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When did PTs start learning manipulation?
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When did PTs start learning manipulation? - March 1, 2004 1:59:00 PM
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chiroortho
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when did PTs start learning manipulative therapy, and what are the qualifications of those who train them?
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ChiroOrtho
"Brevity is the soul of wit"--Shakespeare
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Re: When did PTs start learning manipulation? - March 1, 2004 2:05:00 PM
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Dr.Wagner
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I remember being in PT school and learning manipulation essentially was the "work of the devil"...now the state school where I studied is pushing for manipulative rights. HUGE philosophy shift...sorta like chiros wanting to prescribes NSAIDS.
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Re: When did PTs start learning manipulation? - March 1, 2004 2:15:00 PM
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FLOrthoPT
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From: wellington, fl, usa
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there are several courses..some by the saunders group, many by the naiomt group based out of Canada, and I believe ola grimsby too all have courses that instruct on manipulation. If we know how to mobilize specific joints and segments, is it really that hard to add speed tot he mobilization? I think it is quite a pretentious statement that you made to begin with. I do agree, nor do I think you have to worry about, and new PT grads performing manipulations, nor do I think there are many cases or times when a manipulation would be necessary over a mobilization or muscle energy technique. I think your questions is much like me asking: "so when did chiros learn the science of biomechanics of the human body, when did chiros learn to diagnose and treat orthopedic conditions unrelated to the spine. I mean enough with this terratorial bullshit. You have your methods of treating and we have our methods and many of our techniques, such as manual skills and therapeutic exercises and modalities overlap, and in fact may look (not the rhetoric that goes along with it, but the appearance)the same depending on which clinic someone were to stand in. What many of you fail to recognize is that you are arguing such a small percentage of what therapists treat...I mean all the arguments are over orthopedic high level patients....don't forget that yes, PT's are qualified to do wound care debridement, burn treatment, stroke and other neuro rehab, lymphadema treatment, workplace ergonomic assessments, geriatric treatment, amputee treatments, etc, etc, etc. Now why do hyou sit here and argue over the one small group that we have in common, is it a fear that we are on your turf? OR a fear that we may do the same treatments for the same dysfunctions? I just don't get the banter on here. Face it, there are some therapists who bedome real specialists in manual orthopedics and are better than you at manipulation. Granted, you too may be better than some therapists at modalities and rehab protocols, but who cares. MArket to your referring physicians, market to the public, and let the patients decide who they get along with better and who provides better care...I feel that there is nothing to argue, so enough with these quipes to start fights on here, it is obnoxious and it gives me a headache. Your profession does not own the right to spinal manipulations, nor does ours own the right to modalities, etc. If someone wishes to further their education and spend the time and money bettering themselves taking extremely high level cont. ed. courses to be a wonderful manual therapist so they can treat all sorts of spinal dysfunctions, then why bash them? Say congratulations, and share information to see if you can learn from them and vice versa. Enough...I need to study for my orthopedic boards for tomorrow...do you have specialty certifications to show the public which provider has become more of an expert in their field?
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Re: When did PTs start learning manipulation? - March 1, 2004 2:49:00 PM
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Andrew M. Ball PT PhD
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I learned manipulation more than 10 years ago in my spinal mobilization course at the MSPT level. I have, of course, taken additional coursework (the military has a great course and materials --- and less expensive than the program through University of St. Augustine).
Personally, I don't see what the big deal is. If a chiro can dabble in rehab, then a PT can certainly dabble in manipulation. It's not as though most PT's use manipulation all that often anyhow. Now DC's who think that they're as skilled as a PT when it comes to rehab --- well that's a horse of a different color!
Drew
[This message has been edited by Andrew M. Ball PT PhD (edited March 01, 2004).]
[This message has been edited by Andrew M. Ball PT PhD (edited March 01, 2004).]
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Re: When did PTs start learning manipulation? - March 1, 2004 3:20:00 PM
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chiroortho
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Whoa, guys, I didn't mean to offend...no sarcasm intended whatsoever.
I just wondered...good grief.
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ChiroOrtho
"Brevity is the soul of wit"--Shakespeare
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Re: When did PTs start learning manipulation? - March 1, 2004 3:24:00 PM
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chiroortho
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[QUOTE]Originally posted by chiroortho:
Whoa, guys, I didn't mean to offend...no sarcasm intended whatsoever.
I just wondered...good grief.
By the way, FLOrthoPt, I readily yield to your expertise in wound care and burns, etc. I have no desire or direct training in that area. I also think you would do a better job in actual hands-on rehab than I would, in all likelihood.
[/QUOTE]
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ChiroOrtho
"Brevity is the soul of wit"--Shakespeare
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Re: When did PTs start learning manipulation? - March 1, 2004 3:26:00 PM
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chiroortho
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The above post was meant to be an addition (edit) to my first...don't know how I did that.
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ChiroOrtho
"Brevity is the soul of wit"--Shakespeare
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Re: When did PTs start learning manipulation? - March 1, 2004 3:44:00 PM
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Andrew M. Ball PT PhD
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I'm not offended. Not at all. I am a litte annoyed, however, when I hear about what's going down in Arkansas with a chiro board attempting to regulate physical therapy practice --- especially considering that while many DC's use the "well I learned it in school" defense when challenged on DC's expanding scope into rehab, nutrition, etc . . . but when other professions respond in kind (e.g. PT's learning manipulation in school), many chiro's loose their mind.
Drew
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Re: When did PTs start learning manipulation? - March 1, 2004 3:58:00 PM
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chiroortho
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I don't blame you Drew, but turf battles are probably always going to be with us.
When I asked the questions, I really was just curious when manipulative therapy became part of the PT curriculum, and wondered who taught it...like other PTs that had training in it, or DOs or DCs, or who...
This forum is interesting to me, and I don't want to stir up any trouble. I hope that my PT friends will accept that at face value.
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ChiroOrtho
"Brevity is the soul of wit"--Shakespeare
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Re: When did PTs start learning manipulation? - March 1, 2004 10:43:00 PM
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Alex Brenner PT MPT OCS
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The Army has a very reputable Orthopaedic Manual Therapy program taught by leaders in military orthopaedic and manual therapy. These skills are also taught by instructors or graduates from this program in the US Army-Baylor University graduate program in physical therapy as an entry-level skill. I am a graduate of this program and have been performing manual therapy and manipulation since I was a new physical therapist with great success. The US Army-Baylor program and many other programs are advocates of manual/manipulative therapy as an entry level skill. I think that manipulation is an entry level skill and should be taught by all physical therapy programs. Just my thoughts.
Thanks,
ARMYPT, OCS
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Re: When did PTs start learning manipulation? - March 2, 2004 12:45:00 AM
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miklavda
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From: SLOVENIA
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[QUOTE]Originally posted by chiroortho:
when did PTs start learning manipulative therapy, and what are the qualifications of those who train them?
[/QUOTE]
This is my answer: [URL=http://www.etgom.be/shopping/english/EN_home.asp]http://www.etgom.be/shopping/english/EN_home.asp[/URL]
Good grief...
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Re: When did PTs start learning manipulation? - March 5, 2004 2:48:00 PM
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Mitch
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From: Somerdale, NJ
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PT's typically manipulate for reasons other than that presented by chiro's! Self mobs, to gradually increasing pressures, then Manips; however, there might be occassions when ya just might want to manip, but you are not doing so in an endeavor to align something that was never meant to be perfectly aligned to begin with (The Dynamic Spine).
PREMANIPULATIVE TESTING - Note The Logic - "Dynamic testing by repetitive motion should always precede the application of hands-on procedures and is a vital part of any mechanical assessment programme." "By applying patient-generated forces in the form of repeated movements, the ****stability of healing and reduction of derangement is tested and potentially unstable pathologies are exposed." 'The progressive increase of the applied stress from patient-generated to therapist-generated forces is a built-in safeguard of the McKenzie approach." "Once improvement ceases or slows or centralization remains incomplete, the next progression utilizing an increase of applied stress is indicated. In this way repeated movement testing serves as premanipulative testing prior to the use of therapist technique.(Wijmen,P., The Use of Repeated Movements in the McKenzie Method of Spinal Exam.,The McKenzie Ins., USA, Newsletter, Vol. 3, #2, Summer, 1995, p. 25). (End Quote).
"Asymmetry of spinal segments are not related to the incidence or occurrence of mechanical spinal pain." "Diagnosis based on identification of palpable or radiological asymmetries is unreliable." "In a review of 20 studies on the topic of the natural history of adolescent idiopathic scoliosis, Weinstein, and Dieck, (previously noted) report that 40% to 60% of these patients complain of back pain." "This incidence is comparable to the incidence of back pain in the general population." "The location of pain in scoliotic patients was variable and generally unrelated to the locations or magnitude of the curve." "The pain was also unrelated to the severity of radiological osteoarthritic changes." "Weinstein estimates that one percent of patients with scoliosis will require surgery specifically for backache." "That incidence is similar to that for the general population." "Three Swedish long-term studies of scoliosis with greater than 90% patient follow-up at more than 30 year's, demonstrated that low back pain was not a significant complaint."
“Based on epidemiologic studies, it appears that many radiographic anomalies are not associated with pain, including spina bifida occulta, single disc narrowing and spondylosis, most facet joint abnormalities, sacralization of a lumbar vertebra, lumbarization of a sacral vertebra, hyperlordosis, and Schmorl's nodes (However, a study by Frishman, Fidman and Azor found in their study that Spina Bifida occulta of S1 showed a higher incidence of posterior disc herniation, which increased with age, and which can be explained by instability of the base of the lumbar spine, (J Orthop Res 12:186-192, 1994). "Where palpable movement restrictions and other anomalies are identified, it is impossible to state that these are either the cause of the pt's present symptoms or are likely to cause symptoms in the future."
"The presence of palpable anomalies or restrictions of motion should not alone be the justification for the application of mobilization or manipulation." McKenzie teaches the use of manipulation, however, manipulation is to be utilized only as it is proven needed. Mobilization is frequently used to further centralize LBP when it stubbornly remains to one side, or one side greater than the other. (McKenzie, R, The Lumbar Spine, Mechanical Diagnosis and Therapy"; Waikanae, New Zealand,. Spinal Publications Ltd.; 1989. p. 96).
Witt and Vestergaard, Spine 1984. 166 Subjects - 66 Never had Low Back Pain. 100 Did. X-rays were taken. There were no significant differences in DDD, spondylitic changes, etc… X-ray findings did not significantly differ among the groups.
J Orthop Res 12:186-192, 1994 - “Based on epidemiologic studies, it appears that many radiographic anomalies are not associated with pain, including spina bifida occulta, single disc narrowing and spondylosis, most facet joint abnormalities, sacralization of a lumbar vertebra, lumbarization of a sacral vertebra, hyperlordosis, and Schmorl's nodes
Spine, V 22, No 4, February 15 1997 Spinal Radiographic Findings and Nonspecific Low Back Pain Maurits W. van Tulder, PhD, Willem J. J. Assendelft, MD, PhD, Bart W. Koes, PhD, and Lex M. Bouter, PhD Objectives. To examine the causal relationship between radiographic findings and nonspecific low back pain. Conclusions. There is no firm evidence for the presence or absence of a causal relationship between radiographic findings and nonspecific low back pain. Spine 1997;22:427-434 Spine 1997; 22:427 © 1997 Copyright owner Lippincott-Raven Publishers [URL=http://www.lippincott.com/spine/main.cfm?action=contents]http://www.lippincott.com/spine/main.cfm?action=contents[/URL]
Mark St., DC: This goes right to the root of the subluxation theory as it applies to upper cervical work. In humans nothing is truly symmetrical yet the concept is tantamount in the determination of subluxation and the means chosen for correction. Symmetry is only an implied reality. If one uses this implied reality as a basic operational premise they are operating with their own implied reality and assumptions, and not that of the natural. JMPT vol. 15, No. 9 Nov-Dec 1992 Asymmetry of the Occipital Condyles: A Computer-Assisted Analysis Teresa A. Febbo, D.C., Roger Morrison, D.C., and Richard Valente ABSTRACT Objective: To ascertain the incidence of asymmetry of the occipital condyles. The a priori hypothesis of symmetry (which is pervasive both in the determination of "subluxation" and in the means chosen for correction) was tested. Conclusion: The data suggest that the underlying premise of symmetry in chiropractic analysis needs to be reexamined.
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Re: When did PTs start learning manipulation? - March 5, 2004 3:24:00 PM
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chiroortho
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Mitch,
You've done an excellent job in collecting these studies.
If I understand the thrust (no pun intended) of your post, it's that xray findings suggestive of "malposition" or of certain anomalies do not necessarily predict the presence of pain.
If I understood correctly, I agree with you.
The fact is, I cannot look at an xray and tell you whether or not the person in the xray is having pain. And my purpose for obtaining radiographs is not to ascertain "malpositioned" vertebrae. I obtain films for reasons such as ruling out fractures, dislocations, or other pathology that may or may not explain the patient's pain, and to rule out contraindications to the type of therapy that I wish to utilize. If referral is indicated, I refer.
If I've misunderstood your point, my apologies.
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ChiroOrtho
[This message has been edited by chiroortho (edited March 05, 2004).]
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Re: When did PTs start learning manipulation? - March 6, 2004 9:25:00 AM
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Alex Brenner PT MPT OCS
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From: Kentucky
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[QUOTE]Originally posted by chiroortho:
The fact is, I cannot look at an xray and tell you whether or not the person in the xray is having pain. And my purpose for obtaining radiographs is not to ascertain "malpositioned" vertebrae. I obtain films for reasons such as ruling out fractures, dislocations, or other pathology that may or may not explain the patient's pain, and to rule out contraindications to the type of therapy that I wish to utilize. If referral is indicated, I refer.
[/QUOTE]
Chiroortho, I rarely order lumbar spine x-rays and tend to order them to help answer the same questions you mentioned above. With that, what are your thoughts on having a patient x-rayed in the supine position versus standing? Also, knowing what we know about the spines subtle normal variances that Mitch cited above, why would one spend so much time analyzing the x-ray and then treat the patient based on the x-ray findings and not based on your findings from the history and physical exam? I think this is a common Chiropractic approach if I am not mistaken (as read on my post on chiroweb). I am not knocking that approach, just curious as to the thought rationale.
ArmyPT, OCS
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Re: When did PTs start learning manipulation? - March 6, 2004 10:38:00 AM
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Scanner
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ArmyPT,
I think utilizing the x-ray as a way of determining thrust is becoming passe as chiropractors view the pathology of subluxation /joint dysfunction as "functional" vs. "structural." Some DC's still do "pre" and "post" x-rays to see if the spinal alignment has improved but I really can't think of one colleague in my county who does that. I know for sure it is discouraged at a lot of colleges and not recommended in the Mercy Document, a guideline document.
I am a bit of a throwback in that I will on certain cases do a pre and a post x-ray for lordosis assessment following extension traction.
But I tend to reserve for the more difficult chronic cases. That is, I am not pre and post x-raying George, a 20 year old male, who just hurt his back in the garage last week. . .
I will also occasionally use the x-ray to determine the size of a heel lift to see if there is major pelvic unleveling or if it is just functional. A PT may not do that and find that too aggressive I admit. . .
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Re: When did PTs start learning manipulation? - March 6, 2004 12:44:00 PM
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chiroortho
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[QUOTE]Originally posted by ArmyPT:
Chiroortho, I rarely order lumbar spine x-rays and tend to order them to help answer the same questions you mentioned above. With that, what are your thoughts on having a patient x-rayed in the supine position versus standing? Also, knowing what we know about the spines subtle normal variances that Mitch cited above, why would one spend so much time analyzing the x-ray and then treat the patient based on the x-ray findings and not based on your findings from the history and physical exam? I think this is a common Chiropractic approach if I am not mistaken (as read on my post on chiroweb). I am not knocking that approach, just curious as to the thought rationale.
ArmyPT, OCS[/QUOTE]
Supine xrays are fine with me in most cases, in contradistinction to some of my colleagues...this would not apply, for example, to a scoliosis study, or any other study where I felt that axial loading might produce a significant change. An advantage of supine films is that the patient is less likely to move, thus blurring the image and requiring a retake. Also, if the patient is obese, a supine AP lumbar projection can allow for a bit of flattening of the abdomen, thus better penetration and a better overall image. That said, I always prefer upright C-spine films in an office setting...of course in the ED, a single lateral cervical view while in a collar/on a spine board is prudent for obvious reasons. But not for routine imaging for a patient that walks into my office.
As to using lines and such on films...I do not draw ANY lines on my films, with the exception of an occasional Cobb angle measurement for scoliosis, or to measure angular displacement for impairment rating purposes. I do not believe that "listings", as they are called, are of any utility whatsoever. No offense to those who disagree.
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ChiroOrtho
(edited for multiple typos-sorry)
[This message has been edited by chiroortho (edited March 06, 2004).]
[This message has been edited by chiroortho (edited March 06, 2004).]
[This message has been edited by chiroortho (edited March 06, 2004).]
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Re: When did PTs start learning manipulation? - March 11, 2004 5:28:00 AM
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Diane
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From: Vancouver, B.C., Canada
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To chiroortho, and especially doughnut, and all...
The world moved on while you were fighting with PTs and MDs and DOs around you in your own limited locale, in the US. You may find the answers you seek about when PTs started manipulating by checking out this conference. As you will see PTs do much much more, and PTs MDs DOs, osteos, chiros worldwide are actually moving forward, TOGETHER!!! What a concept.. I'm sure it's strange and a little difficult for you to grasp.
You might want to attend this conference in Melbourne in November to get up to speed on how at the world level (that's i-n-t-e-r-n-a-t-i-o-n-a-l-l-y...) the disciplines are cooperating. You'll note that chiros will be there.
[URL=http://www.worldcongresslbp.com/]http://www.worldcongresslbp.com/[/URL]
Cheers,
Diane
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Re: When did PTs start learning manipulation? - March 11, 2004 5:33:00 AM
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chiroortho
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Diane,
Thanks for responding. I didn't mean to offend you by my question, but I understand how it could have seemed so...I was simply curious.
Sorry if I came across awkwardly.
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ChiroOrtho
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Re: When did PTs start learning manipulation? - March 11, 2004 7:09:00 AM
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Diane
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From: Vancouver, B.C., Canada
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No offense taken chiroortho. Here's to the world wide future of manual treatment, from all branches of the 'family tree' of practitioners.
(Imagine me raising a glass..)
I reeeeaaaaaally hope the more vitriolic chiro posters, the ones who took enlightened down with them when they got the boot, read about it.
Diane
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