Manual therapy: always a passive treatment?

Key Points

1. Manual therapy is more a management model consisting of multiple integrated elements, rather than a singular modality.

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BACKGROUND & OBJECTIVE

Manual therapy (MT) has become a polarizing component of physiotherapy practice, with opponents arguing that passive therapies provide expensive and low value care. The authors of this viewpoint paper contest that this perspective is “shallow and overly simplistic”. Taken in the context of how MT is usually employed in the clinical setting, they propose that manual therapy is an integrated multi-element, active and passive management model founded on clinical reasoning. Another aim of the paper was to highlight the need for more detail of the MT interventions used in studies to enable study reproduction and easier clinical decisions as to usefulness.

Manual therapy has become a polarizing component of physiotherapy practice.

A multi-modal model involving synergistic passive and active strategies is promoted as optimal by the authors of this paper.

DEFINING “PASSIVE INTERVENTION” AND “HIGH QUALITY MANUAL THERAPY”

The definition of MT is varied and confusing. In clinical physiotherapy settings, “passive” describes treatments such as modalities (e.g. ultrasound, electrical stimulation) and some forms of non-interactive MT. It is this passive nature that points towards low value care (1,

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