{"id":61455,"date":"2025-02-01T04:57:20","date_gmt":"2025-02-01T04:57:20","guid":{"rendered":"https:\/\/peraltafinancing.com\/alternative-medicine\/can-we-agree-on-a-definition-of-manipulation\/"},"modified":"2025-02-01T04:57:20","modified_gmt":"2025-02-01T04:57:20","slug":"can-we-agree-on-a-definition-of-manipulation","status":"publish","type":"post","link":"https:\/\/fivemor.com\/?p=61455","title":{"rendered":"Can we agree on a definition of manipulation?"},"content":{"rendered":"


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The precise definition of the word \u201cmanipulation\u201d to indicate a certain technique has always been quite problematic for manual therapists, and a recent paper attempts to pin it down to something neater which can be universally used and understood.<\/p>\n

here is the link:\u2003https:\/\/pubmed.ncbi.nlm.nih.gov\/36918833\/<\/a><\/p>\n

What do we mean by manipulation?<\/strong><\/p>\n

When I was at osteopathy college, back in the 90s, \u201cmanipulation\u201d basically meant clicking a joint. This was usually the spine, but if you wanted to be a bit fancy-schmancy you could also click other joints \u2013 in the ankles, wrists, the radial head. In practice, patients often used the word manipulation in a more general way. \u201cThe physio manipulated my arm a bit\u201d. When pressed for more specific details, their idea of manipulation seemed to mean moving something about and\/or prodding it a bit.<\/p>\n

Manip or HVT?<\/strong><\/p>\n

In notes I started my career writing \u201cmanip.\u201d to indicate that I had clicked a joint, but as it did seem a bit vague and might be misinterpreted, I began to write HVT (for high velocity thrust) and if I was in a hyper defensive mood I would write HVLAT (high-velocity low-amplitude thrust \u2013 \u201chardly any force was used at all, your honour\u201d).<\/p>\n

Using the word manipulation in studies is currently confusing<\/strong><\/p>\n

Yet another problem with the vagueness of this word is that if it is used in a study without clarification, it renders the study meaningless. If you are comparing a group which has had manipulation with a group without, you really need to know which specific techniques have been used \u2013 is it general manual treatment, a bit of soft tissue? Mobilising? or a specific thrusting, cracking technique? Clearly, someone needed to end this confusion.<\/p>\n

David Evans and Nicholas Lucas ride in to the rescue<\/strong><\/p>\n

So I was pleased to be introduced by colleague Jim Hurden to a study published earlier this year (March 2023), entitled What is Manipulation? A new definition, written by David Evans and Nicholas Lucas.<\/a> These two have been published before, alongside famous physio Roger Kerry, no less, on the topic of causation. They have previously published on the topic of manipulation too, notably their 2010 paper \u201cWhat is manipulation? A reappraisal\u201d<\/a> seeking to find a correct model for the technique. It seems they were hoping to inspire others to join them in their quest for the ultimate manipulation definition, but they were sadly disappointed. Everyone\u2019s just so busy these days! On the bright side, evidence supporting their 2010 ideas grew and so they decided that to try to end the ongoing confusion, they might as well just finish the job themselves. <\/p>\n

The definition<\/strong><\/p>\n

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The Tower of Babel \u2013 a tower built in an attempt to reach heaven, which God frustrated by making its builders speak different languages so that they could not understand one another (Genesis 11:1\u20139).\u2002Let\u2019s not make the same mistake<\/em><\/figcaption><\/figure>\n<\/div>\n

So, to cut to the chase, what is the definition they have come up with, and how? Well, the paper includes a nice table of examples of existing definitions from sources as diverse as the Ontario government, the Parliament of New South Wales and the Chartered Society of Physiotherapy. They looked at these to help them to decide which components to include, and which to exclude. The inclusion criteria had to be things that were always <\/span>part of the technique, and the exclusion criteria \u2013 anything that was not absolutely essential to the definition:<\/p>\n