Research Findings: Should They Be the Gold Standard for Treatment Decisions?

This past weekend I was honored to give a 3-hour presentation entitled, Manual Therapy Strategies to Treat Complex Patients at the American Physical Therapy Association of Maryland and DC annual conference.  I discussed what I believe are the 3 primary pillars that manual therapists can use to improve the symptoms and functional abilities of this challenging population – Seeing the Big Picture, Understanding Physiology, and Layer Palpation.  It is these concepts that allow me to see the totality of the problem, the aberrant physiology that is preventing the patient from healing, and the specific location of where the dysfunctions and tissue restrictions are located.

While the presentation was generally well-received, there was a statement, more than a question, at the end of the talk that basically said that nothing I presented was compatible with the current pain research and that there was no scientific evidence to validate 1of the techniques I commonly use, Chapman’s Neurolymphatic Reflexes.  Similar arguments have been made against other techniques manual therapists commonly use as well, such as visceral manipulation and cranial mobilization.  I politely responded to this “questioner” that I disagreed with his opinion as I am also an avid reader of pain research and base most of my treatment choices on what I consider solid physiological rationale and research findings.

While this type of comment was a little annoying, I was not surprised as people have been telling me for the entire 27 years of my cash practice that I cannot do what I am doing.  Yet here I am.  With a full practice all of these years later.  However, I felt that a more complete answer is needed to address this type of question. So here I go.

Does it make sense to rely only on research findings and ignore decades, if not a century, of experiential evidence?  Not to me. First of all, what exactly is a good research finding and should you believe everything you are reading? Of course there is a lot of good research, and the scientific process has fueled the advancement of our society for generations.  I believe in science and what it can tell us. But much of it is flawed, and you have to be careful to know what to believe and what is junk.  I encourage anyone interested in this topic read John Ioannidis article in the 2005 issue of Plos Medicine entitled, “Why Most Published Research Findings are False”.  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1182327/ .  Or the 2017 article in The Annual Review of Statistics and Its Application by Jeffrey T. Leek and Leah R. Jager, entitled, “Is Most Published Research Really False?”  https://www.annualreviews.org/doi/pdf/10.1146/annurev-statistics-060116-054104.

To navigate through the good and bad research to determine what to believe and what not to believe requires you to be a critical thinker. My mentor, Loren (Bear) Rex, D.O. used to always tell his students to keep in mind several things:

Let’s take Chapman’s Neurolymphatic Reflexes for example.  These are points that were discovered by Frank Chapman, D.O. in the early 1900s.  They are pairs of points that form a reflex with 1 point in the front of the body and 1 in the back.  They represent a viscerosomatic reflex where an irritation in an organ travels back to the spinal cord and causes constriction of lymphatic vessels in the area leading to lymphatic congestion and delayed healing. To reset this reflex, you simply lightly massage the anterior point for usually less than a minute until the congested tissue begins to drain and the surrounding tissues start to soften.  Often you also begin to see the patient show signs (sighs or tummy gurgles) that their body is beginning to change from a sympathetically-facilitated state that delays healing to a more parasympathetic one that improves it.  But is this non-sense? Let’s examine.

Is it Simple: This technique is easy to do, does not take long, and causes no pain or undue harm to the patient.

Does it Make Sense: Yes. It is well-known that massage can enhance lymphatic drainage. Ask any lymphedema specialist. In addition the location of these points, especially the posterior ones, fit very well with the how the organs are formed embryologically and their known segmental neurology.

Accordingly, it seems prudent to at least try to reset these reflexes if they are present when this technique is the most appropriate to do at the time.  Do they work? Let me share 1 particular story out of the hundreds I could tell.  A little over 25 years ago my wife began to work as a landscaper. Not long after she started she discovered that she was allergic to sycamore trees after working under one all day.  She came out of the shower gasping for air in the middle of a full-blown allergy-induced asthmatic attack.  She could barely vocalize the thought that I needed to call 911 or drive her quickly to the ER.  It was very scary! Fortunately I had learned that Chapman’s reflexes had been successfully used in osteopathic hospitals for decades before the advent of bronchodilators.  I was able to turn down these reflexes for the pharynx, larynx, and bronchi, and she was able to begin breathing normally in less than 2 minutes.  She now has a bronchodilator, but if her lungs ever become irritated by spring allergies, cigarette smoke, or heavy perfume, dampening these Chapman’s points work every time.

So in conclusion, while I believe in the value of research, you need to be a critical reviewer of the findings and look to see if the results are reproducible.  But you also need to look at experiential results as well.  Just because certain techniques have not been studied, it does not mean they shouldn’t be used if they make physiological sense. To me it only makes sense to consider both and not doing so is both silly and potentially dangerous.  So when a patient is in need of care or a loved family member is struggling to survive, you may have a choice to make about what to do.  I made my decision. What are you going to do?