Few would argue that manual therapy has been used by physical therapists (PTs) since the beginning of the profession. Traditionally, manual therapy training for PTs has begun in entry-level professional programs with courses specifically directed at manual therapy and related foundational courses. Therapists with an interest in manual therapy can then choose to pursue post-professional educational opportunities in the form of continuing education seminars, clinical residency and fellowship training, postgraduate academic and diploma programs, clinical mentorship and manual therapy certification programs.1,2 Both at national and international levels, documents have been developed to standardize entry-level and post-professional manual therapy curricular content.3-5 Arguments to include manual therapy interventions within the PT scope of practice are based on the profession’s educational preparation, history, contributions to technique and concept development, development of clinical practice guidelines, research, and a superior safety record in the clinical application of manual therapy
Until recently, manual therapy education in the United States was similar to that described above. Research has shown increasing emphasis on incorporating manual therapy into U.S. entry-level curricula, including both thrust and non-thrust techniques. With the publication of its manipulation education manual , 6 the American Physical Therapy Association (APTA) has shown its commitment and intent to standardize manual therapy entry-level curricular content and include thrust and non-thrust techniques for spinal and extremity joints. In contrast, the Canadian Physiotherapy Association’s entry-level manual therapy curriculum guidelines state that the introduction of spinal and peripheral manipulation techniques should be at the discretion of individual physical therapy educational programs.3 We contacted all English-speaking physical therapy schools in Canada by e-mail and followed up with schools that did not respond with two reminder telephone calls. Ten of the 11 physical therapy schools responded, and of these, three stated that they included spinal thrust manipulation in their curriculum. These survey results may explain the low use rates for thrust manipulation in the management of patients with low back pain (LBP) among Ontario PTs, as reported by Li and Bombardier.7
Undoubtedly, political motives have influenced the APTA decision to emphasize thrust technique instruction in its accredited entry-level programs: For years, our U.S. colleagues have been involved in an ongoing struggle to defend the inclusion of manual therapy and, more specifically, thrust techniques in the PT’s scope of practice against a nationwide initiative by the chiropractic profession.8 Of course, Canadian PTs have faced similar legal challenges to their scope of practice in the past.9 In our opinion, there are valid reasons to include spinal thrust manipulation in Canadian entry-level curricula.