Manual therapy has become somewhat controversial in recent times. Manual therapy general covers the physical therapy techniques of manipulation and mobilization. This controversy is based around the lack of good research that actually shows it works. That does not mean that it does not work, it just means that the quality of the research that supports its use is not very good. The other issue that is making it controversial is if it does work, then how does it work. In the past it was the dramatic cracking sound as a joint is put back into place. All the evidence now shows that that is not how it works and it probably works via some sort of pain interference system giving the impression that the pain is better. None of this is totally clear and more research is ongoing to try and resolve this problem. This poses a dilemma for clinicians who use these manual therapy techniques and need to make decisions about how to help their patients clinical and still be evidence based in what they do.

A recent episode of the podiatry livestream, PodChatLive attempted to address these sorts of issues when it comes to manual therapy for foot problems. In that episode the hosts interviewed Dave Cashley who gave his personal experience both from his many years of clinical practice and his own research on manual therapy. His research has been on its use for intermetatarsal neuroma and it is appearing to be promising. He also voices his opinion on some of the criticisms that have been directed at manual therapy.  David Cashley is podiatrist and a respected international speaker and educator. David is a fellow of the Royal College of Physicians and Surgeons and has published a number of papers on podiatric manual therapy in the literature in recent years. During his career, he has worked with professional sportsmen, elite athletes, world champions, international dance companies and the British military.