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Re: "special skills"
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Re: "special skills" - September 18, 2006 3:09:00 PM
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PainFree
Posts: 83
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Mounting evidence? Evidence grows exponentially? Where did that come from? The evidence you have cited has been tossed around for some time and is not an example of exponential growth. Most of the other so-called "new evidence" is just little spin offs of the old stuff which is nonconclusive.
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Re: "special skills" - September 18, 2006 3:23:00 PM
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jbird007
Posts: 297
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From: USA
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I can see this discussion "spinning" out of control.
This is classic proud allan work. The same quotes, references etc, :)
Jbird
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Re: "special skills" - September 18, 2006 3:52:00 PM
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proud
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http://www.chirobase.org/15News/lewis.html
All I am saying is follow the recomendations and settle the debate before using patients as a laboratory.
If it turns out that all is fine, then great, we return to cervical manipulation with established guidelines. No problem.
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Re: "special skills" - September 18, 2006 4:05:00 PM
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jbird007
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From: USA
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..but it is acceptable to use patients as lab rats for new marketed drugs.(while thousands die from adverse reactions per year)
J
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Re: "special skills" - September 18, 2006 4:34:00 PM
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PainFree
Posts: 83
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LOL Linking to Stephen Barrett now? You must be running our of credible sources. JK
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Re: "special skills" - September 18, 2006 4:53:00 PM
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jbird007
Posts: 297
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From: USA
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lol!
PROUD ALLAN HAS BEEN EXPOSED! AGAIN.
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Re: "special skills" - September 18, 2006 4:57:00 PM
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proud
Posts: 868
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Painfree,
Did you even read it? It had nothing to do with Stephen Barrett.
It was about the jury conclusions and recomendations. I could have posted it in numerous ways.
Hey painfree, try to keep up.
And here you go again. I simply post a set of recomendations and suggest that we look to do the right thing and follow the suggestions and the chiro's turtle and hurl insults. Think guys. Think.
The point was to read the recomendations. I happen to agree with them. That does not make me a bad person with an evil agenda.
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Re: "special skills" - September 18, 2006 5:04:00 PM
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Jon Newman
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It is always good to remember that it is the patient that assumes the risk and not the practitioner. At least the risk that we're talking about here. A good orthopedic surgeon knows this and tries conservative measure first in order to try to side step risk. At least that's how I see it. Maybe those practicing cervical manipulation could follow a similar ethic. Of course, then you have the problem of a desperate patient on your hand that might have questionable insight to risk/benefit concepts.
Jbird, I'm trying to understand your point about adverse drug events. It seems like you're taking the stance that "if it's good enough for them it's good enough for me."
_____________________________
[URL=http://www.sonymusic.com/clips/selection/30/064887/064887_03_03_30.wav]Evidence[/URL]
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Re: "special skills" - September 18, 2006 5:18:00 PM
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jbird007
Posts: 297
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Not at all Jon.. and I mentioned that issue on my first posting with regards to the comparison. I admit manip can cause strokes (and it is serious) but we do what we can to avoid them. But it is a very very slight risk in comparison to many many other procedures.
Many people decide to turn the other cheek on adverse reactions with larger risks (from the medical community) yet want to condemn the low risk of stroke and manip issues from DC's. And again as I pointed out, PT's are always left out as cervical manipulators. That is shallow.
Your statement is a very common although weak.
Respectfully,
J
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Re: "special skills" - September 18, 2006 5:23:00 PM
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Jon Newman
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Who is turning their cheek to others adopting risky behavior. I think we discuss the cervical manipulation because it is within our skill set. Drug testing isn't. What other neck pain procedures are you comparing manipulation to?
and what statement are you talking about that is weak?
_____________________________
[URL=http://www.sonymusic.com/clips/selection/30/064887/064887_03_03_30.wav]Evidence[/URL]
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Re: "special skills" - September 18, 2006 5:24:00 PM
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proud
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jbird007,
Read the recomendations I posted. You said PT's are always left out as cervical manipulators...#2 I believe.
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Re: "special skills" - September 18, 2006 5:26:00 PM
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jbird007
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"Maybe those practicing cervical manipulation could follow a similar ethic. Of course, then you have the problem of a desperate patient on your hand that might have questionable insight to risk/benefit concepts."
Jon, It seems you really do not know what many DC's do in practice. Many of us do the VBAI screens but sadly these are unreliable. Most of us have the knowledge to rule out who is not a good candidate for cerv manip after our work-up. And by no means does a "desperate" patient ever force me to do something against my will.
Again you seem to be a example of misinformation and/or disinformation regarding DC's. I just wish you would be open to accept a DC who you can trust and are comfortable with his/her beliefs. It took me some searching to find PT's who I can work with and the benefits are rewarding. If you have a bias for DCs then so be it. Thats all. :)
JBird
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Re: "special skills" - September 18, 2006 5:27:00 PM
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touchiba
Posts: 101
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Proud,
Sorry, I was away for a few days.
I don't know how to get my point across exactly, but I know that I can definately manipulate all areas of the spine with less effort and force, and make it more comfortable to the patient, than I could when I first learned the skill. Also, not ever patient is a 20-something, in-shape person with relatively few health complaints. I believe it takes a certain skill set to be able to manipulate across a wide variety of patient presentations.
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Re: "special skills" - September 18, 2006 5:43:00 PM
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Jon Newman
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JBird,
My statement was that those (DC, PT, barber, whomever) practicing cervical manipulation choose that as a last option. If this already is standard practice in a chiropractic office then you are correct that I don't know what many DCs do in practice. It would seem that many feel that it is such a small risk that they will use it preferentially.
_____________________________
[URL=http://www.sonymusic.com/clips/selection/30/064887/064887_03_03_30.wav]Evidence[/URL]
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Re: "special skills" - September 18, 2006 9:22:00 PM
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nari
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From: Australia
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Can I intervene with a comment about manips - I have no great inclinations either way, but I came across someone who had been every ten days for some months for management of a chronically painful neck post car accident,3 years ago.
The therapist is a highly experienced PT who had done all the right courses for manips and has a good reputation. This patient, a lawyer, was so impressed with the 20 minute total pain relief from the PT's manips that, for the past year, he has been self-manipulating his neck every hour or so, hunting for the 'pops'. I am quite sure the PT was unaware of this; he would not have approved at all. The self-delivered movements were full range and fast.
OK, so it was only one patient. But this patient has become addicted to that 20 minute pain relief; and he will continue to perform these movements, despite the warnings I gave him...
I think that is a problem and a half.
Nari
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Re: "special skills" - September 18, 2006 10:00:00 PM
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jbird007
Posts: 297
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Nari, I have heard of people popping their own thoracics and lumbars by twisting and turning whether or not they were exposed to manipulation or not.
For the PT to continue seeing a pt who only got 20 minutes relief from a manip just doesn't sound right. IMO that is not patient improvement and the treatment plan should have been altered and/or referred elsewhere. It is possible that over-manipulation (either too agressive and/or excessive frequency) can cause hypermobile/unstable joint integrity. Every new pt of mine gets a short talk about self adjusting and the dangers.
Once again, someone "taking all the right courses" does not always qualify he/she will be proficient at manipulation. DC students have the most curriculum hours and have a one year internship under the supervision of licensed DC's. As an fresh grad associate I saw 40-50 pts per day for 2 years, went into my own practice and saw 20-25 per day. It took me approx 5 years before I was comfortable and highly skilled in manipulation.
Without knowing all the facts regarding your case it seems both parties were at fault but this could have been any region of the spine. I have met parents who boast to me about popping their childrens back and necks and co-workers who perform crude methods of manipulation on each other and others who have demonstrated to me (in person) how they snap their cervicals. I document it in my SOAP notes and try to have these patients sign a form stating they are self manipulating (or manipulating others) should a problem arise further down the road.
Under manip, over manip, poor manip and self manip creates a multitude of problems. And yes it is a real problem.
Jbird
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Re: "special skills" - September 18, 2006 11:50:00 PM
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Jeep
Posts: 353
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From: USA
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>>>>Did you even read it? It had nothing to do with Stephen Barrett.<<<<
C'mon Proud-----GEESH!!
Chirobase is a site operated by Barrett!! Google the two. It is well known information. Do you claim not to know this?
BTW- A freindly reminder-----I am still waiting on the citation source from you on another thread.
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Re: "special skills" - September 19, 2006 12:09:00 AM
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nari
Posts: 1568
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From: Australia
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jbird
Quite true - why did the treatment go on for so long without any satisfactory outcomes. This is an endemic problem, world-wide.
I know people crack their bits and pieces frequently, but this guy grabbed the short term relief and just flew with it; I suspect he would not have attempted self-manip on the neck unless it had been done by a 'professional'.
I know that a piece of paper plus years of experience does not mean that patients can be selected appropriately for cervical manips; despite the guidelines for such categorisation.
By the way, this fellow was willing to fork out $60 per visit to this particular PT, every ten days, indefinitely.
Scary.
Nari
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Re: "special skills" - September 19, 2006 1:39:00 AM
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Jeep
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Nari-
Let's take a different approach- Let's say this PT did mobs on him-------what do you think he would be "self" doing? Self mobs perhaps? or if with a different provider------- how about a gentle, undocumented, mysterious, push/pull? Perhaps even with a feather?
The patient is merely trying to replicate, at home, what has been "relieving" in the office. Negligence/laziness, on the part of the provider to integrate and inform, is what really the issue here.
Scary
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Re: "special skills" - September 19, 2006 2:07:00 AM
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MPT
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From: Syracuse, New York
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I find it interesting that any time adverse outcomes with cx manipulation is talked about the conversation automatically goes to the worse case scenario (stroke). Although this is obviously an important thing to talk about what about less dramatic complications? IMO there is a much greater chance of simply increasing the pt's symptoms with manipulation vs mobs. I have seen a study reporting this and will try to find the reference (done by chiros).
I am sure many of you will say "not if it is a skilled manipulator" but what is a skilled manipulator? What criteria do people use to determine who is appropriate to manipulate or not? I have yet to find anything in the literature that identifies a reliable way to predict the appropriateness of cx manip. I look forward to the CDR on cx manip that is in the works.
I think Jon makes a very good point and it is close to how I practice. I do perform cx manip but only after I have tried other treatments that have failed. Due to this, I very rarely manipulate the cx spine.
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