A dinner party physio question.
Why don’t you use manipulation or IMS in your practice Dave?
I always find this question hard in a casual setting because the answer is complicated.
I need to work on my quick response so I’m going to write that first.
Manipulation can feel great but it really only offers temporary relief. There isn’t anything obviously wrong with temporary relief…I’ve taken Tylenol before, I’ve massaged my neck.. However if we look a little deeper there are problems. Often the structural cause that leads to the treatment is based upon bunk science and often misleads our patients. I also think it can foster dependence on a treatment especially if the special practitioner “fixes” something. We fix a car, we want to build up a humans. It can further lead to problems for people in chronic pain both directly and indirectly through social norms of what good treatment looks like.
Almost every clinic in Vancouver is built upon IMS and manual therapy, I think if they were built upon exercise, support and education we would have a much healthier relationship with pain, rehab, and ourselves! These treatments won’t go away and nor should they completely - a massage is nice - we just need to be better informed.
In the end, I don’t want to fix people, because we can’t, I’d rather someone feel healthier, with less pain because they were supported and coached. If the pain takes a little longer to resolve that’s ok with me:)
The long answer is covered all over the internet if you read the best papers. Here are just a few my favourite papers:
Reformering how we treat MSK pain
The Elephant in the Room: Too Much Medicine in Musculoskeletal Practice
Strength training benefits on msk pain
Greg Lehman, Peter O’Sullivan, Lorimer Mosley, Adam Meakins, Jeremy Lewis have all shaped my practice.
