Blogs, Buses, and Back Rubs!

My blogs are a lot like buses, you wait for ages then two appear together. I was not planning to write another blog so soon after my last one, but, I was made aware of a recently published editorial and response letter discussing a ‘puerile anti manual therapy trend’ and ‘self-perceived social media experts’ that I have been referenced in. So I thought a reply was warranted.

Another reason my blogs are a bit like buses is just like buses have passengers who want to go somewhere, it’s the driver who decides what route, how fast, and what potholes it goes over. So as ‘passengers’ of my blog, I would suggest holding on tightly because this bus is going down some rough roads. If you think this is not the right bus for you then I would suggest getting off now.

Been Here Before

The first thing to say is that I have been here many, many, many times before responding to these kinds of pathetic whiney publications from the higher ranks of the manual therapy community, moaning about those who question and challenge its use and usefulness.

I was in two minds whether to give these silly articles any time at all as I really don’t think they are worth it. They are published in a low-value journal, written very poorly, and don’t construct much of an argument at all. I also don’t know the authors and so don’t really care what they think of me or my blogs.

However, as I have been referenced I thought a response from me may get the discussions around the efficacy and effectiveness of manual therapy going again, and it gives me another opportunity to have another rant about the egos and elitism of the manual therapy gurus which is something I love to do.

Insecurity and Desperation

So my first thought after reading these ‘glorified blogs’ is that they scream of insecurity and desperation from those whose identities and careers are deeply embedded within their manual therapy interventions. If these authors are that concerned to reference a blog I wrote a few years ago as a significant threat to manual therapy they must be standing on some very thin ice, or I am massively underestimating the influence of my blogs.

These editorials are nothing more than weak appeals to antiquity and authority wrapped up in a very thin disguise of professional concern. They are basically saying that manual therapy has been around for a long time so therefore it must be good, and as a profession, we have always used it so therefore we should continue to do so.

It’s honestly some of the worst justification for manual therapy I have ever read. They even try to use the current chronic pain epidemic and opioid crisis as grounds for the continued use of manual therapy. What they don’t provide, however, are any plausible arguments or evidence that manual therapy can do anything about these issues.

Conflicts of Interest

When I see these kinds of editorial, papers, and reactions it often leads me to suspect that there may be some personal bias and conflicts of interests camouflaged as ‘professional concern’. So I did some background investigation into the authors, who I will state again I have had no interaction with at all, and do not know in any way. I found that the lead author and a co-author are both faculty members of well known manual therapy institutions and they both teach post-graduate manual therapy continuing education courses, therefore earn incomes from manual therapy.

Now there is absolutely nothing wrong with this, but it is a clear conflict of interest and so should be clearly disclosed to the readers of this article, which it is not. In fact, the authors declare no conflict of interest (see image below) which is another reason why I think this journal and editorial board are poor, it literally took me 2 minutes to find this out.

Anyway, the authors of this piece continue to moan away in that usual passive-aggressive academical way, about how the profession is in danger of losing its identity if it abandons manual therapy blah blah blah. They also appear to blame ‘charismatic presenters’ and accuse those who are ‘anti manual therapy’ of being ill-informed and biased. Which I find hugely hypocritical especially in light of them not declaring their own biases.

Exercise Not Manual Therapy

Also, despite what they claim in this editorial the modern physiotherapy profession was NOT born from manual therapy but from EXERCISE. One of the earliest documented origins of physiotherapy as a profession dates back to Per Henrik Ling from Sweden who founded the Royal Central Institute of Gymnastics in 1813 (ref). The UK physiotherapy profession evolved after the first world war to help aid wounded soldiers back to function, and originally we’re called remedial gymnasts (ref). Yes, they used massage and other things, but their foundation was always exercise.

But putting that aside the physiotherapy profession is simply NOT defined by ANY intervention, be that manual therapy or exercise. Just as medicine is NOT defined by any one drug or surgery by any one procedure. One of the biggest reasons I challenge and critique manual therapy so much is NOT because I don’t think it can’t help people. It can, for some, for a bit, for a short while. It’s just not that special, skilled or specific that many like to think or claim.

I criticise manual therapy because I just don’t think it deserves the time, energy, effort, respect, or reverence it gets from therapists or patients. Manual therapy is a pretty low-value treatment that doesn’t need years of dedicated study or practice, or thousands of pounds, dollars, yen, or shekels spent on it to perfect. Personally, I think manual therapy sucks because of its arrogant, aloof, egotistical and elitist attitude that many of its gurus, tutors, and associations have.

Sick and Tired

I am sick and tired of soft-skinned megalomanic manual therapists thinking they have some sort of intellectual superiority or moral high ground over other therapists just because they crack a few necks and give out back rubs.

I am sick and tired of hearing many dedicated young physios telling me they feel demoralised and discouraged because they are made to feel foolish and inferior by these self-obsessed narcissistic wassocks who think they can feel sacrums move or a multifidus fire late.

I am sick and tired of the manual therapy fraternities who are more interested in monthly subscriptions than patient benefits, whose members look down and belittle others because they haven’t passed their group’s pseudo-scientific entrance exams and hazing rituals.

I am sick and tired of all the bluff, bluster, and bull shit that constantly oozes from the manual therapy community, such as muscle knots, fascial adhesions, overactive psoas, underactive glutes, wonky thoracic rings, or twisted pelvic joints.

Manual Therapy Sucks

I will say again that Manual Therapy Sucks NOT because it doesn’t or can’t help some in pain or with a disabilit. Manual therapy SUCKS because of all the above. If manual therapy could rid itself of all the over-complicated pseudo-scientific egotistical narcissistic bollocks and pathetic whiney editorials that infests and surrounds it then I think it could be more effective for more than it currently is.

I will however still continue to argue that manual therapy as a treatment does not belong in an evidence-based healthcare profession being administered by highly trained degree qualified clinicians due to the time-cost/reward ratio. Instead, manual therapy should be given as a service by less qualified non-diagnostic therapists at lower costs and greater reward ratio for patients.

And Finally…

ALL these points I make do NOT apply to ALL manual therapists, just a good few of those in so-called positions of authority. I know many excellent manual therapists who use their hands-on techniques simply, rationally, and within a patient-centred well-rounded treatment program. I know many excellent manual therapists who also join me in my rants and share my frustrations against the bullshit and bollocks in their midst. For them, I am forever grateful.

I will end by saying that these pathetic pieces of writing are only more fuel to my fire that proves the manual therapy dinosaurs are becoming more and more threatened that their days of rule, reign, and regulation are coming to an end. And in my opinion the sooner the better. Viva la revolution.

Until next time!





  1. I think it is so interesting that now we are using virtual consultations, some colleagues feel totally distraught and others feel this is a great opportunity to improve communication skills and exercise prescription , particularly in private practice when the pressure to use manual therapy from patients is so strong .
    Perhaps it is a great learning curve for all of us ?

  2. Great article Adam. Could you speak to what potential benefits you do see from manual therapy? I’ve often heard practitioners mention that all manual therapy does is give the patient a ‘window of opportunity’ where prescribed exercises have a better chance of ‘sticking’. Is that a mechanism you’ve observed and agree with? Thanks

  3. Always interesting & tactful, Adam!
    You would make a bad politician, but a strong advocate.
    Gurus are in it for the short term success. I used to have an ego longer than my name, but humbled by learning not everyone can be “fixed.”
    The problem of ego in the medical professions is that when success does not occur, the ‘patient’ is blamed and shamed into thinking that THEY are the problem. (Nocebo)
    I probably average about 2% of my clinical time using manual therapy, immediately followed by a self stretch they can continue on their own. Teaching self management with exercise has a longer life impact than a fix.

  4. I get the impression this blog was a pressure valve for you. I can’t completely agree on the lack of usefulness of manual therapy but do agree the ‘fly’s knees bending, grade one mobilisations’ dressed up with any amount of pseudoscience is not good for the profession. Just get them fitter, stronger and more resilient…that we are agreed on. I hope yoiu’re feeling better now ! BW. G.

  5. Hi Adam. I fully support your views on manual therapy and have done for many years! I too am sick of the nonsense that pervades the industry. Terms such as trigger points, muscle knots, muscle imbalances, adhesions, shifted ribs, rotated pelvises, weak core, leg length discrepancy etc. These labels create fear and fear drives pain and disability.

    Sadly, there are many gullible members of the public who believe this nonsense, which is being pedalled by therapists to lock people into continual care.
    Hence, we have an industry that is feeding off people’s ignorance in terms of understanding pain and what causes pain.

    This situation will not change until people understand pain.

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