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Re: Should manipulation be taught in Entry Level Physical Therapy Programs?
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Re: Should manipulation be taught in Entry Level Physic... - February 21, 2005 10:03:00 PM
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Alex Brenner PT MPT OCS
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From: Kentucky
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Mcap,
Duration of symptoms is only one of the clinical predictors for success with manipulation. The authors of these research articles suggest that manipulation should be considered if a patient has at least 3/5 of the clinical predictors. Certainly you are seeing patients in your clinic who have three out of five. If you are not fortunate enough to see acute low back pain then duration of symptoms may never be one of your predictors, but I am sure you are seeing patients with 1) low back pain not distal to knee 2) hip internal rotation greater than 35 degrees, 3) FABQ work subscale less than 19 and 4) hypomobility in at least one lumbar level as measured by a central PA glide.
MCap, you have certainly stated your case above that you will not use manipulation. That is fine, but I strongly feel that your students should be learning these techniques. If they don't, then I truly think they will be left behind in spine care.
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Alex Brenner, PT, MPT, OCS
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Re: Should manipulation be taught in Entry Level Physic... - February 21, 2005 10:09:00 PM
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Alex Brenner PT MPT OCS
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[QUOTE]A lot of the reserach is really, really poor.[/QUOTE]Could you please provide a list of this really, really poor research that has been published in the last 3 years?
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Alex Brenner, PT, MPT, OCS
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Re: Should manipulation be taught in Entry Level Physic... - February 22, 2005 4:39:00 AM
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mcap56
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To Army and Jason;
Your arguements are well reasoned and I don't necessarily disagree with your points. Again, I think you are both making too much out of my critique. All I am saying is that the bulk of evidence for manipulation indicates a short term benefit. What I object to is that the major proponents of this movement do not present the evidence that way. In an entire presentation last year, we were told, repeatedly, that there is no debate about the efficacy of manipulation. That is not an objective summary.
Do not confuse my own philosophies for what I teach. I often teach techniques and aspects of PT that I don't personally employ. I present the evidence in as balanced a manner as possible and let my students make their own decisions.
There are reasoned arguements for including manipulation in entry level programs. There are also, experienced manual therapists who would prefer to see that education take place post-entry level. You act as if there is no room for this debate. As a CI for students of many different schools over the years, some of them really, really good ones, I have met my share of students who do not understand back pain, have very little idea of psychosocial factors, can not perform a competant neurological scan and in general, demonstrate poor technqiue with the most basic mobilizations.
Why isn't the professor of cardiopulmonay PT receiving packets about what should be included in her curriculum? Why aren't the neuro professors receving packets about constraint induced therapy or partial weight bearing treadmill training?
This movement has become a major issue. And in light of that, I would like to see a more balanced presentation of the research. We still don't know how manipulation works. We still don't know what the effects are. And, we don't know what the long term effects are.
I respect both of you. If you are going to CSM, send me an email and perhaps we could meet over lunch or something. mcam54@hotmail.com
Take care,
Mcap
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Re: Should manipulation be taught in Entry Level Physic... - February 22, 2005 9:56:00 AM
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Jon Newman
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JMA,
Are you stating that you are actively being marketed to teach something?
jon
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[URL=http://www.sonymusic.com/clips/selection/30/064887/064887_03_03_30.wav]Evidence[/URL]
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Re: Should manipulation be taught in Entry Level Physic... - February 23, 2005 9:46:00 AM
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OrthoSam
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Hi Jason S,
Sorry I missed your post on Feb 8. I think I may have mis-phrased my comment a little. My comment was implying that current PT's/ recent grads ( those not taught to manipulate in school) who have now since graduated may or may not ever learn to manipulate. If they do decide to learn the technique, it will be optional.
When learning to manipulate in school, certain competencies for both mobilization and manipulation must be met (written and practical exam.)If a student has a patient where manipulation is an option, then if they choose not to manipulate they need to rationalize why they they chose other options. Personal preference really doesn't come in to the picture at that early stage of they game, because most just don't have enough experience to have formed preferences.
Undergrad student manipulation is,well... terrible! It may not ever get that much better. I think the point of having manipulation in school is to make sure that manipulation is a fundamental technique of physical therapists. I also believe that pscychology,nutrition and radiology should be fundamental classes taught to PT's also.
At times I think I am more of a psychologist than a P.T.
Cheers,
Sam
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Re: Should manipulation be taught in Entry Level Physic... - February 23, 2005 3:38:00 PM
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BRuchin
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From: Atlanta, Georgia
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I agree with what everyone is saying in respect to the belief that it should be taught in school and should be taught while students are in clinic. The field of manual therapy and a hands on approach is taking on a new level in the field and needs to be learned as soon as possible.
I believe that schools are slow to teach becasue most school's faculty are not in the clinic anymore and have not learned nor practiced to where they feel comfortable teaching the skills to students. when this is the case, the faculty should call on those from the community to facilitate this aspect of the curriculum. My school did it for us for the lumbar spine and we learned far more than our own faculty could have taught us.
I think educators should focus their CEUs not just on education, but should also focus on new skills, techniques, and methods that are developed and used. We are taught to use the research when we get out of school and the whole evidence based practice section of the APTA website, but why not use what the research says in the curriculum.
I do disagree with those who think it should be taught specifically in DPT programs compared to others. DPT, MPT, and MSPT are all on the same level. they are not paid more or less for the degree. A business cannot make more money off a DPT than a BSPT. We are all equal still. With that said, we should still be taught all that the same level. the schools that have not gone to the DPT as of yet is because the faculty again do not feel comfortable teaching the added courses that are required to be in a doctoral program.
I will use an arguement that I used in my research in school, more of an independent study, but still research...."Manual therapy is not the only way to treat a patient, but it is one choice of treatments from the therapist's tool box. To have it available to use through practice acts and through reinbursement, we need to learn it in school. if we are to begin to have autonomous practice as the APTA wants us too, we as therapists should be taught all ways to treat a patient and then let the therapist decide which "tool" to use, when, how, and why."
Manual therapy is a treatment technique and one that is being heavily researched at this time. In order to be effective in our treatments, we need to be able to use all methods. This is my belief. But I say this as a student that will graduate in May, and from the fact that I had to take it upon myself to learn and feel confident with the techniques. I met with area clinicians and learned hands on what i needed and the theory of why. I did it myself and i do not feel that others should have to. It should be in the curriculum.
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Re: Should manipulation be taught in Entry Level Physic... - February 24, 2005 4:25:00 AM
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jma
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Hello Jon,
To which post are you referring to, "that I am being actively marketed to teach something". I don't recall stating this. Perhaps you are referring to someone else's post.
JMA
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Re: Should manipulation be taught in Entry Level Physic... - February 24, 2005 4:51:00 AM
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Jon Newman
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Hi jma,
You stated, "Why isn't the professor of cardiopulmonay PT receiving packets about what should be included in her curriculum? Why aren't the neuro professors receving packets about constraint induced therapy or partial weight bearing treadmill training?"
In the context of that post it sounded like you are receiving packets suggesting what ought to be included in your curriculum and that this is not standard practice. Hence my request for clarification. Are you essentially being marketed?
jon
_____________________________
[URL=http://www.sonymusic.com/clips/selection/30/064887/064887_03_03_30.wav]Evidence[/URL]
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Re: Should manipulation be taught in Entry Level Physic... - February 24, 2005 5:01:00 AM
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jma
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Hello,
Please direct me to the date of the post you are referring to. I have look at the whole site, pertaining to this particular post and I do not see these particular statements said by me. Thanks for the clarificiation.
JMA
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Re: Should manipulation be taught in Entry Level Physic... - February 24, 2005 5:30:00 AM
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Sebastian Asselbergs
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jon, it's mcap's February 22, 2005 10:39 AM post you are referring to - not JMA's.
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Mundi vult decipi
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Re: Should manipulation be taught in Entry Level Physic... - February 24, 2005 5:52:00 AM
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Jon Newman
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My apologies.
jon
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[URL=http://www.sonymusic.com/clips/selection/30/064887/064887_03_03_30.wav]Evidence[/URL]
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Re: Should manipulation be taught in Entry Level Physic... - February 24, 2005 6:09:00 AM
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jma
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No apology necessary.
JMA
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Re: Should manipulation be taught in Entry Level Physic... - February 24, 2005 8:42:00 PM
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Alex Brenner PT MPT OCS
Posts: 1057
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From: Kentucky
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BRuchin,
I think you have made some good points. I would not agree however with the faculty using the excuse about inexperience. If there is little experience among the faculty with manual therapy/manipulation then I believe they owe it to their students to bring in guest lecturers/instructors. The faculty at my PT school were all orthopaedic and manual therapy instructors so for most other areas of PT such as pediatrics, neuro etc. they had guest instructors or faculty from other parts of the country come in and teach us. In my opinion your school should be doing the same for teaching manipulation.
In fact, the AAOMPT is sponsoring a course. It is advertised in this months Articulations newsletter.
Teaching Manipulation: An Evidence Based Approach; A Clinical Instructor and Faculty Workshop
COURSE DESCRIPTION DESCRIPTION:
This 2-day clinical instructor and faculty forum and laboratory workshop is designed to assist with the enhancement of thrust and non-thrust
manipulation in professional physical therapist programs. This program is cosponsored by the AAOMPT and the University provides the current best evidence on mobilization/ manipulation
in the management of musculoskeletal disorders and discusses the methods and resources available to more fully integrate these procedures into the
current professional curriculum and clinical internships. The main part of the program will be hands-on learning sessions in select spinal and extremity manipulation with an emphasis on skill
acquisition and laboratory instructional methods.....
University of Texas Health Science
Center-San Antonio:
March 18-19, 2005
Seton Hall University:
June 4-5, 2005
_____________________________
Alex Brenner, PT, MPT, OCS
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Re: Should manipulation be taught in Entry Level Physic... - February 25, 2005 5:42:00 AM
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BRuchin
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From: Atlanta, Georgia
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ArmyPT,
I am not saying that the faculty use an excuse, but they do not take the CEUs that in my opinion they should. But that is just my opinion. And I know that they now are starting to take the courses that you menitioned earlier. Tim Flynn and those have put together the CD of basic skills that they use, and I really like that for basic skills. But there is not a lot of discussion about the physiology of what is going on with manipulations.
I just feel that some schools are not bringing in the guests when they need to. I would like to see more schools bringing in guests to maximize the curriculum.
BRuchin
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Re: Should manipulation be taught in Entry Level Physic... - February 25, 2005 7:12:00 AM
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steve
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From: victoria, bc Canada
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Bruchin,
Where do you get the CD of basic skills from Flynn - I'd love to have it as a reference.
Steve
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Re: Should manipulation be taught in Entry Level Physic... - February 25, 2005 8:40:00 AM
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Synergy
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From: Forney, TX
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Steve,
I believe BRuchin is referring to this site:
[URL=http://www.manipulationsinc.com/products.asp]Manipulations, Inc.[/URL]
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Chris Adams, PT, MPT
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Re: Should manipulation be taught in Entry Level Physic... - February 25, 2005 9:03:00 AM
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jma
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From: NY
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Yes, they are very good references. I have only two of the CD's and the powerpoint presentations, with media, were excellent to go over. Well worth it. Thanks for the site.
JMA
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Re: Should manipulation be taught in Entry Level Physic... - February 25, 2005 9:05:00 AM
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jma
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From: NY
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In addition to those CD's, there are others, also in DVD format, found at the following website: http://www.optp.com
The best manual therapy site I have come across so far.
JMA
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Re: Should manipulation be taught in Entry Level Physic... - March 2, 2005 2:54:00 PM
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BRuchin
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From: Atlanta, Georgia
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Steve, Chris is correct, that is the website, and it can also be found on OPTP.com that site has a catalog you can get with many types of PT equipment, and it has a manual therapy section, very good stuff!!
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Re: Should manipulation be taught in Entry Level Physic... - March 3, 2005 3:22:00 AM
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JLS_PT_OCS
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Sam-
Thanks for your reply, and I couldn't agree more.
I appreciate your response.
I am glad to see more of the EBM (and thus, manipulation) approach being embraced by more people. I would agree with a lot of what BRuchin said, except "manual therapy is taking on a new level in the field." The important thing to realize about manipulation or any other manual therapy technique is that it has long been a part of the armamentarium of the PT, it suffers from a lack of understanding and/or usage pattern, and it is definitely not a new area for us.
That is the substance of our arguments re: practice acts.
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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