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Re: "special skills"
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Re: "special skills" - September 19, 2006 9:00:00 AM
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proud
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Jeep,
Thank you for re-posting.
The reference was from Christopher Kent who was "chiropractor of the year" in 1998 by the international chiropractic association.
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Re: "special skills" - September 19, 2006 9:21:00 AM
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Jeep
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What reference are you talking about? Please provide.
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Re: "special skills" - September 19, 2006 9:32:00 AM
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proud
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Well perhaps a better communicator might get the general points across better than I.
David Butler( The Sensative Nervous System):
>>" Many clinicians take quite umbrage at the randomized clinical trial as it holds all clinicains equal suggesting that the specific clinician does not matter. There are suspicions with trials that test a technique-clinicians realize all the time that a single technique is only part of the total management package that they provide....And as any good clinician knows from hard earned cumalitive experience, there are subgroups of pain patterns and physical features within the diagnsosis of neuromusculoskeletal pain on which a certain approach or technique works better than others. However the challange is now unquestionably on the clinician to document these groups better, and realise that intraprofessional research is critical">>>
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Re: "special skills" - September 19, 2006 9:35:00 AM
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proud
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Sorry Jeep, I just posted that quote above likely at the same time.
I am unable to link it, however you can search it. He wrote an article about the problem back in October 2004.
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Re: "special skills" - September 19, 2006 10:04:00 AM
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dfjpt
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So. I'm getting that any form of hands-on contact with a patient's body is "manipulation" as defined by chiropractic.
I'd say, before you chiro guys come on a PT board and start to become strident about who is or who isn't skilled or unskilled at performing manipulation, start to speak the same language as the board does, so you don't end up vainly trying to assert your POV by only turning up the volume.
Good grief, by your definition I'M a mobilipulator.
I've taken great pains to develop congruence with a deep model of interaction with a patient's nervous system, striving for ways to get it to do most of the work of letting go of its own tension patterns around joints so they can move again, instead of passively shoving them, and here you'd have me back in the Cartesian mesodermal shoving camp again.
I'm going to stick with the scientifically acceptable version of the term, "manipulation", thanks. No coercion from me against someone's nervous system. Not now, not ever.
About monkeys learning manipulation, it's not that far off. We are all various kinds of human primate social groomers if we look at our collective work honestly, not through a glamour lens.
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Re: "special skills" - September 19, 2006 10:11:00 AM
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proud
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dfjpt,
Did you like the David Butler slant...
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Re: "special skills" - September 19, 2006 10:39:00 AM
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Sebastian Asselbergs
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OK, since it came up JBIRD: I have manipulated for about 20 years (verrrry many patients a week), and since I have become more skilled at assessing patients, I use it less...to the point now of not at all with regards to the neck.
So, with regards to "time makes for a better manipulator" - yes, I AM much better and thus do it rarely....
Back to proud: good posts!
_____________________________
Mundi vult decipi
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Re: "special skills" - September 19, 2006 11:06:00 AM
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jbird007
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once again, proud:
If a PT is performing a non-specific general form of palpation, is he/she practicing unethically and is this considered to be quackery?
IYO, What type of palpation is specific?
thanks in advance,
J
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Re: "special skills" - September 19, 2006 11:07:00 AM
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Jeep
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dfjpt-
Thanks for looking at, and your careful, unbiased, consideration of, the sites/links I referenced above. I am confident you will use that information for appropriate DC referral when considering the best interest of your present and future stenosis patients.
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Re: "special skills" - September 19, 2006 11:08:00 AM
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jbird007
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quote:"So, with regards to "time makes for a better manipulator" - yes, I AM much better and thus do it rarely...."
That is great and it is your choice. But remember your "fearless leader" proud has stated you should not manipulate at all. Shame on you! ;)
Jbird
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Re: "special skills" - September 19, 2006 11:12:00 AM
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jbird007
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"So. I'm getting that any form of hands-on contact with a patient's body is "manipulation" as defined by chiropractic."
Diane. That is incorrect. Any form of hands-on contact is NOT a manip. And I stated that was MY definiton, not "chiropractics" definition, although many DC's would agree with me while the others will recognize the subluxation.
Jbird
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Re: "special skills" - September 19, 2006 11:50:00 AM
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Sebastian Asselbergs
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Jbird: READ please: I do not manipulate the neck (anymore). And that is what proud is talking about. And I.
Jeep, that link to the medscape article on stenosis requires a login and password that I don't have...(Both links take me to a loginscreen).
Maybe you can paste? Even just the title and authors - I can access it from EntrezPubMed.
Thanks.
_____________________________
Mundi vult decipi
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Re: "special skills" - September 19, 2006 12:55:00 PM
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jbird007
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DOH!
Sorry Sabastian, I misread. I "unshame" you.
As you have made a educated decision not to manip cervicals, others have made an educated decision to perform them (including MD's and DO's) IMO cervical manip is not a loaded gun pointed at the cerebellum with a shakey finger on the trigger.
Millions of cervical manips happen (per day) globally with very few injuries and/or death. Millions! Now compare that with med-drug deaths, medical errors, plane crashes, DUI auto wrecks, food poisioning, etc etc.
If this was such a common occurance the TV/media would be all over it. The AMA would love to blast the DC/stroke issue loud and clear but it rarely happens. As someone else posted here, if anyone wants to question/attack the DC profession there are other ( more legitimate) avenues to address.
Jbird
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Re: "special skills" - September 19, 2006 1:34:00 PM
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proud
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jbird007,
That we know of...
I am certain now that we have the diagnostic ability to investigate this properly, we will see that cervical manipulation( particularily upper C-spine), has resulted in a great number of "to date" unknown serious events. The Candian Stroke consortium will result in much more interest in the topic.
I will try to locate a really unbiased article I once read on the anatomy of the affected structures. The authors conclusion pre-dated the Lewis jury conclusions and recomendations.
jbird007 and Jeep for the most part. Did you read the quote from Butler? I thought that was a fairly nonpartisan approach really. Just suggesting that we all accept the importance of research. There is no point in getting angry over opinions, especially when supported by the literature. It is not like I am coming on here and making outrageous claims. My "monkey" comment was meant to be funny of course, simply suggesting that the skill is not all that much of a skill. I don't imagine the public is looking for a local primate manipulator( however funny the image is).
You see the main problem chiropractic faces is embodied by the approach you two seem to take. From what I have read in other "clinical" threads, you are both intelligent individuals. However when faced with some basic science and legitimate questions, you turn into angry individuals who see fit to hurl insults. That does not advance anything at all.
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Re: "special skills" - September 19, 2006 1:46:00 PM
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proud
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BT DC,
You have a much more professional approach in these discussions so I will respond to your answer to me.
I agree with you that the more manipulations you perform, the better you get at delivering a comfortable manip. But a comfortable manip does not equal better or safer. And if a PT or Chiropractor is performing any more than 2/20 cervical manips on patients in a day, then you have to question why that would be, in the face of the research.
And although I have no doubt you honestly believe that having multiple ways to manipulate results in better outcomes, I will have to see the research on that one. Maybe, but so far the research suggests mobilization can be as effective. And clinically, this has been my experience.
I have a few articles to show this, however this one you might take more kindly to:
http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1447299
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Re: "special skills" - September 19, 2006 2:14:00 PM
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Jon Newman
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[QUOTE]Millions of cervical manips happen (per day) globally with very few injuries and/or death. Millions! Now compare that with med-drug deaths, medical errors, plane crashes, DUI auto wrecks, food poisioning, etc etc. [/QUOTE]Why would we want to compare those things? What do they have to do with the alternatives to cervical manipulation? I think you'd make better comparisons if you stuck with the other things professionals do to relieve neck pain (neck pain of the type you feel inclined to manipulate, whatever that might be).
_____________________________
[URL=http://www.sonymusic.com/clips/selection/30/064887/064887_03_03_30.wav]Evidence[/URL]
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Re: "special skills" - September 19, 2006 2:59:00 PM
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MPT
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"Adverse reactions to chiropractic care for neck pain are common and appear more likely to follow cervical spine manipulation than mobilization. Other possible clinical predictors of adverse reactions to neck-related chiropractic care are history of neck trauma, increasing pain since onset, severe pain and disability, moderate or severe headache, nausea during the past month, and lack of treatment confidence"
This quote is from the Hurwitz study I linked to above. This would suggest that adverse affects from cervical manipulation are not a rare occurrence. Are there any articles that show millions of cx manips are done without adverse affects? PS: The study I quoted was done by chiros and I am sure cx manps done by PTs would have a similar response.
Also, I am always surprised at how territorial chiros can be (PTs can be this way too). Chiro research seems to always have "Chiro" manipulation in the title as if it is much different than any other manip. It makes one think the technique can only be performed by a chiro. I find that hard to believe but maybe I am mistaken. The Cox distraction stuff reminds me of this. PTs should send all their stenosis pts to a chiro who does Cox. Heck if it works that great why wouldn't I just learn how to do it myself
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Re: "special skills" - September 19, 2006 3:22:00 PM
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dfjpt
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Proud, I'm good with pretty much anything from David Butler.
Jeep, [QUOTE]There are some that like to promote "manipulation=HVLA". While HVLA is manipulation, it is not the ONLY form of "manipulation".[/QUOTE]Here's where we part company. If you can't define manipulation, even chiropractic manipulation, in a way that makes any sense, then don't claim that it's a special skill that only chiros for some mysterious reason are skilled at and no one else is. Thanks, I'll keep my own "stenosis" patients, or else refer them to a good mesodermalist PT if they need table traction.
And from jbird, [QUOTE]Diane. That is incorrect. Any form of hands-on contact is NOT a manip. And I stated that was MY definiton, not "chiropractics" definition, although many DC's would agree with me while the others will recognize the subluxation.
[/QUOTE]Ah, now we have TWO opinions and still no definition. Furthermore we have the subluxation word cropping up.
I propose you two chiro guys get together off board, decide how you want to define manipulation, leave out the subluxation pseudoscience, and come back to the discussion only when you can talk logically from a common frame of reference that you can define in a meaningful way understandable by all.
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Re: "special skills" - September 19, 2006 3:24:00 PM
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proud
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AR15,
Great post.
The territorial thing stems from the fact that money is involved. The sad fact is that none of us are doing a very good job. Terrible even.
Of course within each profession or trade you will have those that "get it" and provide reproducible, long term postive outcomes. However those are the minority within each profession or trade at the moment.
This whole thing will be deceided by the research and which profession or trade documents these findings best and recognizes the importance of the literature on advancing and improving the care delivered. I think the PT profession is well positioned for this. We just need to get on with it.
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Re: "special skills" - September 19, 2006 3:41:00 PM
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nari
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The public seems to use 'manipulation' to cover almost anything from soft tissue work to mobilisation to HVLAs. Heck, they even refer to joint movements in range (AROM) as manipulations.
We should be able to do better than that with a definition.
In Oz we define manipulation as an HVLA. End of story. Rapid, short thrust at end of range with or without the insidious 'cracking'. In brief, it is not much used because of alternatives that give as good a result, and do not carry the baggage that surrounds the apparent mystique of a thrust.
More research is needed to clarify the situation; quite a bit has been done but it hasn't cleared the decks much.
Nari
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