What Manual Therapy Techniques Do You Use? Poll Results
September 2, 2010 
11 Comments
Looks like the votes are in and I would say that I am a little surprised with the results of my poll on what manual therapy techniques are most commonly used. If you didn’t see my past post and poll on popular manual therapy techniques, you may want to go back as there was many great reader comments.
The two most commonly used techniques were muscle energy (MET) and myofascial release (MFR). Out of curiosity, were you referring to actual MFR techniques as instructed by John Barnes or more that you just picked up the concept along the way and use it? I didn’t expect MFR to be so high on the list.
Considering that many of these techniques can be learned from Leon Chaitow’s excellent books (that come with technique DVDs to learn from) on muscle energy techniques and positional release, it looks like this might be a great starting place for those looking to enhance their manual therapy skills. I couldn’t agree more and recommend these books.
Also of note, 12% of people responded that they performed the Graston Technique. Interesting, but if you combine all the instrumented soft tissue mobilization techniques (Graston, ASTYM, and SASTM), over 20% of people use instruments in some manner. I’m not a big fan of these expensive courses and ultra expensive tools, as an educator myself I just think that this is unnecessary. My thoughts and suggestions would be to either go to the Graston or SASTM course and find some cheaper tools on the internet such as Gua Sha tools or the Starr Tool. Think about it, expensive tools are close to $3000. You can get some good quality tools for under $200 and many from under $10. I am sure I’ll get some heat for these comments, and I am sure that the official tools are much better quality but 600x better ($3000/$5)???
Same thing for Active Release Techniques (ART), which 18% of people said they utilized. Great concept and certainly not rocket science, I bet we are all using these techniques already and not calling them ART (would “fake” ART be called “FART?" Sorry I couldn’t resist…), but shame on you for charging so much for these seminars!
Bottom line for me is simply that if you don’t care about the self promotion of a full certification in these techniques, you can do your clinical practice wonders without going broke by reading Leon Chaitow’s books and taking a Graston or SASTM course to get the concepts and going the cheaper route on instruments, if that’s your thing. Then after some experimentation, you can figure out what technique(s) are working for you and seek out further education or certification.
I’m expecting negative comments here, but just my thoughts. I think that taking these full certification routes is an outstanding opportunity, but for many people it just isn’t an option for various reasons. There are other ways to get great manual therapy skills and like many of you commented on the previous post, the best skill set is likely a combination of many techniques.
Agreed – A coworker and I traveled to Indianapolis to attend an SASTM course. The course for two staff members was $500. Plus some travel expenses and a set of Gua Sha tools, we totaled less than $1000 for two certifications. We utilize the tool on a variety of athletes and sports in our athletic training room.
Chris Ham, MSA,ATC,CES
Vanderbilt University – Baseball
Fascinating results Mike, which I do not find at all surprising.
Your comments about ART are pertinent – it was always 'pin-and-stretch', but has been formalized int ART. No doubt in the process there have been refinements, but the basic idea is simple.
As for Graston – you are absolutely correct to say that it is simply a high tech version of traditional Gua sha, where the instruments used were very simple indeed – costing pennies.
Myofascial release has also moved on – in Spain it's now called Myofascial Induction and based on a great deal of clinical and dissection evidence is used a little differently from the Barnes model. Most of these methods (including Graston, Gua Sha, MFR, MET, Fascial Manipulation, Connective Tissue Manipulation and more) will form part of a book I am coediting with Robert Schleip, Tom Findley and Peter Huijing – "Fascia in Manual Therapy" – due out (Elsevier) in 2011.
Mike you bring up a very good point that could be its own blog which I am sure would provide vigorous debate amongst your readers:
When did continuing education in new techniques become their own certification? All these "certifications" devalue our original credentials (PT, ATC, et cetera). Nowadays if you don't have the alphabet soup after your name you aren't keeping up with the Jones'. CE providers know you have to maintain your original degree/license so they charge very large fees to offer these courses. Then they make their technique a new certification and force you to continue to take courses or they will not allow you to say you are trained in their technique. If I take the course but don't maintain their certification it's not like I forgot what I originally learn and should stop using it.
I have been looking into various manual therapy courses to improve my hands on skill and am getting frustrated that they are so expensive and require certification and continuing education to maintain that certification.
Sincerely,
Frustrated
Mike,
It's true that Graston is expensive (especially once you factor in the tools). Fortunately I work for a large hospital system and they funded the course and the tools for a number of clinics. So, it's just another option for my tool box.
The other thing about Graston is they say you shouldn't perform it without being certified. This I don't buy into, because if it's not in the state practice act, then it isn't so.
Donny
Leon- I love your writing style- so easy to read and digest the various techniques that you present. I love that the MET book is a collection of techniques from a number of different practitioners. I look forward to that new fascial book!!
ART, Graston, and other techniques will hopefully come down in price so that more people have access to techniques that will help their patients. Until then, I guess the ol' forearms, elbows, palms, and fingers will have to do!!!
Really looking forward to the new book Leon!
Hey Mike-
Great post. Soft tissue work is essential. I'm an ART provider and attended a graston workshop. There is a hands on component that is important, and sometimes a book might not be sufficient. However, I think an ART course could definitely be condensed into one workshop. There are 500 protocols, but common, who really uses all of them. Most ART providers have about 10-15 key moves.
I'm not saying that one workshop is all you need, but I do feel ART has turned into a circus. Take a course, learn the touch, and then move on.
At the end of the day, it is not the technique that makes the difference, it's understanding your patients condition and implementing an efficient treatment program that may consist of multiple techniques and backgrounds.
Last comment about ART. The workshops sell out, business is business. ART has a love/hate relationship. Many providers feel this way, but they also get many referrals for being a provider. ART definitely has a tribe following, but isn't this what most business books discuss?
Just curious, if you were the founder of ART, what would you do different?
…
I'm curious why thrust manipulation wasn't included as "manual therapy technique"?
I consider myself a manual therapist (a Paris-ite) and I would have answered your poll in the category for manipulation (I didn't see the poll in time).
Doesn't manual therapy run the gamut from Grade 1 (low velocity, low amplitude) to Grade 5 (high velocity, low amplitude)?
Are therapists using thrust manipulations for lumbar and thoracic/cervical dysfunction with greater frequency?
Increasingly sophisticated articles on Treatment Based Classification…
http://ptjournal.apta.org/cgi/content/abstract/90/9/1239
…imply that ALL neck pain patients would benefit from thoracic manipulation (excluding cases with red/yellow flags).
Tim Richardson, PT
http://www.PhysicalTherapyDiagnosis.com
I agree with Tim's observation. Where's the HVLAT?
Thanks for the links to Starr and Gua Sha tools.
So it seems 2 camps exist when it comes to MFR: the ones that call it quackery based on lack of evidence (RCT evidence I suppose is what they are referring to), and the other camp that employs MFR in techniques like ART, IASTM, etc. and hold that lack of evidence doesn't equate to lack of effectiveness. Am I seeing this correctly?
And maybe a third camp that accepts MFR approach, just not the Barnes approach to it.
Great article, and better posts!
I use a stainless steel tool that a local PT designed and had one of his patients fabricate it for him (looks similar to the STARR tool, but easier to hold). He sells to the tool for less then 100 bucks, I find that it works well for large muscle groups (hams, quads, ITB, traps, low back).
Also, I have attended two of the ART courses and use it everyday in clinic and find that patients respond quite well to it.
I would agree with one of the earlier posts that every ART certified practitioner has their favorite protocols and has some that they used once (at the course), but I found the course very helpful with idenitfying tissues that are dysfunctional and how to specifically treat them.
These courses are expensive, and at times over priced, but what's the big deal with spending 2000 bucks on a course if we are going to use the techniques that we learn?
I took a fair amount of courses in college that cost a lot more money than these CEU's and dont use anything I learned from them.
Cheers,
Chris Jones, DPT
Mulligans??
MWM for shoulder and AC help great (MWM working on the chronic posture based humeral derangement to anterior and protracted position making it worse for supraspinatus together with the other length, strength and impingement problems; restoring timely posterior rotation of clavicle by working at AC during elevation beyond 120 degrees..) …..; Traction techniques, i learnt under the same course, work great for headache, MWM for knees also works and SI also responds…
Further Maitlands helps in deranged shoulders (eg correction of superior glide of humeral head during elevation/ pain relief with the grade 1), stiff post traumatic knees
Trigger point release helps release tension and pain..mainly trapezius and IT band
great to share! More knowledge appreciable
ssaraf84@gmail.com