The Science and Clinical Application of Manual Therapy

King H., Jänig W., Patterson M., (Editors)

Churchill Livingstone

ISBN: 978 0 7020 3387 2

This publication came about following an international research conference in Spring 2008, which focused on viscero-somatic interactions and the autonomic mechanisms of manual therapy. The link: http://www.hsc.unt.edu/orc/svressymp.htm takes you to some of the presentation material delivered that served as the catalyst for writing The Science and Clinical Application of Manual Therapy.

This book is directed at all practitioners using a manual skills basis in their work, and is not aimed exclusively at osteopaths. A brief introduction provides a conceptual history of Osteopathic Medicine (OM) and its connections linking the musculoskeletal system to the viscera, followed by four principal chapters. They essentially present the neuroscience supporting viscero-somatic interactions, a concept many take for granted, but which is not universally accepted or utilized clinically. They also investigate supporting evidence showing how and where OM and other manual therapies can work effectively to treat physical illness. This provides an evidence base for related therapies such as chiropractic, physiotherapy, bodywork and associated branches of physical medicine to develop and widen their scope for practice. The authors express the hope that they will encourage further research having illustrated the possible means of tackling illnesses that are mediated via the autonomic nervous system.

Wilfrid Jänig’s commentary follows King and Patterson’s contribution in the first chapter on Irvin Korr’s facilitated segment concept. The authors provide a thorough critique of Korr's model, which underpins so much of the understanding of why manual therapy may affect the body’s recovery from illness at a multi-dimension level. Robert Foreman (et al.,) carries out a similar discourse on cardiac functioning and how manual therapy can influence it. Interested readers should be aware of a parallel line of enquiry by Thomas Lundberg, consultant in Rehabilitation Medicine at University Clinic, Stockholm (2002), who has researched much of the physiology upon which acupuncture is based.

The text is not written as a series of academic essays. Its content retains an authority borne from clinical experience in addition to being grounded in contemporary physiology and neuroanatomy. This is a welcome departure. Those who actually work in a clinical setting, with hands on experience (pun intended) of the real as opposed to the academicworld, rarely determine healthcare policy. Policy is usually left to committees and research bodies. With this observation in mind Theodore Barber (1976) proposed a financial, political and social explanation as to why clinicians in daily practice don’t write more research papers, than those who are primarily researchers. In the battle of ideas perhaps MacDonald (2005) is correct in challenging the primacy of the committee over the clinician?

The Science and Clinical Application of Manual Therapy does not provide systematic reviews nor data on meta-analyses. It does provide manual therapists and researchers with a source for ideas, backed up by current physiology and neurology. The material and commentary provided in its pages is insightful and lucid. It challenges all manual therapists to apply some of these theories in practice. This exceptional textbook may stand alongside a number of other ground breaking works of similar importance–Gatterman’s Foundations of Chiropractic:Subluxation, Homewood’s The Neurodynamics of the Vertebral Subluxation or Pottenger’s Symptoms of Visceral Disease.

This is an important textbook being published at a time when manual therapies are being subjected to a number of potentially challenging issues. These include the influence of financial and political forces acting on healthcare policy within the United Kingdom (Kennedy & Llewelyn, 2001). There is the continuing reliance on pharmaceuticals as the basis of both acute and–even more significantly–chronic illness management. Osteopaths are in addition, being required to identify the legitimate Scope for Practice. This is in part a political attempt to restrict practice to only those specialties that accept orthodox definitions of scientific rigor and have an evidential basis–or potentially face censure (Holmes et al., 2006).

This overriding policy would be a reasonable imposition if funding was to make available by government or other agencies to establish exactly where the boundaries lie. Without funding in legitimate research, this policy can only harm those who cannot depend on the massive funding competing colleagues, associated with pharmaceutical corporations, are provided. There is also the question of applicability–there are a growing number of voices, questioning the suitability of standard medical research methods–such as the randomized controlled trials–to gauge the effectiveness of manual therapies (Ioannidis 2005, Tinetti 2004 & Charlton 1998). The result may be a healthcare policy not based on evidence and clinical benefit expediency, but on financial investment. This would not reflect the genuine intention behind contemporary scientific method in its attempt to determine national healthcare policy.

These compelling initiatives are driven by the necessity of providing an evidential basis to all forms of medical practice, and as such The Science and Clinical Application of Manual Therapyanswers that demand. It provides a huge diversity of potential research material outside the conventional setting that manual therapy is normally found. It offers insight into cardiovascular, gastro-intestinal, immunological and psychosomatic illness and their potential treatment strategies. It would seem to offer a way of providing clinical solutions to many illness that are exclusively treated using only pharmacological agents, and without their attendant costs and side-effects.

The text is peppered with insights that may provide a lifetime of creative practice for students, therapists and researchers alike. All that the practitioner needs to bring to the table is a disposition toward clinical opportunism, and the skills around which manual therapies need to thrive. If you only purchase one textbook this year, it would probably have to be this one.

References

Barber, T.Pitfalls in Human Research: Ten Pivotal Points (1976) New York:Pergamon Press

Charlton, B. G., & Miles, A.(1998). The rise and fall of EBM. QJM : Monthly Journal of the Association of Physicians, 91(5), 371-4.

Holmes, D., Murray, S. J., Perron, A., & Rail, G.(2006). Deconstructing the evidence-based discourse in health sciences: Truth, power and fascism. International Journal of Evidence-Based Healthcare, 4(3),

Ioannidis, J. P. A. (2005). Why most published research findings are false. Plos Med, 2(8), e124.

Kennedy, P., Llewelyn, S.(2001). Does the future belong to the scientist practitioner? The Psychologist, Vol. 14 No. 2.

Lundberg, T. Acupuncture in Medicine 2007;25(3):100-106

MacDonald R., The Battle for Ideas paper can be downloaded from: http://www.brighton.ac.uk/ncor/summaries/Discussion%20article% 20%20The%20Battle%20for%20 Ideas.pdf

Tinetti M., Bogardus S., Agostini J. (2004)Potential pitfalls of disease-specific guidelines for patients with   multiple conditions. N Engl J Med 2004;351:2870-4.