Every two years Mulligan Concept instructors from around the world gather to join forces and grow the Concept. Last month we met in Orlando. It was the first time since Covid that the group was able to get together and it was a wonderful experience! There was a lot of fellowship and good food. It was great to be around so many intelligent multinational therapists who all share a passion for skilled manual therapy.
My favorite day of the meeting was Teacher's Day. This is a whole day devoted to helping teachers become better teachers. It went way beyond Mulligan techniques, although there were plenty of those.
Various international teachers led small break-out sessions designed to engage clinical reasoning, communication skills,and our approach to manual therapy.
It was refreshing to focus on these topics and engage in the process to become a better teacher from a variety of great manual therapy teachers with strong manual therapy backgrounds. However, there was one major thing missing from my interaction with all these international manual therapy experts; Manual Therapy DOGMA! That’s right. There was absolutely none of it! It is a far cry from what many manual therapy critics say is wrong with manual therapy.
Manual Therapy Critics
One of the modern knocks on manual therapy is that it is too dogmatic. I believe this perception comes from the historical rigidity associated with some manual therapy approaches. The dogma of being told to palpate a muscle tone that maybe was not there. The dogma of being told they HAVE TO perform techniques in a specific way for a specific amount of time because of unprovable theoretical models of what manual therapy could do to different tissues. They were made to feel inferior by manual therapy gurus who told them that they were not "good enough" to perform well. This all led many to view manual therapy as a narrow, short-sighted intervention that looked too much like clinical magic tricks providing only short-term pain relief.
I have no doubt this was their experience and that is unfortunate. However, the bitterness toward manual therapy does not need to linger.
The Pendulum is Gone
It is often said the metaphorical treatment pendulum swings away from one intervention and moves toward another. Very often it is said to move toward a new, better, and more efficacious intervention.
Many say the pendulum has swung away from manual therapy toward a pain science or exercise approach. No doubt for a while this may have been true. However, the old hands-on / hand-off debate is no longer an issue. The pendulum is gone!
The pragmatic use of manual therapy when indicated is, and will always be, one pain modulatory approach to help a patient move toward recovery. Modern manual therapy always strives to be multimodal and its effects are likely related to using it on the right person at the right time rather than a perfect technique application.
Simply put a therapist who uses manual therapy when it is not indicated engages in a user error. It is not necessarily the manual therapy approach that is wrong, it is the manual therapy application applied when it was not indicated.
Using manual therapy is one approach, and when indicated, should always strive to be multimodal.
If a dogmatic manual therapy approach has ever turned you off to using manual therapy, I encourage you to give the Mulligan Concept / Mobilization with Movement a look. It is different. It's arguably the most evidence-informed symptom modification approach around with over 300 published studies. Be flexible in your thinking, use your hands when indicated, and combine it with functional meaningful movement.
The Pendulum is gone, SNAG on!
Thanks for reading,
Jarrod