Recently British singer-songwriter Ed Sheeran sang and played his guitar on the witness stand in defense of a $100 million copyright infringement lawsuit filed against his hit song “Thinking Out Loud”. The estate of Marvin Gaye alleged Sheeran's’ chart topper copied a four-chord sequence from Gaye’s classic song “Let’s Get It On”.
The copyright litigation was all about chord sequence. Could different songs have the same chord sequence and still be unique pieces of music?
As Sheeran sang and played his guitar for the jury he showed the four-chord sequence on trial was a common chord progression in hundreds of popular songs across time and musical genres. Sheeran won! He discussed the outcome and played the series of songs that helped him win in a Howard Stern interview (HERE)
Musical chords are the building blocks of a song. When chords and lyrics perfectly join forces, they create a chord signature that just sounds good. It’s that unmistakable feeling, emotion, or rhythm you feel when your favorite song is played. You reach over, turn it up, and smile!
What does Ed Sheeran's chord signature have to do with manual therapy?
Similarly, clinical treatments grounded in clinical reasoning are the building blocks of a successful patient outcome. When patient care is delivered it creates a treatment signature.
A 2022 study by Lutz et.al compared treatment signatures of 1,240 physical therapists (PTs) comparing differences between high-performing PTs and low-performing PTs in the treatment of lower back pain. (HERE)
Can select clinical treatment combinations, like chord combinations that produce hit songs, form a treatment signature that shows superior outcomes for lower back pain (LBP)? Indeed it can!
Lutz et.al states “It is well-established that baseline disability level has the strongest influence on the change in patient-reported outcomes (PROs) from initial to final PRO. However, clinical performance and care delivery strategies of PTs have not been described or demonstrated to vary across patients of differing baseline disability”
The purpose of the study was to compare differences in care delivery, aka treatment signatures, of PTs classified as “outperforming”, “meeting expectations”, or “underperforming relative to the predicted change in the Modified Low Back Pain Disability Questionnaire (MDQ) across patients receiving care for LBP.
Highlights:
Patients were divided into quartiles of baseline disability via the MDQ and outcomes were compared to the type of billed units per visit (UPV). The study examined four types of billed UPV:
- Active Exercise-based UPV
- Manual Therapy UPV
- Modality UPV
- Skilled UPV (this group was created to describe the sum of a combination of active & manual therapy UPV)
A consistent pattern emerged in which “high-performing” PTs maintained a high level of Skilled, one-on-one interventions across their entire caseload.
“High-performing” PTs incorporated a treatment signature that included a consistent blend of Skilled, Active, and Manual therapy interventions distinct from lower-performing PTs.
“Low-performing” PTs significantly decreased the use of the same interventions as baseline disability increased.
My Take:
This study’s massive sample size unmistakably demonstrated the therapeutic power of including MT for LBP. However, the current profession-wide trend of exercise-only and “just load it” remains strong. This trend remains despite a multitude of studies supporting the superiority of multimodal care.
Further, while clinicians continue to weigh the place and importance of MT, there is a steady decline in manual therapy handling and clinical reasoning skills. There are many influences for this trend, however, studies like this suggest we must have and build solid manual therapy skills!
I encourage all clinicians to have confidence that there is good research supporting MT combined with other interventions. It does not have to be only exercise to be EBP. Explore manual therapy courses to find one you like. Dig deep into it and get certified. Not for the letters that come with it, but for the skill and confidence you will gain.
Conclusion:
It is common for hit songs from different times and genres to share similar or even identical chord sequences and yet not sound the same. Some chord signatures sound better together. So too with MT!
Developing and practicing manual therapy handling skills gives you treatment options that create evidence-based treatment signatures. Joining MT interventions with exercise, activity modification principles, and education topics are “four-chords” that will help you create “platinum record” clinical hits.
Find your clinical tune, your rhythm, and your style. See how it plays.
Reach over, turn it up, and smile together with your patients!
Jarrod