Variance in manual treatment of nonspecific low back pain between orthomanual physicians, manual therapists, and chiropractors

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.