![]() ![]() But when it comes down to the hands on vs hands off debate, we’d both be doing hands on work. If someone has the literature to show me otherwise, I will gladly flip sides. I personally think these therapists get their patients better because they have a better understanding of differential diagnosis, are more confident with their patients and provide good home exercise programs and not because they are apparently able to differentiate between a facet and uncovertebral joint restriction. Understandably these therapists are then very passionate about MT and the courses because this course work has helped them become a better therapist. I think this is because traditionally MT courses have helped us develop a better understanding of differential diagnosis and given us more tools in our tool boxes and traditionally these MT courses have come with a biomechanical explanation for their interventions. But for some reason, it seems that I would be grouped in as a hands-off therapist and because I don’t believe MT can be specific, I am attacking our profession. I realize that the majority of the evidence supports a neurophysiological mechanism of manual therapy and this is how I practice but in no way does that make me a hands off therapist. When I read or debate online, it seems that we are all suppose to fall into those extreme parts of the bell curve I talked about above.īut just because I am critical about the specificity of manual therapy does not mean that I do not utilize manual therapy as an adjunct with the majority of my patients to help them gain confidence, restore movement or decrease their pain. To me, this is completely ridiculous and a misrepresentation of the actual debate. biomedical model and manual therapy as a biomechanical vs neurophysiological treatment has somehow become “hands on vs. Hell, that one new study this week showed we weren’t even moving the vertebrae at all with a mobilization! At some point, it seems that the argument of a biopsychosocial model of care vs. We have learned about the the lack of specificity with manual therapy and that it is impossible to be specific with your L4/L5 mobs or manipulations. We have learned about the biopsychosocial model and how there is more to the picture than the biomedical or biomechanical model that was initially presented to us as students. We’ve gone from bed rest and cervical collars for WADs and lumbar strains to education on the safety of early movement and exercise predominant treatment plans. Over the last 10-20 years, we have learned so much more about physiotherapy and an active vs. hands-off” is that because of the loud voices of a few, I think we have truly lost what we are really trying to discuss or “argue” about. The problem with this current debate on “hands-on vs. If you do 20-30 mins of exercise and 5-10 mins of MT in a session and explain it correctly, you’re likely going to get plenty of good outcomes and happy patients. Saying ALL MT sucks and creates harm/dependence is an over-exaggeration of the literature. I am one of the more critical therapists I know when it comes to manual therapy (MT) but these people vilifying MT as a treatment are viewing MT just like all other modalities and that’s just not the case. I’ve never personally met a physiotherapist who only does exercise or spends their entire session doing manual therapy alone and skips over the education on the benefits of physical activity or the complexity of pain. Maybe I’m wrong and just have spent the majority of my time working with good clinicians. Just as is the case with a bell-curve, I would highly doubt that more than 5% of all physiotherapists are at the extremes. In my experience, there are very few therapists who are all or none. In physiotherapy the extremes represent solely passive (hands-on or really any other modality based treatment) or a solely active treatment approach. As is the case with the majority of all debates in the world, the extremists of the world are are loudest. Over the last month or so, I have read and been engaged in several conversations both in person and on twitter regarding the hands-on vs. ![]()
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