Manual Therapy?

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How is manual therapy manipulation different then chiropractic manipulation? And let's actually give answers that are education based. Nothing ignorant or sarcastic about the DC profession. I'm genuinely wondering and trying to learn. Thanks in advance!

From what I've seen, the techniques are very similar (cervical and thoracic pretty much identical with some increased variability in lumbar manipulations). The differences I explain to my patients are the ideas may be different on why we/they perform the intervention. If they don't ask anything else I don't say anything else. If they do, i usually say i'm using this technique because the research literature supports it for his/her condition and can't speak to why DCs use manipulation because i have not gone through their education.

short answer is there isn't much difference just how you present it.

I'm just a student myself, but from what I gather, the difference is in the levels of manual therapy. My PT had told me that PT's practice levels 1-4 modulations, whereas a DC has the option of a level 5 - requiring quick thrusts/rotations, etc. for adjustments. Maybe someone can clarify.

I think it's important to look at a few terms. "Manual therapy" is an umbrella term which can mean anything done manually; very broad. "Manipulation" can also be interpreted a couple of different ways and sort of envelops "mobilization" as well. However, when reading the literature, "manipulation" usually refers to HVLA. In that regard, HVLA is HVLA whether it's a DC, a PT or a DO performing it. There are of course many different techniques and maneuvers within the HVLA category, but they all share the commonality of using a high velocity, low amplitude thrust from which there is often a "pop" or "crack" sound produced. The thrust takes the joint beyond the active and passive ROMs into the 'paraphysiologic zone' as it's been described but never beyond the 'limits of anatomical integrity' (i.e., you aren't damaging anything). So again, it doesn't matter who is performing the thrust, it's still manipulation (or more specifically, HVLA manipulation).

With chiros, there has historically been less standardization when it comes to treatment than is seen in the PT world. This is both a blessing and a curse. The blessing is that a DC conceivably has more options/techniques at his/her disposal; whether they have all been researched per se is a different matter. The other positive aspect to the heterogenicity of chiropractic is that if one chiro doesn't help you, you could really go down the street to another chiro and have a completely different experience (this is sort of true for PT but perhaps less so). The curse is that, these days, there is more emphasis on standardization and proving efficacy, therefore having each individual chiro doing different things for the same patient can be seen in a negative light. If the prediction rules end up working out, I think we'll see movement in that direction from the chiro profession.

facetguy nails it.

I used to be a practicing DC (still have the license) and I am glad to see PT's incorporating more "manual therapy" into their practice including manipulation. The stuff works regardless of who is performing it and our society needs MORE, not less non-Rx interventions for back, neck, extremity pain.

One question though...

What do PT's call the spinal segment of aberrent motion that requires manipulation?

Originally Posted by HVLA

facetguy nails it.

I used to be a practicing DC (still have the license) and I am glad to see PT's incorporating more "manual therapy" into their practice including manipulation. The stuff works regardless of who is performing it and our society needs MORE, not less non-Rx interventions for back, neck, extremity pain.

One question though...

What do PT's call the spinal segment of aberrent motion that requires manipulation?

Are you asking if we call it a subluxation? If that's your question, the answer is no.

But generally I think you'll hear different PTs call it different things based on their training and bias. Given the evidence that indicates we can't reliably palpate spinal motion, and that manipulaiton isn't segmentally specific, I don't tend to bother labeling specific motion segments at all.

Originally Posted by jesspt

Are you asking if we call it a subluxation? If that's your question, the answer is no.

But generally I think you'll hear different PTs call it different things based on their training and bias. Given the evidence that indicates we can't reliably palpate spinal motion, and that manipulaiton isn't segmentally specific, I don't tend to bother labeling specific motion segments at all.

Like what?

and if you can't palpate aberrant motion how do you know when to manipulate, how do you choose angle of thrust/vector of thrust?

Originally Posted by HVLA

Like what?

and if you can't palpate aberrant motion how do you know when to manipulate, how do you choose angle of thrust/vector of thrust?

Well, I suppose some PTs might use the term subluxation, but given its association with the chiropractic profession and the occasional animosity between the two, I don't think there will be many PTs who use this term. Many would probably just call it a segmental hypomobility and indicate at what spinal level they believe it is occuring at. Also, I know there are quite a few PTs who use osteopathic terms to define segmental involvement, so you could likely see PTs using FRS, ERS,etc

And if you think you can palpate aberrant motion reliably, you're kidding yourself. The intra-rater reliability is not good, the inter-rateer relaibility is worse, so if you were to use plpatory diagnosis to determine your vector of thrust, you'd often be choosing the wrong vector. You seem like you keep up with the literature - you have to know that the data we have doesn't support your position here.

Generally, I use the patient's subjective history, and exam findings other than palpation of aberrant motion, in order to determine when/who to use thrust on, but typically, I use it on patients with acute, axial spinal pain that don't have contraindications to thrust, and I choose the technique based on what I'm most comfortable with given the body region I'm treating and the patient's size.

Most DCs I know dont even use the term "subluxation" anymore.

They use "segmental dysfunction" or "hypomobility" or "spinal lesion" but semantics aside they are all the same thing.... a joint that is not moving properly. Animosity or not I am glad to see PTs using manipulation. I was surprised to see that the APTA's official stance towards chiropractic is actually in favor of more cooperation between the two professions, especially in regards to the study of spinal manipulation. I hope the chiros reciprocate, it would be in theirs and ultimately the patients best interest to do so.

Thanks for the info btw....

I would say there is no difference in either of them. The only difference is in the coding. The physicians osteopathic manipulation is coded as 98925 for 1 body part and 98926 for 2 body parts respectively. Where as the physical therapist manual therapy is coded under 97140. The normal PT manual therapy joint mobilization however not limited to that, it does further include Myofascial Release, Soft tissue massage, stretching etc. I have also noted that both the physician and the physical therapist are not allowed to perform both the techniques on the patient on the same day for the same body part.
Hope it helped.

if you don't mind me asking what is the general consensus in PT school about chiropractors? Negatives, positives, possible future collaboration?

Generally negative from my experience.