Comment on How To Cure Evidence B(i)ased Physiotherapy by Pete Smith.

Yes, a very interesting blog. I went to college as a hard-core, medical model scientist; by the time I left I was so disillusioned with ‘science’ that I didn’t know where to turn. Are we talking about evidence based medicine, or are we talking about eminence based medicine? How much statistically valid, double-blind, randomly allocated, crossover trials with FULL patient consent did Mr. Maitland carry out? I read a review of book on sacro-occipital technique once where the reviewer said that the whole book was anecdotal; there was no valid evidence in it at all, but nobody seriously challenges SOT. Anna above describes cranio-sacral therapy as being a whole body technique; I think most people would assume it was about the cranium and the sacrum. Can she really mobilize my little toes by adjusting my cranium? I think science, at least in health care, is at some sort of crossroads, and we, in physical therapy at least, are becoming more and more sceptical but too frightened by the possible consequences to speak out. I notice you didn’t mention intuition, or binary biological biofeedback (love that phrase), or vital force, or qi/chi, or prana etc. I remember being asked by college about 10 years ago to recruit patients for research which would not involve any breach of confidentiality and would not involve any change in treatment; just me filling in forms about them and their treatment, retrospectively, and completely anonymously; not one single patient would consent, so where is the evidence going to come from? I’ve done the evidence/eminence based therapy, I’ve done the forms and questionnaires, I’ve done the biopsychosocial modelling. My musculo-skeletal therapeutic philosophy or rationale (or whatever you want to call it) is now based on the following:- if it’s stuck, and it shouldn’t be, and it’s safe – unstick it; if it’s tight, and it shouldn’t be, and it’s safe – loosen it; if it’s out of place, and it’s safe – put it back. I only wish I could find someone who could do that to me. My neck is so tight!!! [Just to clarify, I do talk to patients and listen to them, and advise them about diet, exercise, ADLs, etc as well, but that’s not musculoskeletal.]