Why I Hate Manual Therapy!

Are we able to comment now? I’d just like to say agree agree AGREE! With all of the above. In a lecture the other day (in my new life as a physio student), the professor asked us ‘why do people stretch?’. He said that for the first time ever, he got some answers that included the nervous system, possible psychosomatic reasons, and ideas about changes in perception and sensation, so it would seem that these ‘new’ theories which go beyond the bio-mechanical model are starting to filter down into the population. Or maybe it’s just members of the population who have done a bit of reading because they’re studying the subject…? Anyway, battling the average Joe’s understanding of massage and acupuncture (give me strength), is one of my daily battles, but I REFUSE to resort to wanky answers about blood flow, adhesions and release, because my clients deserve better. The manual therapy industry is terrified to admit the lack of mechanical evidence for what they do in case it somehow harms their business. However, continuing to teach trigger point therapy, soft tissue release, frictions and massage as ways to ‘break up scar tissue’ is negligent and lazy.

Good post. I do enjoy a massage and do feel it is loosening me up, but I am under no illusions that it is breaking up adhesions etc. I am wondering though, if I am under no illusions, does it really matter if my therapist is?
I mean so long as I am not being ripped off by paying extra to have the same massage done with some silly tool, I am not really bothered as long as I ignore any ‘woo woo’ explanations of what it’s doing.

Well Adam, there is more powerful problem which myth -busters must face on it. It’s a huge number of the patients and clients who already believe in the changes of tissue EVEN bones and spine?! such as discus hernia! The worst I’ve heard and know is that there are thousands of so called “exotic” massage practitioners and gurus recommend massage to the patients with a cancer !!! I had a great argue, and I still have and with such idiots (excuse me but I have to call them with a real name by my opinion). when you are asking them for a science proof they become a very aggressive as you mentioned. They KILL people and because these desperate people in their fear and powerlessness, they are ready for any therapy that help them to survive. These criminals rob them consciously and speed up growth of tumors! Here needs to be running – THE LAW! Anyone who uses medically and scientifically unproven therapy should be prosecuted and treated as a premeditated killer! massage is only for those who want to relax, thougheven then should be careful, due to medical reasons. Regards and Congratulations for the article !

Thank you Adam for another very good post and interesting comment about Liz who, as a student, seems to be getting a different message.
Much more emphasis should be on the role of nervous system in changes seen as well as changes in perception. I use manual therapy in very specific cases and I am indeed met with incredulous stares by my patients when answering the question “what are you trying to do?” as I give a very similar answer to the one Adam presented in his post. Much work needs to be done to inform, educate and kill myths that have been present for so long in the public psyche…I do feel like Don Quichotte sometimes.
Keep on writing Adam and thanks for re-opening the comments option.
Pierre Bonnaud

I am a physiotherapist who puts his hands on patients at times but certainly not in all cases – so i maybe the one who gets the abuse in this scenario – here goes anyway, the risk is mine i guess. I am genuinely pleased when there is discussion and i really am in the same position with regards to the claims of individuals who use misleading interpretations of their mechanistic intervention. Positional palpation has no grounding, the notion that we put anything in or out or that we increase tissue length are not ones that i hold at all, mobilising tissue does not change the extensibility, i cannot see anything that would support these suggestions and so I am very much in agreement with the comments and proposals.
As a Physiotherapist who uses hands as part of a multi-modal treatment process (bit wordy but I feel I cannot class myself as solely a manual therapist as this term is not indicative of the scope of my practice – this would be very limiting) – i place far more emphasis on understanding, empathy, education. Simple movements, and shared decisions to (try) to ensure the patient feels they have a sense of control. Solely using hands without doubt (in my mind) really fails in that process. I believe (rightly or wrongly) that the sensation of force and touch interpreted at a number of interactive neurological processes has a part to play in altering the perception and interpretation of pain for a short period of time, force i feel also links to low level mechanoreceptors involved in the perception of position and movement – again only for a short period of time. The context in which it applies will modify these processes and so it is a way to pain modulate (DNIC) perhaps, link to proprioceptors – maybe, to possibly help in certain patients to begin the motor pattern movement alteration and help interpret their emotional perception associated with that pattern to be subsequently challenged, and then enhanced with exercise and movement –re-education. There is also a great sense of empathy associated with touch that I feel again in the right context is relevant – but this is not mechanistic at all in the true sense of the word. It is vital that the patient does understand the relevancy and importance of what they do, how the clinician is really just enhancing their own ability to recover and respond.
Of course, there are ranges of ways to do this and I don’t believe that MT is better than others. It is a method that under a clinical reasoning methodology is chosen selectively, rationally with the patient at the heart of it rather than clinician bias (or though i do recognise we all bias our selection to things we are comfortable with) that can be used with the right patient group.
I now am going to possibly get really shouted at – i also am involved in facilitating courses that involve using your hands as a physiotherapist (I am certainly no guru – and what an awful term that is) – i without doubt agree it is ethically unsound when given this opportunity to be in an educational environment (a privilege)to not give the context and the balance to the argument – i don’t wish to offer anything more than a reasoned physiological (logical) answer with course participants and university students that i work with, and I actively look to dispel common misconceptions that clinicians may use to make themselves sound clever and detached from the patient as if they have “healed” someone – i really feel that this is unprofessional and massively unhelpful and painfully arrogant.
So, although I use techniques that this forum would classify as MT, I do agree with the view of interpreting it and not over playing it – the key to pro-active practice (IMO) is to be reflective and I have made many errors, and will continue to do so, just try to learn from then to improve. I have a belief system that is underpinned by science and experience, this is a plastic process, and I enjoy considering this system and where it is in a learning continuum.
Just my views of course – and of course time and others will continue to modify that – something to look forward to.

A delightfully opinionated and honest blog as ever Adam. Thanks for sharing!
In this case I reckon the term ‘thanks for sharing’ ‘s association to the self-help-group industry is very apt!
‘I have a problem with manual therapy and here’s why’.
It reminds me of Dr Neil O’Connell’s fave line: ‘I’m a recovering manual therapist’
I very rarely hear anyone disagree that words matter and therefore most are starting to understand the need to move away from language that suggests causative structural and mechanical faults. I agree that the move away from language that suggests structural and mechanical mechanisms of treatment is a slower burner…
What we mustn’t demonise though are the words themselves. Terms like ‘release’ and ‘break-down’ can be attached to abstract concepts, emotions and events, not only structures or other more literal constructs.
For example;
I share your hate for ‘release the upper traps’, however if the patient shares that massage ‘releases tension’, the word can be explored. In this case, if you were to rub said sore traps, perhaps this would be a perfect opportunity to discuss the semantics around the word ‘release’ and highlight mechanisms that might truly be caustive? Thus making manual therapy facilitatory to actual change.
I’ve had some great conversations recently (panic not podcast fans, some are recorded) with some brilliant clinical and academic minds regarding the language used in their fields. The terms ‘entrapment neuropathy’ and ‘trapped nerve’ came up in one of these chats and we agreed that even the ‘diagnosis’ in this case can lead therapists and their patients to attribute symptom relief to ‘untrapping’, despite predominantly physiological mechanisms.
Loving your work. But here’s hoping your groupies don’t blame the actual words!
Jack Chew
@Chews_Health

Hello Adam, first time reader, some-time manual therapist. Thank you by the way for having this conversation, I will be taking it to my students and continuing it. I am struggling/not struggling with what you are saying because I feel very much the same way, though not in any way as articulately. I do not hate manual therapy though. I LOVE getting treatment, but because I also treat, I struggle daily with the question – “what is this doing?” and when I’m a patient I really don’t care what you (therapist) think it’s doing – just do it.
As an osteopathic manual therapist suspension of disbelief of magical thinking is really a necessary requirement to complete the education here. To continue to sustain that disbelief one must also be heavily affected by confirmation bias – an affliction too common in this industry.
I teach Research Literacy as well (making my students evaluate a manual therapy claim using research), and I teach con-ed courses and have recently been altering them to address those language elements I am uncomfortable with. It is proving to be a LONG ongoing project but I frequently use “I don’t know the exact mechanism, but …. insert theory based on current biomechanical/physiological/anatomical/research considerations here”. Your suggestion also welcome, because ‘unlearning’ a rote reply is quite difficult.
My other struggle is the use of research or what is often termed “evidence”. I read A LOT of research and most of it, with relation to manual therapies, is significantly methodologically flawed (whole host of reasons) and suffers from design and reporting bias in fairly obvious ways. This, however, makes the results (quantitative) not usable in the ways they are being used. Unfortunately these same results are continually used to make a point about one thing or another related to manual therapy (as a whole) without critique of the source and without specification to the research itself i.e. way too much generalization to the industry as a whole from one or two small, methodologically questionable studies based on throwaway “conclusions” from the authors. I tell my students and basically anyone who will listen that we cannot have it both ways – either the study is good, really good, and the results are usable, or the study is questionable and so are the results. Also, more than one study, please! This does not make the research unusable (evidence is a gathering process, small piece, by small piece), but like the problematic language around the mechanisms of how manual therapy works, the language around research evidence and the ways in which we take just those pieces of the evidence that suit our argument (for and against) is just as problematic. I have two ways of speaking to this – In order to believe the evidence you have to believe the EVIDENCE (critique, critique, critique), and my fave from a recent article – The Pendulum of Science Swings Again.
The language used around MT is problematic with or without research evidence, and an uncritical reliance on the current available evidence (access is a whole other problem) is just as challenging and can equally contribute to maintaining a dogmatic approach on both sides of the fence.
Challenge however is what we need to continue doing. My current solution is one student at a time, but I might just get myself a blog too rather than piggy backing of yours. (Verbose is a term often used to describe me – maybe why I don’t have a blog already)
Please keep writing and challenging.
Monica

Love your post. I am a newly-hired teacher of massage therapy at a private school. A lot of the curriculum has to do with the mesoderm, the muscles, bones, joints, and how we release adhesions and what-not. I’ve been a fan of Diane Jacobs, the ectoderm, Somasimple, Paul Ingraham, etc. to name a few (this is not a argument from authority fallacy – just trying to make a point of how they were a game-changer, a meme-breaker, and so on). I believe you are spot on. I do feel like a split-personality now and then, having to teach some notions that I don’t agree with. We have yet to speak about skin, cutaneous nerves, placebo, non-specific effects… we jump to “releasing muscles” too quickly, forgetting the foremost purpose of social grooming.
I hope my post is not too horrific in syntax. Had a lot of ideas that I wanted to throw out there. Keep up the good work.
ps: I’m getting all too tired of the “but it worked for me post-hoc fallacy” – lot of effort wasted trying to explain this one to students/believers/etc.

I am a Massage Therapist Adam and there have been great changes afoot. Perhaps we are not doing what we thought we were doing, but we do still get results. I have met Physios that speak of adhesions, muscle release, fascia, I have met physios that explain all problems as mechanical, a structuralist view that involves stretching, exercising. I believe both professions are changing radically.
Will physio as it is today, still be around in 10 years? Maybe not, you guys also have to change your view, your understanding, you too are not necessarily taught pain science as we understand it today. I have just been on a course about the nervous system, full of physios. Their understanding seemed no better than mine. In my view Adam, you are not a perfect profession and nor are we.
We know we need to calm the nervous system, what better way that touch, reassurance, education. Room for us all.

Adam, thanks for your raw honesty!
Many in my [chiropractic] profession here in America insist that not only is it important to choose the one, precisely correct spinal segment to “adjust,” but they add magical, mysterious twists and torques to their hand contacts during a light thrust (often entirely absorbed by soft tissues) as they feign higher wisdom for their years of experience with their particular technique. Nauseating.
With much of spinal manual therapy, does it really matter “where” or “to what spinal segment” our pokes and thrusts are directed? We don’t know (though many of us pretend to know.) When confronted with what many perceive to be a lack of segmental mobility (Triano’s “functional spinal lesion”) does it matter whether manual therapy is performed AT ALL? Still hard to say, and neither the Cochrane Database or prevailing meta-analyses are of much help at present.
So what are we doing with manual therapy? Mobilizing intra-articular synovial folds, as Lynton Giles (Australia) suggests? Breaking up long-standing intra-articular adhesions? Or, in the context of myofascial tissues, are we initiating a molecular process when addressing “lumpy bits” or “fibrous adhesions” within fascia over time (purportedly shortening molecular linkages to the 5-dalton range) as Antonio Stecco (Fascial Manipulation, Italy) suggests? Are we simply creating dependence on passively-applied therapies? Is it really all just the laying-on-of-hands?
You rightly point out that in our discourse with patients we must hold allegiance to the nothing but the truth. Eschew wandering explanations. Reject the blather. In light of the work of Lorimer Moseley and both yours and his BJSM podcasts with Dr. Khan this year, my own conversations with patients are tightening up nicely.
Thank you for your bold work, Adam.

Another good one Adam, you seem to be going through your own personal journey with your blog, your comments are softening,but maybe the comments you are getting are more sensible now. I basically agree with all your saying but feel we have such a long way to go with the patients getting on board with all this, as it is, we are not even close with the therapists. I’m a bit torn as I feel instead of balance, we now have the manual therapists versus the “non” manual therapists. The strict manual therapists clinging to crazy alignment, tissue release,fascial release, shifting molecules etc, and the “non” manual therapists who feel like its a badge of honour to say “I don’t touch patients”. After 20 plus years in practice ,try as I may turning the tide is proving very difficult. Even the patients who “get” what I’m saying, don’t get it. After explanations of change in perception, affecting the nervous system (not de tightening muscles etc), I get a look like “so what, just do what you do”, I.e. They don’t care. 2 patients this week highlighted the medically educated and uneducated expectation of treatment. The first a real estate agent, I had not seen them for 8 months, have you been exercising I asked, answer “no”, have you done the exercises I advised last time, answer “no”, the patients response, “I just need that rib popped, I feel 10 years younger when that’s done”. I did my examination of his shoulder ,gave advice, stretched some ribs a bit, but it didn’t “pop”, he left almost crest fallen because the rib hadn’t been popped. I’m not really asking for advice but someone like this is almost unchangeable in their opinion of what is required, yet these are the tough nuts that need to be changed. The second was a highly regarded radiologist in my city who I had not seen for a couple of years and they proceeded to talk in terms of alignment , asking me if they were “out”, going on tell me they got a CT scan of their spine and there was a little bit of arthritis at one level so that’s why they had pain there. Then going on to tell me about their new imaging centre and how good it was as they were doing a lot of facet injections, PRP injections and other interventions that anyone who was up to speed would know are considered a waste of time now. I was a bit gobsmacked. Sorry for the long rant but that is just a small slice of the week that seems to go on and on! These days I generally take a long metaphorical sigh and wonder if there is any light at the end of the tunnel. Cheers.

Thanks for this healthy discussion topic. I don’t want to discuss the need for a deep critical revision in the way manual therapists comment on what they actually do.
I would like to say two things :
1. Radiologists, rheumatologists and GPs may benefit from engaging in the same critical revision. There’s quite a gap between those who conduct and publish RCTs and other research, and those who treat and explain things to patients. My opinion is that the problem you describe in Manual Therapy is not, alas!, limited to Manual Therapy
2. Your point is focused on “what’s happening when a patient is treated through manual therapy”. I would be interested to read your opinion on “what happened when pain/stiffness/distress suddenly occurred”. I’ve got my idea, based on the same danger signals, complex nervous system interactions, etc. but I would sincerely be happy to read yours.

Thank you very much for your blog that I follow with a great attention.
Your post is very true, I work as an osteopath, and I use the neuromatrix model (neuroscience education and motor graded imagery) with my patients. I agree with you about the dogma of the biomechanical model in manual therapy. Unfortunately, most of the patients believe in that model wich is very Cartesian and easy to understand. It’s difficult to find the good pedagogical way to change their beliefs. If you want to shift their paradigm about pain, you need to be smooth, and maybe the way you wrote your last post is a little bit too agressive for manual therapist who received their training course based on the biomechanical model. Belief is hard to change. Regards. Laurent

Hi Adam,
I am relatively new to this game, and though I love doing ‘manual therapy’ I am aware of the limitations of this and always tell patients this is for short term relief and will require some commitment from them to change their posture/ do their exercises etc. I am not familiar with the level of intensity with which you argue your point(s) (surely discussion can be engaging without being vehement?) and tend to agree with a couple of the gentler comments above that touch, reassurance and confidence in the therapist are all effective ways of improving a patient’s perception of their pain or their overall problem.
I tell my patients that massage and acupuncture stimulate an increase in circulation to the area, and that the body, via the blood, then gets going with its nutrient supply / healing mechanisms, with a bit of endorphin release from the brain. That seems to cover all bases, informs the patient and reassures me that I am giving some benefit to them, but now I am not sure if this is ‘right’…?
I’d be very interested to be pointed in the direction of any research that refutes the existence / relevance of trigger point therapy etc because I have used this and experienced this and it has worked well, again within the context of not letting the problem build up again (e.g. postural problems).
Thanks for the post, though it makes me very uncomfortable I guess that’s the point..?! I’ll keep reading, in a take-your-medicine kind of way… 😉

Adam
Out of curiosity, what interventions to you use for the treatment of your patients and do you know the respective evidence for those interventions (i.e. exercise, modalities, etc). Thanks!

Adam,
Nice to see the comments opened up again. I just graduated and over he course of my internships and own critical thinking I have changed my perception on manual therapy. I have worked and interned at about a dozen places at this point and looking back they all did everything differently, mostly everyone got better, and the people that get better the quickest are those that do some sort of HEP and or are in decent shape. I now feel vindicated for getting the SIJ tests, FRSR, upslips/downslips, nutations, trigger points, MET, and alignment wrong when asked by my clinical instructor what was wrong after she “assessed” the patient. I felt like I was a complete idiot for a few months because I thought I just couldn’t get it.
However, I do perform about 8 minutes of manual therapy each session for a few reasons. 1 patients seem to enjoy it and I feel without it I would question their compliance with attending therapy. 2 It appears that I am assessing them and doing a good a thorough examination. 3 Whatever I am doing seems to work at times. 4 I feel it’s somewhat expected by the patient. Without manual therapy I feel the patient would just say I can do these exercises at home and then not do them resulting in a failed intervention.
Thanks again for your blog, of all the PT pod casts and blogs I read this is the one I look to the most.
-Levin

Not really of benefit to the discussion but having spent the last 12 months studying MT & discovering this blog and alternative thinking early on (probably to the detriment of my scores as most of my papers included a massive chunk of uncomfortable reading for the markers) I both love & hate you Adam .. but you get people thinking and debating.
My scores were average but my eyes are open. And I enjoyed using STSSOAUO when discussing ‘trigger points’ …

Hello Adam, given my position (Chair of the SMA and Chair of GCMT) you might be surprised to hear that I agree with the premise of your article–and I suspect many of my colleagues will also agree. It is absolutely right to challenge ‘conventional wisdom’ and to ensure that any claims made are backed by evidence based research. I think most of the people I work with are pretty comfortable with the “I’m not sure why this works” response–although I’m not sure every client would understand the “I’ve just changed your perception of pain” explanation, even if it is backed up by the latest research. I’ve only just picked up on your post so missed the abusive responses–a little disappointing if I’m honest as there is no need for us to be defensive–manual therapy works on some level, why this might be we are not yet entirely sure, but any profession should be constantly challenging the status quo if it is to develop. By the way I don’t hate Physiotherapy (or Osteopathy, or Chiropractic) Physiotherapists were largely responsible for creating and sustaining the SMA and we continue to work with you in multidiscipline teams across a variety of sports and in private practice.
Paul

I’m really enjoying all of your posts that I’ve read so far, clear cut and honest opinions no matter what the subject is.
Throughout the first year of my degree I sat through manual therapy lectures being told it was magical, only to spend the next few years actually researching and learning what the evidence-based reality was. If only you’d written this article a few years back!
You said you do use MT, albeit rarely…are there any specific cases where MT is your go to treatment? If so, why?
Thanks for the great work you’re putting out, this blog is a favourite of mine.
Karl

I have learned more from your blog and twitter debates than in my schooling thus far. It is reassuring that some of my disbelief in what we are taught is justifiable.
Please keep it up!
Adam

Well – here we are again – neither of us have been prosecuted for tearing a client limb from limb so I think we’re still safe in the assumption that fascia is way tougher than massage.
My two penn’th is based on my experience of what massage/manual therapy seems to do when I do it and what it does when done on my (right and wrong).
It mobilised tissue – hey – we’re physically moving it
It puts heat into tissue – can’t move it without
As we’re moving tissue we’re also stimulation passive fluid flows in the body
When done right it promotes relaxation and trust (both in their body and the therapist) – the whole touch/comfort thing – (conversely do it wrong and you get an increase in muscle tension and elevated pain levels)
This “seems to” make active exercise easier for the client in the bast majority of cases.
Clients report a reduction in pain levels after a manual therapy session
It “appears to” boost confidence in the client’s ability to move and exercise – and do do so without excessive pain.
My inference is that when manual therapy is used right it provides the combined benefits of a warm up and stretching session with a bit of feel good factor and confidence, this could be considered a smoke and mirrors thing – warm it up, move it around and hey its warm and been moved “TADA – CHING”, but at times active stretching or exercise causes pain and undesired muscular reactions in a way that MT doesn’t – the knock on appears to the following.
1) They’re better able to start/resume physical activity safely
2) They’re more likely to listen to keep up exercise regime/modified behaviour suggestions you give them
p.s. – yes there’s the occasional something went clunk and the pain went away either during or shortly after a session, but poking people till they go clunk without a very clear set of symptoms is asking for trouble in my view
p.p.s. a lot of these stupid tools strike me as likely to reduce the beneficial effects of touch as well as cutting the amount of heat that is likely to be put into the client, they also make it harder for me to sense whether the punter is responding well to what I’m doing or whether I’m hurting them unnecessarily.

Thank you for posting this information. I have a “severe shoulder tendinitis” with a small tear, diagnosed by an mri, so I don’t need surgery. I am on my fourth month of PT and have had manual therapy that caused me to have severe pain for weeks. I was told that it works for most people. Thinking I was just the odd duck out there all by myself, I waited for my pain to subside. PT went easier on me also. I feel a bit more empowered now thanks to your post. Never having had any problems with my shoulder, how would I know what to expect? I was fearful that not letting the therapist do manual therapy on me would set me up for future problems with my shoulder freezing up or not being able to move correctly. Logical thinking doesn’t always enter into the picture when you are in pain and afraid.

I always find your articles interesting and it makes so much sense but I am a massage therapist (Sports Therapist) and most of the time people feel better after seeing me and this includes physical parameters such as ROM as well as perceptions of pain. I also feel better after manual treatments such as manipulation and massage. I’m not sure why but it does happen and I want to know why!
You must use and get positive effects from manual treatments? If it can’t be done by altering the tissue I guess it must be circulatory or neural effects?

The problem with most Manual Therapy is that it requires a therapist, making it prohibitively expensive and time consuming. Self-care is usually not offered because there is no money in it for the therapist. The best a patient may get is, ‘use a tennis ball..’ or the much improved ‘place two tennis balls in a sock and use it as your trigger point tool’… We are working to change this, and hopefully someday we will be able to afford a prohibitively expensive study to convince you.
Seriously, why not have some quality tools laying around for your clients to use and see if they say it helps them? Certainly you agree that there is a % of patients who appreciate trigger point therapy and perceive a significant benefit.
Being the Sports Physio you are in the unique position educate clients on the larger structural issues they face, and advise against manual therapy if it clearly will be of no benefit. There is tremendous value in teaching patients about their condition and offering the more traditional stretching and strengthening that will help them in the long run.
I think your position was best said with: “what chance does a bit of manual therapy given at best a few times a week have? None I’d say!” — well at least you were honest enough to include your bias and presumption.
Curious if you have seen any studies on multi-year self-directed therapy at the moments immediately following a strain and for weeks there after?
As you know, there are plenty of professional athletes and their trainers who wholeheartedly disagree with you.
Great write up, thanks for allowing this post!

Much of your argument fits with why I got into the Feldenkrais Method. We do “manual therapy”, in that we’re moving the client around with our hands, but we aren’t raking or scraping fascia or knots or anything. (And the party line is that we don’t do therapy, we help people learn, and that can have therapeutic effects!) Most of our manipulation involves moving the bones within the client’s range of comfort and ease, thereby clarifying cortical maps and interrelations. Sometimes we’ll squeeze/support a muscle that they seem to be holding tight to take over its work, but even then, any change is due to the nervous system deciding tension is no longer necessary, or more generally that particular motor organizations can safely be changed (at least for the moment). Ideally the client learns new motor patterns and can move on, but I have heard from some pracittioners that they have people who come by for years upon years….
We also have movement lessons that students can do on their own, although often led in groups by an instructor giving verbal direction. Many practitioners sell recordings too. This is much less expensive for clients/students than 1 on 1 manual sessions, but both have their place. I know I was getting little benefit from group lessons until I got some personal attention for some specific blind spots I had in my own self image.
Have you had an experience with the Feldenkrais Method? If so, how do you think it compares with typical manual therapy?
(By the way, regarding some comments above, Moshe Feldenkrais had similar problems interacting with the medical establishment in his day, and many of his followers still do. 🙂

I’d like to hear you thoughts on Stecco’s concept. Personally I found this as a very interesting http://www.sciencedirect.com/science/article/pii/S1360859213002027
Its my last semester with physio degree. Ive found your blog very interesting and as a newbie my thoughts about manual therapy and physiotherapy has changed because of your texts.And because of that i feel more comfident as I will start my carwer as a physio in a few next months.
So thank you.

You apparently do not understand the physiology of manual therapies. Vardiman’s study was performed on HEALTHY tissue, not pathologic, and he looked at the IMMEDIATE effects of IASTM. The remodeling phase takes days / weeks / months. Regarding the effect of controlled microtrauma: Damage to fasciae always causes an inflammatory reaction that promotes the healing process. The fibrous layers of the fascia can be perfectly restored; indeed, they are formed by collagen type I, the key molecule involved in the process of scar formation. When deep fascia is disrupted, three sequential, yet overlapping, phases of the reparative wound healing process occur: inflammation, proliferation and remodeling. During the inflammation phase, cell debris is phagocytosed and removed from the wound by white blood cells. Blood factors are released into the wound that cause the migration and division of cells during the proliferative phase. The proliferation phase is characterized by angiogenesis, collagen deposition and wound contraction. Fibroblasts grow and form a new, provisional ECM by excreting collagen type III and then type I collagen and fibronectin. In this phase, the collagen forms an irregular connective tissue that has the main function of closing the wound gap. But for the correct healing of the deep fascia to occur, it is fundamental that collagen be remodeled and realigned along the correct lines representing components of local tensile stress. (Stecco)