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Re: Petition to stop neck manipulation
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Re: Petition to stop neck manipulation - August 25, 2005 5:51:00 PM
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Diane
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From: Vancouver, B.C., Canada
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Ditto Greg. :(
Here's the link again.
http://www.petitiononline.com/mindneck/petition.html
I see there are 139 signatures. :cool:
I see some are by trolls. :rolleyes:
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Re: Petition to stop neck manipulation - August 25, 2005 7:31:00 PM
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Randy Dixon
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Well, you have to have something when that 80 year old lady won't fork over her co-pay.
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Re: Petition to stop neck manipulation - August 26, 2005 1:54:00 AM
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JLS_PT_OCS
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Randy, that's when you snap her down into the guillotine choke and do what we do best!
(just kidding everybody, jui-jitsu joke)
I think you make a good point about how our experience with chokes and neck "crank" submission holds (speaking of end range of motion!) makes us duly suspicious that anything a health care practitioner does can cause such effects. Considering that the people who train that way are male and female, big and small, and from 10 years to even over 70 years old!
Residual soreness and stiffness, yes. VBI, not that I'm aware of.
I don't even think that there are any incidents of VBI reported to be associated with contact sports in general or grappling sports in particular such as wrestling. I can't recall the stats from some of the many papers cited above, but it is my recollection that there are far more spontaneous events than those related to contact sports.
Just brings a new perspective to things, I guess...
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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Re: Petition to stop neck manipulation - August 26, 2005 2:18:00 AM
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Jon Newman
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Perhaps the person whose neck is being cranked upon is guarding and defending. I'm assuming that prior to manipulating a neck some work has been done to minimize or eliminate that protective aspect. I think that is why AROM and low acceleration techniques also seem inherently safer for vestibular arteries that were not simply on the verge of dissecting anyway--there is time to mount a guarding response hardwired in us to protect ourselves not to mention that less force needs to be overcome for the guarding response. Speculative I know.
jon
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Re: Petition to stop neck manipulation - August 26, 2005 3:27:00 AM
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dosrinc
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From: Bonita Springs
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I think I have read of one boxer who died from vertebral aa disection after a blow to the head, will have to look that one up. Also, remember the poor little girl who was hit in the head by the hockey puck a couple of years back, I read that vert. aa disection was her given cause of death.
Rick
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Re: Petition to stop neck manipulation - August 26, 2005 4:09:00 AM
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chiroortho
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My little girl takes TaekwonDo lessons and just yesterday came home with a big grin on her face, told me that she learned some type of choke hold, did it to her sensei(sp?)and she said he tapped out because he nearly blacked out. She must have some chiropractic genes from her daddy. :)
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Greg Priest, DC, DABCO
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Re: Petition to stop neck manipulation - August 26, 2005 6:55:00 AM
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JLS_PT_OCS
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Jon-
That's a good perspective, good thoughts.
You're right about the guarding, it is usually a fairly slow application relative to HVLA application.
Interesting thought on that, thanks.
Greg-
Better make sure that allowance is on time, eh?
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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Re: Petition to stop neck manipulation - August 26, 2005 12:31:00 PM
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Diane
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Good point Jon about guarding.
I think what manipulation fans don't like to consider is that treating a patient means dealing with three things; the peripheral nervous system (both input and output), the brain, and the patient's sense of self. I think manipulators like to imagine that they are treating stretchy corpses and not people. They want the patient's sense of self out of the way, the natural guarding out of the way, so they can get at that pesky thingo that won't move, and they WILL make it move, by ***.
Cooperating with this implicit attitude requires a bit of actively learned passivity on the part of the patient. Can you imagine the sense of betrayal that happens if a manip/adjustment is done without adequate psychological preparation? Or if some sort of vascular event does occur? The therapeutic relationship flies out the window. The patient won't be able to dig out their wallet to pay if their arm has gone numb from the brainstem down. If they are emotionally traumatized their brain will magnify every symptom into a crisis. If they are physically traumatized... well, there simply is no reason on earth so big to bother ever doing cervical manip. This should NEVER happen to ANYone, an iatrogenic vascular trauma.
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Re: Petition to stop neck manipulation - August 26, 2005 12:44:00 PM
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OAK
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"think what manipulation fans don't like to consider is that treating a patient means dealing with three things; the peripheral nervous system (both input and output), the brain, and the patient's sense of self. I think manipulators like to imagine that they are treating stretchy corpses and not people. They want the patient's sense of self out of the way, the natural guarding out of the way, so they can get at that pesky thingo that won't move, and they WILL make it move, by ***.
Cooperating with this implicit attitude requires a bit of actively learned passivity on the part of the patient. Can you imagine the sense of betrayal that happens if a manip/adjustment is done without adequate psychological preparation? Or if some sort of vascular event does occur? The therapeutic relationship flies out the window. The patient won't be able to dig out their wallet to pay if their arm has gone numb from the brainstem down. If they are emotionally traumatized their brain will magnify every symptom into a crisis. If they are physically traumatized... well, there simply is no reason on earth so big to bother ever doing cervical manip. This should NEVER happen to ANYone, an iatrogenic vascular trauma."
This thread has turned into a real riot! Keep it going guys!
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Re: Petition to stop neck manipulation - August 29, 2005 3:08:00 AM
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JLS_PT_OCS
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Diane-
As a manipulation "fan", I like to consider those three things, it is just done with different tools sometimes. Many people can benefit from the procedure and some even ask for it. I admit, far more are afraid of such procedures and request they not be done, but that's the beauty of having such a range of techniques in the toolbox, so to speak.
I use this particular procedure (ie HVLA in the lower Cx spine) sparingly (perhaps only on about 3-5 patients this year maybe?), as I get results as good with more gentle techniques usually.
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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Re: Petition to stop neck manipulation - August 29, 2005 4:46:00 AM
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kragar
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How can you be good at anything you use 3 times a year? Seems like for a manipulation to be safe, it should be in the hands of those that use the techniques frequently.
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Re: Petition to stop neck manipulation - August 29, 2005 4:55:00 AM
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Diane
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Happy to see that this thread warmed back up.
Here is an article from quackwatch that quite apart from the thrust of the site (if you'll pardon the pun) is a good article with a huge bunch of other linked articles referenced at the end of it.
http://www.quackwatch.org/01QuackeryRelatedTopics/chirostroke.html
krager, if you don't ride a bicycle for several months do you forget how?
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Re: Petition to stop neck manipulation - August 29, 2005 6:55:00 AM
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Jeep
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"krager, if you don't ride a bicycle for several months do you forget how?"
No- one does not forget some basic skills, but those in that sporadic catagory are more accurately decribed as "amateur bicyclists".
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Re: Petition to stop neck manipulation - August 29, 2005 7:29:00 AM
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Diane
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Jeep,
[QUOTE]No- one does not forget some basic skills, but those in that sporadic catagory are more accurately decribed as "amateur bicyclists".[/QUOTE]so... are you trying to say that neck manipulation is a feat in the "special advanced athletic" catagory as opposed to the "simple motor skill" catagory?
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Re: Petition to stop neck manipulation - August 29, 2005 8:10:00 AM
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JLS_PT_OCS
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From: USA
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Kragar/Jeep-
The HVLA and the mobilization are the same setup, positioning, direction of force, hand hold, etc.
The only thing different is the velocity and amplitude. Though I do use some low velocity/low amplitude mobs a lot also.
So it's the difference between pedaling a bike at 4 mph and pedaling a bike at 5 mph.
I think I can handle that.
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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Re: Petition to stop neck manipulation - August 29, 2005 8:58:00 AM
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OAK
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An important question to have answered is whether strokes from HVLA thrusts are caused from improper techniques or congenital abonormalities of the artery?
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Re: Petition to stop neck manipulation - August 29, 2005 9:21:00 AM
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kragar
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This is not a question of riding a bike, but rather the exact movements used in a thrust manipulation...on a patient. "Riding a bike" assumes you have done it many many many times over a period of years.
And while you feel as though "you can handle that"...do you think it is safe for your patients and would the authorities in manipulation agree?
Just curious, not attempting to start a angry war.
Simply stated, perhaps if we as PTs are to be using manipulation, perhaps a yearly or bi-annual continuing education requirement/testing should be enacted to allow for continued use.
This is a discussion of the dangers of manipulation right? Perhaps the first step is tighter regulation not abandonment.
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You're my boy Blue!
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Re: Petition to stop neck manipulation - August 29, 2005 9:31:00 AM
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Sebastian Asselbergs
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kragar, I do not think it so far fetched to say one doesn't forget the skills. If I have done those HVLAs for many years, and do them now less and less, do I forget how to use them? Not on your life. The surgeon who does fewer surgeries, but on better "picked" patients is the one I would see, now the one who does 200 a week and is "in a groove". There are dangers there too. Doing things time over time the same way (how do you do that exactly, with people being so d**ned different?), has the danger of breeding complacency. So your idea of testing bi-annually makes sense for both sides of this pointt.
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Mundi vult decipi
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Re: Petition to stop neck manipulation - August 29, 2005 11:03:00 AM
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JLS_PT_OCS
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kragar-
Perhaps we should establish similar requirements for certain types of patients. How many diabetic patients do I see per year? Not many. Should I have bi-annual requirements about them also? Or what about any patient that I do not see enough of. And who decides how many is enough?
Think of what Sebastian said, and also think that if we were sure that manipulation caused such adverse events, and we were sure that skill level was a factor, and we were sure that such skills demonstrably degenerated over time, then perhaps your requirement would make sense. As it is now, that is QUITE a large leap of logic to make, no?
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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Re: Petition to stop neck manipulation - August 29, 2005 12:31:00 PM
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kragar
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So you are actually trying to make a point of (paraphrased of course)..."well they have never proven that frequent practice of a technique is better, then infrequent practice is still ok"
What?
I find it extremely hard to believe that you are of the opinion that skills don't get rusty. That once you are SOOO good, you simply do not forget?
Isn't that WHY you practice...to only get better. That is the basis of EVERY physical artform. Practice and adaptation to the point of effortless movement.
Sabastian, my man, your comment really makes no sense. Reread what you wrote and tell me that you wholeheartedly believe it.
Regardless, to me, continuing education for the application of certain procedures is not a bad idea in any way. Implementation may be difficult, but this works in other arenas, so why not ours?
By the way, getting tested to learn about diabetic/geriatric/pediatric etc patient is not a bad idea...especially since there is no specialty requirement in PT; allowing myself (working in ortho) to move into the geriatric environment simply on a whim. And vice versa.
You make a good point.
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You're my boy Blue!
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