Thanks for your post Erik – it’s great that you’re posing questions and not taking things at face value. I’ll counterpoint – if the patient who you speak of was satisfied with only getting thrust manipulations for their care, why would they be in our clinic? Are there other components to the patient’s problem (weakness, guarding, decreased mobility) that are the underlying mechanisms for their pain? Are you ever using passive treatments alone in your POC?
HVLA thrust manipulations are valuable, powerful tools that we can use to supplement WITH active, exercise approaches to address patient’s problems. It’s important that we communicate to patients on the rationale behind these techniques, to ultimately help them move better. We, as clinicians, need to know the emerging data to understand the true effect of these techniques to then use them ethically and intentionally in our practice.
With this reasoning, we also have to be judicious about who we decide to perform these techniques on. If you believe that it will do more harm than good, then move in another direction to address the patient’s problems. I think it boils down to two things: what does the patient value in their care and what do you, as a clinician, think they would benefit from to achieve the ultimate goal >> exercise, activity, movement.
On another note, don’t forget about treatment effect sizes in intervention studies if the authors don’t report. Easy calculation that can give you the magnitude of the difference between the groups.