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Re: Diagnosis and Palpation in Manual Tx
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Re: Diagnosis and Palpation in Manual Tx - March 8, 2005 1:14:00 AM
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dosrinc
Posts: 335
Joined: December 9, 2004
From: Bonita Springs
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Can I ask what age range the Flynn study with the CPR for spinal manipulation was performed on. We reviewed this in one of our local journal club meetings but can't seem to find it now. Thanks!
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Re: Diagnosis and Palpation in Manual Tx - March 8, 2005 2:55:00 AM
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Pelfixer1
Posts: 25
Joined: February 6, 2005
From: Spring Hill/Brooksville, Fl.
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Army:
There is no such thing as a anterior innominate, but the most common sacroiliac joint malalignment is a posterior rotation of the left ilium.
_____________________________
Roger C. Skovly, P.T.,M.A.
4142 Mariner Boulevard
P.O. Box 413
Spring Hill, Fl. 34609
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Re: Diagnosis and Palpation in Manual Tx - March 8, 2005 2:59:00 AM
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Pelfixer1
Posts: 25
Joined: February 6, 2005
From: Spring Hill/Brooksville, Fl.
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Jason:
No, what I am saying is they are not using the correct method/improper landmarks. There is a difference.
Thanks!
Roger
_____________________________
Roger C. Skovly, P.T.,M.A.
4142 Mariner Boulevard
P.O. Box 413
Spring Hill, Fl. 34609
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Re: Diagnosis and Palpation in Manual Tx - March 8, 2005 3:25:00 AM
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JLS_PT_OCS
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From: USA
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Roger-
Thanks for the clarification.
Given the evidence posted here to date, do you feel your approach is evidence-based?
Thanks again.
J
_____________________________
Jason Silvernail DPT, OCS, CSCS
"It isn't what you're able to do that requires your courage but rather what you have come to understand and are willing to express." - Barrett Dorko,PT
**I no longer post on RehabEdge**
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Re: Diagnosis and Palpation in Manual Tx - March 8, 2005 12:22:00 PM
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dosrinc
Posts: 335
Joined: December 9, 2004
From: Bonita Springs
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Richard DonTigney states in his research that 80% of all back pain is due to SIJ dysfunction, nearly all of which is anterior rotation of the involved innominate, (AAOMPT conference 2003).
Roger Skovly states that there is no such thing as an anterior innominate (Rehab edge today)
Who is right? both? neither? Both admitedly rely on their detailed examination and documentation of thousands of patients over the last several years. Neither can point to RCT's to confirm their findings, both report to have studies in the works. Will we ever know?
Rick
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Re: Diagnosis and Palpation in Manual Tx - March 8, 2005 1:30:00 PM
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Jon Newman
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From: Amherst, WI
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Hi Rick,
In the validation study the age range for inclusion criteria was 18-60 and those that participated in the study were, on average 33.9 (+/- 10.9) for the entire group.
jon
_____________________________
[URL=http://www.sonymusic.com/clips/selection/30/064887/064887_03_03_30.wav]Evidence[/URL]
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Re: Diagnosis and Palpation in Manual Tx - March 9, 2005 1:00:00 AM
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dosrinc
Posts: 335
Joined: December 9, 2004
From: Bonita Springs
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Given the age range on the study listed by jon above, has anybody generalized these findings to an older population? Given my location in SWFLA a high percentage of my patients fall in the 65 and over category and I have been reluctant to take full advantage of the CPR for manipulation on this group, any experiences in manipulation for the older group, am I still practicing EBM if I generalize the findings to the older population?
Thanks in advance for your insight.
Rick
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Re: Diagnosis and Palpation in Manual Tx - March 9, 2005 1:09:00 AM
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JLS_PT_OCS
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From: USA
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Rick,
Good point on your contention of who is right concerning the strong opinions of those with no data to back them up.
I will say that overall, I love working with older folks and dearly wish I had more of them to treat in daily practice.
I find patients who have stiffness or lack of motion respond the best to manual treatment in general (eg recent CPR), and since older folks tend to be...
1. Stiff (in the body)
2. Realistic in their expectations of care
3. Willing to work hard to improve their functional status
...I love them.
Have you considered just mobs in sidelying for those patients who fit the CPR but you are uncertain about manipulating? I have heard that there is a newer study getting started comparing the SIJ/Chicago technique with the sidelying roll manip for folks meeting 4/5 on the rule, so more data may be forthcoming soon.
And remember EBM means applying the best available evidence in conjunction with your clinical experience in the care of an individual patient. That is not, as some would have it, slavishly following a formula.
_____________________________
Jason Silvernail DPT, OCS, CSCS
"It isn't what you're able to do that requires your courage but rather what you have come to understand and are willing to express." - Barrett Dorko,PT
**I no longer post on RehabEdge**
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Re: Diagnosis and Palpation in Manual Tx - March 9, 2005 4:06:00 AM
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dosrinc
Posts: 335
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From: Bonita Springs
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Jason, thanks for the reply,just mobs in sidelying is exactly what I tend to do, I have been reluctant to change not only because of the age generalization issue but also because the sidelying techniques are so darned effective. I have been doing more of the manips than prior to my reading of the Flynn study but usually just on those who haven't responded as well to the mobs alone, a small %. Thanks again
Rick
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Re: Diagnosis and Palpation in Manual Tx - March 10, 2005 3:03:00 AM
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Pelfixer1
Posts: 25
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From: Spring Hill/Brooksville, Fl.
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Dear Jason:
Thanks for the question on evidence based. I am "on-the-road" to some meetingd and will address your question when I return.
Thanks again!
Roger
_____________________________
Roger C. Skovly, P.T.,M.A.
4142 Mariner Boulevard
P.O. Box 413
Spring Hill, Fl. 34609
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Re: Diagnosis and Palpation in Manual Tx - March 10, 2005 3:55:00 AM
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JLS_PT_OCS
Posts: 1684
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From: USA
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Dear Roger:
Thanks for replying yet not answering my question.
Just kidding. :)
Travel safely, look forward to your return and our continued discussion.
J
_____________________________
Jason Silvernail DPT, OCS, CSCS
"It isn't what you're able to do that requires your courage but rather what you have come to understand and are willing to express." - Barrett Dorko,PT
**I no longer post on RehabEdge**
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Re: Diagnosis and Palpation in Manual Tx - March 11, 2005 3:00:00 AM
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Yogi
Posts: 403
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From: San Antonio, Tx., USA
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Bill, have missed your inputs for awhile.
Jason, thanks for your thoughtful Mar. 7 post, very good point about the "middles".
LLD's , lots to look at there, there's "true" and "apparent". It's necessary to identify which, then where it's at, if there is either pain, which most of you deal with, or a gait abnormality. I've sometimes found them very useful in the devlopmentally delay population for gait issues. I would only use on in normal population if the cause was actual identified bony abnormality. Hypermobile hip joint can cause one in standing. Landmarks I use are ASIS's, umbilicus, and trochanters if I can, those are for measuring, and the malleolus. I screen with standing crest heights, then a pull to sit (I know, but it's only a screen), then supine hips and knees flexed with feet on bed or mat, then measure or treat as indicated with info from other tests.
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Re: Diagnosis and Palpation in Manual Tx - March 22, 2005 5:42:00 AM
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JLS_PT_OCS
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From: USA
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Don't want to let this great thread expire just yet.
Roger, you back from travelling yet? Would love to keep discussing....
_____________________________
Jason Silvernail DPT, OCS, CSCS
"It isn't what you're able to do that requires your courage but rather what you have come to understand and are willing to express." - Barrett Dorko,PT
**I no longer post on RehabEdge**
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Re: Diagnosis and Palpation in Manual Tx - March 22, 2005 10:54:00 AM
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lynx
Posts: 29
Joined: March 21, 2005
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Has anyone read this web article on chiropractic Motion Palpation?
"A Close Look at Motion Palpation" by Allen Botnick, DC, BA
http://www.geocities.com/healthbase/chiro_motion_palpation_botnick.html
It has some insightful explanations of the problems inherent in the technique. They agree with the earlier comment about how it is critical to have a good neutral position before expecting a symmetrical ROM.
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Re: Diagnosis and Palpation in Manual Tx - March 23, 2005 5:58:00 AM
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JLS_PT_OCS
Posts: 1684
Joined: January 30, 2005
From: USA
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That's a good article. It pretty much supports what many of us are saying here...that such a system only shows us...how did Barrett put it...something like "inconsistent and unreliable motion differences, and useless asymmetry"...something like that, but he's much more eloquent than me.
Many of the more EBM leaning manual PTs i know disregard that sort of palpatory model for diagnosis, but feel the system does help you get one perspective, as well as practice palpation and tissue handling skills. There seems to be some value in that, I would think.
_____________________________
Jason Silvernail DPT, OCS, CSCS
"It isn't what you're able to do that requires your courage but rather what you have come to understand and are willing to express." - Barrett Dorko,PT
**I no longer post on RehabEdge**
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Re: Diagnosis and Palpation in Manual Tx - March 23, 2005 11:52:00 AM
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lynx
Posts: 29
Joined: March 21, 2005
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Jason,
To me the bottom line is what is the purpose of the manipulation? The Motion Palpation technique is based on the questionable idea that restriction is due to adhesions. However, if the manipulation is just being used as a reflexive therapy to stimulate nerve endings then it would be better to manipulate patients only in a pain free manner to minimize the adverse effects. I don't see any advantage whatsoever in learning to feel diagnostic illusions.
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Re: Diagnosis and Palpation in Manual Tx - March 24, 2005 12:54:00 AM
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JLS_PT_OCS
Posts: 1684
Joined: January 30, 2005
From: USA
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lynx,
I would agree about diagnostic illusions.
I use manipulation to improve the motion and kinematics of the spine, and reduce pain.
It is a limited treatment, and always followed by corrective exercise, but i do feel it is indispensable in the treatment of spinal pain syndromes.
I really don't let myself be bothered too much with what the reason is, mechanistically, for the improvement. I just am comfortable not knowing the whole picture, and proceed with the tools we currently have to try to achieve the best outcome for the patient.
Thanks for your interest.
J
_____________________________
Jason Silvernail DPT, OCS, CSCS
"It isn't what you're able to do that requires your courage but rather what you have come to understand and are willing to express." - Barrett Dorko,PT
**I no longer post on RehabEdge**
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Re: Diagnosis and Palpation in Manual Tx - April 29, 2005 5:08:00 AM
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JLS_PT_OCS
Posts: 1684
Joined: January 30, 2005
From: USA
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New study posted on the Evidence In Motion group:
Anatomy in Practice: Lumbar Zygoapophyseal Joint Palpation
Mercer, Cornwall
NZ Journal of Physiotherapy - NOV 2004
It illustrates the anatomy of the facet joints and brings up the multiple issues and problems associated with the motion palpation approach. Yet another nail in the coffin.
J
_____________________________
Jason Silvernail DPT, OCS, CSCS
"It isn't what you're able to do that requires your courage but rather what you have come to understand and are willing to express." - Barrett Dorko,PT
**I no longer post on RehabEdge**
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Re: Diagnosis and Palpation in Manual Tx - April 30, 2005 2:06:00 PM
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Barrett
Posts: 967
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From: Cuyahoga Falls, Ohio
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It's because of information like this Rehab Edge remains so useful and all but unique. I still wonder why every therapist I describe it to doesn't join, and why virtually none actively participate. Is it because so many sacred cows of traditional practice are challenged? Is it really only the fear of public speaking?
Anyway, Threlkeld's article "The Effects of Manual Therapy on Connective Tissue" (Physical Therapy Volume 72, Number 12/December 1992) makes it clear that though the forces generated by manual care are sufficient to permanently elongate connective tissue, it is not possible to direct sufficient force to the target tissue at the right angle.
My question: Why look so hard (and, as it turns out, unreliably) for something that you can't change anyway?
_____________________________
Barrett L. Dorko P.T.
http://barrettdorko.com
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Re: Diagnosis and Palpation in Manual Tx - April 30, 2005 9:07:00 PM
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TLB
Posts: 356
Joined: September 13, 2002
From: Arizona
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Barrett,
Are you a member of the APTA? If so state why or if not please give some reasons why. You say you don't understand the reason for people not participating in this forum, I say I don't understand people not participating in their career.
I'm not trying to get off topic, just curious.
_____________________________
Todd
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