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Re: Is spinal manipulation working in the suspected area?
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Re: Is spinal manipulation working in the suspected area? - March 10, 2005 1:27:00 AM
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JLS_PT_OCS
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Randy,
Thanks for your post.
CBT and the cognitive-biopsychosocial model is well supported by evidence, hence we use it in our clinic as well.
I liked your gardening example, also.
Sometimes I can get too serious with all this stuff, and reading the word "Cucalopes" is a good antidote for that, so was the smile I got...
J
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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: Is spinal manipulation working in the suspected area? - March 10, 2005 1:31:00 AM
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chiroortho
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[QUOTE]Still I never heard any of them suggest that there was something fundamentally wrong with the thinking in any of the others. I never heard anyone say that others were “unscientific,” they didn’t look bemused at other’s ideas, shake their heads and conclude that they were hopelessly deluded and should just be ignored-and none of these men said that they were somehow “ahead” of the others, they just worked constantly to know more.[/QUOTE]Sounds like they are class acts.
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Greg Priest, DC, DABCO
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Re: Is spinal manipulation working in the suspected area? - March 10, 2005 1:33:00 AM
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Jon Newman
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Chris,
You state: "It appears to me that Child's study has done just that and some here won't so much as bat an eye and give it a shot or admit that it truly is effective."
I don't read anyone here or in any other post stating that the manipulation used in Flynn, Childs, et. al. study is ineffective.
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: Is spinal manipulation working in the suspected area? - March 10, 2005 4:08:00 AM
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Synergy
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Pardon my apparent oversight Jon. I was pretty worn out yesterday and probably shouldn't have posted on any forums! :)
The "...admit that it is truly effective" portion of my statement may have been a bit presumptious and I do apologize.
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Chris Adams, PT, MPT
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Re: Is spinal manipulation working in the suspected area? - March 10, 2005 9:20:00 AM
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Yogi
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Randy, good job, the second paragraph is exactly right, and Nari adds a great bit to that. You two made quite well a point I haven't been able to. As I recall, neurosurgeons would develop a procedure, everyone would begin doing it, and by the time studies were done, everyone allready knew what the results were, from word of mouth and clinical experience. I think we're confusing science (theory, paradigm) vs. technology (techniques, procedures) here sometimes.
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Re: Is spinal manipulation working in the suspected area? - March 10, 2005 10:40:00 AM
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B.Royer
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"Greg, do many of your colleagues in Chiropractic feel the same as you do regarding alignment issues?"
Jason,
I don't think anyone answered this for you so I'll take a crack at it.
What is now being taught is the history of chiropractic theory in chiropractic schools. The first theory in chiropractic was that bone went out of place or misaligned. That really isn't taught anymore as a valid theory. Restriction of movement is probably the best theory and it's the one I go by.
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Bryan Royer, DC
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Re: Is spinal manipulation working in the suspected area? - March 10, 2005 11:50:00 AM
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Jon Newman
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B. Royer,
You stated: "Restriction of movement is probably the best theory and it's the one I go by.
Can you expand on this?
Thanks,
jon
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Re: Is spinal manipulation working in the suspected area? - March 10, 2005 2:46:00 PM
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B.Royer
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Jon,
Wow. Looking back over that post, I can see why you want clarification. And BTW, I just noticed I said "take a crack at it." Funny, but not intentional.
Anyway, I read this whole topic today as I joined this forum about 5 hours ago. I had just read chiroortho's post where he said,
"Lastly, I take issue with those who propose that joints 'misalign'. I suggest that it is the function, the mobility of the joint, that is the primary issue. Vertebral joints allow for some normal 'play', and misalignments in my view are a myth."
That lack of mobility or restriction of movement in a joint as is what I have gone by. Decreased joint play in the paraphysiological zone of movement is why I manipulate. If I palpate someone and they have normal or excessive movement, then I don't adjust them.
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Bryan Royer, DC
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Re: Is spinal manipulation working in the suspected area? - March 10, 2005 7:19:00 PM
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january
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Hi All,
Sorry to be unpleaseant but, there is also some evidences proving that manipulation isn't really superior to any other therapy?
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=14973958
Cochrane Database Syst Rev. 2004;(1):CD000447.
Spinal manipulative therapy for low back pain.
Assendelft WJ, Morton SC, Yu EI, Suttorp MJ, Shekelle PG.
Department of Guideline Development and Research Policy, Dutch College of General Practioners, P.O. Box 3231, Utrecht, Netherlands.
BACKGROUND: Low-back pain is a costly illness for which spinal manipulative therapy is commonly recommended. Previous systematic reviews and practice guidelines have reached discordant results on the effectiveness of this therapy for low-back pain. OBJECTIVES: To resolve the discrepancies related to the use of spinal manipulative therapy and to update previous estimates of effectiveness, by comparing spinal manipulative therapy with other therapies and then incorporating data from recent high-quality randomized, controlled trials (RCTs) into the analysis. SEARCH STRATEGY: The Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE and CINAHL were electronically searched from their respective beginning to January 2000, using the Back Group search strategy; references from previous systematic reviews were also screened. SELECTION CRITERIA: Randomized, controlled trials (RCT) that evaluated spinal manipulative therapy for patients with low-back pain, with at least one day of follow-up, and at least one clinically-relevant outcome measure. DATA COLLECTION AND ANALYSIS: Two authors, who served as the reviewers for all stages of the meta-analysis, independently extracted data from unmasked articles. Comparison treatments were classified into the following seven categories: sham, conventional general practitioner care, analgesics, physical therapy, exercises, back school, or a collection of therapies judged to be ineffective or even harmful (traction, corset, bed rest, home care, topical gel, no treatment, diathermy, and minimal massage). MAIN RESULTS: Thirty-nine RCTs were identified. Meta-regression models were developed for acute or chronic pain and short-term and long-term pain and function. For patients with acute low-back pain, spinal manipulative therapy was superior only to sham therapy (10-mm difference [95% CI, 2 to 17 mm] on a 100-mm visual analogue scale) or therapies judged to be ineffective or even harmful. Spinal manipulative therapy had no statistically or clinically significant advantage over general practitioner care, analgesics, physical therapy, exercises, or back school. Results for patients with chronic low-back pain were similar. Radiation of pain, study quality, profession of manipulator, and use of manipulation alone or in combination with other therapies did not affect these results. REVIEWER'S CONCLUSIONS: There is no evidence that spinal manipulative therapy is superior to other standard treatments for patients with acute or chronic low-back pain.
Publication Types:
* Meta-Analysis
* Review
PMID: 14973958 [PubMed - indexed for MEDLINE]
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Re: Is spinal manipulation working in the suspected area? - March 10, 2005 7:25:00 PM
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january
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And this one is clearly pointing out that it's the patient who is important and governing our treatments!
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15480147
Spine. 2004 Oct 15;29(20):2309-18.
Patient expectations of treatment for back pain: a systematic review of qualitative and quantitative studies.
Verbeek J, Sengers MJ, Riemens L, Haafkens J.
Coronel Institute for Work, Environment and Health, Amsterdam, The Netherlands. j.h.verbeek@amc.uva.nl
STUDY DESIGN: A systematic review of qualitative and quantitative studies. OBJECTIVES: To summarize evidence from studies among patients with low back pain on their expectations and satisfaction with treatment as part of practice guideline development. SUMMARY OF BACKGROUND DATA: Patients are often dissatisfied with treatment for acute or chronic back pain. METHODS: We searched the literature for studies on patient expectations and satisfaction with treatment for low back pain. Treatment aspects related to expectations or satisfaction were identified in qualitative studies. Percentages of dissatisfied patients were calculated from quantitative studies. RESULTS: Twelve qualitative and eight quantitative studies were found. Qualitative studies revealed the following aspects that patient expectation from treatment for back pain or with which they are dissatisfied. Patients want a clear diagnosis of the cause of their pain, information and instructions, pain relief, and a physical examination. Next, expectations are that there are more diagnostic tests, other therapy or referrals to specialists, and sickness certification. They expect confirmation from the healthcare provider that their pain is real. Like other patients, they want a confidence-based association that includes understanding, listening, respect, and being included in decision-making. The results from qualitative studies are confirmed by quantitative studies. CONCLUSIONS: Patients have explicit expectations on diagnosis, instructions, and interpersonal management. New strategies need to be developed in order to meet patients' expectations better. Practice guidelines should pay more attention to the best way of discussing the causes and diagnosis with the patient and should involve them in the decision-making process.
PMID: 15480147 [PubMed - in process]
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Re: Is spinal manipulation working in the suspected area? - March 10, 2005 7:57:00 PM
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january
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Sorry Alex and you'll be surely disappointed a bit more but this topic doesn't bring nothing new for me!
The paper just shows that manipulation is not superior thus it is not more effective. The second one shows that you can't apply blindly a treatment over a patient and wait the same good results because the patient is wanting the one that is the most effective for him.
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Re: Is spinal manipulation working in the suspected area? - March 10, 2005 8:36:00 PM
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Alex Brenner PT MPT OCS
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ok.
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Alex Brenner, PT, MPT, OCS
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Re: Is spinal manipulation working in the suspected area? - March 11, 2005 8:40:00 AM
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JLS_PT_OCS
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Alex, give it up, brother.
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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: Is spinal manipulation working in the suspected area? - March 11, 2005 1:58:00 PM
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Synergy
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I agree Jason!
Today's idiom - Beating a Dead Horse :)
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Chris Adams, PT, MPT
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Re: Is spinal manipulation working in the suspected area? - March 12, 2005 1:55:00 AM
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Jon Newman
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Maybe it would be a good time to examine the purported mechanism by which spinal stabilization brings about pain relief. Is it targeting the suspected area?
jon
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Re: Is spinal manipulation working in the suspected area? - March 12, 2005 7:08:00 AM
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steve
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Jon,
Do you think it brings pain relief? I've never read any research to say that it does and clinically my experience is the same. Looking at Jull et al series of studies on multifidus recruitment and acute low back, they found that there were no differences in pain level or duration of pain for the acute episode of low back pain. There was a significant change in the size of multifidus and reoccurrence of low back pain was dramatically reduced over the next two year.
If I were to theorize, I would say that spinal stabilization could provide pain relief by increasing the activity of the muscles intended to stabilize and decrease the activity of the prime movers that are in spasm.
What do you mean by the purported mechanism? You always have some good link!
Steve
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Re: Is spinal manipulation working in the suspected area? - March 12, 2005 7:13:00 AM
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Yogi
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Jon, yeah I think logically it is targeting the area in a very broad manner, since it is trying to stabilize the spine by avoiding painful movements. Then I suspect by adding the TrA and Multifidis, it then progresses to trying to allow painfree movement. Of course I could be wrong, I'm no expert here. That is a broad stroke of the brush.
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Re: Is spinal manipulation working in the suspected area? - March 12, 2005 11:48:00 AM
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Jon Newman
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Hi Steve,
No good link for this one. I was making the presumption that spinal stabilization exercises are for pain relief. After all, why would we compare it to a technique aimed at pain relief if this technique isn't supposed to accomplish that? And why would it be part of many practice guidelines for low back pain?
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: Is spinal manipulation working in the suspected area? - March 12, 2005 11:53:00 AM
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steve
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Jon,
I get your point but from my perspective, spinal stabilization is used to prevent future episodes of pain in the form of reoccurrence. From the research study manipulation is intended to decrease pain and disability over the course of the acute episode. The reason for the comparison with exercise is that it is a "Standard of care" as recognized by ACHPR guidelines. If you are looking for an intervention that is physiotherapy related that can change the course of an acute episode of low back pain other than manipulation for comparison, I am not aware of any treatment that has significant evidence to back it up.
But I'm really not trying to beat a dead horse, honest.
Steve
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