Physio Edge podcast

Manual therapy (MT) comes in all shapes and sizes - mobilisation, manipulation, mobilisation with movement, soft tissue massage, instrument assisted massage, muscle energy techniques, pointy elbows pressed into flesh and more. Patients (often) love it, and it's a popular treatment modality with therapists. Debate rages, and myths and misconceptions surround MT. Could the time we spend performing MT be better spent elsewhere? How does MT work? Is it worth using if treatment effects are short lived? Is it just used as revenue raising by therapists, while creating reliance on passive therapies?

Is MT evidence-based? Is it worth including in our treatment? Which patients may benefit from MT, and which patients you should steer away from MT?

In this podcast, clinical researcher, physical therapist and Professor at Duke University, Dr Chad Cook, we discuss the evidence around MT, myths and misconceptions, how MT works, and using your clinical reasoning to decide when and how to utilise MT.

You'll discover:

  • What are the arguments against manual therapy?
  • Do the arguments against MT have merit?
  • Does MT break up scar tissue or adhesions, correct alignment of joints, or put them back into place?
  • Do we have evidence that MT creates reliance on passive therapies?
  • Evidence for and against MT
  • How to use clinical reasoning with MT
  • How MT works - potential mechanisms
  • What MT is NOT doing
  • How to explain MT to your patients
  • Clinical reasoning
  • Identifying pain adaptive and non pain adaptive patients
  • How MT can help identify patients with a better or worse prognosis
  • How many sessions of MT should patients receive?
  • How to select MT techniques
  • Does MT cause harm and patient reliance?
  • How to identify patient treatment expectations
  • How to help change patient expectations

Articles associated with this episode:

Bialosky et al. 2009. The Mechanisms of Manual Therapy in the Treatment of Musculoskeletal Pain: A Comprehensive Model.

Bialosky JE, Bishop MD, Penza CW. Placebo mechanisms of manual therapy: a sheep in wolf's clothing?. journal of orthopaedic & sports physical therapy. 2017 May;47(5):301-4.

Cook et al. 2014. Is there preliminary value to a within- and/or between-session change for determining short-term outcomes of manual therapy on mechanical neck pain?

Cook et al. 2013. Early use of thrust manipulation versus non-thrust manipulation: a randomized clinical trial.

Cook et al. 2012. Can a within/between-session change in pain during reassessment predict outcome using a manual therapy intervention in patients with mechanical low back pain?

Cook. 2011. Immediate effects from manual therapy: much ado about nothing?

Deyle et al. 2005. Physical therapy treatment effectiveness for osteoarthritis of the knee: a randomized comparison of supervised clinical exercise and manual therapy procedures versus a home exercise program.

Goss et al. 2004. A Cochrane review of manipulation and mobilization for mechanical neck disorders.

Learmann et al. 2014. No Differences in Outcomes in People with Low Back Pain Who Met the Clinical Prediction Rule for Lumbar Spine Manipulation When a Pragmatic Non-thrust Manipulation Was Used as the Comparator.

Rubinstein et al. 2011. Spinal manipulation therapy for chronic low back pain.

Schneider et al. 2014. Derivation of a clinical decision guide in the diagnosis of cervical facet joint pain.

Traeger et al. 2018. Effect of Intensive Patient Education vs Placebo Patient Education on Outcomes in Patients With Acute Low Back Pain.

When your patient has heel pain with their first few steps in the morning, after sitting for a while or at the start of a run, a diagnosis of plantar heel pain (PHP) or plantar fasciopathy might jump straight to the top of your list. How will you treat your patients with PHP? How long will it take? How can you explain PHP, the rehab and recovery to your patients?

In this podcast with Henrik Riel (Physiotherapist, researcher and PhD candidate at Aalborg University) we take a deep dive into PHP, and how you can treat it, including:

  • How to describe plantar heel pain to your patients
  • How to explain to your patient why they developed PHP, recovery timeframes and rehab
  • Plantar fasciitis, plantar fasciopathy, plantar heel pain? What's the most appropriate terminology?
  • Differential diagnosis for PHP including
    • Neuropathic pain
    • Fat pad irritation, contusion or atrophy
    • Calcaneal stress fracture
    • Other diagnoses
  • How to systematically perform an objective assessment and diagnose PHP
  • Assessment tests to identify factors contributing to your patients pain
  • Whether your patients require imaging
  • How long PHP takes to recover
  • What factors affect your patients prognosis and recovery times
  • How to differentiate your treatment for active or sedentary patients
  • Whether your patients can continue to run with PHP
  • Factors that may hinder the recovery of your sedentary patients, and how to address these
  • Whether your patients should include stretching in their rehab
  • Types of strengthening to include in your rehab - isometric, isotonic or otherwise
  • How many sets and reps should your patients perform of their strengthening exercises
  • Whether orthotics are useful
  • Corticosteroid injections - do they help or increase the risk of plantar fascia rupture?

Articles associated with this episode:

Alshami et al. 2008. A review of plantar heel pain of neural origin: differential diagnosis and management.

Chimutengwende-Gordon et al. 2010. Magnetic resonance imaging in plantar heel pain.

Dakin et al. 2018. Chronic inflammation is a feature of Achilles tendinopathy and rupture.

David et al. 2017. Injected corticosteroids for treating plantar heel pain in adults.

Digiovanni et al. 2006. Plantar fascia-specific stretching exercise improves outcomes in patients with chronic plantar fasciitis. A prospective clinical trial with two-year follow-up.

Hansen et al. 2018. Long-Term Prognosis of Plantar Fasciitis: A 5- to 15-Year Follow-up Study of 174 Patients With Ultrasound Examination.

Lemont et al. 2003. Plantar fasciitis: a degenerative process (fasciosis) without inflammation.

Rathleff et al. 2015. High-load strength training improves outcome in patients with plantar fasciitis: A randomized controlled trial with 12-month follow-up.

Riel et al. 2017. Is ‘plantar heel pain’ a more appropriate term than ‘plantar fasciitis’? Time to move on.

Riel et al. 2018. The effect of isometric exercise on pain in individuals with plantar fasciopathy: A randomized crossover trial.

Riel et al. 2019. Self-dosed and pre-determined progressive heavy-slow resistance training have similar effects in people with plantar fasciopathy: a randomised trial.

Other Episodes of Interest:

PE 062 - How to treat plantar fasciopathy in runners with Tom Goom

PE 061 - How to assess and diagnose plantar fasciopathy in runners with Tom Goom

PE 060 - Plantar fasciopathy in runners with Tom Goom

PE 038 - Plantar fasciopathy loading programs with Michael Rathleff

PE 012 - Plantar Fascia, Achilles Tendinopathy And Nerve Entrapments With Russell Wright