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Re: Petition to stop neck manipulation
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Re: Petition to stop neck manipulation - August 21, 2005 8:18:00 AM
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Jeep
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Thanks DrBuddy
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Re: Petition to stop neck manipulation - August 21, 2005 8:38:00 AM
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Randy Dixon
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I wonder how you would enforce this or choose who has to hang that sign up. Why limit it to chiropractors if lots of people are doing it?
Should we put up signs next to treadmills, Warning: Use may cause heart attack or stroke.
Would you accept such warnings from something that you use in your practice?
The place this needs to be resolved at is at the professional organizational level and at the educational level. Not at the market level.
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Re: Petition to stop neck manipulation - August 21, 2005 9:09:00 AM
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Bournephysio
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Ban those nasty scissors. Someone could get hurt.
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Re: Petition to stop neck manipulation - August 21, 2005 9:12:00 AM
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chiroortho
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[QUOTE]Should we put up signs next to treadmills, Warning: Use may cause heart attack or stroke.[/QUOTE]LOL Randy. There you go. [QUOTE]let's ban NSAIDs, cigarettes, alcohol, and elective surgeries while we're at it.[/QUOTE]All great points. It's my impression that folks pushing this kind of thing are wanting to ban chiropractic, not manipulations.
[QUOTE]"A US study puts the human impact of NSAID-related gastrointestinal deaths into perspective: the rate is higher than that found from cervical cancer, asthma or malignant melanoma." --G Singh. Recent considerations in nonsteroidal anti-inflammatory drug gastropathy. American Journal of Medicine 1998 105(1B): 31S-38S.[/QUOTE]Substitute 'chiropractic manipulations' for 'NSAIDS' and watch the anti-chiropractic meltdown.
_____________________________
Greg Priest, DC, DABCO
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Re: Petition to stop neck manipulation - August 21, 2005 12:05:00 PM
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Enforcer
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Check out the benefit V risk of neck manipulation at http://www.acofp.org/member_publications/0404_3.html
Maybe Diane would like to ban every procedure performed by PTs that had ever been claimed to have hurt someone. Then she can practice whatever is left ...... but that would leave approximately nothing. Fair comparison, don't you think?
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Re: Petition to stop neck manipulation - August 21, 2005 12:23:00 PM
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OAK
Posts: 183
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Hey Diane,
Why don't you start a petition to outlaw driving, bike riding or even walking as they all involve a greater risk of death then cervical manipulations do.
Maybe we should ban going outdoors too, there's a good chance that we could be struck by lightening!
GIVE ME A BREAK!!!
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Re: Petition to stop neck manipulation - August 21, 2005 12:35:00 PM
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nari
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I think Diane is pointing out that there should be warnings about manipulations being done. In other words, informed consent. it is standard practice in Australia for PTs who do manipulate, that their patients are accurately informed of the risks. Just in the same way that we have to inform and gain consent from, patients who undergo any sort of technique; we have laminated posters warning patients of the risks of heat...
What is the difference?
Nari
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Re: Petition to stop neck manipulation - August 21, 2005 12:41:00 PM
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chiroortho
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Nari it seems to me that there aren't any petitions out there demanding informed consent for the use of heat. Or any other physiotherapeutic modality for that matter.
This is akin to using a shotgun to kill a fly, while ignoring the Cape Buffalo in your living room (fellow hunters of dangerous game will understand this).
I suppose that I'm just a bit weary of the anti-chiropractic crusades of Murray Katz and Charles DuVall ('forensic chiropractic physician', as he calls himself), et al.
_____________________________
Greg Priest, DC, DABCO
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Re: Petition to stop neck manipulation - August 21, 2005 1:15:00 PM
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Diane
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From: Vancouver, B.C., Canada
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Well, seems one thing has become polarized here, creating a great divide between those whose arguments are so lame they feel their only resort is to [URL=http://en.wikipedia.org/wiki/Ad_hominem]ad hominem[/URL] protests (feeble.. but they register a tiny wee bit on the screech-o-meter if uttered loudly and often enough....I guess if that's all the ammo some individuals have, they feel obliged to use it..)
..And those who refrain. To the second group, commendations for your show of restraint in the course of a charged topic, a "fierce conversation."
Back to the point:
The only thing that would logically drive a sane human being into the care of a practitioner of any stripe would be pain of some kind, is that a fair assumption?
I point you therefore to Nikolai Bogduk's article, written in 2003 for the American Pain Society, entitled
"Spinal Manipulation for Neck Pain Does Not Work."
An excerpt from toward the end of the two page article, in reference to a review by Ernst:
[QUOTE]In essence, the literature provides an incomplete but unflattering profile of the efficacy of manipulation for neck pain. For acute neck pain, we have no data from any study on what proportion of patients are rendered pain free immediately after treatment or in the short term. The studies only attested to some degree of reduction of pain.(18, 19) At two years after treatment, the only study that provided data indicated that manual therapy is as effective as analgesics, but that home exercises are more effective. For chronic neck pain, only one study provided short-term data on the efficacy of manipulation, namely that 48% of patients were rendered painfree at 1 and 4 weeks. No long term data are available on the proportion of patients achieving complete relief of pain. The studies reviewed by Ernst reported only mean improvements. These amounted to changes in visual analog scores for pain of only 12 of 30 to 6 of 30 i one study (16) and 57 of 100 to 37 of 100 in the other.(6)
Regardless of whether manipulation is more effective when compared to other treatment for neck pain, its absolute effects are limited and modest. Reduce pain it might, but eradicate pain it does not. Moreover, it is not more effective than other interventions, which do not require the same degree of allegedly necessary training and skill, which do not carry the same risks of morbidity, and which the patients can do for themselves, if and once properly instructed.[/QUOTE]Am I right in presuming the Nikolai Bogduk is a researcher who is respected by all?
Also, bear in mind that I didn't personally start the petition at the top of the thread, a group of VAD patients in Australia did. I support them, by signing it and by moving their petition out into the internet so that more can sign it if they choose.... Such a waste of evergy protesting so vehemently. You'd think there was overutilization to lose or something... :rolleyes:
:)
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Re: Petition to stop neck manipulation - August 21, 2005 1:49:00 PM
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flexion
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Oh so now you are saying that every procedure should be banned based on research. Great!
Again, I'd be more than happy to do this if every profession and procedure was held the same standard.
Watch what you wish for...
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Re: Petition to stop neck manipulation - August 21, 2005 2:14:00 PM
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nari
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From: Australia
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Greg, that is true. We went overboard, perhaps, about 6 years ago due to the risks of litigation.
However, the fact remains that we seem to be much more conscious of doing harm than other countries are.
Maybe it's out of perspective; maybe not.
After all, in this country we have to be registered because we can cause death; something that annoys the OTs (who cannot get registered).
This is why we launched into the whole thing of informed consent, particularly with manipulations due to the age-old concerns around the technique.
I can only speak from the point of view of this country's attitudes to PT techniques, of course.
Nari
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Re: Petition to stop neck manipulation - August 21, 2005 2:44:00 PM
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Bill Egan
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Not to add more fuel to the fire, but I couldn't resist. I heard the founder of this organization speak in Oklahoma City. http://www.neck911usa.com/ Despite the sensationalism tactics they use on the web site, this guy, an ER physician, is legitametly concerned about this issue. In his case, he does suffer from some spectrum bias because he is usually the one who sees patients after they suffer from a vertebral artery dissection.
I don't think a ban oncervical manipulation is the answer. But, perhaps the frequency with which they are used and the patients they are used on needs to be reconsidered. Someone else mentioned patient selection. If we knew which patients would most benefit from cervical manipulation and which are most at risk for adverse reactions to this procedure, than we could make more informed decisions. Hopefully, future research will shed some light on this topic.
Bill
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Re: Petition to stop neck manipulation - August 21, 2005 2:46:00 PM
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Enforcer
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The stand of the ACOFP (American College of Osteopathic Family Physicians) on neck manipulation is positive and can be found at:
http://www.acofp.org/member_publications/0404_3.html
This paper has been adopted by the AAO Board of Governors as an official position paper. It has references from 33 sources.
Bogduk is a respected researcher but he is not god, nor is it likely he is always correct.
Diane, shall we limit, label or outlaw any form of treatment that can be shown to be useless or harmful based on one study? Even if there are 100 studies saying that treatment's benefits outweigh the risks? If this will be the standard there will be no treatment available from MDs, DOs, DCs, PTs, DPMs, DDMs etc.
Your bias is so large you cannot reason or see around it but hey, what the heck, it's your opinion and your entitled to it.
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Re: Petition to stop neck manipulation - August 21, 2005 3:01:00 PM
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chiroortho
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[QUOTE]Am I right in presuming the Nikolai Bogduk is a researcher who is respected by all?[/QUOTE] [QUOTE]Spine: Volume 21(1) 1 January 1996 pp 150,151
In Response: Letters
Bogduk, Nikolai MD
There is a difference between consensus, evidence, and faith. Consensus is an exercise in which craft groups may be accorded a niche in a market for political reasons, not because of compelling evidence.
With respect to whiplash associated disorders, the Quebec Task Force3 quite clearly was unable to uncover compelling evidence of the efficacy of physiotherapy, however that may be defined. Specifically it found no evidence to justify the use of soft collars, pillows, electrical stimulation, ultrasound, laser, short wave diathermy, heat, ice, or massage. It found explicit evidence of no significant benefit from manipulation or traction.
The defense of physiotherapy rests solely on the Mealy study2 which showed a greater improvement in patients treated with Maitland mobilization, local heat, and exercises than patients treated with a soft collar or advised to rest for 2 weeks. But this was in patients with acute injuries and limited to 8 weeks' follow-up. There are no comparable data for patients with chronic pain after whiplash, which is where the costs and controversies lie.
One of the weakest defenses of a craft group is that, even if individual therapies don't work, their combination nevertheless does. ****ing in this regard are the results of the McKinney study1 in which patients were offered tailored combinations of hot and cold applications, short-wave diathermy, hydrotherapy, traction, and repetitive movements. Yet it emerged that a comparison group fared better when simply offered 30 minutes of instruction on posture, the use of analgesics, heat and a collar, and home exercises.
Physiotherapists may have a faith in their polyvalent algorithms but I find no evidence that compels me to share that faith. The evidence indicates that reassuring instruction is as good as anything. If rehabilitation counseling is all that physiotherapy limits itself to I have no objection. What I cannot share is the faith that applying modalities, traction, and manual therapy in anything but acute cases is either scientifically valid or cost-beneficial.
Consensus protects physiotherapy for the time being but does not excuse it from the research priorities nominated by the Task Force, for if physiotherapy had been vindicated, why should the Task Force conclude what is the efficacy and cost-effectiveness of common therapeutic interventions for whiplash associated disorders?
-- Nikolai Bogduk MD
Faculty of Medicine and Health Sciences; University of Newcastle; Newcastle, Australia[/QUOTE]Respected by all? 'Craft group'? Beyond question?
_____________________________
Greg Priest, DC, DABCO
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Re: Petition to stop neck manipulation - August 21, 2005 3:19:00 PM
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Diane
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From: Vancouver, B.C., Canada
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More screeching.... must have touched a nerve...
The petition is about a procedure that involves taking someone's neck into one's hands and forcing a motion through it at a high velocity. It has nothing to do with heat or treadmills or scissors.
:)
One wonders about the potential psychological benefit of neck manipulation/adjustment/HVLA... to the practitioners. Given the altitude of the needle on the screechometer dial, it would seem to suggest that there is some sort of possible dominance submission theme lurking below the surface of those who (love to) practice this particular form of social grooming (c'mon boys and girls, that's how the barbers must see it, at any rate..). :cool:
Makes me wonder if all HVLA is a covert form of social grooming that has "climbed the ranks" toward respectability, but hasn't q-u-i-t-e made it yet...
Just musing.. :rolleyes:
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Re: Petition to stop neck manipulation - August 21, 2005 3:24:00 PM
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Synergy
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From: Forney, TX
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I'm not seeing any evidence for a debate to have even begun on this thread. From what I can tell, Diane was simply posting a link to a petition and nothing else! The petition states that it's main objective is to basically arm the patient with more knowledge regarding neck manipulation and the potential for VAD. You'll either sign it or not sign it.
I think people here have jumped the gun and have thrown stones at Diane labelling her a chirobasher when all it appears she has done is placed a link on a thread. Too much reading into it is what it seems to me. Maybe the chiros here feel quite the opposite...that all of this is directed at them because generally chiros perform cervical manipulation much more frequently. Who knows...I may be off. :)
I for one am all for manipulation if I feel the patient is a candidate for it, however, I rarely if ever manipulate the cervical spine. I tend to employ other techniques [read: METs] because I've had good success with it thus far in my early career. That doesn't mean I abhor the practice of c-spine manipulation nor does it mean I think all patients will benefit from it.
The petition should have gone a little further and added PTs to the list as well for obvious reasons. If anything, it should be rewritten to state "Keep barbers from manipulating the c-spine" as that is the most asanine thing I've heard of lately.
_____________________________
Chris Adams, PT, MPT
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Re: Petition to stop neck manipulation - August 21, 2005 3:31:00 PM
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Diane
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From: Vancouver, B.C., Canada
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A sensible post, thanks Chris.
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Re: Petition to stop neck manipulation - August 21, 2005 3:32:00 PM
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nari
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From: Australia
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Just for the record, Nic Bogduk is well known for his anti-physiotherapy stance. Nevertheless, he has high standing for the work he has done over the years; it is just a bias of his. We all have them.
Nari
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Re: Petition to stop neck manipulation - August 21, 2005 3:42:00 PM
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Synergy
Posts: 589
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From: Forney, TX
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Your welcome! I'm just tired of people's words being misconstrued. If one doesn't agree with a particular technique then so be it. I believe everyone is entitled to have and/or form an opinion. The chiros that frequent this forum (Greg, Jeep, UTDC) always offer good insight into whatever topic is being discussed or whatever they choose to respond to. I hate to see a thread like this appear any different than it truly is and for those mentioned above to take a defensive stance. There's really no need to do so...it's a petition...plain and simple...to hopefully increase public awareness.
Again, maybe I'm completely missing something, but I don't think I am. :)
_____________________________
Chris Adams, PT, MPT
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Re: Petition to stop neck manipulation - August 21, 2005 3:43:00 PM
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Diane
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No Chris, you didn't miss a thing.
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