Variance in Manual Treatment of Nonspecific Low Back Pain Between Orthomanual Physicians, Manual Therapists, and Chiropractors☆
Received 8 October 2003; received in revised form 15 May 2004
Objective
The aim of the study was to identify differences in the diagnosis and treatment of nonspecific low back pain among 3 professional groups in the Netherlands: orthomanual physicians, manual therapists, and chiropractors.
Methods
Information was obtained from training materials from professional groups, literature searches, and observation of selected practitioners at work.
Results
In The Netherlands, there are differences in education between the 3 professional groups. The focus of orthomanual medicine is on abnormal positions of components of the skeleton and symmetry in the spine. Manual therapy focuses on functional disorders of the musculoskeletal system. Chiropractic focuses on the musculoskeletal and nervous systems in relation to patients' health in general. Orthomanual medicine considers inspection and palpation the most important diagnostic tools. Manual therapists and chiropractors additionally perform tests to determine functional disorders and manual therapists evaluate psychosocial influences. Chiropractors take radiographs if necessary. Orthomanual physicians apply mobilization techniques using fixed protocols. Manual therapists and chiropractors use various manipulation and mobilization techniques and their manipulation techniques differ in amplitude and velocity.
Conclusions
Diagnostic techniques and treatment methods of the 3 professional groups differ considerably. For more accurate reporting of the efficacy of manipulative and mobilizing therapies, the characteristics of treatments should be described in more detail when reported in studies such as randomized clinical trials.
aMovement Scientist and Junior Researcher, Institute for Research in Extramural Medicine, VU University Medical Centre, Amsterdam, The Netherlands
bClinical Epidemiologist and Professor in Clinimetrics, Institute for Research in Extramural Medicine, VU University Medical Centre, Amsterdam, The Netherlands
cPhD Student, Institute for Research in Extramural Medicine, VU University Medical Centre, Amsterdam, The Netherlands; Private practice of Manual Therapy
dMedical Doctor and Orthomanual Physician, Private practice of Orthomanual Medicine
fProfessor in Epidemiology, Institute for Research in Extramural Medicine, VU University Medical Centre, Amsterdam, The Netherlands
Submit requests for reprints to: Henrica C.W. de Vet, PhD, Institute for Research in Extramural Medicine, VU University Medical Center, Van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands
ABSTRACT