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Re: Looking like a fool on chiro open forum
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Re: Looking like a fool on chiro open forum - February 28, 2006 3:55:00 PM
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FLAOrthoPT
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i think the part you are missing SJ is that knowing when to manipulate and when not to manipulate is what takes knowledge and skill. I am sure any ATC can have someone do plyometrics, it is not unique to PT, but knowing at what moment to integrate plyometrics as a consideration in stability, motor control, loading of neural and muscular tissues, that's what makes our training essential. PTAs can manipulate, and do it well, I have seen some. It does not mean they know when it is appropriate or inappropriate, this seems to be lost on you. I do not think anyone thinks manipulation is difficult, it is assessing the need and reassessing afterwards and being able to know if it had the desired effect, that is where skill is knowledge and knowledge is skill...ok scrubs is back on-
Ben
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Re: Looking like a fool on chiro open forum - March 1, 2006 1:12:00 AM
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SJBird55
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I swore that is what Greg was saying... sorry for missing the point if that was the point.
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Re: Looking like a fool on chiro open forum - March 1, 2006 1:29:00 AM
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chiroortho
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SJ all I can tell you is that it took me a year or two working in the clinic at school getting critiqued to really get good at it. :)
As for generalized techniques getting results, I agree. I don't buy the chiropractic assertion that we can adjust/manipulate just one segment. Just isn't so IMO. As Ben mentioned, one aspect of manipulation is knowing when/when not to manipulate, and another aspect is that there are multiple techniques that can address dysfunction in the same spinal region. For example, there are what we'd call side-posture techniques that might be performed for L-spine dysfunction, but for a given patient we might not want to include a rotary component (e.g. for a disc patient) so we might choose what we call axial decompressive manipulative therapy for that patient instead. Then there are techniques that utilize what's called a drop table (I know it sounds odd but it really isn't).
So the factors that I found took time for me to learn include:
1) Knowing when manip is/isn't appropriate
2) Developing the psychomotor skills to assess the patient's spinal status
3) Developing the psychomotor skills to perform the actual manipulation
4) Learning the different manipulative approaches
5) Learning which manipulative approach would likely be most efficacious for a given patient.
I hope this helps clarify my earlier post.
Greg
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Greg Priest, DC, DABCO
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Re: Looking like a fool on chiro open forum - March 1, 2006 1:36:00 AM
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chiroortho
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By the way, I have no doubt that I could take someone off the street and teach them a single simple manipulative maneuver in an hour or two and they could probably perform a pretty good manip on a LBP patient with good results. But then again I sure wouldn't want to be the patient. :)
As with anything else, the more we do something the better we get at it. I've said for years that I could teach a monkey to manipulate, but I couldn't teach the monkey the necessary algorithmic protocols, nor could I teach him what to do if things went wrong. I'm only slightly smarter than a monkey, so it took me a couple of years in training to get pretty good at it.
Have a great day.
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Greg Priest, DC, DABCO
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Re: Looking like a fool on chiro open forum - March 1, 2006 1:51:00 AM
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SJBird55
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So, I need to ask another question. Greg, if the main part of your business and skill is based on manipulation, well, how often do you not manipulate?
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Re: Looking like a fool on chiro open forum - March 1, 2006 2:22:00 AM
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JLS_PT_OCS
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I think we could say the same thing for many spinal rehabilitative techniques that we are saying about spinal manipulation.
While there do appear to be groups of people who can benefit from a very specific localized muscle retraining approach, most patients can be confidently managed with generalized core stability exercises and graded activity.
So a DC who has some training would probably do very well. With a background in exercise science and anatomy, I don't see it taking all that long, either.
Here is the overlap between professions, I think.
I totally agree with Greg and Drew, we should drop all the "you can't do this or that" on both sides, open it up completely, and just let the market decide.
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: Looking like a fool on chiro open forum - March 1, 2006 3:34:00 AM
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GLASGOW
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No, manipulation is a cop out.A cheap and easy way to seek short term symptomatic relief only
Physiotherapy does not need manipulation.If physiotherapy falls into this category then it is no better than the 200 visit chiropractor clinic down the street.We must seek to avoid this at all cost.
Manipulation should realy be considered a dangerous and outdated simple skill.
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Re: Looking like a fool on chiro open forum - March 1, 2006 4:53:00 AM
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Alex Brenner PT MPT OCS
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Greg,
I am curious about your number 5 listed above. I assume this is taught at chiropractic school and if so is it based on anecdotal evidence/ professor's experience or is there some research to show which technique is effective on a certain subgroup of people with low back pain? I have done many lit reviews on manipulation and I personally have not found much to show; for example, that a certain technique such as an axial decompressive technique is more effective for someone with a disc problem versus another technique lets say a drop table technique (just an example here). To your knowlege is there evidence (i.e. a RCT) to support this? In theory I can understand this but I am wondering if it has been investigated in an actual study.
Thanks.
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Alex Brenner, PT, MPT, OCS
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Re: Looking like a fool on chiro open forum - March 1, 2006 1:42:00 PM
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chiroortho
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SJ, I honestly couldn't give you a percentage but there are patients that we don't manipulate. Sorry I can't be more specific.
Alex, as to your question 'is it based on anecdotal evidence/ professor's experience or is there some research to show which technique is effective on a certain subgroup of people with low back pain?', the answers would be yes/yes/yes. Cox has researched axial decompression manipulation, for example. Another way of looking at my answer would be that one aspect of it should be fairly self-evident, for example I would want to avoid a rotary manipulation on a patient with an HNP and use axial decompression instead, based upon Cox's work.
Now as to research - an example of the efficacy of axial decompressive manipulation would be http://www.coxtechnic.com/EURO%20SP%20J%20GUDAVALLI.pdf or http://www.coxtechnic.com/research.asp
[URL=http://www.coxtechnic.com/casereports.asp]Here[/URL] are a bunch of case reports.
As for the last part of your question about research showing which technique is effective on a certain subgroup of people with low back pain, I'm not completely sure that I understand the question but if my guess is right, you're asking if there is research saying that 'XX manipulative technique is preferable for this type of LBP and YY technique is better for that type of LBP'. If so, then to defer once again to Cox, he has shown that his axial decompressive technique seems to be effective for certain subsets of patients with LBP while other techniques might be contraindicated or at least less advisable.
I know that this is not a totally satisfying answer but I hope it helps to clarify things a little.
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Greg Priest, DC, DABCO
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Re: Looking like a fool on chiro open forum - March 1, 2006 2:10:00 PM
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chiroortho
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Also take a peek at this: http://www.coxtechnic.com/federalstudies.asp , http://www.coxtechnic.com/spinepainmgmtalgorithm.asp , http://www.coxtechnic.com/researchbytopic.asp , http://www.coxtechnic.com/singapore.html , http://www.coxtechnic.com/phoenix.html , and http://www.coxtechnic.com/dallas.html .
Sorry for the cut and paste but I am trying to save you some time looking for specific info about this one technique.
Lastly, this may interest you from the Annals of Internal Medicine (1992 Oct 1;117(7):590-8): [QUOTE]Spinal manipulation for low-back pain.
Shekelle PG, Adams AH, Chassin MR, Hurwitz EL, Brook RH.
RAND, Santa Monica, CA 90406-2138.
PURPOSE: To review the use, complications, and efficacy of spinal manipulation as a treatment for low-back pain. DATA IDENTIFICATION: Articles were identified through a MEDLINE search, review of articles' bibliographies, and advice from expert orthopedists and chiropractors. STUDY SELECTION: All studies reporting use and complications of spinal manipulation and all controlled trials of the efficacy of spinal manipulation were analyzed. Fifty-eight articles, including 25 controlled trials, were retrieved. DATA ANALYSIS: Data on the use and complications of spinal manipulation were summarized. Controlled trials of efficacy were critically appraised for study quality. Data from nine studies were combined using the confidence profile method of meta-analysis to estimate the effect of spinal manipulation on patients' pain and functional outcomes. RESULTS OF DATA SYNTHESIS: Chiropractors provide most of the manipulative therapy used in the United States for patients with low-back pain. Serious complications of lumbar manipulation, including paraplegia and death, have been reported. Although the occurrence rate of these complications is unknown, it is probably low. For patients with uncomplicated, acute low-back pain, the difference in probability of recovery at 3 weeks favoring treatment with spinal manipulation is 0.17 (for example, increase in recovery from 50% to 67%; 95% probability limits of estimate, 0.07 to 0.28). For patients with low-back pain and sciatic nerve irritation, the difference in probabilities of recovery at 4 weeks is 0.098 (probability limits, -0.016 to 0.209). CONCLUSIONS: Spinal manipulation is of short-term benefit in some patients, particularly those with uncomplicated, acute low-back pain. Data are insufficient concerning the efficacy of spinal manipulation for chronic low-back pain.
Publication Types:
Review
PMID: 1388006 [PubMed - indexed for MEDLINE][/QUOTE]
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Greg Priest, DC, DABCO
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Re: Looking like a fool on chiro open forum - March 1, 2006 2:19:00 PM
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paulpt
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Any idea on the identity of the authors of the 25 primary articles from which this data was extrapolated?
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Re: Looking like a fool on chiro open forum - March 1, 2006 3:05:00 PM
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Jeep
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[QUOTE]Any idea on the identity of the authors of the 25 primary articles from which this data was extrapolated? [/QUOTE]Go to the journal(or you can try pubmed) and access the full text. The "25 articles and authors" will be identified.
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Re: Looking like a fool on chiro open forum - March 2, 2006 12:05:00 AM
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Andrew M. Ball PT PhD
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It may be informative to know that of the 25 articles in the RAND and AHCR studies on manipulation, 19 were manipulations done by PT's, 4 were manipulations done by chiropractors --- yet it always seems to be the DC's (and no, I'm not speaking to Greg in this instance) that use this study to try to support their argument as to the effectiveness of manipulation, and why DC's, not PT's should be the only provider of manipulative care.
Drew
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Dr. Andrew M. Ball, PT, DPT, Ph.D.
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Re: Looking like a fool on chiro open forum - March 2, 2006 12:39:00 AM
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Jeep
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[QUOTE]It may be informative to know that of the 25 articles in the RAND and AHCR studies on manipulation, 19 were manipulations done by PT's, 4 were manipulations done by chiropractors [/QUOTE]Drew-
Will you please provide the links to your above claim?
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Re: Looking like a fool on chiro open forum - March 2, 2006 3:14:00 AM
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chiroortho
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A good study is a good study, and I don't mind in the least if it's PTs doing the manipulations. I just like to see data relative to the efficacy of manipulative therapy, and if PTs participate in studies, I for one am grateful.
If we're going to be EBM, we need to look at all of the data, no matter who participates in the studies. I congratulate the PT profession on making strides in manipulative research, eg the CPR for manip by Childs. My hat's off to him. I don't agree with all of the aspects of his algorithm, but like Cox, at least he goes to the trouble of PRODUCING an algorithm. DCs need to do more research.
The more research on manipulative therapy, the better.
Greg
_____________________________
Greg Priest, DC, DABCO
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Re: Looking like a fool on chiro open forum - March 2, 2006 3:30:00 AM
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GLASGOW
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Manipulative treatment never has been and never should be a part of the physiotherapy treatment regimen.Physiotherapy is a rehabilitative profession very superior to the simple and dangerous practice of chiropractic.To wish to follow the chiropractors down the road of manipulation is sheer folly as physio will end up being tarred with the same brush as these charlatans.We need to seek alliances closer to medicine where we can safely broaden the scope practice under the medical umbrella to benefit the clients.As a profession it is not unreasonable to seek ways to limit the practice scope of people like chiropractors for the greater good of the profession and the safety of our clients.This may sound like a hard line approach but in reality it is the only logical course of action while at the same time we should actively strive to expand into the chiropractic patient base using the accepted safe priniciples
of physiotherapy.
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Re: Looking like a fool on chiro open forum - March 2, 2006 3:51:00 AM
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FLAOrthoPT
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sometimes I think you're just kidding, and sometimes I don't. If you're going to make such claims, that is fine,what about some evidence based research to back you up, because I can tell you it is like arguing that the sky is really yellow.
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Re: Looking like a fool on chiro open forum - March 2, 2006 5:24:00 AM
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Jeep
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Greg-
Cox's studies deal with a very specific manipulative procedure. Most of the other studies do not. A very primative, rudimentary, non-specific, manipulative manuever was used in Child's study. It would be very interesting to carry his study to the next level--------critical assessment of this crude manipulative maneuver vs. eg. Cox or another specific maneuver in treatment of the same population. That would lead to qualitative vs. quantitive evaluation.
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Re: Looking like a fool on chiro open forum - March 2, 2006 5:55:00 AM
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Jeffre
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Jeep,
Here is a study in progress that you may be interested in:
Comparison of the Effectiveness of Three Manual Physical Therapy Techniques in a Subgroup of Patients with Low Back Pain Who Satisfy a Clinical Prediction Rule: Study Protocol of a Randomized Clinical Trial. (NCT00257998).
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=16472379&query_hl=1&itool=pubmed_docsum
Glasgow,
I have figured you out. You are really a DC who poses as a PT trying to sway other PTs away from manipulation. That may work in Scotland but it won't work here. In the words of Jason S. "your statements are quite silly". Here is a quote from one of your own: "Manipulation and mobilization have existed in Physical Therapy to some degree from the very beginning."- Karl Kranz DC, Dept of Research and Statistics, American Chiropractic Association.
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"You are as well as your insurance company is willing to allow."
- Dr. Hibbert
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Re: Looking like a fool on chiro open forum - March 2, 2006 6:35:00 AM
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Jeep
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Thanks Jeffe-
I will definately take a look at that article as soon a possible.
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