The APTA Evokes A Visceral Response Over Visceral Manipulation

It should come as no surprise to readers of this blog that I had quite a visceral response when I read the post “Visceral Manipulation Embraced By The APTA” on the website “Science-Based Medicine” (SBM).

Visceral manipulation. Really? C’mon APTA, are you serious? You are supposed to be the bastion of evidence-based physical therapy practice, ye of Vision 2020 and autonomy and evidence and access and ethics and …

Really? Please, say it ain’t so. Really?

If you think that you detect a bewildered look on my face, you are half right. It is bewildered and disappointed. Sadly, none of this surprises me anymore.

As I was reading the SBM article, I was reminded of one of the significant problems facing health care these days: the growth of pseudo-science. When clinicians are faced with little or no evidence to support their far-fetched, hypothetical “scientific” interventions, we are inundated with the standard responses.“Science can't measure and explain everything yet". “It just works”. “Can all these people that it obviously helps all be wrong?”. Or worse.

Manipulating viscera to gain a treatment response? Worse yet, using palpation as a means of assessing it? How about craniosacral therapy? Twisted and distorted fascial planes? Really?

What becomes apparent is that if someone will pay money for the treatment, then it appears to have become acceptable in the psyche of the general public. We have seen countless treatment approaches that have little to no scientific evidence to support their use, and just as many clinicians that will pay the exorbitant fees to learn the method to then attain the revered guru status and esteemed “certification”. This leads to a new market niche for the clinician, a new “service” that can be offered. Voila, income stream – evidence-based or otherwise.

This is where a professional association should step in. Stand up. Raise the bar. Rise to the greatest common denominator of clinical excellence, not the lowest. Yet in the SBM article, Carrie Schwoerer, Director of Education for the APTA, notes that

“adhering to clinical research as the only valid evidence is a disservice to patients who have responded time and again in case studies to so-called “pseudoscientific” interventions and threatens to undermine future innovation in the field”.

Do you feel like you just watched the profession go backwards about 50 years in one swift kick? I would suggest reading not only the full article, but the comments as well.

The disservice here is that any of this has become “acceptable” to a patient or to a clinician. The disservice is the degree of hypocrisy regarding “evidence-based medicine”, the lip service paid to the phrase while members of a professional association utilize anything but evidence-based strategies.

We must ultimately serve as patient advocates. Patients deserve the best that science can offer them. If we are going to move forward as a science-based profession, we have to discard the assessment and treatment approaches that have either little or no rational science-based foundation, or that already have evidence to refute them yet are still practiced consistently within the profession.

As Rand once noted -

“To arrive at a contradiction is to confess an error in one’s thinking; to maintain a contradiction is to abdicate one’s mind and to evict oneself from the realm of reality.”

Maybe a reality check is in order.

Stay tuned for an upcoming Open Letter to the APTA.

Photo credits: jonseidman1988