The graphic you see at the start of this post is from the movie Patch Adams, where a man committed to a psychiatric institution becomes a medical doctor attempting to restore greater humanity to the profession. The scene depicted here is Patch in the psych ward explaining to his attending (but not attentive) physician that he has had a breakthrough in his treatment, after Patch helps one of his inmates to overcome a fear of squirrels. As a result, Patch wants to continue to listen and help people with their problems. When he relays this news, the doctor dismissively says “That’s what I do,” to which Patch responds, “But you suck at it!”
In this post I want to apply the idea of “Raise Your Game” to the use of spinal manipulation by physical therapists. Unfortunately, our profession’s use of this valuable tool can best be summed up by Patch. As a result, many patients with painful neuromusculoskeletal conditions do not usually think first of seeking out a physical therapist. They generally think of calling a chiropractor or a primary-care physician. Direct-access laws can help to change this trend, but only if physical therapists have quick, powerful methods that are used appropriately. Sadly, I believe the PT profession is unaware of its shortcomings in this regard.
As an example, when I first began teaching spinal manipulation courses, I spoke to a fellowship-trained PT who asked me why people should come to my course. Her contention was that PTs already knew how to perform it and it wasn’t worth the additional training. At that time, I hadn’t considered that other PTs might share this opinion. But it occurred to me that many in our profession believe one or both of the following statements.
1) Thrust joint manipulation offers no additional benefits over non-thrust techniques.
2) The audible pop of manipulation does not matter.
A good portion of my first spinal manipulation course, TJM Part 1, tackles these two unproven tenets of our profession head-on. I demonstrate what the peer-reviewed research literature says and does not say, while offering a set of guidelines to optimize manipulative skills for aspiring clinicians. But above all else, I teach in meticulous detail how to actually elicit multiple, audible cavitations in patients. I have seen how IMMT can help both novice and experienced manual therapists to not “suck” anymore.
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