Integrated manual therapies: IASP taskforce viewpoint

I thoroughly enjoyed reading this article—not because it dramatically shifted my perspective or validated my biases, but because it sparked a vivid image in my mind. I imagined massage therapists, osteopaths, physiotherapists, personal trainers, chiropractors, acupuncturists, and others standing together on a mountainside, proudly holding a sign that reads:

"WE ARE WORTH IT!"

Since the publication of this paper, I’ve seen many therapists sharing it on social media, discussing it on podcasts, and praising its insights. However, when I hear these discussions, I notice a recurring theme: the central message of the paper often seems overlooked, misunderstood, or dismissed. Instead, it’s frequently used as a justification for the effectiveness of manual therapy techniques—sometimes without fully considering what the authors are actually saying.

We’re all susceptible to confirmation bias (myself included!), but it’s important to take a step back and focus on the authors’ intended message. Let’s start by revisiting their key points. To avoid misinterpretation, here’s a direct quote from the paper:

"Providing manual therapy in such a model of care may support efficient delivery of services, with particular benefit where access to multidisciplinary care is restricted."

The authors suggest that manual therapy is particularly beneficial in settings where multidisciplinary care isn’t available—implying that, ‘when multidisciplinary care is accessible, it should be prioritized.’ In essence, manual therapy works best when integrated with other disciplines. (My interpretation is that they’re hinting at the importance of combining manual therapy with psychology and exercise, though the paper doesn’t explicitly define "multidisciplinary."

Another important quote is:

"This co-creation of management plans requires excellent communication skills, trust, and time and disrupts the long-established hierarchy of power in health care encounters."

Here, the authors highlight that much of the value of manual therapy lies in the ‘soft skills’—listening, communicating, building trust, and fostering collaboration with clients/patients.

Yet, in many discussions I’ve heard, the focus is placed on the section about the mechanical effects of manual therapy, often at the expense of the broader, more impactful message. While the mechanical effects are fascinating and valuable, they’re not the primary takeaway.

The real emphasis of the paper is on the importance of Time, Active Listening, and genuine Communication to build trust and co-create meaningful care plans. These are the areas where manual therapists truly shine. Let’s not lose sight of this essential message as we discuss and share this important work.

The section on "evidence for human studies" offers some inspiring insights into the potential mechanical effects of manual therapy on clients. However, it’s important to address a critical limitation: the study on massage therapy's impact on inflammation evaluated just nine subjects. Nine! That’s far from a sufficient sample size to draw definitive conclusions. In fact, the authors of the study that the first paper references, “Massage Therapy Modulates Inflammatory Mediators Following Sprint Exercise in Healthy Male Athletes,” explicitly acknowledge this limitation, stating:

“A small sample size was used in the present study, which may have limited statistical power for determining differences between conditions or associations.”

While this second paper presents intriguing findings, we must approach its conclusions with caution. It’s crucial to remember that while inflammation levels ‘may’ be influenced by massage therapy, this doesn’t automatically equate to enhanced muscle recovery. Though the two are often correlated, we should avoid making unsupported leaps in logic. The authors themselves clarify this point, noting:

“Therefore, while results are somewhat conflicting between studies, it appears that massage therapy may not be useful in recovering muscle function in the short term.”

Overall, I find studies like these valuable because they challenge us as manual therapists to revisit our foundations and critically assess our practices. As my good friend Justin Solace wisely says:

“Work hard, keep learning, be humble—the work will prove itself.”