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Rule the Tool: A Patient Centered Manual Therapy Approach by Steven Capobianco

The WHY

In the ever-evolving field of manual and movement therapy, there is a growing recognition of the need to shift from traditional, isolated treatment approaches towards more integrated, holistic models. Traditional therapies often focus narrowly on specific techniques like soft tissue manipulation, spinal adjustments, and kinesiology taping. However, modern approaches are moving towards combining these manual therapies with meaningful movement and exercise, offering a more comprehensive and patient-centered care strategy.

The Shift Towards Integrated Approaches

Integration in Therapy means combining various therapeutic techniques into a cohesive treatment plan that addresses the whole person rather than focusing on isolated symptoms or body parts. This shift is aligned with the ideas proposed by Roger Kerry et al. in their 2024 paper, which advocates for moving beyond clinician-centered assessments and patho-anatomical reasoning. Instead, they propose a framework that emphasizes person-centered care, incorporating patient-reported outcomes, real-time feedback, and a broader understanding of the therapeutic encounter.

Why Integration Works:

    • Holistic Treatment: By addressing multiple aspects of a patient’s condition simultaneously, we create more comprehensive and effective treatment plans.
    • Enhanced Functionality: Combining manual therapy with movement-based interventions promotes functional recovery, helping patients regain their ability to perform daily activities and enjoy life.
    • Patient Empowerment: Integrated approaches foster patient involvement and autonomy, encouraging them to take an active role in their recovery.

Implementing Integrated Manual Therapy

The future of manual therapy involves a significant shift in both teaching and practice, as outlined by Kerry et al. Their framework places manual therapy within a broader context of person-centered care, focusing on safety, comfort, and efficiency while emphasizing communication, context, and individualized care.

Core Elements of the New Framework:

    • Patient-Centered Assessments:
      • Move away from purely clinician-centered assessments to include thorough case histories, validated patient-reported outcome measures (PROMs), and real-time feedback during assessments.
      • Example: Use tools like the Oswestry Disability Index or the Visual Analog Scale to gauge patient progress and adapt treatments based on their feedback.
    • Integration of Touch-Based Therapies:
      • Incorporate non-specific neuromodulation, effective communication, and educational components into manual therapy.
      • Example: Use manual therapy techniques to reduce pain and improve mobility while educating the patient about the importance of movement and self-care.
    • Safe, Comfortable, and Efficient Care:
      • Ensure that treatments are safe and comfortable for both the patient and the therapist and are delivered in the most efficient manner possible.
      • Example: Apply kinesiology tape to support movement and reduce pain, while simultaneously guiding the patient through functional exercises to enhance recovery.

 

Case Study: Integrating Manual and Movement Therapy

Consider the case of a 17-year-old male, seen by the author of this article, who injured his spine while deadlifting. Initially, he was told he had “blown out a disc” and was advised to avoid bending or twisting his spine. These instructions led to fear and maladaptive behaviors, including withdrawal from activities he loved, which compounded his pain and led to depression.

Traditional Approach:

Previous therapists focused solely on his spine, adhering strictly to the diagnosis without considering his overall well-being.

Integrated Approach in Our Clinic:

    • Assessment and Manual Therapy:
      • Gentle manual therapy to alleviate his pain and provide immediate relief, using techniques to help him understand that movement is not harmful.
      • Manual therapy included soft tissue manipulation to reduce tension, improve ‘ception’ (extero, proprio, interoception) and spinal adjustments to improve segmental mobility/’ception’.
    • Movement Reeducation:
      • Introduced controlled, safe movements, reinforcing that bending and twisting are part of natural, healthy motion.
      • Implemented exercises that built his strength and stability around the compromised area, progressively increasing his confidence in progressive activity levels.
    • Patient Education and Empowerment:
      • Educated (pain science) him about his condition and the importance of movement, encouraging a proactive approach to his recovery.
      • Provided tools and knowledge to help him manage his condition independently and confidently.
    • Outcome:
      • The patient regained his ability to move freely without fear, re-engaged with his favorite activities, and developed a resilient mindset towards his condition. This integrated approach not only addressed his physical symptoms but also supported his mental and emotional recovery.

Moving Beyond Cookie-Cutter Modalities

This case highlights the importance of moving beyond one-size-fits-all treatment modalities. Each patient brings a unique set of circumstances, and their care should be tailored to address their specific needs and goals.

 

Key Takeaways:

    • Individualized Care: Recognize that each patient is unique and requires a customized treatment plan.
    • Interdisciplinary Collaboration: Encourage collaboration among different healthcare professionals to create comprehensive care plans.
    • Ongoing Adaptation: Be flexible and ready to adjust treatment plans as patients progress and their needs change.

Conclusion

Integrating manual therapy with movement and exercise offers a pathway to more effective, comprehensive, and patient-centered care. This approach aligns with contemporary healthcare principles and enhances our ability to support patients in achieving their health goals. By embracing the future of manual therapy as proposed by Kerry et al., we can provide more meaningful and impactful treatment experiences.

References:

• Kerry R, Young KJ, Evans DW, Lee E, Georgopoulos V, Meakins A, McCarthy C, Cook C, Ridehalgh C, Vogel S, Banton A, Bergström C, Mazzieri AM, Mourad F, Hutting N. A modern way to teach and practice manual therapy. Chiropr Man Therap. 2024 May 21;32(1):17..
• Kania, K. D., et al. (2021). Integrative Approaches in Physical Therapy: Enhancing Patient Care through Multi-disciplinary Techniques. Journal of Physical Therapy Science, 33(2), 115-125.
• Andersen, L. L., & Zebis, M. K. (2018). The Effectiveness of Combining Manual Therapy with Movement for Chronic Pain. Pain Research and Treatment, 2018.
• Andrýsková, A., & Lee, J.H. (2020). The Guidelines for Application of Kinesiology Tape for Prevention and Treatment of Sports Injuries. Healthcare (Basel).