Re: how would you handle this one?

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Re: how would you handle this one? - February 19, 2006 12:10:00 PM

JLS_PT_OCS

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From: USA
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Tim-
I didn't say the effect of manipulation was different between the two camps, I said the "purpose and meaning" was different.

I agree that traditional subluxation-based chiro notions are not helpful in healing...however this does not mean I would force a patient to make a choice between me and another provider, if the other provider was saying/doing something I disagreed with. I think that is silly.

Why PTs and chiros may compete for some referral business to some degree, it seems that the "regulars" who frequent chiropractic offices have a certain set of beliefs that bring them there. The study I posted seems to support that.
And even if we competed for all patients, why would you not want to parter in a patient's care?

Your citation of evidence is curious. Since I didn't say that the effects of DC vs PT manip were different, the Cleland study (you're right) supports anyone who uses those interventions. That's no jab at me.

You asked "Where is the evidence that we should be for patients seeing us and seeing other practitioners that may be doing the same sorts of things?" - I would reply, "where's the evidence that it's harmful, if it's what the patient wants to do? Who am I to tell someone who they can see for their care?
Why should anyone suggest 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**

(in reply to johnczyk1)

Post #: 41

Re: how would you handle this one? - February 19, 2006 1:40:00 PM

TMondale

Posts: 131
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From: Newton-Wellelsley Hospital
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Jeep,

Again, publish those outcomes. It would help us all out if those of you with such wonderful outcomes would put your findings into the peer review process. In the real world we all struggle with turning these patients around.

For anyone to suggest that Jackyl2 should have been able to create dramatic change by two visits, need to start collecting data on their own cases. Start with ODI's and NDI's; you'll shock yourself with the difficulty of substantiating these claims.

Tim

(in reply to johnczyk1)

Post #: 42

Re: how would you handle this one? - February 19, 2006 1:47:00 PM

TMondale

Posts: 131
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From: Newton-Wellelsley Hospital
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Jason,

I didn't say we should tell them who they should see. What I said is, we should give them the choice and I really can't explain it anymore clearly than I have for you. Jason, would you suggest it is proper for a patient to be seeing two PT's at the same time?

Tim

(in reply to johnczyk1)

Post #: 43

Re: how would you handle this one? - February 19, 2006 3:27:00 PM

Jeep

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From: USA
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>>For anyone to suggest that Jackyl2 should have been able to create dramatic change by two visits<<

Perhaps you have not read correctly-----
No one suggested Jackl "should have" created "dramatic" change. Sometimes my progress in two visits IS "dramatic", however I NEVER claimed "dramatic results" in two visits in all cases. I do, in the vast majority, have "some" positive results in two visits. Do you have a problem with that claim? Please read posts before making sweeping claims regarding others poster's claims. Where did you come up with "dramatic"?

(in reply to johnczyk1)

Post #: 44

Re: how would you handle this one? - February 19, 2006 4:24:00 PM

nari

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Joined: November 14, 2003
From: Australia
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Ginger and Jeep,

I don't know about NSW, but in the public arena of the ACT there is no referral system between chiros and physios. I guess it is traditional - and no-one has changed it. Perhaps it is different in the private sector..I don't know.

Tim
Dramatic, stable changes for the better do occur within 3 visits; but they are few and far between.
Many people are discharged after 2-3 visits to continue with a program by themselves, with the knowledge they can come back if it doesn't work out; few return. Maybe they went off to aromatherapy...I don't know.

Nari

(in reply to johnczyk1)

Post #: 45

Re: how would you handle this one? - February 19, 2006 4:55:00 PM

ginger

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From: Melbourne Victoria
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Thanks Nari , point taken about there being no systematic means for intra disciplinary referrals , physio/chiro etc.I refer in my posts to those relationships that may happen between private practitioners.

"Dramatic, stable changes for the better do occur within 3 visits; but they are few and far between."

That does it , I'm giving up with any further explorations of shacklock et al.
My methods are interventionist, with immediate effect, producing stable strong results within three treatments for most Low back and referred pain issues confronting the uninjured. Any methods that don't get these sort of results would not get a look in around here.
Having done my best thus far to willingly explore the prospects of "neurodynamics", I feel increasingly confident that continuous mobs stack up very weel indeed.

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Ubi est mea anaticula cumminosa?

The Grand Pediculator

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Post #: 46

Re: how would you handle this one? - February 19, 2006 5:23:00 PM

chiroortho

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Hey guys listen, if it makes any of you feel better I had a patient referred to me last week by a neurosurgeon 'because he failed PT'. I didn't take it as a slight, I know the neurosurgeon very well and he is just following the protocol that he's comfortable with. I asked the patient about his PT, the PT did nothing wrong. The patient had L4-5 lami in 2003, did well for a while but pain returned late last year and the surgeon just doesn't know what to do. The MR showed scar tissue around the nerve root (no duh) but the patient isn't having radicular sx, he's just hurting in the LB/buttocks, sometimes up into the T-spine.

Just one of those things. The PT did what he could do, I'll do what I can do. I'm kind of neutral about all of this, told the patient that if he wasn't any better in two weeks (t.i.w.) that I wouldn't waste his money or my time.

Greg

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Greg Priest, DC, DABCO

(in reply to johnczyk1)

Post #: 47

Re: how would you handle this one? - February 19, 2006 6:54:00 PM

nari

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Ginger

So be it. I'm waiting for your thumbs/hands to disintegrate down the wallaby track...but if you are happy with megamobilipulation, who am I to disagree? Uhoh..I can hear your CMCJs and distal phalanxes squeaking already. :rolleyes:

Greg

Well said. I can hear Ginger saying 'mobilise!!' but this guy sounds just the goods for neurodynamics..Ginger,stop groaning.

Nari

(in reply to johnczyk1)

Post #: 48

Re: how would you handle this one? - February 19, 2006 8:05:00 PM

ginger

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From: Melbourne Victoria
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Nari, megamoba whaaat?, you'll slip and fall on your tongue saying words like that. Steady on girl, anyhow the wallabies are thick round these parts , up and down the track.
Good to hear from you Greg.

_____________________________

Ubi est mea anaticula cumminosa?

The Grand Pediculator

(in reply to johnczyk1)

Post #: 49

Re: how would you handle this one? - February 19, 2006 8:50:00 PM

nari

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Joined: November 14, 2003
From: Australia
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Ginger

You will get our North American colleagues thinking they go galloping down Bourke St....
even in the Capital they don't do that. :p

Nari

(in reply to johnczyk1)

Post #: 50

Re: how would you handle this one? - February 20, 2006 6:04:00 AM

JLS_PT_OCS

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From: USA
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Tim-
Of course seeing two PTs is I think counterproductive. But then again, they provide some of the same treatments with the same rationales. I've always felt the thrust of the care (no pun intended) provided by PTs and Chiros was so different that co-treating wasn't really a big issue.
Though I'm sure there are exceptions to 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**

(in reply to johnczyk1)

Post #: 51

Re: how would you handle this one? - February 20, 2006 6:30:00 AM

aquatherapysc

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I had a very similar situation. I went to the patient and got the rundown as to what the Chiro was doing in terms of treatment. I spoke frankly to the patient and went through step by step what my treatment would be and how in many ways it was not conducive to simultaneous treatment, in fact it had the potential to cause additional injury/discomfort. I asked that he come to me for additional treatments and we would re-evaluate in a few weeks. Long story short, the pain ended and the patient did not have a need to see the Chiro.

(in reply to johnczyk1)

Post #: 52

Re: how would you handle this one? - February 20, 2006 2:51:00 PM

TMondale

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From: Newton-Wellelsley Hospital
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By the way the either/or approach is far less confusing to a patient than one profession speaking in sound scientific terms, and the other speaking in pure hokum.

Tim

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Post #: 53

Re: how would you handle this one? - February 20, 2006 4:18:00 PM

docb

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"one profession speaking in sound scientific terms, and the other speaking in pure hokum."

Now Tim you shouldnt down PTs (I went to PTA school and have alot of respect for PTs)most of them that I refer and work with dont speak "pure hokum" at all.

Bryan

(in reply to johnczyk1)

Post #: 54

Re: how would you handle this one? - February 21, 2006 2:44:00 AM

TMondale

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From: Newton-Wellelsley Hospital
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Bryan,

At least you had a little professional training.
Good for you.

Tim

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Post #: 55

Re: how would you handle this one? - February 21, 2006 3:59:00 AM

GLASGOW

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Joined: July 30, 2005
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Quote
By the way the either/or approach is far less confusing to a patient than one profession speaking in sound scientific terms, and the other speaking in pure hokum.

This is the kind of sad mentality that produces interprofessional misunderstanding-indeed very poor show.

(in reply to johnczyk1)

Post #: 56

Re: how would you handle this one? - February 21, 2006 8:45:00 AM