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vertebral manipulation for PT
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vertebral manipulation for PT - March 6, 2003 1:10:00 PM
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river
Posts: 2
Joined: January 6, 2003
From: Franklin, TN
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I would like to ask a well seasoned PT his/her opinion on whether a PT can learn and practice new techniques(specifically spinal manipulation) whether or not you learned it in school.
My interest stems from my current employment working as an assistant with a Chiropractor as well as a fitness trainer. An awful lot of patients seem to get at least temporary relief of localized and referred pain via their spinal adjustments. How long it lasts I am not sure.
I have an M.S. in applied exercise physiology and have been accepted into a DPT program and am not sure whether PT is legally allowed to practice whatever is needed to treat and improve patient care.
I understand that PT is primarily a rehab profession, but I need to know if adjustments or other "advanced" techniques, whether manual or not can be learned and practiced.
A good parallel for those of you reading can be found in the field of exercise physiology. Their are a few individuals with my background allowed to conduct various exercise stress tests, utilizing radioactive tracers, medications etc.. with a physician present.
My final point is, once a license is obtained, one should be able to practice various techniques after having demonstrated their efficacy and competence.
Thanks, any help you may be would be appreciated.
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Re: vertebral manipulation for PT - March 7, 2003 9:37:00 AM
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Matthew Hauger
Posts: 37
Joined: February 11, 2003
From: Hermitage, PA, United States
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I'm not exactly a "seasoned PT", but my school gave some small training in spinal manipulation in our orthopedics classes. We're also offered the oppurtunity to take a PT elective in basic spinal manips. I really don't know if this is the case in all schools, but I doubt it. However, if that's something you're intested in, there are continuing education classes that include this type of manual therapy. Look for courses teaching the Stanley Paris or Freddy Kaltenborn methods. That's all I know of off hand. Hope it helps.
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Re: vertebral manipulation for PT - March 7, 2003 10:15:00 AM
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Andrew M. Ball PT PhD
Posts: 855
Joined: July 28, 2002
From: Charlotte, NC
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We must be carefull here, "manipulation" doesn't mean the same thing to a PT as it does to a chiropractor.
PT's tend to focus upon the mobility of a single joint (such as is the case with rib-screwing), whereas chiropractors tend to focus upon blanced forces up the spine --- a subtle difference, but a major one in terms of clinical use of mobilization and manipulative techniques used.
Drew
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Re: vertebral manipulation for PT - March 7, 2003 8:58:00 PM
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johnjfraser
Posts: 102
Joined: June 11, 2000
From: Staten Island, NY
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I received a lot of training in PT school in spinal/peripheral joint mobilization & manipulation. My ortho professors where both man therapy certified and trained under Paris' program. I cant say the same about my academic preparation in Neuro (besides theory).
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John J Fraser, PT, MS
johnjfraser@yahoo.com
[URL=http://www.geocities.com/johnjfraser]http://www.geocities.com/johnjfraser[/URL]
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Re: vertebral manipulation for PT - March 19, 2003 8:10:00 AM
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Superchiro
Posts: 16
Joined: March 18, 2003
From: Lawrence, NY
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Hi river,
I think what you are referring to would probably be called a Grade 5 mobilization in the PT world.
Not trying to discourage you or be professionally jingoistic here, but as a chiropractor I can tell you that performing spinal manipulation/adjustments-- performing them well-- is a lot more difficult than it looks. It is a learned art that is continually refined as one moves through practice life. Since it is an applied skill, didactic instruction in manipulation is no substitute for actually doing it.
When I was in chiropractic school, we had hundreds of hours of laboratory time on technique. We practiced on our classmates palpating and setting up manuevers (not actually following through with the thrust). When I graduated, my adjustments went like I had two left hands of all thumbs. I "rubbernecked" patients left and right. It took me a few years of continuous pracrtice to feel competent. Now, after about nine years, I feel pretty confident, and based on comparative feedback from patients I feel like my skills are better than average. But every patient comes with their own challenges. Most DCs who do osseous manipulation and are good at it are good because they do it all day, every day, 20 times a day, on short/tall/fat/thin/muscular/flabby/tense/relaxed/in severe pain/minimal pain patients.
My point is, if manipulation is going to be an occasional trick for your bag, it will probably take you a very long time to feel competent at it and do it well....... tou have to consider if that will be serving your patients' interests. If you really feel that a patient might benefit from manipulation-- refer him/her to a chiropractor. We like to work with PTs, regardless of what some other threads may have people believe.
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Supe
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Re: vertebral manipulation for PT - March 19, 2003 9:38:00 AM
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Andrew M. Ball PT PhD
Posts: 855
Joined: July 28, 2002
From: Charlotte, NC
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I agree with superchiro here, to a point. I think that like DC's who use rehab as a trick in their bag, it's okay for PT's to grade V one joint that's jammed. Where our language gets a little twisted is in the realization that DC's mobilize/manipulate multple joints in order to achieve balanced ground reaction forces up the spine when the person is in standing --- PT's are all about range of motion and mobility at that joint.
Drew
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Re: vertebral manipulation for PT - March 19, 2003 12:21:00 PM
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Andrew M. Ball PT PhD
Posts: 855
Joined: July 28, 2002
From: Charlotte, NC
Status: offline
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Over my head? Perhaps, perhaps not. I do still do one day a week of outpatient ortho work, and I've done grade V mobs to kids with CP in order to get greater trunk rotation prior to rotational stretching of the trunk and subsequent gait training with focus upon pelvic rotation.
Out of my league? No . .. but perhaps not the best messenger on the subject.
Drew
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Re: vertebral manipulation for PT - March 19, 2003 12:23:00 PM
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rehabdoc
Posts: 51
Joined: March 17, 2003
From: Butte, MT US
Status: offline
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Enlightened. I don't think you have enough clinical background to back up your statements. It's like saying I can take a weekend course in something such as "Post-stroke Rehabilitation" (as an example) and be as proficient as a PT in 4 weeks. Not likely at all. The difference in clinical experience doesn't make it possible. I see a lot of NMS rehab, but Drew would blow me away in pediatric cases of CP, etc. Why? Clinical experience. I don't see many pediatric cases.
BTW, I see you are already over here telling these folks they are over their heads. And I imagine you will be here to try to paint a negative light on chiropractic. It's just your style.
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Re: vertebral manipulation for PT - March 19, 2003 12:31:00 PM
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Superchiro
Posts: 16
Joined: March 18, 2003
From: Lawrence, NY
Status: offline
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Yeah..... go ahead, take a four week manipulation course. Then, please set up your clinic right next door to my office.
I could really use the patients.
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Supe
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Re: vertebral manipulation for PT - March 19, 2003 1:32:00 PM
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touchiba
Posts: 101
Joined: November 11, 2002
From: PA
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You don't need experience? I'll let that comment speak for itself.
Also, I've said it on other board to you, but I think you need to read more about what evidenced based medicine is all about. For some reason your experiences have seemed to push you to one end of the continuum. Perhaps being a clinician didn't suit you, so why not get into research(assuming you haven't burned too many bridges)?
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Re: vertebral manipulation for PT - March 19, 2003 2:01:00 PM
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Superchiro
Posts: 16
Joined: March 18, 2003
From: Lawrence, NY
Status: offline
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Smelly, you could not be more wrong. You do need experience. There is a definite learning curve with manipulation, as with any manual application. You're not going to start out on Patient One making music from their spine. I know, I've been there, and so has anyone who has adjusted more than three people.
And Buddy is right as well. EBM does not begin and end with the indexed, peer-reviewed, double-blind controlled study. Those are important, very important, but of equal weight is clinical experience, judgment, and yes even anecdote.
I'll admit this profession has more thanits share of problems, but it also has more value than you give it credit for. You would do well to try and find it, and use it to enhance the profession instead of striving to tear it down.
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Supe
[This message has been edited by Superchiro (edited March 19, 2003).]
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Re: vertebral manipulation for PT - March 19, 2003 2:09:00 PM
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touchiba
Posts: 101
Joined: November 11, 2002
From: PA
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Are you claiming that 100% of the evidenced based chiros are members of the NACM?
80% of all chiros don't belong to any organization at all.
As another doc once said, does one change significantly on the day of graduation? Plus, like you said, experience doesn't matter.
Also, how many surgeries are inappropriate? How many prescription meds are inappropriate? What percentage of MDs follow evidence based protocols? We should work to improve this in chiropractic, but it's present in other fields as well.
Conclusions: Evidence-based medicine has been formally incorporated into relatively few internal medicine clerkships. Faculty development programs in conjunction with innovative teaching methods may help overcome these barriers. South Med J 95(12):1389-1395, 2002.
Again, your selective use of the literature and facts shows yor extreme bias.
[This message has been edited by touchiba (edited March 19, 2003).]
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Re: vertebral manipulation for PT - March 19, 2003 2:16:00 PM
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flexion
Posts: 151
Joined: August 7, 2002
Status: offline
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A voluntary association translates to what in terms of statistics? LOL
"Relative" might be a useful word to learn regarding inappropriate treatment.
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Re: vertebral manipulation for PT - March 19, 2003 3:27:00 PM
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rehabdoc
Posts: 51
Joined: March 17, 2003
From: Butte, MT US
Status: offline
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I believe I just skewed your "off the cuff" statistic. I am considered EB, yet I don't belong to the NACM. Heck, I don't belong to the ACA.
Can I see the reference to support your 5% statement?
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