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thoughts on manual therapy for scoliosis
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thoughts on manual therapy for scoliosis - March 18, 2008 12:43:18 PM
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Kaden
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Do folks out there do any specific manual therapy for joint mobility with scoliosis patients either idiopathic or adult scoliosis.
Thanks for any advice.
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RE: thoughts on manual therapy for scoliosis - March 19, 2008 3:35:06 PM
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OAK
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You can perform manual therapy with these patients. It won't change the scoliosis though.
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RE: thoughts on manual therapy for scoliosis - March 19, 2008 8:29:57 PM
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bobmfrptx
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We have had good results with scoliosis using MFR techniques. Prevented surgery for one lady and returned her to golfing, stopped progression of several patients we've followed for 6 years now and of course had little or no effect on others. I let the clients know that we can't guarentee anything and use the mfr as well as active stretching and exercise programs.
If we see no results after 6 visits (3 weeks)then we give the patient the option of continuing. I cannot tell you the exact techniques since every client is different, but it centers around the sacrum.
BOB
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RE: thoughts on manual therapy for scoliosis - March 19, 2008 8:53:49 PM
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SJBird55
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Bob, Bob, Bob... now, I was employed for a stint with a group of surgeons. I saw multiple radiographs of patients with idiopathic scoliosis. The vertebral column is definitely "curved" and definitely abnormal.
Myofascial release isn't going to do a darn thing to the bony structure! What the heck are you spouting??
If the measured angles were such that intervention was required, those folks were in braces, in particular with kids. AND, radiographs were taken every 8 - 16 weeks to ensure that angles were changing. I never saw that bracing completely normalized the spine.
When you talk about "progression," come on, you have no idea if you "stopped progression!" You have no control group of patients with the same angle and same degree of scoliosis from which to compare!!
Reduction of pain is one thing... "progression" of scoliosis is another.
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RE: thoughts on manual therapy for scoliosis - March 19, 2008 9:05:04 PM
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bobmfrptx
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SJ
The measured angle of the lady who did not need the spinal fixation surgery actually decreased 4 degrees. AETNA initially was not going to pay our bill of 28 hundred dollars, but the client who is a very big member of the PA republican party went to the insurance commission and we were paid. AETNA had approved the 100,000.00 dollar surgery for fixation you would have thought they would be happy, but they had the same belief as you...fortuneatly xrays, doctors letters and the client herself were evidence enough to change the minds of the insurance company. That was10 years ago and this lady who is a friend of mine is still golfing and her curve is not progressing. She is in her mid 60's now. The other two ladies who are in their 40's now are still doing well. So, who knows what really happened since I didn't have a control group and such. Clients averted major surgery, remain functional and are happy. End of story. Of course as I have said there are those that had no change of angles. So do not say it never happens. It did. we can ask how and why?
Bob
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RE: thoughts on manual therapy for scoliosis - March 19, 2008 10:20:09 PM
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Kaden
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Oak,
I agree with you that one cannot drastically change an adult scoliosis. However, do you believe these joints can be hypomobille and need mobs or are they simply fixed.
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RE: thoughts on manual therapy for scoliosis - March 20, 2008 6:31:35 AM
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SJBird55
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Well, Bob, reality is that you really don't know if that lady REALLY needed surgery. The need for surgery is sometimes determined simply by geographical location. What evidence was used to determine she required surgery? (And THAT was 10 years ago!)
Since you want to speak about change in angles of scoliosis, what is a clinically relevant change in angle OR what is a the standard amount of error when measuring scoliotic angles? What is the reliablity of measuring angles? Did the same person measure her angles?
And Bob, that testimonial for myofascial release was on one patient 10 years ago. Is your memory accurate? Do you remember the details correctly?
I would be more willing to bet that pain was reduced, there wasn't any spinal cord problem occurring, and none of the ladies had a scoliosis that was progressive anyways.
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RE: thoughts on manual therapy for scoliosis - March 20, 2008 7:43:01 AM
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bobmfrptx
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You would lose SJ. Do you want the person to contact you? She would be glad to oblige. Why do you refuse to accept that which happens. I can understand not accepting the percieved mechanism, but what is it when someone makes a remarkable correction that challenges your belief system throwing you immediately into denial?
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RE: thoughts on manual therapy for scoliosis - March 20, 2008 7:58:05 AM
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Sebastian Asselbergs
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Bob - it is because the tales you tell are unbelievable - without supporting evidence. It is UP TO YOU to prove the cases you present - not up to us to suspend all disbelief! You have a nasty way of telling a tall story and then accusing anyone who questions the veracity of being in denial.... We are just supposed to take your - and we don't know you from a hole in the wall - word for it?!?
If I tell you I can cure insomnia by meditating over a photograph of the patient - and tell you that it is true; will you just accept that? And then pay $2,500 to take my course?
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Mundi vult decipi
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RE: thoughts on manual therapy for scoliosis - March 20, 2008 8:01:29 AM
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Sebastian Asselbergs
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...and BOB, I noticed you did not address ONE of the the pointed questions by SJ. Let me refresh your memory:
"The need for surgery is sometimes determined simply by geographical location. What evidence was used to determine she required surgery? (And THAT was 10 years ago!)
Since you want to speak about change in angles of scoliosis, what is a clinically relevant change in angle OR what is a the standard amount of error when measuring scoliotic angles? What is the reliablity of measuring angles? Did the same person measure her angles? "
Go to it, my young jedi, since the force is already with you!
Oh yes: "peace"
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RE: thoughts on manual therapy for scoliosis - March 20, 2008 8:41:22 AM
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bobmfrptx
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Bas,
You don't need to believe me, I really don't care that you don't. But why would I lie? I'm not selling anything. The surgeons at John's Hopkins made the determination for surgery and then against after the 4 degree change. I do not make surgical decisions only influence them.
Keep the faith Bas.
Bob
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RE: thoughts on manual therapy for scoliosis - March 20, 2008 9:42:58 AM
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Sebastian Asselbergs
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From: Barrie, Canada
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....and still no answers.....
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Mundi vult decipi
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RE: thoughts on manual therapy for scoliosis - March 20, 2008 11:06:26 AM
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jesspt
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How was this 4 degrees measured? I've seen surgeons measure this, and typically it involves using a goniometer to measure the angle as see on x-ray. 4 degrees falls within the standard error of measure for goniometry. What I'm getting at here is that it sounds like there was no actual change in the degree of the patient's scoliosis. Now it sounds as though the person had functional improvements, and likely a decrease in pain, so I guess that I could agree that you may have been treating the pain and functional limitations that the pain caused the patient, but I just don't see a way that you treated the scoliosis, as there was essentially a zero structural change.
Surgeons know the standard error of measure for goniometry as well, so I doubt that 4 degrees was enough for them to jump off of the surgery bandwagon. Were they possibly given pause due to the patient's functional progress?
Bob: you mention "keep the faith." Man, do I take issue with that statement. An evidence-based practitioner shouldn't need to "keep the faith." They should know which treatments have the greatest efficacy. Many of your posts imply that you rely far more on faith than evidence. The same type of arguments are put forth by Iams, Barnes and various providers of "energy medicine". "Faith" healing isn't physical therapy, nor will it ever be.
_____________________________
Jess Brown, PT
Board Certified in Orthopaedic Physical Therapy
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RE: thoughts on manual therapy for scoliosis - March 20, 2008 12:51:33 PM
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SJBird55
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Bob, why are you making this personal? A 4 degree change is a "remarkable" correction? You haven't even responded the the specific questions that I posed. Just because the institute of John Hopkins is respectable or people believe it is respectable, does not in any way, shape or form mean that the surgeons were correct in their recommendation.
See... when it comes to surgery. The recent research is indicating that those that choose to undergo surgery (EVEN if they were randomized to NOT receive surgery), chose the surgery route because of higher pain intensity AND higher functional deficits. No, this research isn't revolving around scoliosis... but 4 degrees of change wasn't the determining factor for no surgery. Even though this was 10 years ago... I'd be very willing to bet that 1) the patient had no neurological deficits 2) her pain decreased and 3) her function increased. Therefore, since the patient responded to whatever you did, she did not feel the need for surgery and didn't want surgery. A surgeon back then could not force surgery - just as now a surgeon cannot force anyone to undergo surgery.
I'm not sure how I "lose." Not sure why that even comes into play with this topic.
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RE: thoughts on manual therapy for scoliosis - March 20, 2008 1:39:24 PM
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Sebastian Asselbergs
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Bob, Jess and SJ make some other good points: I just want to respond to this quote
"But why would I lie? "
I do not think you are lying at all. I just think you do not apply due diligence to what you have been taught and to what you experience. You are letting faith and belief and personal interpretations of interpersonal neurological events become your foundation of therapy. I guess it is better than those who just see $$ when looking at a patient, but it still does not belong in PT in this world.
< Message edited by Sebastian Asselbergs -- March 20, 2008 1:43:32 PM >
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RE: thoughts on manual therapy for scoliosis - March 20, 2008 4:54:53 PM
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bobmfrptx
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quote:
ORIGINAL: Sebastian Asselbergs
Bob, Jess and SJ make some other good points: I just want to respond to this quote
" You are letting faith and belief and personal interpretations of interpersonal neurological events become your foundation of therapy. I guess it is better than those who just see $$ when looking at a patient, but it still does not belong in PT in this world.
What does that mean personal interpretations etc etc.
The client came to our therapy office after conventional PT failed to reduce her complaints of pain and dysfunction (e.g. pain upon rising in the AM, pain with ADL's of shopping, difficulty reaching the top shelves, inability to golf without pain, difficulty playing her violin due to pain) Yes a lot of pain. Neurological signs in L.E. sciatica, weakness of great toe extensors, decreased sensory LT, vibration . She even had to get her clothes (slacks ) altered. 28 treatments the illiac crests were more level, shoulder heights were more level, rib hump less severe. All Trunk ROM increased reaching ability increased. she could drive without pain, she rejoined the symphony, she went back to golf!!! Painfree and with less postural deviations. Her curve had been progressing through the years. I do not know who or how these were measured. I would assume standing x-ray. We did MFR, heat, movement awareness training, stretches over the physioball strengthening, guided imagery and relaxation training. All of her progress wasn't just due to MFR.
She had objectively measured progress as wel as subjective.
The outcome was no surgery, returned to painfree ADL's, no alteration of the new slacks and a very happy women. The mechanism of change I would assume involved her brain and nervous system which responded to the input stimulus we provided. We are a stimulus response organism are'nt we?
What did I interpret and how???
SJ Its not personal, I meant you would lose the bet...thats all.
There was cord compression on MRI, her curve had been progressing.
Was it strictly manual care...no.
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RE: thoughts on manual therapy for scoliosis - March 20, 2008 7:39:59 PM
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Sebastian Asselbergs
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Bob, THIS: " We have had good results with scoliosis using MFR techniques."
This is an interpretation on your part or (personal opinion coming) a belief on your part. There is NO evidence that the MFR techniques had a darn thing to do with it.
MFR has no logical, scientific or sound biochemical, neurophysiological or quantum physical basis. MFR has no outcome studies (despite the millions of treatments every year). Not saying gentle hands-on doesn't have some of the afore mentioned; but MFR as it is presented by JB himself - woo-woo.
Then you add: "We did MFR, heat, movement awareness training, stretches over the physioball strengthening, guided imagery and relaxation training".
This means that you don't know which of these aspects, let alone MFR, was the effective agent of change.
You treat a patient, you observe a change, and you post that you "have had good results with scoliosis using MFR techniques".
Sooo much more is needed before one can state that.
Anecdotal. And, as I have said before, the world is full of anecdotes - very often wrong, but that is their nature. A personal interpretation of an event. And therefore subject to personal beliefs.
(Sorry Kaden - stole the thread...)
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RE: thoughts on manual therapy for scoliosis - March 20, 2008 7:40:22 PM
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SJBird55
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Wow.. you have a great memory to remember such specifics after 10 years... wow.
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RE: thoughts on manual therapy for scoliosis - March 20, 2008 8:00:18 PM
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bobmfrptx
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SJ
Do you remember clients who have been spared the pain and suffering of surgery? I have become very good friends with this lady and yes I do remember her and her events well. We see each other at least 4 -5 times a year despite the 3 hour distance between us.
Bas,
The only difference between the therapy services this women recieved was the MFR...woo woo to you good buddy!!!
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RE: thoughts on manual therapy for scoliosis - March 21, 2008 8:12:18 AM
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SJBird55
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Bob, I can't remember what I ate for lunch yesterday. I honestly don't care if someone does or doesn't have surgery. I don't view surgery as "pain and suffering." Surgery has a time and a place and we do need surgeons. I highly recommend surgery at times and at other times I highly suggest alternatives other than surgery. The ultimate decision is the patient's.
I will respectfully disagree with your thought processes with regard to the lady that ended up not requiring surgery.
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