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proud -> "special skills" (September 16, 2006 1:59:00 PM)

More evidence in this abstract that a trained monkey can manipulate with postive results.

The skill is understanding when to manipulate, and more importantly when not to manipulate. And in the C-spine, evidence is suggesting mobilization is often as effective anyway...

But here is the question: Does it take course after course from someone who claims to be "special" to learn it? I think not.

Hopefully we can move on from "guruism" and our seeming thirst for the "gifted" mentor. Rather, take the time to read and understand the research and apply it into practice. It is suprising how well that works.


http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=12782973&query_hl=5&itool=pubmed_docsum



PainFree -> Re: "special skills" (September 16, 2006 2:49:00 PM)

hmmmmm........I would much rather be adjusted, manipulated or mobilized by someone (regardless of their academic training) who is trained and skilled in the cervical spine than someone who has had minimal training and choses to read research all day and only knows second hand knowledge on who and who not to manipulate. Proud, are you in active practice?



proud -> Re: "special skills" (September 16, 2006 3:06:00 PM)

Painfree,

1. No need to worry about my manual "traning" in either the lumbar or cervical/thoracic regions. Which, in part, is how I recognized the problems with "motion palpation". The supporting evidence has come 5 years latter. More will come out, don't worry.

2. I have been in active and very busy practice for 10 years.

3. Just because someone takes the time to read research and remain current does not imply "minimal training...knowing only second hand knowledge..."

I will say that I agree with you that just reading the research is not likely to produce a good clinician. Which is why I stated in my post..."...read the research and apply it into practice.." capiche?



PainFree -> Re: "special skills" (September 16, 2006 3:24:00 PM)

Proud,

You seemed to have taken my post personally which was not my intent. With the exception of asking whether you were in active practice or not, no comments were directed towards you.



proud -> Re: "special skills" (September 16, 2006 3:41:00 PM)

painfree,

Very good. And I did agree with your thoughts about just reading the research.

Thanks.



dfjpt -> Re: "special skills" (September 16, 2006 3:45:00 PM)

I would rather not have any manipulation done on my neck by any primate, monkey or human.



jbird007 -> Re: "special skills" (September 16, 2006 5:16:00 PM)

proud,

Do you manipulate the cervical region?

JBird



touchiba -> Re: "special skills" (September 16, 2006 8:12:00 PM)

All of the abstracts you have posted thus far only speak of specificity. None have addressed patient comfort and saftey, nor the effectiveness of skilled versus unskilled manipulation.

I will agree that specificity is of little importance, but I think that there is a difference between a "skilled" manipulator verusus "unskilled".



dfjpt -> Re: "special skills" (September 16, 2006 9:14:00 PM)

[QUOTE]I would rather not have any manipulation done on my neck by any primate, monkey or human.[/QUOTE]...skilled or unskilled.



touchiba -> Re: "special skills" (September 16, 2006 9:49:00 PM)

You're right, it's safer to tickle someone's neck with a feather. Just not sure how effective that would be...



Jon Newman -> Re: "special skills" (September 17, 2006 3:35:00 AM)

[QUOTE]I would much rather be adjusted, manipulated or mobilized by someone (regardless of their academic training) who is trained and skilled in the cervical spine than someone who has had minimal training and choses to read research all day and only knows second hand knowledge on who and who not to manipulate. [/QUOTE]I'm wondering if someone who chooses to read research all day would feel it necessary to manipulate another's neck in the first place. If a person would much rather be manipulated (in the first place) then that's a whole different issue.



SJBird55 -> Re: "special skills" (September 17, 2006 3:42:00 AM)

BT, I believe that there is some literature recently published that indicates that there isn't a difference between say a recent grad that had some training in manipulation versus a person with quite a few years and letters behind his/her name. Both were effective. You'd have to go to the blog at Evidence in Motion because I'm pretty sure I read it there.



rwillcott -> Re: "special skills" (September 17, 2006 4:12:00 AM)

People, stop cliniging to manipulation as the be all end all! It's quite clear that we aren't specific and it's not the most effective treatment. The sooner we accept this the better off we'll be!

As proud mentioned, it's those who percieve themselves as "experts" and "gurus" who continue to cling to manipulation as this magical treatment that only those with "special" training can perform. Quit fooling yourselves and others.

Rob



proud -> Re: "special skills" (September 17, 2006 6:09:00 AM)

1. jbird007, I used to manipulate the cervical region. I do not anymore. I have not for over 5 years. In light of the uncertain safety and the fact that simple mobilization is often as effective. To be clear, I do not think anyone can tell what level is "stiff" or what structure( Z-joints, U-joints...whatever). I do think you can tell general hypomobility on one side compared to another. But even that finding holds only minimal to moderate credability in my treatment plans.

2. BT DC, How do you define "skilled" versus "unskilled". The abstracts and articles suggest that if you cannot be specific, then that takes away the "skill" almost completely. I figure 6 months( if even that) of training on how to do it comfortably and safely is about right. But then a degree required to understand differential diagnosis, pathology, anatomy, etc.

3. rwillcott, you are correct. The point being from my end that we need to discontinue misleading the public into thinking this is a mystical treatment and that it is required for most neck/back pain conditions. Hardly. Likely less than 5-10% of all cases really. And even then it is a simple skill.



jbird007 -> Re: "special skills" (September 17, 2006 8:03:00 AM)

proud,

You stated "In light of the uncertain safety..." (regarding cerv manip risks)...
IYO, is it acceptable for PT's to manipulate the cervical region?

Since you have stated there is little or no credibility by palpation what is your opinion of PT's who use these methods prior to manipulation?

Thanks,
Jbird



proud -> Re: "special skills" (September 17, 2006 1:26:00 PM)

Well, that is an acceptable question. If you had not at one time proclaimed me as someone without clinical credability, I would proceed with a pretty clear answer for you.

However, given our history, I must start out with a question for you. Then maybe we can proceed.

Question: IYO, is it acceptable for chiropractors to manipulate the cervical region in light of the safety uncertainty?

And, since motion palpation has little or no credibility, what is your opinion of chiropractors who use these methods prior to manipulation?

Quid pro quo jbird007.



PainFree -> Re: "special skills" (September 17, 2006 2:52:00 PM)

"Question: IYO, is it acceptable for chiropractors to manipulate the cervical region in light of the safety uncertainty?"

I am assuming that you are talking about the issue of stroke.

Yes, it is acceptable to manipulate the cervical spine although this would not be a true statement for some candidates.

Are there procedures that may provide the patient relief without manipulation? In many cases the answer is "yes". However, many patients respond very well to manipulation where other procedures have failed. Ask any chiropractor, we see many patients in our office respond to manipulation when they have already been to GP's, PT's and an assortment of other specialists. On the other hand, I know of many (of my own) patients who have gone down the street and have gotten results (from say an acupuncturist or a PT or another chiropractor) where I have otherwise failed.

Are some areas of the cervical spine more prone to adverse reactions following an ill timed manipulation? Yes, IMO. Are some type of manipulations more prone to problems than others? Yes, IMO.

Does the literature point out that a higher percentage of stroke cases occur from individuals with less training? Yes, satistically this appears to be the case.

Is it possible that many patients who are having symptoms that may be indicative of being at risk for a stroke ever a candidate for manipulative therapy? Yes, and there are several neurologists in town who, after screening these patients, like to refer them for manipulative care....and, lo and behold, they respond very nicely much of the time. Always? No.



proud -> Re: "special skills" (September 17, 2006 4:56:00 PM)

Painfree,

With respect. Your post helps me outline the many problems facing MSK care.

For example:

1 You say: "it is safe to manipulate the cervical spine although this is not a true statement for some candidates"...Define "some candidates".

2. Your paragraph about how some patients get results while others do not( some from PT, acupuncture, chiro). Do you care to ask the question why? Could clinical prediction rules, sub grouping eliminate this variability? Could standardized practice eliminate this variability? I think so.

3. You suggest that: "some areas of the cervical spine may be more prone to adverse reactions following an ill timed manipulation"...Are there any reliable or valid tests to pre-screen for this possiblity? Nope.

4. You say: "some type of manipulators are more prone to problems than others"... Define "type of manipulator"

5. You say that: "the literature points to a higher percentage of stroke cases occur from individuals with less training". Really? And can you define "less training"... At what point would you consider someone "safe" to perform manipulation?

6. Again, you say: "several neurlogists in town who, after screening these patients..." ...Screening how? And show me the studies that indicate these "screening" tests reduce the likelihood of an adverse event from manipulation.



jbird007 -> Re: "special skills" (September 17, 2006 5:05:00 PM)

quote;"Well, that is an acceptable question. If you had not at one time proclaimed me as someone without clinical credability, I would proceed with a pretty clear answer for you."

proud, this has almost nothing to do with clinical credibility. Our topic is about cervical manipulation safety and manual assessment. A person could have zero clinical experience and present research/opinions to continue a professional discussion.

quote: "However, given our history, I must start out with a question for you. Then maybe we can proceed."

You are requesting that I first "answer your questions" and then you state "MAYBE we can proceed?" Why avoid answering a simple question or two, proud? In my short time here it appears you seem to be the designated spokesman. I think my questions are fair and reasonable. I look forward to reading your response to two simple questions, then we can proceed forward with the discussion. I will give you my opinions and answer your questions accordingly. Fair enough?

Once again, here are my questions:
[QUOTE]You stated "In light of the uncertain safety..." (regarding cerv manip risks)...
IYO, is it acceptable for PT's to manipulate the cervical region?

Since you have stated there is little or no credibility by palpation what is your opinion of PT's who use these methods prior to manipulation?
[/QUOTE]JBird



proud -> Re: "special skills" (September 17, 2006 5:29:00 PM)

Jbird,

1.I think the safety concern needs to be adequatly researched before anyone( PT , Chiro, or hairdresser in Italy...) continues with this approach. This is why I discontinued. Especially in light of recent research indicating mobilization is often as effective.

2. I think any chiropractor or PT who bases their manipulation on motion palpation is either fooling themselves or their patients.



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