A recent editorial1 and several related articles in the July issue of JMMT really got me thinking about the clinical use of manual therapy and perceptions about its use amongst our colleagues. I was also disappointed in a recent conversation I had with an Osteopathic physician (a recent graduate from their curriculum) who stated “Oh, I didn’t know that Physical Therapist’s performed articulations…”. This physician’s practice is focused on Osteopathic Manual Therapy care.
The JMMT articles, represent a call to action. They ask us to voice our opinions, educate the public and provide manual therapy interventions at a ‘mastery’ skills level, as a valuable piece of our integrative approach to caring for patients.
Another article2, this time from JOSPT in 2014 was further cause for disillusion. Had I been the patient in this case description, I would have been upset that the “first” series of “Physical Therapy” provided, appeared to not capture the “full” scope of the patient’s dysfunction and was reportedly done in a manner not consistent with current treatment evidence. Is that the kind of Physical Therapy you would want to receive as a patient? I say, no. Thankfully, referral to another therapist facilitated access to “multimodal” patient management. This included i.e. a thorough evaluation and the integration of multiple body systems for targeted treatment, including appropriate manual therapy, in addition to the required post-operative exercise and strength training.
Of course, not every single patient needs in depth manual therapy interventions, but the detail of the evaluation, along with clinical reasoning, and the hope that you were able to place your hands on the patient at some point in their course of care (COVID-19 and telemedicine may limit this) all speak to the level of professional care you strive to provide. Now, I am also an advocate for tele-physical therapy, for the appropriate patient, environment and time. Just like we learn in NAIOMT coursework and mentoring, using the right evaluation & treatment techniques at the precise time and sequence as needed will facilitate the patient’s best outcome.
Have you seen your primary care physician recently? Did they put their ‘hands on’ you and perform a clinical exam or just asked you a few questions? Abraham Verghese, MD speaks eloquently to the importance of the detailed clinical exam.3
If you take a ‘high level’ overview of all this information, it re-enforces why the principles shared by NAIOMT faculty with students and fellows in training remain so very relevant.
- Focus on the details: The manual therapy basics MATTER
- Learn to listen well: Consistently be an excellent “listener” with your patient
- Integration of the evaluation and ongoing assessment findings through the mastery of clinical reasoning. Specificity of treatment based on the symptom drivers, patient choice and multiple other factors
Remember, “Chronicity only exists when good therapists do ‘nothing’. We wouldn’t have (the volume) of chronic patients if we did our job well enough and early enough”
NAIOMT Faculty (E. Pettman)
- Cameron W. MacDonald, Peter G Osmotherly & Darren a Rivett (2020) COVID-19 wash your hands but don’t erase them from our profession – considerations on manual therapy past and present, Journal of Manual & Manipulative Therapy, 28:3, 127-131, DOI: 10.1080/10669817.2020.1766845
- Robert T.LeBeau & Shane J Nho (2014) The Use of Manual Therapy Post-hip Arthroscopy When an Exercise Based Therapy Approach Has Failed: A Case Report. Journal of Orthopedic & Sports Physical Therapy.44:9, 712-721.
- Abraham Verghese: A doctor’s touch TED Talk video