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msundi83 -> SMT (October 10, 2005 12:56:00 PM)
Do PTs use spinal manipulative therapy? I assume it takes additional training, but is it within the scope of practice or is that the domain of the D.O. and chiropractor?

JLS_PT_OCS -> Re: SMT (October 11, 2005 6:04:00 AM)
Michael- Spinal manipulative treatment has been part of the treatment skill set of the PT since the profession's inception. Different schools of thought use different techniques, and different states have rules that govern the services offered by various professions, including PT. This may change what treatments are offered in an individual state. Many forms of manual therapy, including manipulation, are covered in the entry-level education program of Physical Therapists, and questions on it's use are covered on the licensure exam. There are postgraduate courses, but they are not required to practice this part of Physical Therapy safely and effectively. For more information, see [URL=http://www.apta.org.]www.apta.org.[/URL] Have a great day. J

UTDC -> Re: SMT (October 11, 2005 8:25:00 AM)
[QUOTE]Spinal manipulative treatment has been part of the treatment skill set of the PT since the profession's inception [/QUOTE]This is something that I have heard a number of times, however I have not been able to come up with a reference. If you know of one, could you point me to it? Thanks

JLS_PT_OCS -> Re: SMT (October 11, 2005 9:32:00 AM)
I'm not sure what kind of reference you're looking for. I'll provide you several. It is discussed at length in the history of the profession, which you can get at [URL=http://www.apta.org.]www.apta.org.[/URL] Pictures of techniques and instructions abound in even the early textbooks of our profession. We have published in journals in this area since the 1920s and 1930s, here are some references: McKenzie RT. The place of manipulation and gymnastics in corrective treatment. The Physiotherapy Review 1929:9:240-241. Sampson CM. Physiotherapy Technique:A Manual of Applied Physics. St Louis. CV Mosby Co. 1923 Leadbetter GW. The etiology, diagnosis, and treatment of lumbo-sacral and sacro-iliac strains. The Physiotherapy Review. 1930: 10: 458-460 Herman RF. The art of mobilizing joints. Physical Therapy. 1936: 16:94-95 Thornhill MC. Manipulative treatment for the lumbosacral derangement. Physical Therapy. 1936: 15 Is that a good start? J

JLS_PT_OCS -> Re: SMT (October 11, 2005 9:44:00 AM)
Here's an important one I shouldn't have left out: Paris SV. The history of manipulative therapy. JMMT. 2000:8(2): 66-67 Happy reading everyone... J

UTDC -> Re: SMT (October 11, 2005 10:49:00 AM)
Thanks Jason. Bummer is my online access to JMMT only goes back to 2001. I'll try to dig up some of the others, but so far I have not had any luck. Jeff

jma -> Re: SMT (October 11, 2005 10:55:00 AM)
I don't think you can get a better start without looking at those articles.

UTDC -> Re: SMT (October 11, 2005 12:05:00 PM)
[QUOTE]I don't think you can get a better start without looking at those articles. [/QUOTE]JMA, you lost me, although that is easy to do sometimes. Jason, I did run across this article: History of IFOMT. By: Lamb, David W.; Kaltenborn, Freddy M.; Paris, Stanley V.., Journal of Manual & Manipulative Therapy, 2003, Vol. 11 Issue 2, p73, 4p This seems to point out that manual therapy/manipulation entered into the physical therapy in the 1950's/60's

jma -> Re: SMT (October 11, 2005 2:43:00 PM)
They should have made us read those articles when we were in school. Classic research. Wonder if the hospital library has them.

MickeyPT -> Re: SMT (October 11, 2005 5:51:00 PM)
Physical Therapy as a profession is thought to have began in 1894 when English nurses formed the Chartered Society of Physiotherapy. Physiotherapy (Physical Therapy) treatment primarily consisted of exercise, massage, and traction up to, and into, the 1940's. Manipulative procedures to the spine and extremity joints began being practiced in the early 1950's and, unlike past treatment with manipulation, was combined with exercise.

Randy Dixon -> Re: SMT (October 11, 2005 6:15:00 PM)
Just looking over some of the notes from Paris, and it seems that even in the 60's manipulation was confined mostly to Osteopaths and DC's. However, PT's certainly do it now and lead much of the research.

UTDC -> Re: SMT (October 11, 2005 8:07:00 PM)
[QUOTE] Just looking over some of the notes from Paris, and it seems that even in the 60's manipulation was confined mostly to Osteopaths and DC's. However, PT's certainly do it now and lead much of the research. [/QUOTE]Randy, That was my understanding. I agree with your comment re: research. There are a handful of PT researchers that are pumping out some huge papers.

JLS_PT_OCS -> Re: SMT (October 12, 2005 3:32:00 AM)
I know that since it is seen as only one tool in our box, so to speak, that it has gone through several periods of more/less popularity. I think, for example, CBT type treatment is recently coming back into vogue in much the same way, whereas the isokinetic testing and measurement has gone out of favor. One of the benefits of not being a one-trick pony, I guess, is that stuff comes in/out of prominence... Jeff- I think probably the same can be said of you guys as far as different parts of your practice coming into and fading out of popularity. I'll bet it's a very similar pattern. The forming of the IFOMT was really where things got more codified and organized, international cooperation started, and manipulative care given greater attention. I think it was at the top of one of those waves of popularity, it subsequently got less popular, and now recently is enjoying another resurgence. Only this time with evidence to back it up... J

Barrett -> Re: SMT (October 12, 2005 3:45:00 AM)
Here's a personal story about manipulation's rise and fall. In '72 while I was a senior PT student at Ohio State, John Mennell M.D. was invited to present a program for the physiatrists in the rehab clinic. He was the son of James Mennell who preceded Cyriax at St. Thomas in London and had written a book titled "Joint Play" about his personal method and philosophy of manipulative care. One of the PT instructors asked permission to attend his workshop and it was denied. She was then denied permission even to so much as observe. The medical director was apparantly fearful of any PT learning something like this. Three years later I was assisting John (a wonderful gentleman) when he taught courses organized by Stan Paris.

Diane -> Re: SMT (October 12, 2005 4:56:00 AM)
[QUOTE]One of the PT instructors asked permission to attend his workshop and it was denied. She was then denied permission even to so much as observe. The medical director was apparantly fearful of any PT learning something like this. Three years later I was assisting John (a wonderful gentleman) when he taught courses organized by Stan Paris.[/QUOTE]Barrett, was it sexism? My impression has always been that manip has been handed down as a specific form of occult knowlege since before the dark ages, through generations of the same army gymnasts who hooked up with the therapeutic massage nurses to form PT in its early days as a profession, taught only in one on one fashion to those who had a set of attributes perceived to be favorable, who were selected by those who knew how and wanted to pass on a skill set. Furthermore, my understanding is that this underground method of passing on the tool of manipulation only surfaced into "regular PT" (civilian) in the last 30-40 years, aided by these medicos who were interested in it. Is this verifiable or is it myth?

JLS_PT_OCS -> Re: SMT (October 12, 2005 5:15:00 AM)
I don't know how underground it ever was, it does appear in references as early as the 1920s by PTs, and on and off through our profession's history. I do think it somehow acquired a level of mysticism or a reputation as being a secret only a few could access and use. I'm not sure why this is, but protectionism sure seems the most likely culprit. Funny how recent scientific research has demonstrated that in order to be successful neither a large amount of training nor experience is required in this simple pyschomotor skill. I wonder how the protectionists feel about that. I'll ask the Arkansas chiro board what they think... :) J

Barrett -> Re: SMT (October 12, 2005 5:23:00 AM)
Diane, I don't believe the sex of the therapist had a thing to do with this. My instructor's name was Ann Downer, the author of a widely used "cookbook" (her own description) for the use of PT modalities. She was Army trained and most hesitated to mess with her. I would have loved to see what happened when she was told she wouldn't be allowed to watch Mennell work. When Paris arrived in Boston circa 1967 he was forbidden to teach any manipulation.

Diane -> Re: SMT (October 12, 2005 5:27:00 AM)
So, Barrett, how did you manage to surmount the barrier that Ann Downer with all her 'don't mess with me' attributes, couldn't? Just curious about wisps of PT history/trends. I should think that within the 'protectionist' mentality a great deal of sexism would be in effect. It has been that way all through time. I'm sure it would have taken hundreds of thousands of Ann Downers to change the internal culture of a protectionist attitude toward manipulation. Think of the stratospheric levels of vasopressin/testosterone that must have surrounded that knowlege base. Jason, sounds like it's more than a myth then.

Barrett -> Re: SMT (October 12, 2005 5:37:00 AM)
It's simply that when I want to learn something nothing stops me. My lack of concern for the opinion of others seems to be genetic in nature and is, I suppose, the opposite of charm. Mennell didn't care who he taught-it was the paranoia of the medical men at Ohio State that ruled the day when I was there.

Diane -> Re: SMT (October 12, 2005 5:48:00 AM)
Presumably Ann Downer was someone who wanted to learn too, and who wouldn't have accepted anything/anyone stopping her yet someone/something did... Can you fill out for me who stopped her and why she let them get away with it?

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