The future of orthopedic manual therapy: what are we missing?

Over the last decade, there has been an increased focus on and expansion in orthopedic manual physical therapy (OMPT) clinical practice and research. Along with this focus have come numerous research studies assessing the effectiveness of OMPT, a dramatic increase in the number of orthopedic residency and manual therapy fellowship programs, and an increased emphasis on OMPT in entry-level Physical Therapy academic programs. These changes would seem to indicate that OMPT is an effective approach to the management of musculoskeletal (MS) dysfunctions. However, it is surprising to know that the evidence on the overall effectiveness of OMPT interventions remains quite controversial. While some recent systematic reviews and clinical trials demonstrate the positive benefit of OMPT in the management of neck pain, low back pain, and cervicogenic headache others indicate small, short-term benefits from OMPT in the management of MS dysfunction leaving clinicians without strong scientific support for the use of OMPT in the management of their patients. The recent studies suggest that manual therapy is not effective in the long-term management of MS dysfunction and pose great challenges to the provision of evidence-based physical therapy. Instead of simply accepting these conclusions, physical therapists (PT) should ask why the research on the effectiveness of OMPT in the long-term management of MS dysfunction remains inconclusive.

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