To treat or not to treat: New evidence for the effectiveness of manual therapy

Abstract

In summary, I return to the question that was the genesis of this leader, what explains the apparently inconsistent data in the field of manual therapy outcomes? Critical appraisal suggests that more precise interventions are successful in treating low back pain, chronic neck pain, and cervicogenic headache. There are clinically relevant differences between studies reporting positive results of manual therapy and those reporting no significant difference over other conservative treatments. Specifically, the treatment protocol needs to reflect what therapists are actually doing in clinical practice-that is, using more than one manual therapy technique or combining manual therapy with other modes of treatment such as specific exercise training. Interventions based on best practice guidelines/texts appear to be more successful, and physical therapy including manual therapy at a dose of 30-45 minutes per session, for four to eight weeks has been shown to be effective. Further research is needed to identify populations who are most likely to improve with manual therapy. For example, Flynn et al identified five variables to form a clinical prediction rule for patients with low back pain who are likely to respond favourably to a specific manipulative technique. In that study decisions on the side to be manipulated were not based on clinical best practice guidelines and only one manipulation technique was used (thus not representative of clinical practice), yet this approach to refine clinically relevant procedures may prove very useful. Finally, manual therapy is not only used in the treatment of low back and neck pain. Further investigations of the effectiveness of manual therapy in special populations are needed. Pilot studies have been conducted in patients with thoracic pain, cervicobrachial pain syndrome, and we have conducted studies on the safety of manual therapy in the osteoporotic spine. The next step is for researchers to conduct well designed RCTs to determine the effectiveness of manual therapy for pain and disability in these populations.