Manual therapy (also called manual medicine and manual healing) involves the use of the hands to diagnose and treat illness. Traditionally, osteopathic and chiropractic physicians have used manual therapy to treat a wide range of disorders including systemic illness such as asthma. The use of manual therapy to treatment systemic illness is very controversial. A study reported in The New England Journal of Medicine illustrates the point.

The study compared "active" and "simulated" chiropractic manipulation as adjunctive treatment for childhood asthma.
The "active" treatment consisted of "manual contact with spinal or pelvic joints followed by high-velocity low-amplitude
directional push often associated with joint opening, creating a cavitation, or "pop."  This treatment is a standard technique used by a wide variety of practitioners, such as osteopathic physicians, chiropractors, and physical therapists.

The "simulated" (placebo or sham) treatment involved soft tissue work similar to the type of manipulations used by traditional osteopathic physicians. The positive results that were obtained by both groups were dismissed because the "active" treatment was not any better than the "simulated" or placebo treatment. Meridian Institute staff wrote a letter pointing out that the placebo or sham treatment was actually an "active" treatment used by the early osteopaths to treat asthma.

Read the Meridian Institute letter published in the New England Journal of Medicine.

This was followed by longer, detailed articles that were published in the top chiropractic and osteopathic journals calling attention to the problem of using traditional osteopathic treatments as placebo or sham treatments in research studies.

"Manual Healing Diversity and Other Challenges to Chiropractic Integration" is an article published in the Journal of Manipulative and Physiological Therapeutics.  This peer-reviewed, Medline journal is the top scientific journal for the chiropractic profession.

"Manual Medicine Diversity: Research Pitfalls and the Emerging Medical Paradigm" is a similar article that was published in the  Journal of the American Osteopathic Association, the official peer-reviewed, Medline journal of the American Osteopathic Association.

Meridian Institute staff also had two pieces published in the AAO Journal, the peer-reviewed publication of the American Academy of Osteopathy.  "Osteopathic Treatment of Asthma" was a letter to the editor documenting the vasomotor model of asthma described in the early osteopathic literature.  Edgar Cayce used this model in many of his readings on asthma. This letter provides an explanation of why the traditional osteopathic manipulations could be effective for treating asthma and should not be used as placebo treatments.

"Osteopathic Regulation of Physiology" is another article published in the the AAO Journal.  It discusses an empirical study conducted by Meridian Institute to measure the physiological effects of an osteopathic technique recommended by Edgar Cayce.  The study compared this technique to simply touching the shoulders (a "placebo" treatment).  Both techniques produced measurable physiological effects, although the osteopathic technique was more distinctive in specific parameters.

The question of what constitutes an appropriate placebo treatment for manual therapy, or whether a placebo is really needed remains open to further debate.