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A modern way to teach and practice manual therapy

Kerry, Roger; Young, Kenneth J.; Evans, David W.; Lee, Edward; Georgopoulos, Vasileios; Meakins, Adam; McCarthy, Chris; Cook, Chad; Ridehalgh, Colette; Vogel, Steven; Banton, Amanda; Bergström, Cecilia; Mazzieri, Anna Maria; Mourad, Firas; Hutting, Nathan

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Roger Kerry

Kenneth J. Young

David W. Evans

Tutor in English Language

Adam Meakins

Chris McCarthy

Chad Cook

Colette Ridehalgh

Steven Vogel

Amanda Banton

Cecilia Bergström

Anna Maria Mazzieri

Firas Mourad

Nathan Hutting


Background: Musculoskeletal conditions are the leading contributor to global disability and health burden. Manual therapy (MT) interventions are commonly recommended in clinical guidelines and used in the management of musculoskeletal conditions. Traditional systems of manual therapy (TMT), including physiotherapy, osteopathy, chiropractic, and soft tissue therapy have been built on principles such as clinician-centred assessment, patho-anatomical reasoning, and technique specificity. These historical principles are not supported by current evidence. However, data from clinical trials support the clinical and cost effectiveness of manual therapy as an intervention for musculoskeletal conditions, when used as part of a package of care. Purpose: The purpose of this paper is to propose a modern evidence-guided framework for the teaching and practice of MT which avoids reference to and reliance on the outdated principles of TMT. This framework is based on three fundamental humanistic dimensions common in all aspects of healthcare: safety, comfort, and efficiency. These practical elements are contextualised by positive communication, a collaborative context, and person-centred care. The framework facilitates best-practice, reasoning, and communication and is exemplified here with two case studies. Methods: A literature review stimulated by a new method of teaching manual therapy, reflecting contemporary evidence, being trialled at a United Kingdom education institute. A group of experienced, internationally-based academics, clinicians, and researchers from across the spectrum of manual therapy was convened. Perspectives were elicited through reviews of contemporary literature and discussions in an iterative process. Public presentations were made to multidisciplinary groups and feedback was incorporated. Consensus was achieved through repeated discussion of relevant elements. Conclusions: Manual therapy interventions should include both passive and active, person-empowering interventions such as exercise, education, and lifestyle adaptations. These should be delivered in a contextualised healing environment with a well-developed person-practitioner therapeutic alliance. Teaching manual therapy should follow this model.

Journal Article Type Review
Acceptance Date Apr 17, 2024
Online Publication Date May 21, 2024
Publication Date 2024
Deposit Date May 22, 2024
Publicly Available Date May 22, 2024
Journal Chiropractic & Manual Therapies
Print ISSN 2045-709X
Electronic ISSN 2045-709X
Publisher BioMed Central
Peer Reviewed Peer Reviewed
Volume 32
Issue 1
Article Number 17
Keywords Soft-tissue therapy, Physiotherapy, Chiropractic, Person-centred healthcare, Evidence-based healthcare, Manual Therapy, Osteopathy
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