Manual Therapy (2000) 5(2), 6162

# 2000 Harcourt Publishers Ltd

doi:10.1054/math.2000.0236, available online at http://www.idealibrary.com on

Editorial

Manual therapy and science: a marriage of convenience?

By now the memory of vintage champagne imbibed

around the 2000th New Year will have faded along
with most of the resolutions pledged during that
period. But what of the New Year resolutions for the
journal Manual Therapy? With its expanding international subscriber base and meteoric rise in recognition as a credible science publication, indexed widely,
what are the responsibilities of this Journal and its
mentors for the next few years? As tempting as it
might be to coast on these recent achievements, it
would be valuable to `raise the bar' in promoting the
developing science of manual therapy. There are
three dimensions to this challenge, ranging from the
philosophical to the practical and the political.
The now worn phrase `Evidence based Medicine'
(EBM) imposes a stringent demand on all professionals to align their practice according to best
available evidence. This is a serious challenge to all
to reconcile market place demands with the delivery
of treatment that confers clinical ecacy. The
rhetoric of evidence is seductive whereas a real
commitment to changing practice requires a change
in philosophy. Recognition of the fact that change

can be resisted by clinicians is amply demonstrated by

Volinn (1966) who challenges the readership of
professional journals to use new information and
not abandon this to library shelves.
Educators too must discern between a traditional
syllabus in favour of emphasising evidence. This
process does not insist on the rejection of all
traditions for, as Sackett indicates, knowledge will
never replace individual clinical experience (Sackett
1998). However, it still requires that we seek the best
source of evidence to complement clinical empiricism.
The continued rapid expansion of the Cochrane and
PEDRO evidence databases serves to remind us of
the dramatic rate of change in knowledge. One risk
here is to downgrade the real research priorities
in manual therapy for yet another meta-analysis. In
some areas of back pain research the latter are
beginning to outnumber original studies.
Embracing the research process is the most
fundamental way forward for manual therapy, but
only if this tool is used skillfully and dispassionately.
Good evidence will be rated as such, poor evidence
discarded, thus the research sponsor must identify a
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sound pre-investment in terms of research design,

execution plan and objectivity. With diminishing
research funding, such eorts should be concentrated
on investigations which bridge clinical science and
verication of intervention ecacy.
Manual skills are the hallmark of the therapy
clinician; combining the intellectual process of
clinical reasoning and mechanical dexterity. However, such practical ability must be developed alongside guidelines on the appropriateness of application
and the requirements for safe practice. In parallel
must be a recognition of the value of in-depth
fundamental science and of the psychological domain
of neuromuscular and musculoskeletal pain disorders
(Main & Watson 1999). Indeed, new neuroanatomical information dening the intricacies of spinal
innervation, and of complex pain referral patterns
(Groen & Stolker 2000), may invite a re-think of
traditional clinical belief systems.
The political dimension of manual therapy will
require a preparedness to advocate our proven
outcomes in relevant multidisciplinary forums. Why
should this be necessary? At a recent conference,
`contemporary physiotherapy' was identied as contributing negatively to the management of chronic
back pain subjects recruited into a longitudinal
outcomes trial (Mannion et al. 1999). The nature of
this presentation to an international audience of
senior spine researchers and clinicians has obvious
implications. The challenge will be for manual
therapists to broaden the scope of their presentations
away from partisan groups if their research is to
impact meaningfully on our medical and science
colleagues, and in turn on health policy advisors.
In a global world, there needs to be a serious resolve
to mediate dierences, join forces and funds to
improve knowledge and practice. In order for manual
therapy practice to advance, opportunities for decision
makers, clinicians and educators to agree on the
directions to take in the future, to secure the necessary
resources to examine major research issues and to
execute these in a transparent manner will be
imperative. To these ends, we must also be prepared
to collaborate outside of our professional disciplines to
invite constructive scrutiny and challenge. Within such
discussions a commitment to use a clear classication

Manual Therapy (2000) 5(2), 6162

system for neuromuscular and musculoskeletal disorders, without sectarian jargon, will be crucial.
The up-coming IFOMT conference (IFOMT 2000)
is one such opportunity for interactions on all
levels, including clinical and scientic exchange. The
convenors of this and similar meetings have the
responsibility to ensure that delegates are confronted
as well as comforted with new knowledge. Greater
eorts must be made to enhance relationships
between educators and clinicians, and colleagues
from other disciplines, to ensure that our science is
founded on the best available knowledge and
intellectual rigor.
There must be more than a marriage of convenience between manual therapy and science if our
profession is to gain enhanced credibility in the years
ahead.
Raise the bar!
Acknowledgements
I express my gratitude to colleagues: Max Zusman,
Stephen Edmondston and Garry Allison for their
critical and collegial argument. Illustration by Leonardo da Vinci (14521519).
Kevin P. Singer
Editorial Board Manual Therapy
References
Groen GJ, Stolker R-J 2000 Thoracic neural anatomy. In: Giles L,
Singer KP (Eds) Clinical anatomy and management of thoracic
spine pain. Butterworth-Heinemann, Oxford, 114142
Main CJ, Watson PJ 1999 Psychological aspects of pain. Manual
Therapy 4: 203215
Mannion AF, Muntener M, Taimela S, Dvorak J 1999 A
randomized clinical trial of three active therapies for chronic
low back pain. Spine 24: 24352448
Sackett D 1998 Evidence-based medicine. Spine 23: 10851086
Volinn E 1996 Between the idea and the reality: Research on bed
rest for uncomplicated acute low back pain and implications for
clinical practice patterns. Clinical Journal of Pain 12: 166170

Web links
IFOMT 2000: http://www.ifomt.uwa.edu.au
PEDRO database: http://ptwww.cchs.usyd.edu.au/pedro/
Cochrane database: http://www-epid.unimaas.nl/cochrane/
eld.htm

# 2000 Harcourt Publishers Ltd