I would like to take a minute to express my agreement with recent letter to editor in JMMT entitled “Manual Therapy: process or product” by Jason Silvernail, DPT, DSC, FAAOMPT (subscription required). I typically like to read these individual memos from top professionals in our field not only because they are short :), but honestly provide a straightforward commentary but respectable disagreement of several topics of interest. As a young clinician myself, it tends to fill the gaps that I may not have “thought” of yet so far in my career; at least not to the extent to put into well constructed paragraphs.
First and foremost, I am a huge advocate of teaching clinical reasoning to my interns rather than just simple, quotable knowledge of memorized facts. This recent written account by Dr. Silvernail comparing the systemic clinical reasoning model likes of Mechanical Diagnosis and Therapy (MDT) system and manual therapy is definitely up my alley. In my amateur perspective, it seems MDT therapist(s) overwhelm manual therapy therapists in simple numbers in physical therapy for the treatment of spinal disorders. As a manual therapist and not MDT therapist (is this proper terminology?); Why is this?. I know MDT has been shown in research to provide positive outcomes but I get positive outcomes everyday through other approaches. It is my opinion that most therapists attend MDT as it provides them not only a positive outcome-based approach to treating spinal disorders, but more importantly, provides a systemic process of examination and treatment. Now remember, I have not had any formal training in MDT so my comments to this approach is layman at best.
What I do know is that my short experience in teaching doctoral interns (students), is that they want a way to examine but most importantly; to treat. Such as “how did you come up with that conclusion to treat the patient this way”. I teach an comprehensive approach of neurodynamics, directional preference movements, manipulation, soft tissue releases, etc. but I find students have a hard time fitting the correct treatment approach to the situation. Maybe they just need more experience?
I find that MDT does a better job at this compared to manual therapy, at least to the extent of an algorithmic, precise process. Clinical prediction rules are a start for us manual therapists, but we need to get better at getting young therapists on board. I agree with Dr. Silvernail that it is a ‘process’, not a ‘product’ that gets us there; but how? I want to be able to better explain my reasoning model to someone who has minimal experience to get them jump-started early.
I will post later this week a sample examination method that I use for spinal patients but would love to have your feedback, even now. This could be a great way to share ideas to help create a structured intervention approach.