A Perspective on Manipulative Therapy

This paper attempts to persuade those interested in the topic that a reassessment of the direction is required as the social cost of treating back pain is placed under scrutiny and an alternative method for managing low back pain using patient-generated forces is described.

Abstract

Summary Physiotherapists worldwide are now using spinal mobilisation and manipulation (SMT) as the main treatment for mechanical spinal disorders. Courses providing education in the techniques of SMT flourish in most countries of the western world. There arises the distinct possibility that this trend will create, for the third time this century, a profession whose main tool for the treatment of back pain is SMT. The indiscriminate use of SMT must cease if we are to avoid the criticisms that have been justifiably levelled at chiropractic and osteopathy. We cannot condone the dispensation of SMT to the whole population with back pain in order to deliver the procedure to the very few who require the technique. We cannot justify the application of external forces to treat mechanical spinal disorders, if there is the slightest possibility that the patient can resolve the problem alone. The continued use of methods that create patient dependency must be questioned when successful treatments based on patient responsibility and self-treatment are available. This paper attempts to persuade those interested in the topic that a reassessment of our direction is required as the social cost of treating back pain is placed under scrutiny. An alternative method for managing low back pain using patient-generated forces is described. A rationalisation of the use of mechanical tools in the treatment of back pain is proposed.