Manual Therapy Myths

Myths and health

Accordingly to the Oxford dictionary, a myth is a widely held but false belief (or idea). We commonly encounter health-related myths in our daily lives. For example, despite what you may have heard, cracking ones knuckles does not cause arthritis. Coffee doesn’t stunt the growth of children and 10,000 steps per day isn’t necessarily the magic number when it comes to activity levels. Chocolate is not an aphrodisiac and muscle doesn’t necessarily turn to fat when you stop exercising.

There are a number of orthopaedic manual therapy-related myths that have been propagated over the last century or so. Most of these myths originated as philosophical explanations on how and why the orthopaedic manual therapy (OMT) treatments work and are tied to selected professions. Some grew as a method of enhancing the marketing of the OMT approaches, which in turn generated dogmatic following from clinicians who adopted a dedicated philosophy. Many of these philosophical explanations have been extricated from the clinician’s thought processes but some still linger to this day. The following are common OMT myths that deserve recognition.

Manual therapies and ongoing myths

Myth One: The first myth involves vitalism, which is a mostly rejected tradition in biology that proposes that life is sustained and explained by an unmeasurable and intelligent force or energy. Conceptually, vitalism [1] is poorly understood and likely has limited to no influence on the clinical effectiveness of OMT.

Myth Two: There is an ongoing myth that some OMT techniques heal the body in ways science can’t explain. This has generated treatment approaches that are poorly grounded in science (i.e., craniosacral movements) and are often saturated in strange and unmeasurable concepts. Although science can’t explain every element of a clinical encounter, it is unlikely we need to adopt strange and untestable theories to support our OMT care processes.

Myth Three: An ongoing myth that was enabled by 19^th and early 20^th century manual therapists is that selected OMT techniques can cure and influence cancer, colds, flu, and other community shared illnesses, provide immunity versus virus-borne illnesses (such as COVID-19), correct conditions such as cerebral palsy, asthma, Autism, disorders related to pre-term birth, primary dysmenorrhea, high blood pressure, infantile colic, and irritable bowel syndrome. None of the above are appropriate treatment conditions managed with manual therapies and a recent collaboration among chiropractors has questioned a continued emphasis on this [2]. All are appropriate treatments that might be better managed with conventional medical care.

Myth Four: Routine use of ongoing, periodic OMT adjustments can reduces future illness or prevent injury. A recent review suggests there is no evidence to suggest this is the case [2]. If an OMT practitioner suggests this during the management of a musculoskeletal problem it is unlikely related to an impairment-related issue and sadly, more likely related to wanting to increase revenue.

Myth Five: OMT techniques reposition or adjust joints. Although there are small studies suggesting slight changes in spine joint positioning [3] and the pelvis [4] after sustained manipulation, no studies demonstrate large improvements. No studies tie the amount of movement to a clinical outcome.

Myth Six: Some practitioners of OMT are taught that some techniques are better than others are. In well-designed comparative studies that look at the clinical outcomes between different OMT techniques, the results (outcomes and safety) are quite similar [5,6], although the effects of spine manipulation may be slightly higher [7]. When outcomes are compared in studies where the authors have a stake in the outcome, the results tend to favor the technique that the authors advocate.

Myth Seven: If one trains enough they will reach an existential level of healing. Certainly, experience with a technique and with patient management are going to influence a patient encounter. However, there are no golden manipulations. Experienced clinicians likely have better patient engagement strategies and are able to identify the type of care that the patient truly needs.

Myth Eight: Clinicians spend a great deal of time and money getting educated on treatment techniques that are designed to replicate the way a joint moves. At this point, techniques that mimic joint movements have not demonstrated superiority over other options. This suggests there is not one way to perform an OMT technique and that the way a technique is provided may be different depending on the needs of the patient.

What does this mean?

Do these myths discredit OMT and suggest that no manual therapy procedures should be used in clinical practice? Of course not. These myths suggest that the clinical benefits we see in practice are likely related to something other than what we historically assumed.

Bibliography

1. Simpson JK, Young KJ. Vitalism in contemporary chiropractic: a help or a hinderance? Chiropr Man Therap. 2020 Jun 11;28(1):35. doi: 10.1186/s12998-020-00307-8. PMID: 32527259; PMCID: PMC7291741.
2. Côté P, Hartvigsen J, Axén I, Leboeuf-Yde C, Corso M, Shearer H, Wong J, Marchand AA, Cassidy JD, French S, Kawchuk GN, Mior S, Poulsen E, Srbely J, Ammendolia C, Blanchette MA, Busse JW, Bussières A, Cancelliere C, Christensen HW, De Carvalho D, De Luca K, Du Rose A, Eklund A, Engel R, Goncalves G, Hebert J, Hincapié CA, Hondras M, Kimpton A, Lauridsen HH, Innes S, Meyer AL, Newell D, O’Neill S, Pagé I, Passmore S, Perle SM, Quon J, Rezai M, Stupar M, Swain M, Vitiello A, Weber K, Young KJ, Yu H. The global summit on the efficacy and effectiveness of spinal manipulative therapy for the prevention and treatment of non-musculoskeletal disorders: a systematic review of the literature. Chiropr Man Therap. 2021 Feb 17;29(1):8. doi: 10.1186/s12998-021-00362-9. Erratum in: Chiropr Man Therap. 2021 Mar 8;29(1):11. PMID: 33596925; PMCID: PMC7890602.
3. Cramer GD, Cambron J, Cantu JA, Dexheimer JM, Pocius JD, Gregerson D, Fergus M, McKinnis R, Grieve TJ. Magnetic resonance imaging zygapophyseal joint space changes (gapping) in low back pain patients following spinal manipulation and side-posture positioning: a randomized controlled mechanisms trial with blinding. J Manipulative Physiol Ther. 2013 May;36(4):203-17. doi: 10.1016/j.jmpt.2013.04.003. Epub 2013 May 3. PMID: 23648055; PMCID: PMC3756802.
4. Xu Z, Li Y, Zhang S, et al. A finite element analysis of sacroiliac joint displacements and ligament strains in response to three manipulations. BMC Musculoskelet Disord. 2020;21(1):709.
5. Cook C, Learman K, Showalter C, Kabbaz V, O’Halloran B. Early use of thrust manipulation versus non-thrust manipulation: a randomized clinical trial. Man Ther. 2013 Jun;18(3):191-8. doi: 10.1016/j.math.2012.08.005. Epub 2012 Oct 2. PMID: 23040656.
6. Leaver AM, Maher CG, Herbert RD, Latimer J, McAuley JH, Jull G, Refshauge KM. A randomized controlled trial comparing manipulation with mobilization for recent onset neck pain. Arch Phys Med Rehabil. 2010 Sep;91(9):1313-8. doi: 10.1016/j.apmr.2010.06.006. PMID: 20801246.
7. Coulter ID, Crawford C, Hurwitz EL, Vernon H, Khorsan R, Suttorp Booth M, Herman PM. Manipulation and mobilization for treating chronic low back pain: a systematic review and meta-analysis. Spine J. 2018 May;18(5):866-879. doi: 10.1016/j.spinee.2018.01.013. Epub 2018 Jan 31. PMID: 29371112; PMCID: PMC6020029.