‘Manual therapy….how far is too far?’

CSP Professional adviser Sara Conroy asks how far is too far for manual therapy

Sara Conway
Sara Conroy CSP professional adviser

Recent pictures on a social media site generated considerable debate as to how far is too far when it comes to soft tissue manipulation. The pictures of a young man’s back following ‘deep tissue manipulation’ by a physiotherapist exposed extensive bilateral bruising over his upper trapezius muscles, his erector spinae, and into the axilla. 

The skin looked to have been grazed. Apparently the patient was pleased as his hips had ‘re-aligned’ and shared the pictures as a ‘trophy’.

Surprisingly the response was mixed. Some claimed it was acceptable practice. Others commented that as long as the patient had signed a disclaimer it was fine or compared it to the response from cupping or Gua Sha. Few considered evidence-based practice. 

As an evidence-based, scientific healthcare profession are we concerned how patients experience physiotherapy and consequently portray us? Are we concerned that some physiotherapy practice lacks an evidence base and can harm? 

How should we respond and do we call out the practice?  

Cupping and Gua Sha are not regarded as physiotherapy interventions; they lack an evidence base. Furthermore, healthcare professionals cannot avoid their liabilities - disclaimers have no place in physiotherapy practice. If we aspire to shared decision-making with our patients what place could conversations about the use of modalities without an evidence base possibly have?   

The CSP gives clear guidance around the scope of our profession of which a robust evidence base is an essential. While medical malpractice insurance covers claims for personal injury to patients such as harm, it only applies when that intervention is within scope. 

Where registrants have concerns about interventions, like the one illustrated on social media recently, they have a duty to report these to the Health and Care Professions Council.

Manual therapy….how far is too far?...This is too far.

Points for reflection:

  • what images should be shared on SoMe sites? 
  • are you aware of your duty to report poor practice and potential harm?
  • when does massage and manipulation cross the line and cease to be part of our professional scope?

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