Case studies can carry immense value if used appropriately. They cannot be extrapolated to all our patients but they can provide insights into clinical assessment and decision making. Trials lack details and by nature must have strict protocols. As all patients are unique, we benefit from seeing examples of Evidence-Based Practice being successfully implemented.
As someone who is cautious about the application of manual therapy in clinical practice, I found this case study interesting. The title expresses a common viewpoint of many clinicians who commonly implement manual therapy.
A critical point of this case is the clinician emphasized a reconceptualization of the patient's pain and did not create a dependence on manual therapy, which is a risk of using passive modalities. The patient expected to receive manual therapy and was frustrated with previous PTs who were scared to implement manual for fear of damaging her spinal fusion.
By implementing manual therapy, the therapist was able to strengthen the therapeutic alliance. At this point, the specific manual therapy used was not as important as the simple act of doing something manual based. This helped the patient reduce fear and anxiety that she was fragile.
The patient reported that her ability to tolerate the thrust manipulation made her feel that her spine was stronger than she initially thought. Manual therapy is a powerful tool when used appropriately.
Expectations are powerful.