|
|
Re: who's going to do the manipulation?
|
Logged in as: Guest
|
|
Users viewing this topic:
none
|
|
Login  | |
|
Re: who's going to do the manipulation? - October 3, 2006 9:02:00 AM
|
|
|
Jon Newman
Posts: 1706
Joined: April 24, 2004
From: Amherst, WI
Status: offline
|
Steve not only are those misquoted, you're wrong. Those statements don't say that at all.
Jason, start doing manipulation only. No education and no ROM and then get back to me on that. Do the converse too and see how you do.
_____________________________
[URL=http://www.sonymusic.com/clips/selection/30/064887/064887_03_03_30.wav]Evidence[/URL]
|
|
|
|
|
Re: who's going to do the manipulation? - October 3, 2006 9:43:00 AM
|
|
|
jlharris
Posts: 476
Joined: April 12, 2006
From: Nebraska
Status: offline
|
Mr. Newman,
[My opinion]
I think I'd get the results without them
[/My opinion]
That said, I wouldn't feel confortable. Why? I think one of the best services I provide is education. Also, my PT education stressed that one needed to specifically move into newly aquired ROM to avoid losing it. Do I have research to back that up? Nope. And could be just a dogma I hang on to.
I do get you point, though, sir. I have done ROM and education only for pt's that fit the CPR. Did they eventually get better? Yep. But not pain one day, manip the next, and no pain the day after. But that is just my clinical experience, and may not be the norm.
_____________________________
Jason L. Harris, PT, DPT
My PT Blog
|
|
|
|
|
Re: who's going to do the manipulation? - October 3, 2006 9:47:00 AM
|
|
|
Jon Newman
Posts: 1706
Joined: April 24, 2004
From: Amherst, WI
Status: offline
|
Hi Jason,
I wouldn't be surprised at all at those findings. My point hasn't been that manipulation does not have an affect despite what others are (perhaps understandably based on my past rants) reading into my posts.
_____________________________
[URL=http://www.sonymusic.com/clips/selection/30/064887/064887_03_03_30.wav]Evidence[/URL]
|
|
|
|
|
Re: who's going to do the manipulation? - October 3, 2006 11:07:00 AM
|
|
|
Shill
Posts: 1092
Joined: February 13, 2003
From: Madison WI USA
Status: offline
|
Jon,
Not to quibble, but my screen shows, for your first post on this topic: "My answer is, minimally, "Anyone who thinks they must".
My impression of your meaning may be wrong, but there is no misquoting unless a virus has hijacked either my computer or my eyes.
_____________________________
Steve Hill PT
|
|
|
|
|
Re: who's going to do the manipulation? - October 3, 2006 11:49:00 AM
|
|
|
Jon Newman
Posts: 1706
Joined: April 24, 2004
From: Amherst, WI
Status: offline
|
I get it. I should have left the quotes off so that the whole sentence be considered . I stand corrected. By minimally I meant that, at the very least, anyone who thinks they must, will. Of course others will have a much lower threshold than that.
Maybe I should have said maximally.
_____________________________
[URL=http://www.sonymusic.com/clips/selection/30/064887/064887_03_03_30.wav]Evidence[/URL]
|
|
|
|
|
Re: who's going to do the manipulation? - October 3, 2006 12:19:00 PM
|
|
|
nari
Posts: 1568
Joined: November 14, 2003
From: Australia
Status: offline
|
Jason,
Just a query: if your manipulated patient returns with pain after, say 20 hours of 'relief', what would you do next? Let's say the pain is now perceived by the patient as less than previously; would you manip again? How long would you keep going, along with ed and ROM, etc...
I have no doubts at all that manipulations work for certain people; it is the strange concept that the reasons for pain relief via manips are not (yet)fully understood, and that does not seem to matter, as long as it works for a little while.
Couldn't the same be said of ultrasound, massage, acupuncture,CST, MFR, and anything else one could think of?
I'm still battling to work out the logic of concepts presented here. Perhaps there lies a difference in the sort of 'education' each of us delivers to LBP patients. Maybe that is a clinching factor...worth another thread?
Nari
|
|
|
|
|
Re: who's going to do the manipulation? - October 3, 2006 12:24:00 PM
|
|
|
Sebastian Asselbergs
Posts: 1191
Joined: September 29, 1999
From: Barrie, Canada
Status: offline
|
Sara C.: yes, I know - sorry I did not make that clearer. It is an example of reasonable research showing effectiveness and good outcomes. My point was that I hope people posting here don't treat subacute LB patients with anything with less evidence....(LOL)
_____________________________
Mundi vult decipi
|
|
|
|
|
Re: who's going to do the manipulation? - October 3, 2006 12:26:00 PM
|
|
|
Sebastian Asselbergs
Posts: 1191
Joined: September 29, 1999
From: Barrie, Canada
Status: offline
|
nari - excellent question with regards to the pain relief...
_____________________________
Mundi vult decipi
|
|
|
|
|
Re: who's going to do the manipulation? - October 3, 2006 1:51:00 PM
|
|
|
nari
Posts: 1568
Joined: November 14, 2003
From: Australia
Status: offline
|
proud
Thanks for that; at least they are heading in the right direction.
Nari
|
|
|
|
|
Re: who's going to do the manipulation? - October 3, 2006 2:13:00 PM
|
|
|
proud
Posts: 941
Joined: March 22, 2006
Status: offline
|
I have a theory on why manipulation works( for some). I think it has the neurophysiological effect described above which allows(convinces) the patient that they have been "cured" and they then have a reduction in fear of movement. They just get back to regular activity, which is the main therapuetic component.
On one course I know of, they teach you to perform end range flexion and end range extension immediately following a lumbar manip. I imagine part of that is to reduce fear avoidance and get the person moving again. Basically if the patient came in unable to flex, after the manip neurophysiological effect, they suddenly have markedly improved painfree range. In the patients eyes, you "popped" something back into place..."now I can move!".
I know of a PT( 5-6 years ago) that used to manip a certain subgroup of military soldiers( I think based on his own "unknown" critera) and then tell them to get up off the plinth and "run across that field". Literally these guys would walk in barely able to move and run across the field. Hilarious to watch. When asking the PT what he did...he replied he had no idea and laughed. He knew nothing was "out of place"...
I think the manip has the effect described above as well as a huge psycological impact on fear avoidance behaviors. Chiropractors have made a living on this. The problem is many of them believe that they actually "put something back in place" and that this requires "special skills" deserving of years of experience. Which of course is false...
All just theory for fun of course.
|
|
|
|
|
Re: who's going to do the manipulation? - October 3, 2006 2:36:00 PM
|
|
|
nari
Posts: 1568
Joined: November 14, 2003
From: Australia
Status: offline
|
proud,
The patient satisfaction factor in the 'click'/'pop' experience cannot be denied, and you would be right in suggesting that normal movement can be restored in the patient's context if he/she knows that the back has been 'put back into place'. That is part of the success of a manip, plus a few other effects, namely neurophysiological.
To me, it propagates the 'out of place' myth and that is a very difficult concept to alter in patients' thoughts. However, most of us will try to alter that concept.
Nari
|
|
|
|
|
Re: who's going to do the manipulation? - October 3, 2006 2:48:00 PM
|
|
|
proud
Posts: 941
Joined: March 22, 2006
Status: offline
|
I would argue the neurophysiological part comes first...followed by the psycological( decrease fear avoidance and get moving).
What is important is to avoid telling the patient that "I am going to adjust your spine to align things up". That can create dependance and I do not think advisable...unless you want to build a huge empire...
|
|
|
|
|
Re: who's going to do the manipulation? - October 3, 2006 2:50:00 PM
|
|
|
dfjpt
Posts: 238
Joined: April 9, 2006
Status: offline
|
So, the key piece of "therapy" going on with manip is cognitive behavioral. It figures.
|
|
|
|
|
Re: who's going to do the manipulation? - October 3, 2006 2:54:00 PM
|
|
|
proud
Posts: 941
Joined: March 22, 2006
Status: offline
|
dfjpt,
No neurophysiological is the "key"( I think). Read the article above. It has full text.
And what figures?
|
|
|
|
|
Re: who's going to do the manipulation? - October 3, 2006 3:20:00 PM
|
|
|
dfjpt
Posts: 238
Joined: April 9, 2006
Status: offline
|
Hello? :) proud, I got that idea straight from your post: [QUOTE]I know of a PT( 5-6 years ago) that used to manip a certain subgroup of military soldiers( I think based on his own "unknown" critera) and then tell them to get up off the plinth and "run across that field". Literally these guys would walk in barely able to move and run across the field. Hilarious to watch. When asking the PT what he did...he replied he had no idea and laughed. He knew nothing was "out of place"...
I think the manip has the effect described above as well as a huge psycological impact on fear avoidance behaviors. [/QUOTE]It's like graded exposure, but with just one big dramatic impactful step instead of several smaller ones. "It figures" means, it figures that it's razzledazzle. I always thought it was razzledazzle, still do. Not that razzledazzle doesn't have its place. See the posts about placebo. Nothing wrong with setting up a situation where placebo is elicited, then reinforcing it with CBT and movement. That's what PT is all about.
What's amusing is that all the mesodermalists so earnestly try to find a mechanism or a tissue or something that is biomechanical or that they can blame pain on, push on, then take credit for having done something "real". Something physical, you know? Not psychological or any of that feathery, hard-to-pin down stuff.
|
|
|
|
|
Re: who's going to do the manipulation? - October 3, 2006 3:29:00 PM
|
|
|
proud
Posts: 941
Joined: March 22, 2006
Status: offline
|
See dfjpt, we have more in common than one would think. I just happen to follow what the research says and apply it.
I think it is important that our interventions have support through the literature. The CPR use of manipulation is documented...are your "several smaller ones"?
I am adding this: You mention manipulation like it is placebo? Well that is unfounded. If we agree with the findings in the article I posted then there is a neurophysiological effect. That is not placebo.
If I read your post correctly, you are indicating that you achieve the same neurophysiological effect through "smaller" less dramatic techniques. Well I am suggesting where is the documentation on intervention effect?
If we have a technique with documented outcomes, then this is a higher "level" of evidence than your clinical experience. According to sackett:
“Evidence Based Medicine (EBM) has been defined as “the conscientious”, explicit, and judicious use of current best evidence in making decisions about the care of individual patients. The practice of evidence based medicine means integrating individual clinical expertise with the best available external clinical evidence from systematic research” David Sackett et.al “Evidence Based Medicine: What it is and What it isn't” BMJ 312 No. 7023 (1996).
If you choose to employ "smaller steps" in the face of current best evidence, I have to ask why?
|
|
|
|
|
Re: who's going to do the manipulation? - October 3, 2006 3:57:00 PM
|
|
|
rwillcott
Posts: 425
Joined: March 20, 2006
From: Canada
Status: offline
|
Nari you stated:
"The patient satisfaction factor in the 'click'/'pop' experience cannot be denied"
There has been a recent study that demonstrated that the sound cavitation has no affect on the patients respnse to manipulation. Many have believed that you must here the "pop" for the placebo effect. In fact, if a patient meets the 4/5 prediction rules they will repsond positvely regardless of the "click/pop."
This is an excellent example that there is not a placebo affect when using the manipulation for the appropriate sub-group of patients. I'll look for the reference for you.
Rob
|
|
|
|
|
Re: who's going to do the manipulation? - October 3, 2006 4:03:00 PM
|
|
|
jlharris
Posts: 476
Joined: April 12, 2006
From: Nebraska
Status: offline
|
Nari,
Thank you for your question. I would not manip again. It's not like the pain is gone for 'only' a few hours than comes back. For acute back pain, it's gone - let me rephrase that - it is significantly reduced. How do I know? - I choose to use the Oswestry to help measure my pt's change. Although it's not perfect, IMO it's better than a pt's "hey, I feel a little better" statement to rely on.
[Quote from Nari]
Couldn't the same be said of ultrasound, massage, acupuncture,CST, MFR, and anything else one could think of?
[/Quote]
Not at all. I've found loads of research that says that none of that has significant results. Although maybe unintended, I take this as a backhanded insult. I do none of the above in my clinical practice.
Don't get me wrong, sir, I respect your clinical knowledge. I'm early in my career and know there is so much I don't know or understand that it's almost scary. And I know it's the realm of neurophysiology that I'm to most remidial at.
_____________________________
Jason L. Harris, PT, DPT
My PT Blog
|
|
|
|
|
Re: who's going to do the manipulation? - October 3, 2006 4:04:00 PM
|
|
|
Synergy
Posts: 592
Joined: March 11, 2004
From: Texas
Status: offline
|
Rob,
Perhaps Nari was referring to the psychological impact of knowing something was being 'put back in place'...not so much the cavitation itself. If you tell a patient or the patient assumes the technique you are about to deliver will indeed place the maligned segment back to its normal position, perhaps this is sufficient for them. Correct me if I'm wrong Nari. ;)
BTW Jason...Nari happens to be a female :)
_____________________________
Chris Adams, PT, MPT
|
|
|
|
 New Messages |
 No New Messages |
 Hot Topic w/ New Messages |
 Hot Topic w/o New Messages |
 Locked w/ New Messages |
 Locked w/o New Messages |
|
 Post New Thread
Reply to Message
Post New Poll
Submit Vote
Delete My Own Post
Delete My Own Thread
Rate Posts |
|
0.094
|
Printable Version
