Consider the evidence . . .
The medical world aims to practice evidence-based medicine (EBM). In the future, we hope to have evidence-based treatments for all illnesses. The problem is that we don’t live in the future and medical science today is in its infancy.
We often hear the following advice . . .
“When considering any health product or service, consider the evidence . . .
Did the research have greater or less than 100 subjects?
Were the subjects all otherwise healthy 22-year-old college students? Were they all male?
Did the study include females, multiple age ranges & socioeconomic levels?
Were the experiments run by a company or organization that would receive financial gain?
Was the research done on a living organism or in petri dishes? If the trial was on living organisms, see above questions.
Are they claiming to know something “that your doctors aren’t telling you”?
Are you confident in your statistical analysis skills? Do you think the author of that article has statistical analysis skills?”
This is good advice. And particularly good advice when the stakes are high . . . an invasive test, drug, injection, or surgery, or even if the treatment is particularly expensive and/or would result in dependency upon the treatment.
But, because medical science is in its infancy, there has likely been no independent research on your particular issue with your particular complicating factors. So what if there have been no/few studies? What if the studies are poorly constructed? What if they were sponsored by the industry selling it? What if the treatment is of such a nature that it can’t easily be replicated like a pill so it is unlikely to ever be tested thoroughly? What do we do then? You are living today, and have to make decisions in light of evidence available to you today.
Manual therapy in many ways falls into this category. There have been studies; but manual therapy is of such a nature that it is so individualized, and the complicating factors such as past surgery, bone breaks, anatomical restrictions . . . all play significant roles in how your particular musculoskeletal system functions. I have a client with two shoulder replacements and two hip replacements. That physical reality is different than the client with one hip replacement and a previous dislocated shoulder. That physical reality is different than the client who had a heart transplant and several surgeries since. How many people with these particular issues would be willing to participate in a study where the treatment is manual therapy and they would need to have the same manual therapy treatment, for the same, significant amount of time? This may never happen.
What do we do then?
Many seek treatments that have little independent evidence, but little potential for permanent damage. The client decides, ultimately, what they are willing to take the time and spend the money to try. These are some considerations when deciding such treatments . . .
Does the practitioner have very specific treatment goals in a short period of time?
Can the practitioner explain how you know if their treatment is working?
Can they demonstrate changes that occurred as a result of the treatment?
Does the practitioner have the attitude “you may not be getting better, but I will be with you until the treatment finally works,” requiring you to continue spending money on hope and not real appreciable results they can demonstrate or you can feel?
For those seeking our services for particular issues, we suggest trying our manual therapy for four sessions. If there is no improvement in range of motion, mobility, muscle strength, then it is likely that something other than our approach to manual therapy is necessary.