An important and thorough review of the scientific evidence surrounding the use of manual intervention for a variety of common conditions has recently been published and is seriously recommended reading for both the professional and the public – indeed in the case of the former, hopefully the subject for compulsory continuing professional education points and in the case of the latter, leading to a better understanding of the therapeutic benefits and limitations associated with manual intervention – despite what a practitioner or your friends might tell you.

Irrespective of the discipline of practice eg. osteopath, chiropractor, manipulative physiotherapist, musculoskeletal general practice, the key message from a substantive and recently published report, which provides a comprehensive summary of the scientific evidence regarding the effectiveness of manual treatment for the management of a variety of musculoskeletal and non-musculoskeletal condition is that effective utility resides in manual intervention.

Effectiveness of manual therapies: the UK evidence report. Chiropractic & Osteopathy, 2010, 18:3. Bronfort G et al.    doi:10.1186/1746-1340-18-3

Commentary on the United Kingdom evidence report about the effectiveness of manual therapies. Chiropractic & Osteopathy, 2010, 18:4. Haldeman, S. Underwood, M.    doi:10.1186/1746-1340-18-4

The study concludes the following:

‘Spinal manipulation/mobilization is effective in adults for: acute, subacute, and chronic low back pain; migraine and cervicogenic headache; cervicogenic dizziness; manipulation/mobilization is effective for several extremity joint conditions; and thoracic manipulation/mobilization is effective for acute/subacute neck pain.’ (Bronfort et al. 2010).

The evidence is inconclusive for cervical manipulation/mobilization alone for neck pain of any duration, and for manipulation/mobilization for mid back pain, sciatica, tension- type headache, coccydynia, temporomandibular joint disorders, fibromyalgia, premenstrual syndrome, and pneumonia in older adults.’ (Bronfort et al. 2010).

‘Spinal manipulation is not effective for asthma and dysmenorrhea when compared to sham manipulation, or for Stage 1 hypertension when added to an antihypertensive diet. In children, the evidence is inconclusive regarding the effectiveness for otitis media and enuresis, and it is not effective for infantile colic and asthma when compared to sham manipulation.’ (Bronfort et al. 2010).

‘Massage is effective in adults for chronic low back pain and chronic neck pain. The evidence is inconclusive for knee osteoarthritis, fibromyalgia, myofascial pain syndrome, migraine headache, and premenstrual syndrome. In children, the evidence is inconclusive for asthma and infantile colic’. (Bronfort et al. 2010).

A more detailed analysis of the report is underway and you can read it here in the next week.

So, the humble and ubiquitous fibroblast whose normal role is to manufacture the material of the body structure – collagen proteins – may be persuaded to turn into a functioning nerve cell or neuron – and not with stem cell technology but instead with three transcription genes!

The advance article published online in the prestigious scientific journal Nature, 27 January 2010, doi: 10.1038/nature08797 – Direct conversion of fibroblasts to functional neurons by defined factors – Vierbuchen, T. and colleagues highlights this work of such tremendous potential. The researchers took embryonic and postnatal mouse fibroblasts and identified a combination of three genes that were capable of inducing these fibroblasts to become functional neurons capable of generating action potentials and forming synapses.

It is known that fibroblasts may be genetically re-programmed to a pluripotent state using a number of genetic transciption factors but it was unknown whether they could be persuaded directly into another defined somatic cell. Vierbuchen et al. have shown that this is feasible by their work on mouse fibroblasts. The implications are huge for the treatment of disease, the regeneration of compromised, traumatised or aged nerves and the therapeutic intervention in development, to name a few.