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Re: Spinal Manipulation on someone with a partial sacralization of the L5 vertebrae
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Re: Spinal Manipulation on someone with a partial sacra... - March 24, 2004 12:44:00 PM
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j
Posts: 74
Joined: January 7, 2004
From: wi
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Barrett, I have actually read that article. In fact, I have read most of your articles. They are well written, insightful and scientific minded.
Regarding my identity: I have not yet developed a sense of trust in the cyberworld. With the exception of emailing a couple of my closest friends, this is the first time I have used the internet to communicate with others. Even if I get an attachment on an email from a close friend I delete it if I'm not expecting it. I don't like to think of it as paranoia but rather extremely private. But I'll take a (giant) leap here. My name is John (ok it's really Jon), I live in rural WI. I have 1 wife and 2 dogs, all of whom I seem to be subserviant to. I am an APTA member.
You now know my real first name, one of my neurosis, something about my private life and my professional affiliation. I'm not ready to give my email or other personally identifying (or contact) information. I'm not sure if that's what your looking for but it's the good faith gesture that I can currently muster.
jon
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Re: Spinal Manipulation on someone with a partial sacra... - March 24, 2004 4:14:00 PM
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j
Posts: 74
Joined: January 7, 2004
From: wi
Status: offline
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Bill, thanks for the reference: Rob Wainner,
Reliability of the clinical examination: how close is "close enough" ? JOSPT. 2003;33(9): 488-490.
I agree it is a good article. I especially like his last sentences, "...finally, the reliability of results for a particular test or measure must be interpreted within the context of its intended use. Otherwise, how are we to know how close is close enough?" I think Flynn successfully answered the question if the special tests are reliable enough to predict success with manipulation (at least the selected technique). They are not. Flynn then goes on to demonstrate that they are not reliable enough to predict non-success either. But this may be my own confimation bias. It is to avoid being victimized by this potential bias that I request other's point of view but I'm suprised how little interaction (from a wider audience) this topic has gotten. Surely these are widely used tests. It was a good article regardless of interpretation.
Again, thanks for the reference, jon
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Re: Spinal Manipulation on someone with a partial sacra... - March 25, 2004 2:42:00 AM
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chiroortho
Posts: 655
Joined: February 18, 2004
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Maybe time for a new thread?
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ChiroOrtho
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Re: Spinal Manipulation on someone with a partial sacra... - March 25, 2004 6:58:00 AM
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j
Posts: 74
Joined: January 7, 2004
From: wi
Status: offline
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Chiro-ortho: Why? Are you bored? Do the issues leave you conflicted?
The (special tests used to predict manipulation)horse may be down with 4 broken legs but its still breathing. Someone could still revive it or put it out of its misery.
Since, no one is stopping you from starting a new thread I presume your comments were mostly a request for, at least me, to quit beating on the horse. I will. I don't feel I have much more to offer at this point. But there must be some silent readers itching to discuss the topic. Perhaps, you. What's your take on the utility of special tests to predict manipulation outcomes and the role reliablity plays? I see you published a paper on the topic of regional physical examination. That's more than I've ever done. Perhaps your comments will shed some insight.
jon
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Re: Spinal Manipulation on someone with a partial sacra... - March 25, 2004 11:49:00 AM
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chiroortho
Posts: 655
Joined: February 18, 2004
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Jon,
Your post was funny, thank you. [IMG]http://www.rehabedge.com/forums/smile.gif[/IMG]
As to pre-manip evals, Jon, I'd like to impress you, but honestly motion-augmented palpation combined with patient response re: capsular irritation (tenderness) is what I use in my "algorithmic decision tree" when caring for my patients. If the joints move to my satisfaction, and they're nontender, I leave them alone. If they are restricted, +/- tender, I utilize HVLA or axial decompression manipulation.
Where are all of the scientific studies, you ask? I don't know, my friend. I wish that there were a plethora of RCTs out there confirming what you and I know clinically.
But take heart. With time, the studies will come, and your instincts will be proven valid. But until that time comes, I have to be honest with you since I'm on your PT forum, and tell you that the RCTs are lacking in number, and those that exist are not compelling, to my knowledge.
So, do we eschew manipulative therapy? Absolutely not. At least I won't. But do we push aggressively for more studies to support diagnostic and therapeutic protocols? You bet.
Respectfully,
Greg Priest
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ChiroOrtho
[This message has been edited by chiroortho (edited March 25, 2004).]
[This message has been edited by chiroortho (edited March 25, 2004).]
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Re: Spinal Manipulation on someone with a partial sacra... - March 25, 2004 4:51:00 PM
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j
Posts: 74
Joined: January 7, 2004
From: wi
Status: offline
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"Where are all of the scientific studies, you ask? I don't know, my friend. I wish that there were a plethora of RCTs out there confirming what you and I know clinically."
Just to be clear, that is not what I am asking and I'm afraid what you and I know clinically may be disparate. But thanks for your honest reply.
jon
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Re: Spinal Manipulation on someone with a partial sacra... - March 25, 2004 9:51:00 PM
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Alex Brenner PT MPT OCS
Posts: 1057
Joined: February 29, 2004
From: Kentucky
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John,
What is your hesitation with performing manipulation? You mentioned in any earlier post about the risks being minimal and you state that you know it works for some people. Why aren't you doing it or learning it?
Army
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Re: Spinal Manipulation on someone with a partial sacra... - March 26, 2004 1:02:00 PM
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j
Posts: 74
Joined: January 7, 2004
From: wi
Status: offline
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Army,
Good questions. I'll answer them under Bill's new thread. I suddenly realized that what chiro-ortho might have been suggesting is that I was so far off topic, why not start a new thread. Bill's new topic may be a more appropriate subject heading. I'm interested in going down this road even though I myself may be on shaky ground.
Also, it may be later than today. My in-laws are coming and I have to get our home in-law acceptable.
jon
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Re: Spinal Manipulation on someone with a partial sacra... - June 16, 2004 10:33:00 AM
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Flexxion
Posts: 16
Joined: March 16, 2004
From: Miami, FL USA
Status: offline
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ArmyPT,
There are a couple things i'd like to ask of you. Before anything else, I feel compelled to say that I have profound respect for your knowledge and skills as a physical therapist. Every response i read from you has a rational explanation and is supported clinically.
I was reading about your right SI mobilization, the one you referenced to a PT journal article. I simply wanted to know which one this was specifically if you had the time to briefly describe the position and mobilization. I am not a member of the APTA so i dont have access to the mag. Im always open to new tx ideas for future potential patients.
Another thing completely off topic, I had been recently seriously considering joining the army as a physical therapist. What i would like to know is, are there a handful of bases i would have to work at? You have mentioned boot camp and i know of one in north carolina, but i was considering my options. Again, im not sure what entry level would be salary-wise, but i really have no say, being that i just recently acquired my license. Are there any pros or cons you think i should be aware of before considering?
Nonetheless, you can reply here or via email at Liquidglas@aol.com, I would sincerely appreciate it.
thank you so much in advance,
_____________________________
-Gil
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Re: Spinal Manipulation on someone with a partial sacra... - June 17, 2004 1:56:00 AM
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Alex Brenner PT MPT OCS
Posts: 1057
Joined: February 29, 2004
From: Kentucky
Status: offline
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Gil,
Thanks for the kind words. I sent you a couple of emails to the above address.
Army
_____________________________
Alex Brenner, PT, MPT, OCS
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Re: Spinal Manipulation on someone with a partial sacra... - June 17, 2004 5:46:00 AM
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Yogi
Posts: 403
Joined: April 5, 2004
From: San Antonio, Tx., USA
Status: offline
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Wow, amazing. I am so intrigued with this dialog, not having been trained or utilizing Manipulation (Grade 5 Mobs.) except once or twice, at my wit's end as a last resort. I do little to no ortho treatment though, for a long time. However, I found Jone's Strain/Counterstrain treatment and tenderpoint treatment guidance, to be entirely safe, rationale easily explainable to the pt., and effective acutely and chronic, except in cases of fibro and CMP (www.sover.net).
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Re: Spinal Manipulation on someone with a partial sacra... - December 3, 2004 5:40:00 AM
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Alex Brenner PT MPT OCS
Posts: 1057
Joined: February 29, 2004
From: Kentucky
Status: offline
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Hi. Someone on this thread had mentioned about writing this up as a case report. So I did and sumbitted it to JOSPT back in July. After a couple of revisions over the past several months I just found out today it will be published. Look for it in JOSPT in the next several months. Thank you all for making this topic interesting and thought provoking.
Army
_____________________________
Alex Brenner, PT, MPT, OCS
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Re: Spinal Manipulation on someone with a partial sacra... - December 3, 2004 9:32:00 AM
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Shill
Posts: 1056
Joined: February 13, 2003
From: Madison WI USA
Status: offline
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Not only that, but we get to find out if your real name actually IS Army!
I plan on doing a case study for publication as well, thanks in advance for being a good reference if I need one! (Please?)
_____________________________
Steve Hill PT
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Re: Spinal Manipulation on someone with a partial sacra... - December 3, 2004 10:39:00 AM
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SJBird55
Posts: 2292
Joined: May 10, 2004
From: Michigan
Status: offline
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Congratulations, Army!
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