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  • CT Is manual therapy science based?

    In the context of pain resolution and improved health and functionality, is manual therapy science based? Why or why not?
    -Evan. The postings on this site are my own and do not represent the views or policies of my employer or APTA.
    The reason why an intellectual community is necessary is that it offers the only hope of grasping the whole. -Robert Maynard Hutchins.

  • #2
    Originally posted by Evanthis Raftopoulos View Post
    In the context of pain resolution and improved health and functionality, is manual therapy science based? Why or why not?
    It turns itself into knots trying to be, but in the end, it's mostly tooth fairy science.
    Diane
    www.dermoneuromodulation.com
    SensibleSolutionsPhysiotherapy
    HumanAntiGravitySuit blog
    Neurotonics PT Teamblog
    Canadian Physiotherapy Pain Science Division (Archived newsletters, paincasts)
    Canadian Physiotherapy Association Pain Science Division Facebook page
    @PainPhysiosCan
    WCPT PhysiotherapyPainNetwork on Facebook
    @WCPTPTPN
    Neuroscience and Pain Science for Manual PTs Facebook page

    @dfjpt
    SomaSimple on Facebook
    @somasimple

    "Rene Descartes was very very smart, but as it turned out, he was wrong." ~Lorimer Moseley

    “Comment is free, but the facts are sacred.” ~Charles Prestwich Scott, nephew of founder and editor (1872-1929) of The Guardian , in a 1921 Centenary editorial

    “If you make people think they're thinking, they'll love you, but if you really make them think, they'll hate you." ~Don Marquis

    "In times of change, learners inherit the earth, while the learned find themselves beautifully equipped to deal with a world that no longer exists" ~Roland Barth

    "Doubt is not a pleasant mental state, but certainty is a ridiculous one."~Voltaire

    Comment


    • #3
      I think most folks approach manual therapy as a skill to be learned. It is not until they realise (if they do) that having skill does not necessarily succeed in getting everyone better, do they start to ask questions. Many, if not most, resort to expanding their skillset in order to meet the apparent mismatch. It is to this gap, the space between claimed effectiveness and actual effectiveness, that the CPD/ConEd providers address their marketing. Science is only thinly applied - a fig leaf to cover the embarrassment of being found naked - much like the fabled Emperor. After all how many of us were taught to approach the subject of scientific enquiry with any kind of rigour?

      Now that all might sound rather negative perhaps but actually in many situations the skillset approach is enough to do a passable, if not completely successful, job of treating the client. What it fails to identify is that there is a significant number of ppl who pass under our hands who not only do not meet with successful treatment but are actually pathologised. Furthermore I think it also fails to appreciate that the claim that we "fix" people in turn leads people to believe that we can fix them, they need us to fix them and can encourage the endless merry go round of looking for the right therapist with the right skillset for their injury.

      They might get lucky - but it will be luck.

      ANdy
      Last edited by amacs; 02-02-2014, 11:22 PM.
      "Here is Edward Bear coming downstairs now, bump, bump, bump, on the back of his head behind Christopher Robin. It is, as far as he knows, the only way of coming downstairs, but sometimes he feels that there is another way, if only he could stop bumping for a moment and think of it." A.A. Milne

      Comment


      • #4
        The more we give correction over to the patient's own instinctive devices the "luckier" we'll get. After all, marketers seek to capture our instinctive inclinations and exploit them. Many, many methods have done this and some endure. It might be said that instinct is the holy grail of addiction, but it seems to be a moving target.

        Science based? The ideas that form its premise can be. But the method itself may stray from that.
        Barrett L. Dorko

        Comment


        • #5
          Evan,

          I'd have to counter with 'In what manner can the scientific attitude be applied to the manual therapy interaction?' and/or 'Which scientific 'facts (observations/processes)' should be employed in the thought process of a therapist when applying manual therapy?'.

          Thinking of a recent thread the discussion wasn't about science vs science but significance of one aspect of science relative to another in terms of application and a particular a priori goal.
          "Whereof one cannot speak, thereof one must be silent." ("Wovon man nicht sprechen kann, darüber muss man schweigen.“) Tractatus Logico-Philosophicus Ludwig Wittgenstein
          Question your tea spoons. Georges Perec

          Comment


          • #6
            Mark, the questions you ask presume that manual therapy (in the context of pain resolution/health/functionality) is science based to begin with, no?

            If Diane is right about MT being mostly tooth fairy science, then this means that we are trying to examine why MT is effective without first establishing if MT actually is effective.
            -Evan. The postings on this site are my own and do not represent the views or policies of my employer or APTA.
            The reason why an intellectual community is necessary is that it offers the only hope of grasping the whole. -Robert Maynard Hutchins.

            Comment


            • #7
              I think that manual therapy in some form or other very much predates the scientific method - as human primate social grooming may even be labelled as manual therapy, even our most distant ancestors were involved in that.
              It effect on pain or suffering made sure that it remained part of our societies for eons, and explanations were being created.
              This ensured that at some point, when science provided us with more information people were changing the explanations.

              I think that manual therapy is not built on science; I think science is being used to justify it.
              We don't see things as they are, we see things as WE are - Anais Nin

              I suppose it's easier to believe something than it is to understand it.
              Cmdr. Chris Hadfield on rise of poor / pseudo science

              Pain is a conscious correlate of the implicit perception of threat to body tissue - Lorimer Moseley

              We don't need a body to feel a body. Ronald Melzack

              Comment


              • #8
                Brillant post ANdy….

                beware !! http://www.youtube.com/watch?v=R_hlMK7tCks

                Comment


                • #9
                  Originally posted by Evanthis Raftopoulos View Post
                  Mark, the questions you ask presume that manual therapy (in the context of pain resolution/health/functionality) is science based to begin with, no?

                  If Diane is right about MT being mostly tooth fairy science, then this means that we are trying to examine why MT is effective without first establishing if MT actually is effective.

                  No, other way round.

                  MTs have been trying to establish that it is effective without caring about why.
                  Diane
                  www.dermoneuromodulation.com
                  SensibleSolutionsPhysiotherapy
                  HumanAntiGravitySuit blog
                  Neurotonics PT Teamblog
                  Canadian Physiotherapy Pain Science Division (Archived newsletters, paincasts)
                  Canadian Physiotherapy Association Pain Science Division Facebook page
                  @PainPhysiosCan
                  WCPT PhysiotherapyPainNetwork on Facebook
                  @WCPTPTPN
                  Neuroscience and Pain Science for Manual PTs Facebook page

                  @dfjpt
                  SomaSimple on Facebook
                  @somasimple

                  "Rene Descartes was very very smart, but as it turned out, he was wrong." ~Lorimer Moseley

                  “Comment is free, but the facts are sacred.” ~Charles Prestwich Scott, nephew of founder and editor (1872-1929) of The Guardian , in a 1921 Centenary editorial

                  “If you make people think they're thinking, they'll love you, but if you really make them think, they'll hate you." ~Don Marquis

                  "In times of change, learners inherit the earth, while the learned find themselves beautifully equipped to deal with a world that no longer exists" ~Roland Barth

                  "Doubt is not a pleasant mental state, but certainty is a ridiculous one."~Voltaire

                  Comment


                  • #10
                    Originally posted by ian s View Post
                    Brillant post ANdy….

                    beware !! http://www.youtube.com/watch?v=R_hlMK7tCks
                    Given my cultural upbringing it might not be the first time Ian!!

                    and thank you for the compliment - not sure I really earned it!

                    ANdy
                    Last edited by amacs; 04-02-2014, 12:16 AM.
                    "Here is Edward Bear coming downstairs now, bump, bump, bump, on the back of his head behind Christopher Robin. It is, as far as he knows, the only way of coming downstairs, but sometimes he feels that there is another way, if only he could stop bumping for a moment and think of it." A.A. Milne

                    Comment


                    • #11
                      Originally posted by Diane View Post
                      No, other way round.

                      MTs have been trying to establish that it is effective without caring about why.

                      I think it can go either way. Tooth fairy science, as coined by Harriet Hall, is trying to research the effects of something that might not actually exist.

                      From http://www.skepdic.com/toothfairyscience.html

                      You could measure how much money the Tooth Fairy leaves under the pillow, whether she leaves more cash for the first or last tooth, whether the payoff is greater if you leave the tooth in a plastic baggie versus wrapped in Kleenex. You can get all kinds of good data that is reproducible and statistically significant. Yes, you have learned something. But you haven’t learned what you think you’ve learned, because you haven’t bothered to establish whether the Tooth Fairy really exists.
                      -Evan. The postings on this site are my own and do not represent the views or policies of my employer or APTA.
                      The reason why an intellectual community is necessary is that it offers the only hope of grasping the whole. -Robert Maynard Hutchins.

                      Comment


                      • #12
                        The whole thing we're discussing in your post #11 and what Harriet Hall discusses when she talks about tooth fairy science is having some prior plausibility.

                        The tooth fairy isn't plausible. Neither is Reiki. Neither is a biomechanical model of pain.

                        Sticking some basic understanding of nervous system function and some decent pain science in there could go a long way toward providing prior plausibility for manual therapy. If manual therapy isn't willing to be pried away from its beloved biomechanics, then to h--- with it, IMO.
                        Diane
                        www.dermoneuromodulation.com
                        SensibleSolutionsPhysiotherapy
                        HumanAntiGravitySuit blog
                        Neurotonics PT Teamblog
                        Canadian Physiotherapy Pain Science Division (Archived newsletters, paincasts)
                        Canadian Physiotherapy Association Pain Science Division Facebook page
                        @PainPhysiosCan
                        WCPT PhysiotherapyPainNetwork on Facebook
                        @WCPTPTPN
                        Neuroscience and Pain Science for Manual PTs Facebook page

                        @dfjpt
                        SomaSimple on Facebook
                        @somasimple

                        "Rene Descartes was very very smart, but as it turned out, he was wrong." ~Lorimer Moseley

                        “Comment is free, but the facts are sacred.” ~Charles Prestwich Scott, nephew of founder and editor (1872-1929) of The Guardian , in a 1921 Centenary editorial

                        “If you make people think they're thinking, they'll love you, but if you really make them think, they'll hate you." ~Don Marquis

                        "In times of change, learners inherit the earth, while the learned find themselves beautifully equipped to deal with a world that no longer exists" ~Roland Barth

                        "Doubt is not a pleasant mental state, but certainty is a ridiculous one."~Voltaire

                        Comment


                        • #13
                          Yes Diane. It comes down to the plausibility of the premise.

                          If one is not stated, defended and used to drive method then everything falls apart.
                          Barrett L. Dorko

                          Comment


                          • #14
                            Originally posted by Diane View Post
                            The whole thing we're discussing in your post #11 and what Harriet Hall discusses when she talks about tooth fairy science is having some prior plausibility.
                            I agree. And prior plausibility and probability is what differentiates science based from evidence based medicine (in which it seems that everything under the sun gets a free pass to be researched), but that is not to downplay the importance of evidence/clinical trials.

                            At the same time, I'm becoming convinced that manual therapy usefulness should be mostly discussed on a case by case basis. Also, I think there are some differences between movement based MT and massage based MT( at least at the cognitive-evaluative level). I think movement -based tends to be more plausible than massage based if the goal of the patient is improved movement towards becoming more functional (eg after injury). Just sharing some thoughts.
                            Last edited by Evanthis Raftopoulos; 04-02-2014, 11:11 PM.
                            -Evan. The postings on this site are my own and do not represent the views or policies of my employer or APTA.
                            The reason why an intellectual community is necessary is that it offers the only hope of grasping the whole. -Robert Maynard Hutchins.

                            Comment


                            • #15
                              I would certainly agree that movement is key and must accompany care if mechanical deformation is the origin. But not just movement; corrective movement.

                              This is not always painless. Nor is it always instinctive. Feldenkrais' genius was evoking and understanding all of this. He did so with therapeutic presence, education, handling and a premise he could defend.

                              He understood the nature and power of context.
                              Barrett L. Dorko

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