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RE: Obama and Chiropractic: Wow...

 
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RE: Obama and Chiropractic: Wow... - June 19, 2009 12:06:25 PM   
Sebastian Asselbergs

 

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Tim, I wasn't kidding about what I tell a patient with regards to their subacute or chronic restricted motions. In various modifications to appeal to individuals' level of a) education, b ) knowledge of the body, and c) previous exposure to creative but bogus explanations ("out of place/alignment", "fascial restriction", etc etc).

Been doing that way, slowly evolving as I modify analogies to improve clarity and so forth, for three years now. Works very well with my particular (likely self-selecting) caseload, although I always have a few new ones each week who make me really work hard to tear down some of the above mentioned notions.

With regards to what proud says about the back epidemic: I can not speak for him, but it seemed to me that his focus is more on the long term patient modification of attitude and awareness than on the short term benefits of the most commonly applied manipulations. Your point about the appropriately applying it to specific subgroups in combination with exercises is of course well taken. But really, how many patients a week do I see who fit that subgroup? Or you?
Compared to the "every lumbar, thoracic and cervical spine gets cracked" type of manipulation, the judicial application as you and the most recent studies support, will occur MUCH less often given the same mixed spinal caseload.  So, for past-manipulation-freaks like me, YES, we use it much, much less.

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RE: Obama and Chiropractic: Wow... - June 19, 2009 12:34:17 PM   
SJBird55

 

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I believe Tim is a PT... in literature, thrust manipulation is NOT used very frequently at all by physical therapists.  Educational programs as a whole are not educating physical therapist students on how to perform a thrust manipulation.  Do we count chiropractors and their treatments for subluxation theory as a thrust manipulation?  I think we probably shouldn't because their theory is bunk and when I hear patients describe to me what happens, the chiropractic techniques sound very different than the PT thrust manipulations.  I'm interpreting Tim's perspective to suggest thrust manipulation needs to be included as an intervention with appropriate patients.  I really don't think we're going to have an overabundance of thrust manipulation added to the situation of treating low back pain as proud is suggesting.

Physical therapists are underutilized in the States.  We aren't even brought into the picture the majority of the time.  I believe that is the biggest hurdle to overcome when it comes to back pain.  Consumers need the right treatment at the right time and it just isn't happening.  Either physician gate-keepers are to blame OR we are to blame because we don't educate the public.

At the same time though, and I don't want to sound too wishy-washy... I HAVE seen changes in the referral patterns of my local physicians.  I haven't run the numbers yet, but it mentally feels to me that I AM having patients referred to me 3 weeks to 3 months post lumbar pain complaint.  I remember when the majority of the patients with back pain were chronic - like 6 months or more after pain initiated.  When there is a change in referral patterns and patients come to your doors sooner, that does tip the scale to indicate manipulation just might be appropriate.

(in reply to Sebastian Asselbergs)
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RE: Obama and Chiropractic: Wow... - June 19, 2009 1:03:36 PM   
Sebastian Asselbergs

 

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I know that Tim is a PT.
As you can see in my post, I agree with the judicial use in the small but specific group of patients. 

I do not see why we can not talk about the chiro "adjustment" as a manipulation? HVLA is quite normal in chiro offices. And it is the group that uses it more per registered professional than any other profession - AND they are part of this community on the Edge.  The underlying theories of application is not really an issue here.

I and a few of my colleagues here in town, used to manipulate a heck of a lot (starting in 1986) . That is what I am referring to when I say that I use it rarely now.



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RE: Obama and Chiropractic: Wow... - June 19, 2009 1:24:36 PM   
SJBird55

 

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I don't know Bas... if you look on YouTube and you listen to what patients describe to you about the chiropractic adjustment, what chiropractors do and what physical therapists do are like 2 different things.

Chiropractors seem to have quick, larger amounts of motion occurring... where physical therapists... the end position is slowly reached and then basically a quick joint mobilization occurs.  They look like 2 very different animals to me.

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RE: Obama and Chiropractic: Wow... - June 19, 2009 2:30:59 PM   
Sebastian Asselbergs

 

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I wait for bonez to chime in here, but I have worked in the past side by side with chiros, and most did NOT use those large motions. I believe there are different schools and "types" of chiro adjustments. Bonez?

(And SJ, you want to be careful using Youtube or patients as a guideline .... )

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RE: Obama and Chiropractic: Wow... - June 19, 2009 3:27:10 PM   
TMondale

 

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SJ,
I am a PT.  CAPTE has since 2006 required that all american PT curriculums include both thrust and non-thrust manipulation.  As to weather there is any difference between the techniques chiro's use and those that we use, I don't believe there is much. 

Sebastian, sorry for the assumption.  It must work for you.  How much direct access do you see? 

Tim

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RE: Obama and Chiropractic: Wow... - June 19, 2009 3:40:44 PM   
proud

 

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quote:

ORIGINAL: Sebastian Asselbergs

Been doing that way, slowly evolving as I modify analogies to improve clarity and so forth, for three
With regards to what proud says about the back epidemic: I can not speak for him, but it seemed to me that his focus is more on the long term patient modification of attitude and awareness than on the short term benefits of the most commonly applied manipulations.


Yes. The energy I extend here is exausting....but effective.

Tim,

quote:

It seems you're saying that there is some link between manipulation for low back pain and the ever worsening epidemic of skfyrocketting cost and poor outcome.


I never said that. That would imply correlation.

What I said is thrust manipulation and spinal related pain have co-existed together for over a century.

Imagine a medical problem. Let's say Ricketts. Now imagine a treatment for Ricketts was proposed in 1897 or something. 110 years latter we have more people with Ricketts than ever. Is the proposed treatment for Ricketts still viable? Should we add more of the proposed treatment for Ricketts?

I propose a simple challange to you Tim: Ask your next 10 patients to explain to you why they have pain( new patients whom you have not been involved with). I'd bet 10/10 will give you a biomechanical explaination. Bones not moving enough, bones moving too much, pelvis out of alignment, scoliosis, pinched nerve in the neck. You name it.

People first and foremost need to know nothing is ripped, torn or broken or even in danger of doing so. Although the thrust manipulation provides some neuro-modulatory impact( a nice one)....the concept itself just feeds the beast in my opinion.

If you can find a way to use the manip for pain modulation and at the same time convey the message that it actually did very little to "change" any bone, break scar tissue, re-align etc....then you are really good. Guaranteed if you do explain it the correct way....you would overhear that same patient at the local bar telling his buddies how he went to this Physiotherapist who "cracked" his back and put every thing back in place. Guaranteed.

It's branding.....like Kleenex to us North Americans.

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RE: Obama and Chiropractic: Wow... - June 19, 2009 5:15:26 PM   
Long Tracts

 

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quote:

ORIGINAL: proud

quote:

ORIGINAL: Sebastian Asselbergs

Been doing that way, slowly evolving as I modify analogies to improve clarity and so forth, for three
With regards to what proud says about the back epidemic: I can not speak for him, but it seemed to me that his focus is more on the long term patient modification of attitude and awareness than on the short term benefits of the most commonly applied manipulations.


Yes. The energy I extend here is exausting....but effective.

Tim,

quote:

It seems you're saying that there is some link between manipulation for low back pain and the ever worsening epidemic of skfyrocketting cost and poor outcome.


I never said that. That would imply correlation.

What I said is thrust manipulation and spinal related pain have co-existed together for over a century.

Imagine a medical problem. Let's say Ricketts. Now imagine a treatment for Ricketts was proposed in 1897 or something. 110 years latter we have more people with Ricketts than ever. Is the proposed treatment for Ricketts still viable? Should we add more of the proposed treatment for Ricketts?

I propose a simple challange to you Tim: Ask your next 10 patients to explain to you why they have pain( new patients whom you have not been involved with). I'd bet 10/10 will give you a biomechanical explaination. Bones not moving enough, bones moving too much, pelvis out of alignment, scoliosis, pinched nerve in the neck. You name it.

Why would I expect anything else? 

People first and foremost need to know nothing is ripped, torn or broken or even in danger of doing so. Although the thrust manipulation provides some neuro-modulatory impact( a nice one)....the concept itself just feeds the beast in my opinion.

If you can find a way to use the manip for pain modulation and at the same time convey the message that it actually did very little to "change" any bone, break scar tissue, re-align etc....then you are really good. Guaranteed if you do explain it the correct way....you would overhear that same patient at the local bar telling his buddies how he went to this Physiotherapist who "cracked" his back and put every thing back in place. Guaranteed.

Exactly, they don't really give a flip what was causing it.  They just want to know if you can 'fix it'.

It's branding.....like Kleenex to us North Americans.

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RE: Obama and Chiropractic: Wow... - June 19, 2009 10:06:49 PM   
proud

 

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I'd suggest starting with Butler, Shacklock, Wall etc. Good sources if you want to know "why"... 

What are you "fixing" long tracks? 

Details any person delivering care for pain should familiarize themselves with for the benefit of their patients.

< Message edited by proud -- June 19, 2009 10:20:22 PM >

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RE: Obama and Chiropractic: Wow... - June 19, 2009 10:44:41 PM   
TexasOrtho


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I've never done anything other than low amplitude manipulations.  I would imagine if you were able to honestly stratify risk across all forms of manipulation, you would find the majority of adverse events stem from high velocity high amplitude varieties.  Just pure speculation of course.

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RE: Obama and Chiropractic: Wow... - June 19, 2009 10:46:39 PM   
Long Tracts

 

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quote:

ORIGINAL: proud

I'd suggest starting with Butler, Shacklock, Wall etc. Good sources if you want to know "why"... 

I already know  'why'....Patients don't care about  'why'.
 
 


What are you "fixing" long tracks? 

I didn't say I was 'fixing' anything.  Re-read my comment.

Details any person delivering care for pain should familiarize themselves with for the benefit of their patients.

(in reply to proud)
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RE: Obama and Chiropractic: Wow... - June 19, 2009 11:00:57 PM   
proud

 

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quote:

I already know  'why'


I cannot be sure of that  given your comments to date. Like this one:

quote:

Why would I expect anything else?
 


And even within this singular comment there is ignorance:

quote:

Patients don't care about  'why'.


Why don't they? Are you sure about that? Does that mean we should keep them in the dark? And what if we educated them( Morsely for a reference BTW).





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RE: Obama and Chiropractic: Wow... - June 19, 2009 11:24:44 PM   
TexasOrtho


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Patient's may not care about "why", but a supposed professional should.

Repeatedly asking this question prior to considering a treatment (assuming the practitioner's brain is up to the task or not completely brainwashed) is what separates a profession from a trade.

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RE: Obama and Chiropractic: Wow... - June 20, 2009 10:03:05 AM   
ginger

 

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My patients regularly reflect on the value my explanations provide . An outline of the physiology of spinal pain accompanies almost all new patient's treatments. Most report that no one had even  bothered to inform them before, and thank me for detailing spinal pain phenomena with reference to their problem.
Not sure I can understand an attitude where explanation is not given. It is possible that many who  treat spines actually do not understand the physiology, I suspect this is true, if the impressions gained by reading a few lesser quality blog sites here in Oz is any guide.

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RE: Obama and Chiropractic: Wow... - June 20, 2009 12:20:31 PM   
proud

 

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quote:

ORIGINAL: ginger

My patients regularly reflect on the value my explanations provide . An outline of the physiology of spinal pain accompanies almost all new patient's treatments. Most report that no one had even  bothered to inform them before, and thank me for detailing spinal pain phenomena with reference to their problem.
Not sure I can understand an attitude where explanation is not given. It is possible that many who  treat spines actually do not understand the physiology, I suspect this is true, if the impressions gained by reading a few lesser quality blog sites here in Oz is any guide.


Yes and let's be clear what that explaination is( I gather Long Tracks feels an explaination that the patients vertebrea our out of alignment or pelvis is assymmetrical would suffice).

Given his confusion over my challenge to Tim to ask his next 10 patients what they feel the origin of their pain might be.....

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RE: Obama and Chiropractic: Wow... - June 20, 2009 2:27:45 PM   
chiro123

 

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http://www.mdconsult.com/das/citation/body/144516352-2/jorg=journal&source=MI&sp=16271803&sid=0/N/16271803/1.html?issn=

Good explanation of chronic neck and back pain.

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RE: Obama and Chiropractic: Wow... - June 20, 2009 2:55:24 PM   
Spondylo

 

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quote:

ORIGINAL: proud

Yes and let's be clear what that explaination is( I gather Long Tracks feels an explaination that the patients vertebrea our out of alignment or pelvis is assymmetrical would suffice).

Given his confusion over my challenge to Tim to ask his next 10 patients what they feel the origin of their pain might be.....


I don't see any evidence that Longtracts didn't understand completely what was said.

If he did, perhaps having 6 spelling errors/improper uses in one sentence (3 in a row) may have caused the confusion.

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RE: Obama and Chiropractic: Wow... - June 20, 2009 3:01:34 PM   
rwillcott

 

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The misconception that patients don't care 'why' has contributed IMO to the poor treatment of LBP.  Why would we assume they don't care?  The better informed a patient the better chance of a positive outcome.

If we assume the patient doesn't care why a manipulation helped then we perpetuate the myth that a (fill in the space) was put back in place.

Patients are always very grateful when you take the time to explain the cause of their injury.  I know I like when my family physician explains why I have a persistent cough follwong a cold etc. 

People are less fearful when they understand why they are in pain.  However, to educate patients that a mnaipulation does not realign a subluxation would contribute to eliminating a very washed up theory.  The great DD Palmer's greatest invention.....the 'subluxation theory'.

When reading and diccussing the subluxation theory I feel I am arguing that the world is in fact round!

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RE: Obama and Chiropractic: Wow... - June 20, 2009 3:48:05 PM   
Sebastian Asselbergs

 

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Tim, my clinic and my profession here are 100% direct access.


With regards to the patients "not caring" about the why:
As Rod, proud and willcott said, it is our duty and responsibility to give the BEST treatment - ethically, if you are giving an explanation based on faulty evidence, or outdated ideas, you are not providing the BEST care. You do need to read a bit more about the patients' need to understand - there is good evidence that when patients really understand their issues, the therapy is already well on the way. And they are more capable to understand than medical professionals generally assume.

Now for the anecdotal stuff - being in a direct access world, I am seeing more and more patients looking for understanding of the t/issues involved. Just like willcott says: they appreciate it.

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RE: Obama and Chiropractic: Wow... - June 20, 2009 7:06:22 PM   
proud

 

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quote:

ORIGINAL: Spondylo

quote:

ORIGINAL: proud

Yes and let's be clear what that explaination is( I gather Long Tracks feels an explaination that the patients vertebrea our out of alignment or pelvis is assymmetrical would suffice).

Given his confusion over my challenge to Tim to ask his next 10 patients what they feel the origin of their pain might be.....


I don't see any evidence that Longtracts didn't understand completely what was said.

If he did, perhaps having 6 spelling errors/improper uses in one sentence (3 in a row) may have caused the confusion.


Ah you got me Sponylo. Very insightful....again.

Anyhow, I don't really care that much if Long tracks truly understands anything. But if he is not up to date on some of the most recent understanding in pain and how it impacts how we practice, then as one clinician to another I suggest he reviews.

I have moved from a place of pure orthopeadically driven notions and thanks to some persistent buggers over at Soma simple....I have updated myself for the better. I still manipulate. I still mobilize etc but I just understand better. And it seems the more I understand, the less I manipulate. It's always someones choice to learn and progress or remain static and stale while they defend a theory.

This is a place to come and learn. Take it really...or leave it.

Again...Wall, Shacklock, Moseley, Butler are good start points. I'm still reading these texts and articles. Long way to go before I assimilate all the information. And likley once I do....there will be new stuff.

But if you would prefer to be Rehabedge's grammerman and spell checker exraordinaire rather than contribute anything of clinical value...have at er' Spondylo. E'll keap yu vary busie.

< Message edited by proud -- June 20, 2009 7:16:54 PM >

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