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Re: Spinal manipulation and pregnancy
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Re: Spinal manipulation and pregnancy - July 25, 2006 2:17:00 PM
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nari
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From: Australia
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Chris
Exactly. I have visions of all complex biomechanical approaches becoming extinct - well, nearly all of them - and the prime protagonist of everything that happens to us will 'rule' our interventions.
But that is some way off yet...
Nari
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Re: Spinal manipulation and pregnancy - July 25, 2006 8:40:00 PM
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steve
Posts: 451
Joined: May 14, 2003
From: victoria, bc Canada
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Nari,
The use of manipulation certainly does not require biomechanist thinking - I believe based on research that it has the same effect that you speak of - neurophysiological.
I also agree with what both you and Emad do from a treatment perspective although I would argue that neural sliding gliding is just neurophysioogical input to the brain. Hey the more I go on here the more hope I have for that poor horse.
Steve
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Re: Spinal manipulation and pregnancy - July 25, 2006 9:34:00 PM
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nari
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From: Australia
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Steve
If manipulation has a neurophysiological effect, ie, input, and I certainly agree it does, and probably the only effect - then what is the difference between glides and a thrust? Both achieve the same effect: appropriate neurophysiological input.
Surely any other reason for manipulation to be effective is to resort to the subluxation theory (mechanical malpositioning)and that has been blown out of the water, I thought. Stiffness and pain are only associated, not related.
Maybe the horse will get up and kick us for being so nasty to it....
Nari
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Re: Spinal manipulation and pregnancy - July 25, 2006 9:51:00 PM
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steve
Posts: 451
Joined: May 14, 2003
From: victoria, bc Canada
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Nari,
I agree both mobilizations and manipulation have similar effects and in the cervical spine no significant differences have been noted in comparing the two techniques. Malpositioning is quickly becoming an antiquated theory based on recent research identifying the non specificity of both mobilization and manipulation and the significant change in both facilitation and inhibition of muscles immediately following manipulation. I know Tony Wright has done some interesting work on proximal mobilizations causing distal changes in pain sensitivity, all be it in rats.
The two may very well have similar effects but at present, lumbar spine manipulation has demonstrated such a strong treatment effect in the lumbar spine and contrary to beliefs here such minimal chance of significant harm that I choose to use it. If and when mobilization or neural gliding demonstrate as significant effect in outcome based studies I will use them as the research suggests, if that makes any sense.
I would also point out that this isnt a one trick pony show - manipulation is effective on a specific sub group and is alwats combined with stabilization/ROM exercise and reassurance/pain education as the evidence suggests that both of these treatments are highly efficacious.
Steve
Steve
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Re: Spinal manipulation and pregnancy - July 25, 2006 10:33:00 PM
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Randy Dixon
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Nari,
You say that manipulation and other neuromodulatory methods are equal in effectiveness, this hasn't been shown, but that's the dead part of the horse. More significantly, the mechanisms and structures involved are different. Different receptors, different response. For example, a manipulation affects the joint itself much more than the surrounding tissue. I don't think there is any reason to look at it as an either/or proposition but it makes more sense to look at it as an and/and viewpoint.
Did you see the Child's study about slump stretching I posted on the other site?
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Re: Spinal manipulation and pregnancy - July 26, 2006 12:52:00 AM
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nari
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From: Australia
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Thanks for the replies; I don't think we are getting anywhere, but it is interesting to read different views.
Randy,
I did see that Child's study but would argue that slump stretching is inappropriate to be called neuromodulation. It is far too severe for normal desensitisation unless very carefully executed with tiny amplitudes.
I guess that same sentence applies to manipulations, as well. Careful execution with small amplitude.
Where your argument seems to falter is this: can you explain how a stiff joint (say a knee or facet or something like that, not post-op, post-long immobilisation) will quite quickly regain normal ROM without the use of force as in a manip?
Soft tissue work, ectodermal or endo, SC and other techniques can restore ROM without touching the joint in particular.
I have no real argument with manipulation plus other techniques done together except for the passivity of this approach and the need for force.
Anyway, c'est la vie.
Nari
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Re: Spinal manipulation and pregnancy - July 26, 2006 2:24:00 AM
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emad/emad
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Randy :
I agree with you that Mnipulation and Neuromodulation have different peripheral pathways ,but the main point all ways to the central/controller/regulator/governor cortex .
to all :
Where is this horse going to reach ?!
Cheers
Emad
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Re: Spinal manipulation and pregnancy - July 26, 2006 4:57:00 AM
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ALICIAPT13
Posts: 95
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From: North Syracuse, NY
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Wow. Thanks for all the responses, guys. The course I went to was offered by evidence in motion, and I see it was referenced here. This is why I am so intent on getting a concrete answer with sources on this subject. Again, thanks for all the great feedback.
Alicia
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Re: Spinal manipulation and pregnancy - July 26, 2006 4:59:00 AM
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dfjpt
Posts: 238
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[QUOTE]The two may very well have similar effects but at present, lumbar spine manipulation has demonstrated such a strong treatment effect in the lumbar spine and contrary to beliefs here such minimal chance of significant harm that I choose to use it. If and when mobilization or neural gliding demonstrate as significant effect in outcome based studies I will use them as the research suggests, if that makes any sense.[/QUOTE]This horse rears her nearly dead head to say, ah.. I finally see what this argument has been about. Those who paid good money to learn a fancy set of complicated and dazzling stage tricks want to continue to use them as long as they can, even though most of the audience now says, "all it is is a trick and not even all that good a trick.. a major subgroup of us have a brain that sees it's a trick and we don't buy it.. it doesn't help our pain. We want something less quick&dirty, something that will feed our brain for longer than a quick burst, whambamthankyoumam, paythereceptionistonthewayout, that will help it learn to down regulate itself and be free of pain production."
A small group of would-be dazzlers still want to learn to do the tricks, still hope there will be people sucked in by them...mmmm- science now shows there are still a few people out there who appreciate them.
A small group of die-hard (and likely really nice, well-meaning) old magicians who have done the tricks for years (like Steve probably) want to keep the tricks alive, but, to their credit, are grudgingly willing to allow science to curtail their performance. They aren't, however, necessarily as willing to entertain the possibility that the tricks are and always were mere flim flam and razzledazzle, small subgroup of nervous systems that benefit aside, resent the implication even, unless/until all the science is in stating the same definitively, while many others of us have long since left them behind or were never seduced into learning them in the first place.
So I owe the mesodermalists a bit of an apology, probably, the PT mesodermalists specifically, in that you are the ones doing the science that shows manipulation to be less relevant than you formerly suspected it was. So thank you Childs et al. The rest of us knew this all along, but thanks for proving it.. it's a service to humankind.
OK, I'm dead again.
Diane (Whuh-heheheh..plop.)
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Re: Spinal manipulation and pregnancy - July 26, 2006 5:19:00 AM
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dosrinc
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Diane, your post implies that what you and your subgroup do offers more than that of the would be dazzlers using trickeration, flim flam and razzledazzle. This then begs the question: What is it that you and your subgroup do and where is the evidence that it is not more of the same in a different package.
Rick
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Re: Spinal manipulation and pregnancy - July 26, 2006 5:29:00 AM
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Alex Brenner PT MPT OCS
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From: Kentucky
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wow
_____________________________
Alex Brenner, PT, MPT, OCS
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Re: Spinal manipulation and pregnancy - July 26, 2006 5:45:00 AM
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steve
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From: victoria, bc Canada
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Hi Diane,
Nice to see you are still around :)
Steve "The magician"
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Re: Spinal manipulation and pregnancy - July 26, 2006 7:22:00 AM
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dfjpt
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Whoops, up comes that almost dead horse's head again for one last neigh. Hello to you all once again.
Rick: [QUOTE]your post implies that what you and your subgroup do offers more than that of the would be dazzlers using trickeration, flim flam and razzledazzle.[/QUOTE]Rick Rick Rick.. you're so earnest you make me smile on my death bed. Well, make that my hay-covered stall floor.
You don't seem to get the big point that manual therapy is all pretty much placebo.
In defense of placebo, Patrick Wall said, "Placebo is not something that is administered to someone, instead it is something that elicited from someone's brain." It's the best painkiller there ever was. It is made endogenously, it is exactly the right dose, it neuromodulates precisely, it can't ruin receptor sites, and it's natural. (Did I mention it can't give anyone a stroke? Or cauda equina syndrome? Or jostle their quiescent perineural cysts into permanent spinal cord irritants?) It's the tool the brain uses to get itself off the pain square it's on and move on. And it's highly desireable! We should WANT to elicit this! Not just in some little bitty subgroup, but in everyone with a nervous system who sees us! And we need to understand it, be open about it, and frame it in a proper way to patients so we aren't being unethical about it! Read the Explain Pain book by David Butler, please. Let it sink into every sulcus of your mind. People want their brains/nervous systems to learn how to not hurt, not have someone fill them full of images of unyielding mesodermal structures that must be coerced into co-operation.
We all missed the point for a very long time. Pain science has revealed the cards we never knew we had up sleeves we never knew were there - we all have been kidding ourselves for decades, trying to find placebo-less factors in PT. We will stay muddled up perpetually when we research things to try to prove they have any sort of value beyond placebo. Simultaneously, there are so many easier and less expensive ways to learn how to elicit placebo besides manipulation, way less costly to learn and less effort to perform, perfectly ethical... that all the extra effort it takes to learn and perform manipulation is what constitutes the flimflam razzledazzle stageshow stuff, IMHO. Who wins? the manipulation gurus, as they walk off to the bank with your money. Who loses? The ones who earnestly pay good $ to learn something that seems to be complicated, a set of expensive/impressive tricks that are effective for only "a small subset" of the patient population. And the major subset who get nothing out of the treatment, whose spines have been pushed around for nothing, because their brains don't get anything out of it. :D :p
(I good-naturedly await rebanning. :) )
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Re: Spinal manipulation and pregnancy - July 26, 2006 9:19:00 AM
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steve
Posts: 451
Joined: May 14, 2003
From: victoria, bc Canada
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Diane,
I hope you dont get banned, both sides of the story enhance everyones learning.
Your wrong about me, I began manipulating lumbar spines more frequently when the research was so strong as to its effectiveness that not manipulating would be with holding a treatment that I was certain would be effective with a patient. That would be unethical and practicing suboptimally. Funny enough, I agree with you regarding the expensive and complicated tricks. Therapists who spent 15 minutes learning the manipulation in the low back study were as effective as those who were well versed in manipulation. I keep it simple in my explanation of what manipulation does - helps you increase movement and decreases some muscle tone and people who are appropriate that have it done
are much more likely to have a reduction in their pain and disability over the short and long term. I think we have discussed this before but much of this disagreement is based on caseload demographics - you often deal with chronic pain patients and I would agree with an "Explain Pain" approach. Acute patients without established pain patterns are the ones who typically respond to the manipulation approach.
I think explain pain is a must read for all physical therapists and that it is very effective specific patients but I have to ask, how are your ramblings about one treatment being a panacea any different than those manipulation gurus that you despise?
Steve
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Re: Spinal manipulation and pregnancy - July 26, 2006 10:24:00 AM
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emad/emad
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Steve :
Reasoning ? ??
Why Manipulation is effective in Acute back pain more than chronic ??
It worth to be thought of !!
Cheers
Emad
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Re: Spinal manipulation and pregnancy - July 26, 2006 10:41:00 AM
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dosrinc
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From: Bonita Springs
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Diane, still waiting for a description of what it is that you actually do, as well as the evidence that it is a better/safer approach than anything else out there.
Rick
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Re: Spinal manipulation and pregnancy - July 26, 2006 10:46:00 AM
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ALICIAPT13
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From: North Syracuse, NY
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Don't get me wrong, I am not manipulating everyone with LBP. There is evidence that shows patients who meet certain criteria DO benefit from manipulation. If they meet other criteria they may benefit from a stabilization program or a directional preference program. I am referencing Flynn, et al from Spine 2002. A Clinical Prediction Rule for Classifying Patients with Low Back Pain Who Demonstrate Short-Term Improvement with Spinal Manipulation.
Alicia
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Re: Spinal manipulation and pregnancy - July 26, 2006 10:48:00 AM
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ALICIAPT13
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From: North Syracuse, NY
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Oh, and emad--
According to the article I referenced above, acute patients do benefit from manipulation more than chronic patients do. It is a variable used in their clinical prediction rule.
Alicia
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Re: Spinal manipulation and pregnancy - July 26, 2006 11:19:00 AM
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Alex Brenner PT MPT OCS
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From: Kentucky
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Steve,
Your post above is spot on. This explanation and clinical reasoning is what currently is being taught in PT schools and what should be taught to our students during their clinicals by their CI's and backed by the quality research that has been pointed out by Alicia above.
_____________________________
Alex Brenner, PT, MPT, OCS
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Re: Spinal manipulation and pregnancy - July 26, 2006 11:42:00 AM
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dfjpt
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Hi Steve,
[QUOTE]Your wrong about me,[/QUOTE]OK, I stand corrected. :)
[QUOTE]I hope you dont get banned[/QUOTE]Thanks. I probably will. This is one chiro loving site. I don't really belong here.
[QUOTE] how are your ramblings about one treatment being a panacea any different than those manipulation gurus that you despise? [/QUOTE]Could you rephrase this question? I don't know what you are asking. I'm saying, ALL treatments are panacea(elicit placebo), all of them some of the time for some people, others most of the time for most people.
Rick,
[QUOTE]Diane, still waiting for a description of what it is that you actually do, as well as the evidence that it is a better/safer approach than anything else out there.[/QUOTE]Wait on. I treat in what looks like slow soft tissue ways with a reasoning based on helping ectoderm breathe, not pushing hard or fast on mesoderm. I don't think I have to prove safety, as there are no large forces generated at all.
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