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Re: Spinal manipulation and pregnancy
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Re: Spinal manipulation and pregnancy - July 27, 2006 6:27:00 AM
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jbird007
Posts: 297
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From: USA
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The most important aspect involving manipulation is knowing when NOT to adjust. Most PT's do not have those skills. Your DDX is weak and you have little access to radiology. Heaven forbid you guys miss the spinal tumor or the AA on the elderly gentleman. I commend PT's for rehab. Do what you do best. I commend ER docs for their crisis intervention but I won't use them for anything else. I won't take my dog to a carpenter for a check-up. Specialization needs to be special, no need to be a jack-of-all-trades and master-of-none.
2 cents worth
jbird
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Re: Spinal manipulation and pregnancy - July 27, 2006 6:27:00 AM
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dfjpt
Posts: 238
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jbird, why are you here sounding defensive. The discussion is on manipulation. Tell us why you think it "works" (if it really does..), what it "does", i.e., the mechanism, why you think PTs don't have a right to discuss whatever the **** we want.
OK, our posts crossed, you "special" person you. ;)
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Re: Spinal manipulation and pregnancy - July 27, 2006 6:52:00 AM
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jbird007
Posts: 297
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From: USA
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The questions I presented are clear and they pertain to manipulation. I am curious to see if anyone can answer them honestly.
jbird
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Re: Spinal manipulation and pregnancy - July 27, 2006 7:20:00 AM
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UTDC
Posts: 222
Joined: December 21, 2003
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jbird,
This is a physical therapy forum above all else. How about if we avoid the political issues here. This has been a good discussion regarding various manual medicine interventions so lets not side track it with opinions on who does what better.
PS- PT's have performed some important research showing that they can competently perform spinal manipulaiton that produces consistent and beneficial outcomes.
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Re: Spinal manipulation and pregnancy - July 27, 2006 8:57:00 AM
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dosrinc
Posts: 335
Joined: December 9, 2004
From: Bonita Springs
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jbird:
spinal manipulation for maintainace of spinal health
Talk about something without any evidence to support it
Walking,jogging, lifting weights, eating right, even massage I get but what exactly are you maintaining with your spinal manipulations, axoplasmic flow, neural energy, what? please explain.
Rick
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Re: Spinal manipulation and pregnancy - July 27, 2006 9:02:00 AM
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emad/emad
Posts: 42
Joined: July 4, 2006
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Buddy:
Too late answer , i do not apply Manipulation at all , i do apply what i wrote before in one of my posts .
Concerning acute VS chronic efficacy of my approaches , most of my patients are chronic because doctors try to keep them within their hands under drugs ,rarely i address acute consumers .
All , i do not know why the discussion mis-direct here , the key point of the thread was safety of manipulation in preganancy ,then misdirected toward Diane,s or other,s techniques ,then Chiro or physio and Alex asked me to present studies against lumbar manipulation efficacy or complications , i have currently no studies ,could you present what you have to support complications of neurodynamics .As well , yes i do meet pain evoking or flaring up with neurodynamics ,but no seroius complication . Why all that ?
Better to keep Scientific .
Cheers
Emad
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Re: Spinal manipulation and pregnancy - July 27, 2006 9:19:00 AM
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OAK
Posts: 184
Joined: September 1, 2003
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"The most important aspect involving manipulation is knowing when NOT to adjust. Most PT's do not have those skills. Your DDX is weak and you have little access to radiology. Heaven forbid you guys miss the spinal tumor or the AA on the elderly gentleman. I commend PT's for rehab. Do what you do best. I commend ER docs for their crisis intervention but I won't use them for anything else. I won't take my dog to a carpenter for a check-up. Specialization needs to be special, no need to be a jack-of-all-trades and master-of-none."
Interesting theory, but then why are the majority of manipulation complications caused by Chiropractors?
Secondly, an x-ray may pick up a spinal tumor, but how acurate are they at testing the integrity of the vertebral artery?
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Re: Spinal manipulation and pregnancy - July 27, 2006 9:24:00 AM
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ALICIAPT13
Posts: 95
Joined: December 12, 2005
From: North Syracuse, NY
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Yes, Jbird you are being awfully defensive and somewhat rude (ie my training is low-level and inadequate). I am not claiming to be a master of manipulation, I just want as many tools as I can for those LBP patients who don't respond to anything else. Especially if studies shows that IT DOES HELP. And rest assured, I WILL ALSO be using my rehab skills. I would never just manipulate someone and send them on their way... exercise and other manual techniques are just as important.
If you recall, my original question was whether or not manipulation can be done on pregnant women???
SJBird, I do realize that the only reason manipulation is more effective for acute than chronic b/c those were the results in the study. I still believe that is enough reason to say acute backs respond to manipulation better than chronic backs.
Randy... nice comment.
Glad this is such an interesting thread!
Alicia
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Re: Spinal manipulation and pregnancy - July 27, 2006 9:49:00 AM
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Alex Brenner PT MPT OCS
Posts: 1057
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From: Kentucky
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Diane,
I don't think that speed has anything to do with it but rather what is shown in research. I agree with you that we are most likely having a neural effect from manipulation. I also agree with you that intuitively it seems we should go slowly with these patients but currently the research suggests otherwise. Again, we are talking about a subgroup. This subgroup is small for you, but very large for me.
JBird,
I was taught spinal manipulation while in graduate PT school and have honed my skills through clinical practice and continuing education. The reason it probably appears that PTs are "jumping on the bandwagon" is because our profession has moved towards a more evidenced based practice. Recently, (within the last 3-5 years) some high quality research (not just published in PT journals but in more prestigious medical journals) has been performed by Physical Therapists that supports that manipulation is very effective for a certain subgroup of people with low back pain. It is taking some time to get the word out to some PT schools that do not teach manipulation as well as getting it accepted in everyday practices as a treatment option. I also would like to point out that there are some other studies to show that manipulation can be taught and applied with very little instruction with similar outcomes as compared to other professionals with several years experience in manipulation. So your comment about our inferior weekend education I just don't buy. Manipulation, although still taught in continuing education courses, is mostly being taught now in PT schools.
Do you find it interesting that a lot of the quality research in manipulation is published by PTs rather than Chiropractors?
_____________________________
Alex Brenner, PT, MPT, OCS
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Re: Spinal manipulation and pregnancy - July 27, 2006 10:06:00 AM
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Lehmkuhler
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It's no surprise to me that manipulation is being researched by PT's more than DC's. PT's are much more homogenous than DC's and receive a more standardized education. DC's are kind of all over the place, some are absolutely amazing practitioners of NMS care, others are complete weirdo's out for a quick buck...
Sometimes the variability is a strength, but not in producing science based research.
My general rule of thumb is, 2 chiropractors = 3 opinions... :) Hard to build a unified front based on that.
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Re: Spinal manipulation and pregnancy - July 27, 2006 10:16:00 AM
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steve
Posts: 468
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From: Canada
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jbird,
To answer some of your questions, I choose to use manipulation based on the evidence (Which, incidentally has been done by physiotherapists for the most part) and there is no evidence that years experience leads to significantly better outcomes with respect to the treatment, Julie Whitman published a very nice trial on this subject. With respect to not having adequate DDx skills, screening patients for other pathology is definately important and we have access to radiology through physicians that we work closely with (I am in a direct access area but can call a doc at any given time). There is evidence that on tests used in medical schools to evaluate clinicians ability to manage musculoskeletal disorders, physical therapists score better than GPs, residents and with advanced training, just marginally less than orthopaedic surgeons:
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=15963232&query_hl=4&itool=pubmed_docsum
There is also evidence to suggest that patients randomized to have X-rays and MRIs for what appears to be non specific low back pain take longer to recover and have greater disability compared to those randomized not to have x-rays. This, along with needless exposure to radiation and increased health care costs question the need for most patients to be subjected to x-rays. Certainly there is a subset of patient for whom x-rays is appropriate. Despite the fact that radiographic imaging can potentially increases pain and disability, it seems to consistantly be associated with greater patient satisfaction.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=11701101&query_hl=6&itool=pubmed_DocSum
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=12394910&query_hl=6&itool=pubmed_DocSum
I know of no research identifying increased risk of manipulation complications when performed by physiotherapists, so I assume you are talking about your subjective biases, similar to what some posters have done on your profession. It seems to get us nowhere.
Steve
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Re: Spinal manipulation and pregnancy - July 27, 2006 10:17:00 AM
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Lehmkuhler
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Joined: December 14, 2005
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OAK
Don't you think the vast majority of manipulations are done by DC's, therefore it would make sense that more complications would also be attibuted to DC's. After all, Tiger Woods is a hell of a lot better golfer than I am but he's probably also shanked more shots than I have...
And as for the v. artery, of course xray doesn't assess it's integrity. There are other tools for that. FYI, screwdrivers also work very poorly at pounding nails...
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Re: Spinal manipulation and pregnancy - July 27, 2006 11:34:00 AM
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nari
Posts: 1568
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From: Australia
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Nobody, even those armed with references and scientific backup (which in this case means something works better than something else) has mentioned the long term outcome of performing manips on a regular basis.
Can anyone say with confidence that >50% of their CPR-selected patients who have been manipulated and given exercises, do not come back because they are painfree?
If that is so, then that is very good. But if not, then what is all the fuss about? Manips are then not any better than chance, other mobilisations, exercise regimes and whatnot. Some patients (and we are talking acute here)will actually be 'cured' with a hot pack and a session on pain physiology.
Nari
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Re: Spinal manipulation and pregnancy - July 27, 2006 11:37:00 AM
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Alex Brenner PT MPT OCS
Posts: 1057
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From: Kentucky
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Nari,
The Childs study tracked outcomes out to 6 months and were able to demonstrate that the manip and exercise intervention maintained these improvements at least this far. I consider this long term. That is pretty good compared to your anecdotal statements about the hotpack and patient education.
_____________________________
Alex Brenner, PT, MPT, OCS
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Re: Spinal manipulation and pregnancy - July 27, 2006 12:47:00 PM
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jbird007
Posts: 297
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From: USA
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I must say I am impressed with most of the posters here. I see dedication and williness to improve.
Back to the original thread:
For those of you who will manipulate a pregnant patient tell me what will you say to the woman who miscarries the next day or up to 1 week after your treatment.
Answering the question will see how well you handle the situation.
jbird
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Re: Spinal manipulation and pregnancy - July 27, 2006 12:59:00 PM
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jbird007
Posts: 297
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From: USA
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Can PT's diagnose medical conditions?
j
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Re: Spinal manipulation and pregnancy - July 27, 2006 1:32:00 PM
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Lehmkuhler
Posts: 69
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You explain the situation before manipulation. Give the pro's and con's of manip vs other options to the best of your knowledge. Allow the patient to decide.
If the woman declines, proceed with other techniques that she is comfortable with. If she understands the situation and would like to proceed with manipulation, proceed with due caution.
Possibly another way to look at this, is that if your wife/daughter/sister were pregnant, would you manipulate?
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Re: Spinal manipulation and pregnancy - July 27, 2006 1:39:00 PM
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OAK
Posts: 184
Joined: September 1, 2003
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"Don't you think the vast majority of manipulations are done by DC's, therefore it would make sense that more complications would also be attibuted to DC's. After all, Tiger Woods is a hell of a lot better golfer than I am but he's probably also shanked more shots than I have...
And as for the v. artery, of course xray doesn't assess it's integrity. There are other tools for that. FYI, screwdrivers also work very poorly at pounding nails..."
You've brought forth an interesting dilema. Are manipulation complications the result of a poorly performed thrust ("shanked shot") or from the treatment of an innapropriate client, as jbird007 claims, "The most important aspect involving manipulation is knowing when NOT to adjust".
Does it really matter how great Tiger's stroke is if he hits a glass golf ball?
;)
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Re: Spinal manipulation and pregnancy - July 27, 2006 1:50:00 PM
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nari
Posts: 1568
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From: Australia
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Alex,
6 months is not particularly long term, to my way of thinking. Anyway, I won't try to answer your remark about education. Lorimer Moseley has done some interesting studies on the benefit of education alone and with other techniques; and the virtue of self-efficacy, but I understand he is not accepted or known in the USA. Not sure why.
Nari
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Re: Spinal manipulation and pregnancy - July 27, 2006 2:28:00 PM
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jbird007
Posts: 297
Joined: May 2, 2006
From: USA
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How about manipulation of a fused joint/s?
How many times do you whack on it before you say UH OH!
Are you skilled enough to dx it?
I bring up these questions because I do not think PT's OR some DC's have the ability to properly screen for contraindications. The more manipulations one does the more the risks escalate. And these risks can be severe.
My comments are not meant to be "scare tactics". I cannot stop non- DC's from performing manipulations therefore it is important that the risk vs benefits be known for the patients safety and that the PT is fully aware of the liability issues.
It is not pleasant fracturing a patients rib or sending a patient home with a migraine due to a poor manipulation. Not to mention the worse case scenario, your patient strokes out on your table.
,,things to ponder
j
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