title: Reconceptualising manual therapy skills in contemporary practice.
abstract: With conflicting evidence regarding the effectiveness of manual therapy calls have arisen within some quarters of the physiotherapy profession challenging the continued use of manual skills for assessment and treatment. A reconceptualisation of the importance of manual examination findings is put forward, based upon a contemporary understanding of pain science, rather than considering these skills only in terms of how they should "guide" manual therapy interventions. The place for manual examination findings within complex, multidimensional presentations is considered using vignettes describing the presentations of five people with low back pain. As part of multidimensional, individualised management, the balance of evidence relating to the effectiveness, mechanisms of action and rationale for manual skills is discussed. It is concluded that if manual examination and therapeutic skills are used in a manner consistent with a contemporary understanding of pain science, multidimensional patient profiles and a person-centred approach, their selective and judicious use still has an important role.
authors.affiliation: Le Longfrie Surgery, Guernsey. Electronic address: martinrabey@gmail.com.
authors.forename: Martin
authors.initials: M
authors.lastname: Rabey
authors.affiliation: School of Physiotherapy and Exercise Science, Curtin University, Perth, Australia. Electronic address: halltm@netspace.net.au.
authors.forename: Toby
authors.initials: T
authors.lastname: Hall
authors.affiliation: University of Brighton, Eastbourne, UK. Electronic address: c.l.hebron@brighton.ac.uk.
authors.forename: Clair
authors.initials: C
authors.lastname: Hebron
authors.affiliation: Department of Health Science and Technology, SMI(®), Aalborg University, Aalborg, Denmark. Electronic address: tsp@hst.aau.dk.
authors.forename: Thorvaldur Skuli
authors.initials: TS
authors.lastname: Palsson
authors.affiliation: Department of Health Science and Technology, SMI(®), Aalborg University, Aalborg, Denmark; Department of Physiotherapy, University College of Northern Denmark (UCN), Aalborg, Denmark. Electronic address: stc@hst.aau.dk.
authors.forename: Steffan Wittrup
authors.initials: SW
authors.lastname: Christensen
authors.affiliation: Faculty of Medicine and Health Sciences, Macquarie University, NSW, Australia. Electronic address: Niamh.moloney@mq.edu.au.
authors.forename: Niamh
authors.initials: N
authors.lastname: Moloney
mesh_terms: D006801:Humans; D017116:Low Back Pain / Q000628:therapy*; D020393:Manipulation, Spinal / Q000379:methods / Q000592:standards*; D026201:Musculoskeletal Manipulations / Q000379:methods / Q000592:standards*; D026741:Physical Therapy Modalities / Q000592:standards*; D017410:Practice Guidelines as Topic
keywords: Contemporary; Manual therapy; Pain