|
|
Re: Spinal manipulation and pregnancy
|
Logged in as: Guest
|
|
Users viewing this topic:
none
|
|
Login  | |
|
Re: Spinal manipulation and pregnancy - July 22, 2006 1:51:00 AM
|
|
|
emad/emad
Posts: 42
Joined: July 4, 2006
Status: offline
|
valmarie:
I agree with your views .
Okay ,let us say manipulation works well with back pain and in pregnancy .let us wait until research/evidence supports this pradaigm and further more Evidnce -Based practice means both evidence combined with experience .
I see much evidence concerning efficacy of manipulation in acute back pain ,hoever personally i do NOT apply it at all ,and never have thought of it as a choice of my tools .How am i going to apply sudden manipulation to cervical ,while there are sure researches talk about complications of the cord .
What will i manipulate the Disk !HOw could i be sure that the real background of the problem is the disc ?!
Several Questions ?!!!
I can NOt skip over the training /competence factor of my practice ,yes i have NOT attended a course practically ,but i like to be on the safe side .
Cheers
Emad
|
|
|
|
|
Re: Spinal manipulation and pregnancy - July 23, 2006 7:51:00 AM
|
|
|
blast7
Posts: 101
Joined: July 28, 2005
Status: offline
|
This is a very interesting discussion. I can't say that I remember directly reading an article on this subject matter, but as someone previously stated, I thought it was contraindicated at a specfic point during the pregnancy. This is due to the elevated prolactin levels causing ligamentous laxity.
|
|
|
|
|
Re: Spinal manipulation and pregnancy - July 24, 2006 2:55:00 AM
|
|
|
Alex Brenner PT MPT OCS
Posts: 1057
Joined: February 29, 2004
From: Kentucky
Status: offline
|
[QUOTE]I see much evidence concerning efficacy of manipulation in acute back pain, however personally i do NOT apply it at all ,and never have thought of it as a choice of my tools [/QUOTE]Yikes. Many leaders in our field would say then that you are practicing suboptimal. Why would you ignore the evidence? In regards to your questions about the mechanism, I say that it does not matter. That does not mean that we should not continue to try to answer these questions with good research but in the same sense we should not withhold the intervention either.
_____________________________
Alex Brenner, PT, MPT, OCS
|
|
|
|
|
Re: Spinal manipulation and pregnancy - July 24, 2006 7:16:00 AM
|
|
|
emad/emad
Posts: 42
Joined: July 4, 2006
Status: offline
|
Hi alex :
To be honest i do not know if there difference between the physio-manipulation and Chiro-manipulation ,anyway i do NOT like at all using sudden/thrust techniques for 2 reasons .First of all Evidence like the follwonig;
[QUOTE] [/QUOTE]J R Soc Med. 2001 Mar;94(3):107-10.
Neurological complications of cervical spine manipulation.
Stevinson C, Honan W, Cooke B, Ernst E.
Department of Complementary Medicine, University of Exeter, 25 Victoria Park Road, Exeter EX2 4NT. C.D.Stevinson@ex.ac.uk
To obtain preliminary data on neurological complications of spinal manipulation in the UK all members of the Association of British Neurologists were asked to report cases referred to them of neurological complications occurring within 24 hours of cervical spine manipulation over a 12-month period. The response rate was 74%. 24 respondents reported at least one case each, contributing to a total of about 35 cases. These included 7 cases of stroke in brainstem territory (4 with confirmation of vertebral artery dissection), 2 cases of stroke in carotid territory and 1 case of acute subdural haematoma. There were 3 cases of myelopathy and 3 of cervical radiculopathy. Concern about neurological complications following cervical spine manipulation appears to be justified. A large long-term prospective study is required to determine the scale of the hazard.
Add to ;
[QUOTE] [/QUOTE]I am sure this is NOT the first time you see such researches .
So ,How do you use manipulation ispit of the above researches?
The second reason why i do NOT use manipulation practically , i think the cortex and the body defend itself against any outside threat /force ,so you may notice protective reflex while you apply thrust manipulation!!
Cheers
Emad
|
|
|
|
|
Re: Spinal manipulation and pregnancy - July 24, 2006 7:22:00 AM
|
|
|
emad/emad
Posts: 42
Joined: July 4, 2006
Status: offline
|
Another evidence ought to be quoted within the last post ,here you are it is another time
J Neurol. 2002 Aug;249(8):1098-104
Stroke, cerebral artery dissection, and cervical spine manipulation therapy.
Department of Research, Southern California University of Health Sciences, USA.
Stroke represents an infrequent adverse reaction associated with cervical spine manipulation therapy. Attempts to identify the patient at risk and the type of manipulation most likely to result in these complications of manipulation have not been successful. A retrospective review of 64 medical legal cases of stroke temporally associated with cervical spine manipulation was performed to evaluate characteristics of the treatment rendered and the presenting complaints in patients reporting these complications. These files included records from the practitioner who administered the manipulation therapy, post stroke testing and treatment records usually by a neurologist, and depositions of the patient and the practitioner of manipulation as well as expert and treating physicians. A retrospective review of the files was carried out by three (two in 11 cases) researchers using the same data abstraction instrument to independently assess each case. These independent reviews were followed by a consensus review in which all reviewers reached agreement on file content. Ninety two percent of cases presented with a history of head and/or neck pain and 16 (25 %) cases presented with sudden onset of new and unusual headache and neck pain often associated with other neurological symptoms that may represent a dissection in progress. The strokes occurred at any point during the course of treatment. Certain patients reporting onset of symptoms immediately after first treatment while in others the dissection occurred after multiple manipulations. There was no apparent dose-response relationship to these complications. These strokes were noted following any form of standard cervical manipulation technique including rotation, extension, lateral flexion and non-force and neutral position manipulations. The results of this study suggest that stroke, particularly vertebrobasilar dissection, should be considered a random and unpredictable complication of any neck movement including cervical manipulation. They may occur at any point in the course of treatment with virtually any method of cervical manipulation. The sudden onset of acute and unusual neck and/or head pain may represent a dissection in progress and be the reason a patient seeks manipulative therapy that then serves as the final insult to the vessel leading to ischemia.
Cheers
Emad
|
|
|
|
|
Re: Spinal manipulation and pregnancy - July 24, 2006 9:42:00 AM
|
|
|
steve
Posts: 455
Joined: May 14, 2003
From: victoria, bc Canada
Status: offline
|
Emad,
I think Alex was referring to manipulation of the thoracic and lumbar spine, which has very little in the means iof complications. Your two posted articles refer to cervical spine where the risk factor is less known and complications severe and I would agree that based on the uncertainty, mobilizations may be just as effective and safer.
With respect to protective reflex, you may be right, that certain patients exhibit this reflex but actually there is significant evidence of inhibition of tone in muscles (And facilitation in inhibited muscles) post manipulation - Walter Herzog has done some interesting research in this area.
Perhaps your decision making on manipulation is based on prior experiences and I would suggest that you read some of the more recent research with an open mind - It gives you clear guidelines on choosing appropriate patients that will benefit from manipulation.
Steve
|
|
|
|
|
Re: Spinal manipulation and pregnancy - July 24, 2006 10:14:00 AM
|
|
|
emad/emad
Posts: 42
Joined: July 4, 2006
Status: offline
|
Steve :
Well, you concluded that cervical Manipul could be more risky in relation to other spine regions,quite right ,i tried so much to find evidence concerning that complication more recent but i could not find later than 2002.
I concluded in one of my posts that ,there is enough evidence/research supports the efficacy of thrust manipulation even over mobilization ,which means i do not criticise for just personal views , i am trying to reach the safer and best.
Just a thought ,we are just practising science .Science for me means change/develop ,not orthodxy positions, i mean i try,apply ,practice ,reflect ,select !
open-mind could be interpreted from different views according !!
Cheers
Emad
|
|
|
|
|
Re: Spinal manipulation and pregnancy - July 24, 2006 11:38:00 AM
|
|
|
nari
Posts: 1568
Joined: November 14, 2003
From: Australia
Status: offline
|
I tend to agree with emad - why use some technique which is 'unknown' as to its physiology of effect. There is no doubt it works, and within the grouping, appears quite safe. However there are other ways to skin a cat which are effective and harmless, as far as any intervention from another person is 'harmless'.
If manips facilitate inhibited muscles and reduce tonus, then why? How? It always seems strange that people are so keen to use a technique which 'works' and has a minor level of risk, but are happy to say they have no idea *why*. Sounds like the rationale used for ultrasound in the 80s - it works, but we don't have a clue why.
It always seems odd to me that there is stated preference for a technique which does have a small risk of complications. However, this has been done to death in previous threads, and I guess the preference comes down to a personal one.
Nari
|
|
|
|
|
Re: Spinal manipulation and pregnancy - July 24, 2006 12:19:00 PM
|
|
|
Bournephysio
Posts: 576
Joined: April 25, 2002
From: Calgary
Status: offline
|
Why would you choose a treatment that you don't know works over one you do?
What treatment in neuromusculoskeletal physio has more solid research on how it works than manual therapy?
Doug
|
|
|
|
|
Re: Spinal manipulation and pregnancy - July 24, 2006 12:31:00 PM
|
|
|
nari
Posts: 1568
Joined: November 14, 2003
From: Australia
Status: offline
|
Doug
Why would I choose a treatment where there is no evidence at all that it works?
I have no idea.
Manual therapy has a lot going for it. I thought we were talking about manipulation, which is only a small part of manual therapy.
Nari
|
|
|
|
|
Re: Spinal manipulation and pregnancy - July 24, 2006 1:14:00 PM
|
|
|
steve
Posts: 455
Joined: May 14, 2003
From: victoria, bc Canada
Status: offline
|
Nari,
I think Doug's point is that we know far more about manipulation (In the form of its outcome and the reason for why it works)than any other form of manual therapy and that it was ironic that you would choose a treatment with unknown outcomes over a treatment with specific outcomes.
As for risk, the literature shows very little risk of significant harm with manipulation (Ie. Cauda equina is estimated at 1 in 10 million) and we are unsure of the risk with mobilization or massage (Although intuitively I would agree that the risk of harm is lower).
Again, this has been done to death and your right it comes down to personal preference but dont you think there is something wrong with that? I mean we should all be striving to give the best care possible and if there is significant hard research to establish a specific treatment is beneficial, shouldn't we be obligated to use/ inform our clients of its presence as to provide them with optimal care? If this is unsuccessful we could then move on to less established forms of care.
How would you feel if you had cancer and your physician opted not to use a treatment that had a 95% success rate in well conducted trials because it didnt agree with their experiences or theoretical views?
Steve
|
|
|
|
|
Re: Spinal manipulation and pregnancy - July 24, 2006 8:23:00 PM
|
|
|
nari
Posts: 1568
Joined: November 14, 2003
From: Australia
Status: offline
|
At the risk of winding around countercultural circles, I assume Aust PTs generally have a high reputation around the world. Yet, even the manip therapists, when sent appropriate clients, will use manips for less than 3% of "musculoskeletal" "back" patients...
Why? Because it carries more risk and why bother with them when other methods are just as or more effective?
So there we have it - different education, different cultures, perhaps. A moving away from the mechanical joint/muscle model which has been shown to be defective with respect to pain.(IASP conference 2006)
Probably no point in flogging dead horses any further.
Cheers
Nari
|
|
|
|
|
Re: Spinal manipulation and pregnancy - July 24, 2006 9:58:00 PM
|
|
|
emad/emad
Posts: 42
Joined: July 4, 2006
Status: offline
|
Hi ;
Comparing the issue of cancer treatement and our pain approaches is NOT fair at all .
I am so sure the pain which we usually deal with if neglected ,or dealt with using rest ,or distracting from it ,soon it will reslove without any intervention ,this fact can not be denied at all .
Cheers
Emad
|
|
|
|
|
Re: Spinal manipulation and pregnancy - July 24, 2006 10:51:00 PM
|
|
|
steve
Posts: 455
Joined: May 14, 2003
From: victoria, bc Canada
Status: offline
|
Emad,
How is the cancer example not fair? In both situations we want to provide the best care for our patients, irrespective of the consequences of the outcome of the disease.
With respect to your comments on rest and neglect resolving pain, recent research has identified that 70% of low back pain sufferers continue have pain at one year post initial episode. Manipulation (Childs 2004) and exercise (Jull 2001) have both been shown to have a significant impact on this.
Nari,
How do we know that mobilizations for the lumbar spine are just as effective and safer? But again, we are now kicking the horse while it lies on the ground....
Steve
|
|
|
|
|
Re: Spinal manipulation and pregnancy - July 25, 2006 12:10:00 AM
|
|
|
nari
Posts: 1568
Joined: November 14, 2003
From: Australia
Status: offline
|
Steve...
True, but I don't think there has been anything published on neurological changes for the worst with mobilisations and other techniques.
What say we agree to disagree and leave the poor horse to recover? Or not?
Nari
|
|
|
|
|
Re: Spinal manipulation and pregnancy - July 25, 2006 1:38:00 AM
|
|
|
emad/emad
Posts: 42
Joined: July 4, 2006
Status: offline
|
Steve;
The culture here plays role to some extend concerning our views with that cancer example .For me , i think a patient who is going to die and you know that ,when you tell that patient i have a good treatement for your cancer which is A with 95% good outcome and severe complication with only 5% ,of course,he/she will think and may accept .
For us the position is different , i can NOT understand how to skip over danger /life risk using that manipulation . I can NOt agree at all using risky technique ( Manipulation ) to address non-risky patient (pain ).
I suugest ,we should reach agreements regarding what is manipulation and mobilization ,there is a possiblity that you are performing Manipulation gently (not suuden ) which we may consider mobilization .
Cheers
Emad
|
|
|
|
|
Re: Spinal manipulation and pregnancy - July 25, 2006 9:32:00 AM
|
|
|
UTDC
Posts: 221
Joined: December 21, 2003
Status: offline
|
I find this to be a very interesting discussion.
Nari,
You mentioned: [QUOTE]will use manips for less than 3% of "musculoskeletal" "back" patients...
Why? Because it carries more risk and why bother with them when other methods are just as or more effective?[/QUOTE]What methods are you referring to here. I can recall several trials comparing manipulation to other interventions and it seems to me that manipulation has been shown to produce better outcomes.
I remember that you are a fan of the neuromobilization approach. I do not believe that it has been compared to spinal manipulation, in fact the one trial that I am aware of showed that neuromob's were actually harmful to the participants in the study.
|
|
|
|
|
Re: Spinal manipulation and pregnancy - July 25, 2006 9:50:00 AM
|
|
|
emad/emad
Posts: 42
Joined: July 4, 2006
Status: offline
|
Hello ;
Good ,i & nari are criticising Manipulation ,what do we present in place so ?
A combination from assurance ,fixing patient,s belief ,education ,breathing ex , neural mobilizations ,mobilization !!
In fact , i have NOT seen at all a study comparing Manipula VS neurodynamics ,but i have a study for compination of both .
I like to see any study shows harms or complications of neurodynamics .
Cheers
Emad
|
|
|
|
|
Re: Spinal manipulation and pregnancy - July 25, 2006 11:01:00 AM
|
|
|
nari
Posts: 1568
Joined: November 14, 2003
From: Australia
Status: offline
|
UTDC,
I recall that study, although I can't remember who did it, but the only harm likely to be done is by incorrect use of neurodynamics. Most PTs think of sliders and glides as stretches, which can be extremely nociceptive.
Other methods which are neuromodulatory in nature are effective, fast and do not involve any rapid thrusting, have been described by Diane in her occasional posts here. As emad has said, there are other ways, including pain education (not anatomy education!)which has been shown to reduce pain without physical intervention (Moseley); and movements which do not aim to strengthen or stretch anything. (Butler, Shacklock)
But I understand that these methods are not well accepted in the USA; the focus seems to be only on anatomical structures, and mechanical in nature.
As I said, different PT culture, different focus; we all get results in our own way; whether they are backed by RCTs or an understanding of neurophysiology; hopefully one day, both.
Nari
|
|
|
|
|
Re: Spinal manipulation and pregnancy - July 25, 2006 2:04:00 PM
|
|
|
Synergy
Posts: 589
Joined: March 11, 2004
From: Forney, TX
Status: offline
|
[QUOTE]But I understand that these methods are not well accepted in the USA; the focus seems to be only on anatomical structures, and mechanical in nature.
As I said, different PT culture, different focus; we all get results in our own way; whether they are backed by RCTs or an understanding of neurophysiology; hopefully one day, both.[/QUOTE]Nari,
I couldn't agree more! However, I do foresee a paradigm shift (I believe one is already taking place) with more attention being paid to the CNS/PNS. As a huge proponent of both manipulation and neurodynamics (the latter thanks to you, Diane, Barrett, and Jon), I believe the two will have to meet each other sooner or later. Current research is still void of a reason as to why manipulation impacts nociception (correct me if I'm wrong).
In response to UTDC, I have yet to have a patient respond negatively to a neuromodulatory appraoch, but at the same time, the benefits they did get via the technique(s) were not as lasting as a manipulation. Why? Who knows...but part of it might be too little education given to the patient re: pain or perhaps my technique.
Regardless, I do think the neuro approach still has infinite amounts of potential that has yet to be discovered or fully understood.
_____________________________
Chris Adams, PT, MPT
|
|
|
|
 New Messages |
 No New Messages |
 Hot Topic w/ New Messages |
 Hot Topic w/o New Messages |
 Locked w/ New Messages |
 Locked w/o New Messages |
|
 Post New Thread
 Reply to Message
Post New Poll
Submit Vote
Delete My Own Post
Delete My Own Thread
Rate Posts |
|
0.094
|
Printable Version
All Forums >> [RehabEdge Forum] >> Open Forum >> Re: Spinal manipulation and pregnancy 
