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Re: Things we have to get over
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Re: Things we have to get over - June 12, 2007 11:38:00 AM
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3.5fig
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ONstudent,
Try the reference I posted earlier in regards to the relationship between upper cervical manipulation and hypertension...
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Re: Things we have to get over - June 12, 2007 11:46:00 AM
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OAK
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Quote:
"Can someone reference some good quality evidence(level 1) perhaps an RCT that points to some potential of manipulation having influence on non-NMS conditions (benefit the nervous/immune/autonomic nervous system)???"
How about even a rational/reasonable explanation based on the human body's anatomy/physiology of how manipulating the spine could influence non-NMS conditions?
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Re: Things we have to get over - June 12, 2007 11:50:00 AM
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ONstudentPT555
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3.5 fig,
Sorry ... I may have missed it but could you post the reference again .. i dont seem to see it anywhere in the thread. I tried to search for literature on it..but could not find anything thats close to convincing.
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Re: Things we have to get over - June 12, 2007 12:15:00 PM
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JCOY
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How about even a rational/reasonable explanation based on the human body's anatomy/physiology of how manipulating the spine could influence non-NMS conditions?
HMMMM?? OH Well..............
Anyway-
Here is one study addressing manipulation for a non-NMS issue:
Effects of Osteopathic Manipulative Treatment on Pediatric Patients With Asthma: A Randomized Controlled Trial
http://www.jaoa.org/cgi/content/full/105/1/7
>>snip<<
Further, asthma itself produces a self-sustaining cycle of viscerosomatic and somatovisceral reflexes long recognized in the osteopathic medical literature.4 Although pharmacologic agents have been proven effective in improving asthma symptoms—and also have demonstrated results for direct action on airways and pulmonary inflammation—the musculoskeletal component of respiration is clearly not addressed by pharmacologic therapy.
As a result of this conventional approach to treating asthma, breathing efficacy is not maximized and destructive somatovisceral pathways are allowed to continue their negative facilitative influence on the chronic cycle of recurrent asthma...>>snip<<
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Re: Things we have to get over - June 12, 2007 12:15:00 PM
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ONstudentPT555
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The only unbiased RCT I found was this so far:
Treatment of Hypertension with Alternative Therapies (THAT) Study: a randomized clinical trial.Goertz CH, Grimm RH, Svendsen K, Grandits G.
Berman Center for Clinical and Outcomes Research, Hennepin County Medical Center, Minneapolis, Minnesota, USA. goertz@mail.nih.gov
OBJECTIVES: To examine the effect of spinal manipulation on blood pressure. DESIGN: This randomized clinical trial compared the effects of chiropractic spinal manipulation and diet with diet alone for lowering blood pressure in participants with high-normal blood pressure or stage I hypertension. Blood pressure observers were blinded to treatment group. SETTING: The study was conducted at the Berman Center for Clinical and Outcomes Research in Minnesota. Chiropractic treatments were administered by chiropractic physicians within private practice settings.PARTICIPANTS One hundred and forty men and women, aged 25-60 years, with high-normal blood pressure or stage I hypertension, were enrolled. One hundred and twenty-eight participants completed the study. INTERVENTIONS: (i) A dietary intervention program administered by a dietitian or (ii) a dietary intervention program administered by a doctor of chiropractic in conjunction with chiropractic spinal manipulation. The frequency of treatment for both groups was three times per week for 4 weeks, for a total of 12 visits. MAIN OUTCOME MEASURES: The primary outcomes for this study were change from baseline in diastolic and systolic blood pressure. RESULTS: Study groups were comparable at baseline. Changes in potentially confounding covariates did not differ between groups. Average decreases in systolic/diastolic blood pressure were -4.9/5.6 mmHg for diet group and -3.5/4.0 mmHg for the chiropractic group. Between group changes were not statistically significant. CONCLUSIONS: For patients with high normal blood pressure or stage I hypertension, chiropractic spinal manipulation in conjunction with a dietary modification program offered no advantage in lowering either diastolic or systolic blood pressure compared to diet alone.
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Re: Things we have to get over - June 12, 2007 12:23:00 PM
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3.5fig
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ONstudent,
here is the link...it was in another thread
http://www.chiroweb.com/articles/25/10/05.html
OAK,
I would first start with checking out viscero-somatic and somato-visceral reflexes and there relationship to the human body's physiology. Think of the relationship between the sympathetic and para-sympathetic systems, the ganglions, the central connections in the processing centers of the brain. There is alot out there that you will be able to find on your own. I am going out of country for 2 weeks, if you would like I can explain it in more detail when I come back....no off to Ireland....
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Re: Things we have to get over - June 12, 2007 12:27:00 PM
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ONstudentPT555
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fig,
I cant view it .. can you post the reference for it .. journal, authors, year.. and I will get it through Medline.
Thanks
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Re: Things we have to get over - June 12, 2007 12:50:00 PM
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JCOY
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Onstudent-
I was going to pull up the link(that I am pretty sure Fig is talking about) for you. But everytime I try to access Pubmed, I get a "virus detected" alert. I've never had that happen before- kinda scary.
Anyway- this is the best I can do for you right now:
Bakris G, Dickholtz M, Meyer PM, et al. Altas vertebra realignment and achievement of arterial pressure goal in hypertensive patients: a pilot study. Journal of Human Hypertension, March 2, 2007 (advance online publication).
This is the chiroweb article of the study:
Results of University of Chicago Pilot Study Are Promising
In a pilot study conducted at the University of Chicago, a one-time specialized chiropractic adjustment, delivered to patients suffering from high blood pressure and misaligned C1 vertebrae, resulted in significant reductions in diastolic and systolic BP compared to controls. According to a press release from the University of Chicago Medical Center, Office of Public Affairs, the decrease in BP was equivalent to that seen with concurrent administration of two blood pressure drugs. None of the patients took any antihypertensive medications during the study period.
The study was led by George Bakris, MD, director of the Hypertension Center at the University of Chicago Medical Center. Study participants were referred to Dr. Marshall Dickholtz Sr., a Chicago-area chiropractor and member of the National Upper Cervical Chiropractic Association (NUCCA), for cervical assessment, including paracervical skin temperature determination, postural analysis, pre-alignment craniocervical X-rays, and supine leg-length check. NUCCA practitioners focus on precise manual adjustment of the Atlas.
Half of the 50 patients received a NUCCA adjustment, while the remaining half received a sham procedure, carefully designed to mimic the actual adjustment in order to ensure blinding. This was possible due to the delicate nature of the C1 adjustment. The primary outcome measure, assessed after eight weeks, was change in systolic and diastolic BP compared to baseline readings. Average age of the study participants was 52.7 years; 70 percent were male.
At week eight, differences were noted in systolic and diastolic BP when comparing the adjustment group with the control group (patients receiving the NUCCA adjustment: –17±9 mm Hg systolic, –10±9 mm Hg diastolic; patients receiving sham treatment: –3±11 mm Hg systolic, –2±7 mm Hg diastolic). Additionally, patients administered the NUCCA adjustment showed 0.04 degrees lateral displacement of C1 after eight weeks, compared to 1.0 degrees at baseline. By comparison, patients in the control group had an average of 0.5 degrees displacement after eight weeks, compared to 0.6 degrees at baseline.
The study authors emphasize that “[while] the mechanism as to why this improvement in blood pressure occurs is unknown and cannot be determined by this study … the data presented, however, raise a number of important questions including a) How does misalignment of C1 affect hypertension?; and b) If there is a cause and effect relationship between C1 and hypertension, is malposition of C1 an additional risk factor for the development of hypertension?” A larger clinical trial is being planned to address these questions.
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Re: Things we have to get over - June 12, 2007 1:24:00 PM
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OAK
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"OAK,
I would first start with checking out viscero-somatic and somato-visceral reflexes and there relationship to the human body's physiology. Think of the relationship between the sympathetic and para-sympathetic systems, the ganglions, the central connections in the processing centers of the brain. There is alot out there that you will be able to find on your own. I am going out of country for 2 weeks, if you would like I can explain it in more detail when I come back....no off to Ireland.... "
That's the response I was expecting.
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Re: Things we have to get over - June 12, 2007 1:31:00 PM
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OAK
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"How about even a rational/reasonable explanation based on the human body's anatomy/physiology of how manipulating the spine could influence non-NMS conditions?
HMMMM?? OH Well..............
Anyway-
Here is one study addressing manipulation for a non-NMS issue:
Effects of Osteopathic Manipulative Treatment on Pediatric Patients With Asthma: A Randomized Controlled Trial"
Did you read this study? It primarily refers to increased thoracic spine mobility, a musculoskeletal condition.
How about explantions for spinal manipulation to treat heart disease, cancer, bed wetting etc...
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Re: Things we have to get over - June 12, 2007 1:36:00 PM
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3.5fig
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OAK,
Look, I thought you were actually asking an honest question, not playing some game. I do not have time to teach some rudimentary neurology. If you don't understand what a viscero-somatic or a somato-visceral reflex is that is not my problem...
I was trying to give you a general answer without going into detail about the relationships because 1) I don't have time...I pop on the computer between patients and at lunch time...2) You should already know the material and the neurological connections and how facilitation of a nerve can have numerous side effects. Think about how a manipulation may affect the resting tone of a sympathetic... However,it seems obvious you have your mind made up regarding this subject so further debate is moot. If you have a problem grasping the concept of viscero-somatic and somato-visceral reflexes I worry about any of your patients that may present with shoulder pain that actually may have a gallbladder problem or LBP patient that is actually a kidney problem...I hope you don't have direct access if you refuse to recognize that this is real and affects people on a daily basis...
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Re: Things we have to get over - June 12, 2007 1:41:00 PM
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3.5fig
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OAK,
By the way, nice re-direction there...you seem to completely ignore the hypertension study and fall back into the same old thing with referencing treating cancer, bed wetting, heart disease....it should be evident to you that the Chiropractors that post here do not ascribe to those theories....This has now become the same back and forth with you that happens all the time and gets us nowhere...if you want to continue with debate please leave out the old slams as they get you and us nowhere here...
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Re: Things we have to get over - June 12, 2007 1:46:00 PM
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proud
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Well a few thoughts as we stream along here:
1. The notion that a particular job has "survived" for a long time does not imply it is either ethical OR effective. Palm readers have been around a long time.
2. patient satisfaction is not an outcome measure. Massage therapists have high patient satisfaction rates but in terms of providing long lasting outcomes...nil.
3. Why is it that people like to throw the catch phrase "evidence-based practice" around yet when the subluxation based notion of a link between systemic disease and manipulation gets attacked...we see a bit of a hornets nest effect? Grasping at some fairly meaningless studies on hypertension to somehow suggest that maybe...just maybe...manipulation can cure systemic disease. Clearly this remains entrenched in even those who claim to have moved away from that quakery. At least that is what it tends to sound like to me.
4. Okay, we don't really know the whole spectrum of effects that manipulation may have. But I am quite certain that the day will never arrive when we discover that manipulation "cures" hypertension, asthma, colic, diabetes etc.
5. I notice in the above study that the word "misaligned" C1 was used. Hmmm. How do they know this? There is virtually no reliability in this finding which really destroys the validity of the link anyway. And I might add that simple non specific low grade cervical lateral glide techniques have been shown to have an effect on hypertension..as does yoga...as does acupuncture...
In any case, manipulation is a useful tool for various NMSK compliants. I doubt it is an "essential" skill to have but a nice one. And Tim is correct to point out many of the mis-conceptions that still exist in the PT community.
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Re: Things we have to get over - June 12, 2007 1:57:00 PM
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3.5fig
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Proud,
If you look at the study they reference that C1 showed 0.04 degrees of lateral displacement compared to 1.0 degrees of lateral displacement at baseline and 0.5 vs. 0.6 degrees lateral displacement in the control group. This is easily measured. Nice try. You just seem so opposed to any link at all that your bias is showing. There is a difference between healthy critical thinking and bias. The difference can be summed up that you are "quite certain"...while I am "uncertain".
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Re: Things we have to get over - June 12, 2007 2:07:00 PM
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proud
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Hey fig, the key word is "misaligned". Can you define that? And the assumption then is that the manipultion "re-aligned" C1. Whereas I mentioned simple non specific cervical lateral glides effect hypertension...do you not find that interesting?
And of course you are "uncertain". That does not really suprise me overall. And it's likely to be that sort of "uncertainty" that will eventually sink the chiro ship.
And to be clear, I have no chiro bias. It is clear to be that Marc and Buddy are evidence based chiropractors from my previous discussions with them. But I am very skeptical about the subluxation stuff...yes.
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Re: Things we have to get over - June 12, 2007 2:12:00 PM
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ONstudentPT555
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The osteopathic study was a decent study but a bit misleading by making it seem that it has more to do with treating asthma then actualy helping with the mechanics of breathing..which is more of a MSK thing than treatment of a systemic disease:
"Although pharmacologic agents have been proven effective in improving asthma symptoms—and also have demonstrated results for direct action on airways and pulmonary inflammation—the musculoskeletal component of respiration is clearly not addressed by pharmacologic therapy. "
.. but non the less its an interesting study.
The hypertension study did not convince me .. I would have to see a larger more detailed study...as proud said there are many other things that can help hypertension with less risks ... like yoga, meditation..etc..
Quote :
"I am not all that convinced by the hypertension study.. you seem to completely ignore the hypertension study and fall back into the same old thing with referencing treating cancer, bed wetting, heart disease....it should be evident to you that the Chiropractors that post here do not ascribe to those theories...."
Maybe not on this forum .. but there are many out there who do claim these things and advertise them to the public.
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Re: Things we have to get over - June 12, 2007 2:13:00 PM
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OAK
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"If you have a problem grasping the concept of viscero-somatic and somato-visceral reflexes I worry about any of your patients that may present with shoulder pain that actually may have a gallbladder problem or LBP patient that is actually a kidney problem...I hope you don't have direct access if you refuse to recognize that this is real and affects people on a daily basis...'
I was just trying to question some of your concepts. Do you personally attack your patients if they disagree with you too? :(
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Re: Things we have to get over - June 12, 2007 2:26:00 PM
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JCOY
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Maybe not on this forum .. but there are many out there who do claim these things and advertise them to the public.
But then neither do the many PTs "out here" that do nothing but hot packs, US, and canned/cookbook/generic exercises, post here.
OAK-
C'mon- when your questions were answered, you re-directed/morphed/changed your.... ummmm...."question(s)". They were disingneuous, and you know it. You just didn't like the answers. Are you stuck in dogma?, ignorance? or total bias?
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Re: Things we have to get over - June 12, 2007 2:26:00 PM
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3.5fig
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OAK,
I have to say that your response..."That's the response I was expecting" seemed quite rude to me and yes if a patient is quite rude to me I will say something. You did not question some of the concepts I have posted(they are not mine). You asked for a rational/physiological explanation and I gave you a simple explanation and then you posted "that's the response I was expecting". Your response was loaded to be sure, so don't now play the injured puppy.
Proud,
According to the study they defined misaligned by the amount of lateral displacement that they measured. And, yes I do find it interesting that simple non-specific lateral glides effect hypertension. What area were the lateral glides directed to? Was there a control group? What was the effect on hypertension? What study are you referencing? Did they compare it to treatment with medication?
And no, it shouldn't surprise you that I am uncertain. Just as it doesn't surprise me that you are certain.... :)
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Re: Things we have to get over - June 12, 2007 2:41:00 PM
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OAK
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"OAK,
I have to say that your response..."That's the response I was expecting" seemed quite rude to me and yes if a patient is quite rude to me I will say something. You did not question some of the concepts I have posted(they are not mine). You asked for a rational/physiological explanation and I gave you a simple explanation and then you posted "that's the response I was expecting". Your response was loaded to be sure, so don't now play the injured puppy."
Sorry, I didn't mean to offend.
By stating "That's the response I was expecting", all I meant was that I didn't find your explanation very clear. There seems to be a push by Chiropractors to turn spinal manipulations into a mysterious phenomenon when in reality they are not.
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