(Golden Oldie) Unravelling the mechanisms of manual therapy: modeling an approach

Review written by Robin Kerr info

Key Points

  1. Manual therapy is currently under challenge due to modest effect sizes seen in systematic reviews.
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BACKGROUND & OBJECTIVE

Manual therapy (MT) has occupied a significant component of physiotherapy education and practice for decades, alongside other established MT professions. There is scepticism as to the efficacy of MT due to the modest effect sizes seen in systematic reviews, opening the opportunity for a therapist’s personal bias to influence clinical decisions (1,2,3).

In 2009, Bialosky’s team provided a model on the possible pain inhibiting mechanisms underlying MT (4). They initially proposed a model (encompassing all types of MT) in which the mechanical force applied with MT triggered systemic neurophysiological responses in the peripheral nervous system (PNS) and central nervous system (CNS), that ultimately resulted in pain inhibition.

The aim of this clinical commentary was to explore the latest MT mechanistic literature in order to update the 2009 model.

There is scepticism as to the efficacy of manual therapy due to the modest effect sizes seen in systematic reviews.
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Modest outcomes from manual therapy in systematic reviews could be due to individual variability in treatment response, hence a ‘one size fits all’ research approach is problematic.

METHODS

An extensive literature review was performed with focus on advancing understanding of:

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