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Re: Petition to stop neck manipulation
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Re: Petition to stop neck manipulation - August 29, 2005 12:45:00 PM
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SJBird55
Posts: 2438
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From: Michigan
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I believe CPR cards expire after 2 years.... That isn't a skill everyone does every day and I'd guess most of us have a memory of what needs to be done and how, but apparently a refresher course is required every 2 years.
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Re: Petition to stop neck manipulation - August 29, 2005 1:00:00 PM
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nari
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From: Australia
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Kragar
Say you left off practising, say, ortho or paeds for two years and did something else (neuroRehab, eg). Would you expect to be fully primed back into ortho/paeds? In all the aspects of those particular skills? That is a huge ask.
I have to agree with Sebastian - someone who does practise a particular skill many times a week is at risk of becoming mechanical in approach, and possibly not being as cautious as one should be.
Someone who is a bit uncertain is likely to be more cautious and think more about what they do and why.
Nari
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Re: Petition to stop neck manipulation - August 29, 2005 2:07:00 PM
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kragar
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Nari..."mechanical in approach" is a negative spin on what I said, but my examples have support (learning to pass a football, learning piano, karate) innovation comes from practice. Rust developes on the unused part. Example, who do you think may tape an ankle better a PT that does it 3 times yearly or an ATC who does it daily?
This is about safety, something I thought this thread was discussing.
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Re: Petition to stop neck manipulation - August 29, 2005 2:58:00 PM
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Jon Newman
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From: Amherst, WI
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SJ,
One of the reasons why they have you re-certify in CPR (besides a profit generating device) is that the information does actually change. The compression frequency, depth of compression, how long to do it for, etc have changed over the years. I suppose one could argue that the techniques in manipulation will change over the years. Has anyone noticed if that's the case?
Kragar, I agree, we get good at what we practice. However the things I feel are good to practice are taken for granted by many or worse, not even considered.
Wouldn't competency testing of manipulation technique necessarily have a high degree of subjectivity? If so I think there would be great difficulty in setting standards for a national requirement.
jon
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Re: Petition to stop neck manipulation - August 29, 2005 3:07:00 PM
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OAK
Posts: 184
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kragar,
What type of biannual testing are you suggesting? What type of testing did you have when you learned how to perform HVLA? Does this testing really ensure safety?
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Re: Petition to stop neck manipulation - August 30, 2005 1:51:00 AM
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Sebastian Asselbergs
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yes Kragar. I mean it. I know one surgeon personally and he has been doing surgeries for 17 years, but only 6 per week very picky at what he does. Excellent results. And this is not uncommon in this area. And patient safety IS a biggie. I Have been using HVLA for many years, but less and less and the last time I used it, I was extremely careful - moreso than 10 years ago!
I really do not think that it is as simple as stating that something needs to be done often to be better and safer. The level of skills are NOT directly related to the repetition - the intent and focus of the practitioner is a much bigger influence on the safety of the patient. Talent plays a big role in it as well. Similar to your piano example - some can practice and practice and still get it poor! BTW, taping and karate are a teensie bit different than manipulating an upper cervical spine.
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Re: Petition to stop neck manipulation - August 30, 2005 2:40:00 AM
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JLS_PT_OCS
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Kragar-
Your example only makes sense if there were a clearly delineated risk and a clearly connected level of increased risk with decreased skill.
Look, this culture (at least in the USA) lets teenagers of 16 begin driving cars.
Now THERE is a very clear connection between age/experience and safety risk.
Given that information, I find it strange that this issue of manip even comes up.
And it's funny, but I just had someone yesterday with neck pain who I did an HVLA on his lower Cx spine. I thought of all of you. He did much better since the lower velocity stuff was not working as well. I could ask him, but I doubt he thinks I need more practice or some type of "re-certification".
Isn't that sort of nannying reserved for non-professional occupations? Those for which less responsibility is taken for the study and practice of a given job? Is this how we want to equate ourselves? When no other profession does this? How does this makes sense?
Documenting experience and learning through numbers of continuing education hours makes sense and is objective to a large degree, but the ihherent subjectivity and lack of evidence for harm here makes this a very strange road to talk about traveling...
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: Petition to stop neck manipulation - August 30, 2005 3:45:00 AM
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Diane
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Reminds me of the "angels on the head of a pin" argument..
:) ,
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Re: Petition to stop neck manipulation - August 30, 2005 6:28:00 AM
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Jeep
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"I know one surgeon personally and he has been doing surgeries for 17 years, but only 6 per week"
This is very different from 3-4x/year.
Anyone doing something/anything 3-4x/yr. is but an amateur. I would not have my surgery done by any surgeon that only does 3-4/yr.
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Re: Petition to stop neck manipulation - August 30, 2005 7:19:00 AM
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OAK
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"Anyone doing something/anything 3-4x/yr. is but an amateur. I would not have my surgery done by any surgeon that only does 3-4/yr."
So how many manipulations per year does it take to be considered a "professional" in your expert opinion? You logically must have a number as you seem to know that 3 to 4 is not enough.
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Re: Petition to stop neck manipulation - August 30, 2005 7:37:00 AM
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chiroortho
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You know I have to agree with Jeep and kragar that the psychomotor skills attendant to manipulative therapy are perishable. I have to be careful how I say this but if you're able to go 6 months without using manip and you can't tell the difference, either you're extraordinary or your skill level is lower than you think it is.
If I don't use manip for a few weeks I can tell the difference and I've been doing it for 20+ years. Maybe I'm just a dork but I don't think so.
No insult intended, just how I see it.
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Greg Priest, DC, DABCO
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Re: Petition to stop neck manipulation - August 30, 2005 8:19:00 AM
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JLS_PT_OCS
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I don't think anyone is challenging the basic concept of perishibility of skills, Greg.
Now, I won't attempt to address the difference between mob and manip, and the similarity of the techniques, but if the techniques are indeed similar in all but one way (ie amount of force) than one wonders how such skills can be perishable.
If a surgeon does tons of knee scopes, but say only a major synovectomy for synovitis a few times a year, shall we treat the synovectomy as a whole different skill, or acknowledge that that is but a small part of something the surgeon already does everyday, and hence skill perishibility is not really an issue.
This is a better comparison.
To state categorically that mob and manip for the lower cervical spine are vastly different or that experience in one is totally different than experience in another is really quite silly. To those of us who do both, that is.
I guess if someone doesn't have such a continuum of techniques available, then I can see how they would be confused.
Diane-
totally agreed on the splitting hairs thought.
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: Petition to stop neck manipulation - August 30, 2005 9:04:00 AM
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chiroortho
Posts: 655
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Yeah I may be splitting hairs. Don't mean to though. All I can offer is my own viewpoint.
You guys have some pretty good viewpoints yourselves. I dont know anything much about mobs v manip, you'd be better qualified to comment.
All I can tell you is what I've told you.
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Greg Priest, DC, DABCO
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Re: Petition to stop neck manipulation - August 30, 2005 9:29:00 AM
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JLS_PT_OCS
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Appreciate your insight as always, Greg.
You DCs provide a valuable view for us here, especially on these contentious matters!
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: Petition to stop neck manipulation - September 4, 2005 5:20:00 AM
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Diane
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From: Vancouver, B.C., Canada
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I see there are now 146 signatures. Still some trolls contributing, but they'll be weeded I hope. Slow going, but accumulative, just like evolutionary change.
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Re: Petition to stop neck manipulation - September 4, 2005 11:26:00 AM
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Jeep
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From: USA
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WOW!!!
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Re: Petition to stop neck manipulation - September 6, 2005 5:32:00 AM
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avalon
Posts: 181
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Diane,
Only 149 signatures, That's quite few.
Does it mean that some Rehab Egde members are afraid to sign? or they agree with neck manips? (even if it's a case/1000 I do not want to be this one!).
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Re: Petition to stop neck manipulation - September 6, 2005 7:52:00 AM
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Spondylo
Posts: 3
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What's up with viewing the signatures? I can't find them no matter which route I take.
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Re: Petition to stop neck manipulation - September 6, 2005 3:28:00 PM
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Diane
Posts: 1507
Joined: March 9, 2001
From: Vancouver, B.C., Canada
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Spondylo, click on "view current sigatures." Then click on "view signatures" , under whatever big number it says. There are three pages of signatures.
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Re: Petition to stop neck manipulation - September 6, 2005 5:36:00 PM
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gmaven
Posts: 12
Joined: January 28, 2004
From: Edison, NJ, USA
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Avalon:
149 may seem like alot of signatures, but look at the other petitions. THe petition to get softball back as an Olympic sport has 49500 signatures when I looked. Also, the petition to stop Ashlee Simpson has about 398,000. Seems like Ashlee Simpson is more detrimental to society that cervical CMT.
g
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