and ther ex. A part of the class is a debate. Our topic is “Is manual therapy more effective than exercise (is manual therapy necessary)?” My team is on the side that it is not effective (or necessary?). The wording is a bit weird because necessary and effective aren’t the same thing…but anyhow.
The opposing team linked two articles which I will link at the bottom, but I am just looking for a little guidance on digesting them. Im trying to get better at reviewing articles but was just curious on your take. They seem to show that manual is superior to exercise (which would show it is effective) but not that it is “necessary”. From what I can tell your stance is that manual makes the patient form a dependence on the clinician and that much of manual is the fact that a healthcare professional is putting their hands on the pt and there is no real physiological mechanism. Should I just approach the debate from this point of view, that is may be effective but could be detrimental vs exercise? Its hard to argue that hard for exercise when neither may be “necessary” but oh well.
Okay, so before I go down this road for the 100th time I want to know what you think of the two papers you just shared. There are some massive problems with the methodology of the first one and the second isn’t even a “study.” I’m going to give you one piece before hand though. The second “study” (I see the authors reference an actual study but this is a summary) was only 6 weeks. Frankly, I don’t care what they found in that time frame. Most people would concede that manual therapy “feels good” but that doesn’t change anything. I can go out and have some whiskey tonight and feel good while I’m doing it but that does not mean it is going to improve my performance over the long term and may end up costing me if I make it too much of a habit. I would suggest looking up manual therapy crossed referenced with the authors Bialosky and George.
Don’t get discouraged. We all started here. If you’re a member of CA I would highly recommend the original “Manual Therapy” thread. I beat that dead horse so bad there I don’t think it could take anymore. As for getting better at methodology it takes practice and it takes arguing. Basically it comes down to having an idea and letting someone shoot it down for you. Reason the “why” that was the case and start applying that reasoning to what you are reading in the future. I intentionally read things I disagree with as an exercise in the “why” I disagree with them. If I have a study fitting my stance that has a 6 week outcome and another against it with a 6 week outcome, I can’t let the one I like slide just because I like it. It’s also looking through the methodology and results and seeing what they actually found versus what they reported they found. Often there is some discrepancy here and if you want to see a fine example to practice on I recommend https://www.jospt.org/doi/full/10.2519/jospt.2013.4668
In regards to the first study you posted, I don’t know if you are familiar with the term equipoise but it is likely worth looking into (Chad Cook has authored a few papers on this). Let’s look at the interventions part of this study for a little insight though. For the exercise group they state
All participating physical therapists were instructed in training sessions. These training sessions were repeated every 3 months. All patients were treated twice weekly for a period of 5 weeks with a total of 9 treatments. The first treatment session was used to tailor the treatment protocol to the individual patient. Content of treatment, deviations from the protocol, and compliance were registered. In addition, adverse effects were registered.
Not a whole lot to go on there. If you were to try and repeat what those physios did, odds are you would have some difficulty. For the manual interventions
Each manual therapy session started with stretching techniques of identified shortened muscles surrounding the hip joint (Appendix A). Second, traction of the hip joint was performed, followed by traction manipulation in each limited position (a high velocity thrust technique) (14). All manipulations were repeated during each session until the manual therapist concluded optimal results of the session
Can you see how those two interventions may be different? One, the authors basically state “do what you want” and the other is at least a set of techniques that were allowed to be performed until the manual therapist concluded optimal results of the session.
Slight difference in what the groups were doing there.
1 Like