Petition to stop neck manipulation

[Diane]

http://www.petitiononline.com/mindneck/petition.html

I never realized until I talked to the author of this petition from Australia that in Asian countries, barbers routinely crack necks along with the shave and a haircut! Furthermore, it is rumored (according to a PT I know) that in Burma at least, this tradition is a colonial one, left as a dangerous legacy by the British! :mad:

Ram, the author, acquired a vertebral artery dissection 4 years ago. His petition is to stop neck manipulation being done by chiros, barbers and osteopaths. I wish he would add PTs and MDs, but it's too late now.. besides, he thinks PTs and MDs are less apt to cause a VAD because of how infrequently we use neck manipulation as a technique, and how likely we are to try anything but... first.

I urge everyone to support this petition and put a stop to strokes caused in this manner.
Thank you,
Diane

[bernard]

Diane,

I'm number #132 on the list.

[cedric]

number 167

[bernard]

Welcome Cedric on SomaSimple.
Cedric is the second Pt coming from France on this board. ;)

[cedric]

thanks a lot bernard :)

[emad]

Hi Ced ,welcome :

nice to see french therapists here , they begin to like you in france Bernard.

Regards

Emad

[cedric]

he promises me some money but finally it is a nice place here...
i will try to improve my english:)

[bernard]

i will try to improve my english
I'll be jealous! :eek:

[cedric]

why? did i make a mistake?

[bernard]

I'm kiddin' there (juste 1 peu d'humour! ;))

[cedric]

si on parle francais personne ne va suivre ;)

[bernard]

That's true. I used some French words to clarify my position. :D

BTW, I planned to open some foreign forums where members will be allowed to write with their native language. It is an idea and it doesn't cost...

[cedric]

please open a one in finish :)
mita kulu to everybody

[bernard]

Cedric,
At the end, here it is (an eye blink to Nari ;))

Le Petit Prince (http://www.somasimple.com/forums/forumdisplay.php?f=67)

[flaviovitor]

Diane,


another interesting website against NECK MANIPULATION:

http://www.neck911.com/



Flávio.

[Diane]

Yes, thanks Flavio. I have seen this one elsewhere.. good to have them all in a thread.

[Diane]

Here is another website (http://www.gmweb1.net/pr01.htm) by someone who is battling back.

[Unregistered2]

The research has proven, time and again, that SMT is very, very safe. Why are you promoting fear mongering?

Proof

Rubinstein SM, Peerdeman SM, van Tulder MW, Riphagen I, Haldeman S. Related Articles, Links
A systematic review of the risk factors for cervical artery dissection.
Stroke. 2005 Jul;36(7):1575-80. Epub 2005 Jun 2. Review.

[Diane]

From page 27, Topical Issues in Pain Volume 5, Louis Gifford editor:
The safety of mobilization and manipulation techniques
As far as we are aware there is no evidence to suggest that serious tissue based injuries occur with 'reasonable' grades of mobilization techniques. On the other hand, there is little doubt that even modest mobilization techniques administered to patients with significant peripheral neurogenic or maladaptive central sensitivity are easily capable of 'stirring up' pain and associated symptoms. Knowledge of maladaptive pain mechanisms and the potential they have to cause significant flare-ups without tissue damage must surely help therapists and patients to have a better and more confident understanding of the situation. As we all know, it is never pleasant to stir up a patient's pain, especially with the belief that some ghastly damage has occurred.

The literature does contain numerous studies detailing incidents and accidents resulting from spinal and pelvic joint manipulation. Stevinson et al (2001), Grieve (1994), Dupeyron et al (2003), and Assendelft et al (1996) identified vertebrobasilar artery (VBA) injuries, intervertebral disc prolapse/sequestration and cauda equina syndrome as the most common accidents following manipulation. Other documented manipulation related accidents include death, stroke, nerve root compression, paraplegia, vertebral fractures and embolisms. It is pertinent to note that there are as yet no designated pre-manipulative screening protocols capable of eradicating these manipulative accidents (Haldeman et al 2002).

The average age of those patients suffering VBA related strokes following cervical spine manipulation is 38 years old, this is far lower than that of national 'stroke averages'. This is particularly worrying in light of the otherwise 'rare' occurrence of this type of stroke in young people. There are conflicting reports in the related literature surrounding the incidence of manipulative accidents. Risk factors have been quoted to be between 1 in 20,000 to 1 in 4,000,000 manipulations performed. Until recently it has been difficult to ascertain a realistic incidence of manipulative accidents. This has largely been due to the significant under reporting of these events. However, Dupeyon et al (2003) studied the incidence of manipulative accidents occurring to patients who went on to present to 133 physicians including neurologists, neurosurgeons, and rheumatologists over a 2-year period. They found that the incidence of VBA accidents alone was 30 times higher than that in published studies. Potentially this indicates that the risk of serious manipulative accidents could be as high as 1 in every 666 manipulations performed.

In view of the incidence of 'side-effects' associated with spinal and pelvic joint manipulation, it is probably fair to assume that if these techniques were subject to the same clinical trials and scrutiny as new drugs, their licensing would be rejected on the basis of their inherent risk of injury. Furthermore, there is no evidence whatsoever to suggest that manipulation techniques have any superior clinical effect above and beyond alternative non-injurious mobilization techniques. In view of the available evidence regarding risks and benefits, it is our belief that there are no circumstances in which it would appear appropriate to recommend the use of manipulation in clinical practice.

[Jason Silvernail]

Safety is not the real issue - the issue is a risk-benefit, and the clinical judgment about using a particular technique.

If we know that studies show HVLA techniques to be no more beneficial than more gentler methods, then the risk doesn't equal the benefit, no matter how small it is. To me, that's the real issue.

I see neck pain patients all the time and I can't remember the last time I used HVLA. I think it was at least 6 mos ago and only because the patient in question had had the treatment before and was convinced he needed to hear the "pop" if he was going to feel better. Hardly a recipe for a good long term outcome for this patient.

If someone in a manual therapy profession is doing this rarely when other methods fail, then I see no reason for the petition in the first place. I believe this is a response to the commonplace use of a low-but-not-without-risk treatment in the absence of clinical judgement about appropriateness.

In short, some people are over-manipulating, which makes these few cases all the more obvious and egregious. And spoiling things for those of us who use manipulative therapy responsibly and in accordance with scientific standards of evidence.

The risk for NSAIDs is greater, but they are still considered safe. But those who prescribe them think carefully about risk-benefit, they don't close their ears and yell "it's safe! it's safe!" when questioned. But that is exactly the approach many people take in this manipulation situation. Instead of acknowledging a possible issue with overuse and how that might be addressed, they go on about how people are "fear-mongering". This shows either an ignorance of the real issues of overuse and clinical judgement or an attempt to quiet those who have legitimate questions and concerns about a treatment which seems unnecessary in the majority of cases. If we're listening to the evidence, that is.

Jason

[Unregistered2]

The risk for NSAIDs is greater, but they are still considered safe. But those who prescribe them think carefully about risk-benefit, they don't close their ears and yell "it's safe! it's safe!" when questioned. But that is exactly the approach many people take in this manipulation situation.

BWAHAHAHAHAHAHAHAHA!!!! TONS of MD's and their pharmaceutical mistresses routinely overprescibe NSAIDS at the drop without carefully considering risk-benefit.. That is, assuming, they've done their RCT's to prove there are no long term side effects. Same goes for anti-biotics (wonder why all these new "superbugs" are becoming more and more prevalent...) You should stop putting allopathic medicine on such a high pedestal, Jason.

Vioxx, anyone?

[Jason Silvernail]

"pharmaceutical mistresses"?
"allopathic medicine"?

These terms tell me the kind of poster you are and what your agenda is. Silly me for thinking this would be a productive exchange.
Bye...

[Diane]

I came across this list of cases (http://www.medscape.com/viewarticle/446744_2) this morning, Complications of Cervical Spine Manipulation, with 22 cases described.

[ginger]

Like Jason , I too have had occasion to acceed to a patients request ( demand) to be cracked, after already having dealt with the cervical movement problem in a way i consider to be far more effective. When doing so, it is my habit to mention the short term nature of any benefits manipulation may offer , as well as the risks associated with it. In a risk/benefit analysis, it is hardly the sort of approach, done as the central theme of intervention , that figures highly, by those whose therapeutic intention , is to provide long term benefit. This is particularly relevant when using spinal treatments to eliminate associated referred events, such as LE, 'frozen shoulder', PFS, etc. Mobilisation works so much better, there is no time spent speculating on manipulation as a first order intervention.
I fully support the notion of education about safer , more useful method, but find it a liitle pie in the sky to seek legal barriers to manipulation. Maybe that is a little defeatist, but I prefer to focus on the better options , rather than on the ones we should , and will largely abandon, because they are weak options.

[Jason Silvernail]

Recent news story on neck manipulation and stroke here (http://www.myfoxdc.com/myfox/MyFox/pages/sidebar_video.jsp?contentId=5888684&version=1&locale=EN-US).

[Neuro-Orthopaedic]

Follow this link

http://fr.youtube.com/watch?v=IyyTvNhlROg

[Diane]

Has anyone read this (http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6WN0-4RYW7MP-1&_user=10&_coverDate=03%2F03%2F2008&_rdoc=1&_fmt=&_orig=search&_sort=d&view=c&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5=d658bdfe4acdcf80a15eee781358fe4e) yet?Paradigm shift in manual therapy? Evidence for a central nervous system component in the response to passive cervical joint mobilisation

Annina Schmida, Corresponding Author Contact Information, E-mail The Corresponding Author, Florian Brunnerb, Anthony Wrightc and Lucas M. Bachmannd
aUniklinik Balgrist, Department of Physiotherapy, Forchstrasse 340, 8008 Zurich, Switzerland
bUniklinik Balgrist, Department of Rheumatology, Forchstrasse 340, 8008 Zurich, Switzerland
cSchool of Physiotherapy, Curtin University of Technology, Perth, Australia
dHorten Center for patient-oriented research, University of Zurich, Switzerland
Received 28 February 2007; revised 30 November 2007; accepted 18 December 2007. Available online3 March 2008.

Abstract

Segmental neurological modulation, neural hysteresis and biomechanical effects have been proposed as mechanisms underpinning the effects of manual therapy. An increasing number of studies hypothesise activation of the central nervous system resulting in a non-segmental hypoalgesic effect with concurrent activation of other neural pathways as a potential mechanism of action. Whether this model is consistent with the current literature is unknown.

This systematic review aims to assess the consistency of evidence supporting an involvement of supraspinal systems in mediating the effects of passive cervical joint mobilisation.

We searched randomised trials in three electronic databases from inception to November 2007, without language restriction, and checked reference lists of included studies. We assessed study validity and extracted salient features in duplicate.

Fifteen studies met our inclusion criteria. The overall quality was high. We found consistency for concurrent hypoalgesia, sympathetic nervous system excitation and changes in motor function. Pooling of data suggested that joint mobilisation improved outcomes by approximately 20% relative to controls. This specific pattern suggests that descending pathways might play a key role in manual therapy induced hypoalgesia.

Our review supports the existence of an alternative neurophysiological model, in which passive joint mobilisation stimulates areas within the central nervous system.

Keywords: Treatment outcome; Cervical pain; Neck; Manipulation spinal; Joint mobilisation techniques; Physical therapy (speciality)

Take that, put it in your pipes and smoke it, mesodermalists. :D
Now ectodermalist perspectives can start having their day in the "EBP" spotlight.

[Luke Rickards]

The paper can be found here (http://www.somasimple.com/forums/showpost.php?p=49249&postcount=82).

[matt c]

so diane your agreeance with that paper, pushing joints a good thing then you think?:teeth:

[Diane]

No, I like that a paper has come along that suggests a neuro explanation. Next there will have to be a paper that shows pushing even that hard isn't necessary. Well, there already are papers like that, but not published in Manual Therapy in enough number to make any dint in the chiro/meso/orthodigm. I suspect that those who read Manual Therapy for their information don't read much else, nothing neuro.

[matt c]

Quote "I suspect that those who read Manual Therapy for their information don't read much else, nothing neuro." Cmon Diane dont pop us all in the same box, its a gross generalisation that doesnt need to be made, id like to think as rivett states states in his article on manual therapy cults that "It should be borne in mind that
no one system of manual therapy has all the answers
and that the successful management of many clinical
problems requires well-developed clinical reasoning,
often drawing on a number of manual therapy
approaches." Neuro included, Id like to think that this is how the majority thinks, reasons and practices.....well at least i and few of my colleagues do
:teeth:
matt

[Diane]

Good for you.

[matt c]

thanks, it is good for me, also kinda good for my patients too, im happy with myself:clap2::teeth::teeth::teeth::clap2::clap2:

[Luke Rickards]

Diane,

Compared with other journals relevant to manual therapy, I find Manual Therapy to be quite exceptional. Many of the practice relevant, pro-neuro and deconstructionist articles that I bring here come from this journal. Of course, clinicians shouldn't restrict themselves to a single source, but I reckon to avoid this one would be a mistake.

[Diane]

I reckon you're right Luke.

[pht3k]

i just saw this article posted on physiospot (http://webducate.typepad.com/physiospot_msk/2008/03/paradigm-shif-1.html) so i thought that this piece of paper would find its place here on somasimple, just to find that it is already here... you ss are fast on the trigger!
pht3k

[Karie]

Diane,

I didn't catch the research article's name/Journal but on "Good Morning America," this morning (ABC news program) they announced a study where a C2 manipulation decreased blood pressure by 17 points and was reconfirmed 8 weeks post that the blood pressure change remained. They said a larger study was now underway, but only a handful of chiropracters in the US know the particular technique. This study had 25 getting the manipulation and 25 getting the sham technique. So if anyone has access to this one, I think it would be good to look at it here and dissect it further. The way they were presenting it was that it would be possible for people to have this done instead of going on blood pressure medicine.

Karie

[Diane]

They said a larger study was now underway, but only a handful of chiropracters in the US know the particular technique. This study had 25 getting the manipulation and 25 getting the sham technique.Was it a chiro study?

[Jason Silvernail]

I think petting assistance animals and deep breathing might do the same thing.
Without the unnecessary stroke risk and it's available to a larger patient pool.

[Diane]

I think petting assistance animals and deep breathing might do the same thing.
Without the unnecessary stroke risk and it's available to a larger patient pool.
Exactly. And there won't be any sudden surge in chiro "practice member" visits if people just go to the pool to lower their BP, and save their necks at the same time.

[Karie]

I came in after they started reporting it, so I missed that part, but I am guessing it would have to be a chiropracter study, since they were the ones doing the manipulation. The manipulation appeared to be done from a lateral direction when they were showing it on the show.

Karie

[Karie]

Diane
I went to abcnews.go.com/GMA and there was a link to the report. It says that it was a study done at the University of Chicago and it was published this month in the Journal of Human Hypertension. Can you find it from there?

Karie :)

[Diane]

Karie, do you know how to bring a link here to your source?

[Karie]

No Diane, I am sorry I don't know how to do that??

Karie

[Stuart]

the chiro study concerning BP was done using the NUCCA technique. you will find a topic in the Rubbish Cube forum on NUCCA.

[dswayze]

Has anyone read this (http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6WN0-4RYW7MP-1&_user=10&_coverDate=03%2F03%2F2008&_rdoc=1&_fmt=&_orig=search&_sort=d&view=c&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5=d658bdfe4acdcf80a15eee781358fe4e) yet?

Take that, put it in your pipes and smoke it, mesodermalists. :D
Now ectodermalist perspectives can start having their day in the "EBP" spotlight.

Ahh, Diane, you've "discovered" Chiropractic Medicine; aka "Manual Therapy" modulating ("affecting") the nervous system. This type of thing has been stated 25 years ago except no one was listen because it was the chiroquacktors. Good paper and agreed; the nervous system is definitely where it's at and that's why this board rules.

DS

[dswayze]

I think petting assistance animals and deep breathing might do the same thing.
Without the unnecessary stroke risk and it's available to a larger patient pool.

Granted it's a possibility; but there would definitely be a subset who would respond much better to manipulation. This post is sorta the fear mongering type; as an evidence-based therapist you should know about the recent Neck Pain and associated disorders Task Force and their conclusions. Focus on the practitioner; not the modality (SMT).

DS

[Diane]

Here's the link Karie.
http://www.abcnews.go.com/GMA

All you have to do is copy the url and paste it.
I took a quick look at the video - looked like chiro "churnalism" to me. :rolleyes::thumbs_do

Swayze, we are not talking "Innate" here. We're talking brain research since 25 years ago.

[Jason Silvernail]

Granted it's a possibility; but there would definitely be a subset who would respond much better to manipulation. What is your rationale for this statement?

I would think those in the "evidence-based" chiropractic movement would be equally suspicious of this study - some of the excellent chiros I've spoken with focus on the NMS systems and mechanical pain syndromes and have no interest in attempting to treat somatovisceral problems with manipulation. I suppose the "you just hate chiropractic" is an easier line to take, but it's not that simple.

[dswayze]

What is your rationale for this statement?

I would think those in the "evidence-based" chiropractic movement would be equally suspicious of this study - some of the excellent chiros I've spoken with focus on the NMS systems and mechanical pain syndromes and have no interest in attempting to treat somatovisceral problems with manipulation. I suppose the "you just hate chiropractic" is an easier line to take, but it's not that simple.

What are you talking about? I was referring to Childs et al. study on the subset who best respond to SMT.

[dswayze]

Swayze, we are not talking "Innate" here. We're talking brain research since 25 years ago.

Straw man fallacy. We are talking about manual therapy, specifically manipulation affecting the nervous system. It's not PT, it's not osteopathy (rule of blood). You inadvertently just justified chiropractic. I found it amusing given your historical stance on the subject.

DS

[Diane]

DS, I was referring to Childs et al. study on the subset who best respond to SMT.

I think that study was just for L spine, not neck.

[Jason Silvernail]

DS-
Diane's right, Childs' study was the lumbar spine.

My interpretation of your statement was that even though there are other methods of lowering blood pressure, you felt there was "a subset who respond much better to manipulation".
I had thought you were saying there would be people with high blood pressure that would do better with manipulation than with medications or meditation or dietary changes.
I was curious as to your rationale for thinking that, if that's indeed the point you were making.

[bernard]

I do not know if it was already posted but it's terrific!
lDXxlPo4dMg

[jnb300]

I did my seminar in manual therapy and when we went up to the cervical spine the first thing we learned is to do vrterbral artery test and not to proceed if the pt has postive test.

[SMEGC]

Hands up who thinks that the VAT is just as dangerous as an adjustment

[Jason Silvernail]

Unfortunately, vertebral artery testing has not been been shown to be of much value in making decisions about cervical manual therapy. There was an editorial in JOSPT about manual therapy and the presence of uncertainty that summarized the evidence nicely.


J Orthop Sports Phys Ther. 2005 May;35(5):300-6.
Screening for vertebrobasilar insufficiency in patients with neck pain: manual therapy decision-making in the presence of uncertainty.
Childs JD, Flynn TW, Fritz JM, Piva SR, Whitman JM, Wainner RS, Greenman PE.

US Army-Baylor University Doctoral Program in Physical Therapy, Fort Sam Houston, San Antonio, TX, USA. childsjd@sbcglobal.net

Growing evidence supports the effectiveness of manual therapy interventions in patients with neck pain; however, considerable attention has also been afforded to the potential risks such as vertebrobasilar insufficiency (VBI). Despite the existence of guidelines advocating specific screening procedures, research does not support the ability to accurately identify patients at risk. The logical question becomes, "How does one proceed in the absence of certainty?" Given the lack of clear direction for decision making in the peer-reviewed literature, this commentary discusses the uncertainties that exist regarding the ability to identify patients at risk for VBI. The authors hope that this commentary adds additional perspective on manual therapy decision-making strategies in the presence of uncertainty.

[Javier Gonzalez]

I have found this video of neck manipulation in children and I think is terrific, the boy rotate his lumbar spine when the man do the neck manipulation...

http://www.youtube.com/watch?v=UQfiEuWiQ9U

[matt c]

javier im not sure if your serious or not, but that is an excessive amount of rotation to take the cervicals into "even with lumbar rotation" as you say, why do chiros feel the need to take manipulations into such end range or massive rotation positions?
seems unnecessary
matt (aussie osteopath)

[wjrein]

Particularly since the Dens in a child isn't completely developed until around the age of 12. It seems a bit risky to be manipulating an inherently unstable cervical spine. When you talk about cost/benefit ratio in manipulating a child's neck I think its a no brainer.

Bill

[oljoha]

javier im not sure if your serious or not, but that is an excessive amount of rotation to take the cervicals into "even with lumbar rotation" as you say, why do chiros feel the need to take manipulations into such end range or massive rotation positions?
seems unnecessary
matt (aussie osteopath)

From: http://www.theage.com.au/news/National/A-painkiller-and-a-walk-help-back-pain/2007/11/09/1194329483571.html
Dr Dennis Richards, president of the Chiropractors' Association of Australia, said the results should not turn people off manipulative therapy.

"These physiotherapists used mostly low velocity mobilisation techniques," Dr Richards said.

"All the literature points to far better outcomes with the high velocity techniques employed by chiropractors."

Low velocity? Huh? Then it's not manipulation. Besides where is that literature saying high velocity techniques are better. The problem with some old school chiropractors are that they use high amplitude techniques. I can't say I'm against HVLA neck manips. The HVHA's on the other hand...

[Javier Gonzalez]

javier im not sure if your serious or not, but that is an excessive amount of rotation to take the cervicals into "even with lumbar rotation" as you say, why do chiros feel the need to take manipulations into such end range or massive rotation positions?
seems unnecessary
matt (aussie osteopath)

Perhaps I haven't explain myself correctly (sorry for my English). I agree with oljoha that I am not against HVLA spinal manipulation, but I think that HVHA manips, and especially HVHA neck manipulations like the video above, really seems to be a risk for the patient.

[Javier Gonzalez]

I have found this video of neck manipulation in children and I think is terrific, the boy rotate his lumbar spine when the man do the neck manipulation...

http://www.youtube.com/watch?v=UQfiEuWiQ9U
Excuse me matt c, sorry for my post above. I have read it again and I have seen my mistake and now I understand your answer. I wanted to say "TERRIBLE", no "terrific".
Perhaps we agree now about that video

[Diane]

Isn't English fun Javier?
I get your meaning. In English we have the word "horrific" which means the same as "terrible". But "terrific" means the same as "great" or "excellent".

[Javier Gonzalez]

Isn't English fun Javier?
I get your meaning. In English we have the word "horrific" which means the same as "terrible". But "terrific" means the same as "great" or "excellent".
I know, just a mistake. :confused:
Thank you Diane

[oljoha]

I do not know if it was already posted but it's terrific!
I love those leg length tests they do - and then they use the Clickr (that's my trademarked name for a Quacktivator) in the thoracic area and then measure the leg length again.
:clap2: :clap1: :clap2:

[marcelk]

Did you know that in (hopefully) rare occasions cervical traction can be fatal.

A common technique done by worldwide PT's traction of the cervical spine, guess many of you have done this too. Unlike (I hope) cervical manipulation this is used widespread. (I have no numbers)

In a post grad. course we where talkinhg abou red flags ; I brought up RA (reumatoid artritis) can be one for cerv. spine treatment.
Only one person in that room knew (the "teacher") and told he was aware of a PT gave cerv. traction to a patient with acute neckpain but because it was the end of his long working day the PT just started "treatment" (not looking further;)

Result : patient died on PT's "bench" due to a dens fracture; also known as a hangmansfracture.

I remember this vividly from a lecture about possible fragillity of the dens and ligg. in RA from school 23 yrs back.

After that class I knew for sure (even if I where to become an MT) I'd leave the cerv. spine alone.

[marcelk]

Should be (not looking further) without the smile thing!

[oljoha]

In a post grad. course we where talkinhg abou red flags ; I brought up RA (reumatoid artritis) can be one for cerv. spine treatment.
Only one person in that room knew (the "teacher") and told he was aware of a PT gave cerv. traction to a patient with acute neckpain but because it was the end of his long working day the PT just started "treatment" (not looking further;)

Patient comes in - PT asks leading question...
"Are you feeling better today?"
Patient nods and dies...

I don't see why traction would lead to death due to a dens fracture. Perhaps if the patient is left alone in a machine doing the tractioning.

[nari]

It was normal practice in the '80s to leave a patient on neck traction with a bell to jangle if there were any problems. The irony of that is: it's hard to ring a bell if you can't use your paralysed arm/s. As far as I know, mechanical cervical traction is not used anymore; does that apply elswhere?

Lumbar traction also is rarely used; it sometimes worked in the past because of the skin stretch, perhaps - it surely didn't do anything else.

However manual cervical traction should avoid these mishaps, but again what tissue/s are we stretching, if we want to stretch necks in the first place? Just curious...

Nari

[marcelk]

Patient comes in - PT asks leading question...
"Are you feeling better today?"
Patient nods and dies...

I don't see why traction would lead to death due to a dens fracture. Perhaps if the patient is left alone in a machine doing the tractioning.

Oljoha,
Actually this is basic knowledge (things a student should know) if you can't see it I'll explain : extension loading (forced traction from starting position extended cerv. spine) can result in posterior displacement of the dens if the dens fractures in to your spinal cord
well then this wouldn't be a good thing now would it.

("Physicians should be aware of the possibility that even minor injury can cause dens fracture in elderly parients" from Author;NAGAI TOKIHISA(Ehimedai Ronen'igaku) IGASE MICHIYA(Ehimedai Ronen'igaku) KOHARA KATSUHIKO(Ehimedai Ronen'igaku) MIKI TETSURO(Ehimedai Ronen'igaku)
Journal Title;Japanese Journal of Geriatrics
Journal Code:Z0680A )

[oljoha]

Oljoha,
Actually this is basic knowledge (things a student should know) if you can't see it I'll explain : extension loading (forced traction from starting position extended cerv. spine) can result in posterior displacement of the dens if the dens fractures in to your spinal cord
well then this wouldn't be a good thing now would it.


It's the extension that breaks it not the tractioning... perhaps I should have written distraction.

[oljoha]

However manual cervical traction should avoid these mishaps, but again what tissue/s are we stretching, if we want to stretch necks in the first place? Just curious...
At least one provides movement. I don't use it much though.

[Diane]

I found this on chirotalk today:
NECK 911 RESPONSE TO SUSAN MARTINUK'S ARTICLE IN THE CALGARY HERALD (http://healthwatcher.net/chirowatch.com/Chiro-lawsuits/Nette/Neck911's%20response%20to%20Martinuk%20article%20in%20Calgary%20Herald.pdf) re: the Sandra Nette (http://sandynette.com/) case.

Some person named "Susan Martinuk" apparently wrote a pro-neck manip, pro-chiro, anti-Kinsinger article in the Calgary Herald, which doesn't deserve a link because her points are contained inside the response (it could easily have been a chiro copying and pasting a script retort, pretending to be a "regular" person who likes her chiro).

It's interesting to read line for line this carefully crafted refutation. Check out the Sandy Nette site to see a good example of the wonders wellness maintenance can deliver unto humanity.

[Javier Gonzalez]

I have found an article in the New York Times about this subject published on August 25th:

http://www.nytimes.com/2008/08/26/health/26real.html?adxnnl=1&ref=health&adxnnlx=1220196267-dTUALO5sWJyxBUB4QIscSw

What do you think about it?

[Diane]

It's a start. :)
(Congratulations on getting your article published by the way, Javier.)

[Javier Gonzalez]

(Congratulations on getting your article published by the way, Javier.)
Thank you Diane :thumbs_up

[Diane]

Javier, this EIM link (http://blog.myphysicaltherapyspace.com/2008/08/big-press-for-j.html) might interest you.

[Jon Newman]

Javier,

I thought it was a reasonable article and comparable to other work the author has done. What did you think?