Things used to be so simple when we began our careers in physical therapy many years ago A patient would typically present to our clinics with musculoskeletal pain, we would identify treatable impairments in body structure and function, and we would use manual therapy and exercise to improve their function and quality of life. We truly believed it worked pretty well for most of our patients. Of course this was in the time before we started utilizing valid, reliable, patient-reported outcome measures (PROMs) in our practice. Once we did, many patients we thought were getting better (because they told us so!) did not exhibit clinically important changes on PROMs [~(1)]. We want to please our patients, but they also want to please us [~(2)]!Manual therapy is in an identity crisis. Due to reported marginal effect sizes in systematic reviews for manual therapy as a stand-alone intervention for musculoskeletal disorders [~(38)], some physical therapists have suggested abandoning manual therapy as an intervention. Blog posts such as Why I am not a manual therapist [~(9)] and Manual Therapy Sucks [~(10)] abound on the Internet. Why this vehement opposition to manual therapy interventions? A recent editorial by Reid et al. [~(11)] suggested we, as advocates of a specific treatment specialization, have not done an adequate job in providing sufficient and sound evidence that orthopedic manual physical therapy demonstrates high clinical utilityIn other words, we have failed to tell our story. Traditional paradigms of how manual therapy works have been questioned [~(1214)]. At the time, clinical benefits observed from manual therapy were believed to be from local changes in tissue, joint mobility, and alignment [~(15)]. New evidence suggests that many manual therapy theories and paradigms are outdated and invalid, and yet we still cling to them at our own peril [~(12,13,16,17)].
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