Anti- "crack" squad

[Diane]

Hi there,
Some references (including Aussie PT) about cervical manipulation and injury including stroke. Interestingly there is a documented case of injury after a shiatsu treatment. Slow and light on the neck, folks.. please.

http://chirotalk.proboards3.com/index.cgi?board=evidence&action=display&num=1088874483
http://ptglobal.net/ajp/abst9602.html
http://www.mja.com.au/public/issues/176_08_150402/ern10520_fm.html
http://www.ptjournal.org/Jan99/v79n1p50.cfm
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&list_uids=8642364&dopt=Abstract

The links were posted by Paul Lee (also a member here) on chirotalk where I help out; he helps out there too.
Diane

[Servaas]

Greetings,

Well said Bernard!

When people complain of neck problems, have you ever looked at their posture and their movement patterns ?

Have you ever palpated their traps?

After a short investigation like that, it becomes obvious why they have neck problems. And when seeing the Sensory Motor Amnesia in other parts of the body (esp around the trunk, the 'somatic center', the center of gravity), it becomes obvious that the neck is suffering so much!

Learn to move with organic intelligence and there is often no need for further treatment!

Servaas Mes
www.somatichealthcenter.com

[nari]

An interesting topic, certainly.
I think we as physiotherapists have often maintained that a manipulation is a quick fix, but we take the more useful approach that patients can be taught to be independent of the "click" phenomenon.
It does tend to create a dependency on a magic sound that will "keep the spine in good shape".
We can do without it, but manip therapists could argue that a manip could set the stage, and go on from there.
There are many manip (physio)therapists in Australia - and they follow the principle that it is knowing when NOT to manipulate that is essential.

Nari

[Diane]

I think the reason practitioners are attracted to such techniques is that they have the thrill-seeking gene, the one that if they didn't learn to do manips on patients (living dangerously) they would express by going off climbing or extreme kayaking or bungee jumping or something. And they are mostly males. And they (seem to) have an innate need to find quicker and quicker "fixes" (typical of "crack" dealers...) wired into them.

I am having fun considering the whole mentality in PT, the whole "orthopaedic" tissue-based mentality as a form of 'cognitive-osis' that we were infected with by chiropractors, that has been endemic in our ranks for the last 2 or 3 decades. Slowly we're beginning to recover and dis-infect ourselves.

Bernard, the whole osteo mindset is another wild hallucination for the most part, but it has the plus of being very gentle. I wouldn't personally want to be out there in the world of treatment without MET and counterstrain. Those two techniques are really worth getting and keeping. MET is essentially fancy segmental contract relax, if one really wants to treat segmental restriction. Counterstrain is a way to lever the layers of the body to take pressure off a nerve, and give the brain a huge new feed of "no pain" for a couple minutes, just long enough to convince it to change the surrounding tissue and restore normal movement. The difference IMHO between these benign techniques and HVLA, is that in the one case, the patient's brain is actively engaged, and can track the changes as they happen, in the other it isn't and can't.

[bernard]

Dear Diane,

Could you expand the terms; MET, IMHO, HVLA?
Some our foreign people may get trouble with these abbreviations. (I'm. :wink: )

[nari]

Me too - I know HVLO but what are the others?

Abbreviations are a dynamic force - I have two students with me from Victoria and have to keep on asking them what their abbreviations mean.
Even within a continent, it is hard to keep up!
Half of the abbreviations on the Other Forum leave me guessing...

Nari

[Diane]

My apologies.
Could you expand the terms; MET, IMHO, HVLA?

MET: Muscle Energy Technique; a system of very effective segmentally applied contract relax exercises for the paraspinals, no matter in which crazy way they are holding the vertebrae out of whack. The system takes into account the contrary movement of the sacrum, and provides the learner of the system a set of cognitive x-ray goggles with which to see and feel the spine to assess and treat it, and various positions to treat it in.

It's the best way to treat the spine I've ever found, because of how relaxing/non-threatening it is to both patient and therapist. For much of it you sit there with the patient's legs draped over your lap! The amount of force you ask the patient to generate by pressing their ankle(s) up against your hand is 'a pound', hardly anything, ("just the energy already in the muscle") but sufficient to fire trunk stabilizers and undo "stuckness" in and between vertebral segments. An American DO named Fred Mitchell systematized it, and his son, Fred Mitchell junior, completed the task of documenting his dad's life work. There are manuals available, if you go googling you may find them.

IMHO: In my humble opinion

HVLA: high velocity, low amplitude: The sorts of moves made by chiropractors and wannabe chiropractors or the PT or MD persuasions.
Diane

[bernard]

I found that one on MET?

MET (http://www.rmuohp.edu/forms/Muscle%20Energy%20JOSPT%2003.pdf)

[Diane]

Thanks Bernard. Yes, that is one of the better pieces of work out there on MET.
Diane

[bernard]

Hello Somosimplers,

Look at this one?

Cranial Therapy; New Hypothesis! (http://www.somasimple.com/pdf_files/cranial.pdf)

[Diane]

Interesting.... Has there been anything more on this in JMBW since 1999?
Diane

[bernard]

Sorry, only the free stuff!
They reserve full text access to institutions and we aren't (yet). :wink:

[bernard]

Diane,

I found that one

chiropractic management of chronic whiplash (http://www.somasimple.com/pdf_files/chiro_whiplash.pdf)

[Doctor Mike]

I have to say there is still very little out in the clinical market to match spinal manipulation.....everything else is working around the patients problem.
This of course can only be my personal opinion.

[bernard]

Welcome on SomaSimple Doctor Mike,

It seems that you are inclining on the manipulative side of the PT force. SomaSimple being an open discussion forum, it's not a problem.

We have members having often different ones and we try to exchange them to improve our knowledge and skills. But, in my view, our opinion are, also often, scientifically based and science may be controversial!

Of course, we are throwing some strange theories elaborated on physiological/functional facts. Science is evolving by this mean.

Your opinion is then interesting and it would be great to enhance it with some facts and logical arguments.

[ginger]

I am sometimes asked , what is the difference between physio's and chiro's, my answer is firstly( a little tongue in cheek) , chiropractors drive flasher cars. I then suggest that there is an important ethical difference between the two camps. while the physio is trained and perhaps more importantly , is inclined philosophicaly towards, treatments with long term effects leading to cure. Chiropractors on the other hand have a guiding ethic which seeks to create a dependant relationship between themselves and their clients. Why then would chiropractors use as their primary tool manipulation , rather than other more effective means to treat musculoskeletal pain and dysfunction. I believe the answer is two fold , Firstly , to cure would undermine their core business, secondly , because they are not taught better methods. Doomed it seems to remain on the fringes of medicine , along with Osteopaths and Homeopaths. I do think that for the most part there is more crying on the way to the bank , than concern amongst them really for inclusion in the medical orthodoxy.
I get a lot of refugees from the various local chiropractors, all have the same story , lots of 5 minute " adjustments" and no progress. We as physiotherapists can really only gain from their ill advised and conspicuously money hungry methods. At least if we treat patients with the respect and understanding they deserve , along with science based treatments , we are assured a place in the treatment community for generations to come.
This is my little rant for the day , I do get tired of explaining that no I won't be adjusting your neck sir.

[nari]

On the other hand, ginger, although I take on board all of the points you made, chiros gain a large proportion of patients extremely dissatisfied with prolonged, ineffective physio Rx. I know this because we have a friend who is a chiro.
Both professions have a long line of patients who attend for Rx for Years on End...with negligible outcomes.

Why is this so?

Nari

[emad]

Hi Mike & Ginger :

yes, Nari , you are right ,on both sides there are misusers .

I think , both are doing these acts on the consciuos level , i mean they know , no benefits ( even more risky ) to use these procedures /techniques , and they insist to use it .Why ???

I would answer , it is very easy question :arrow: :arrow:

Healthcare service Marketisation , gaining more money ,doing for the patient what he/she wants in both field physio&chiro .

Applying scientifc physio is NOt of benefit for the practionner ,it will make him/her loses his/her fnancial resources .

Just my view .
cheers
Emad

[ginger]

Nari et al, , yes there are certainly some physio no hopers around in my city. Some who are stuck in the past , others who maybe ought to have been bankers or accountants instead. It is always a pleasure to find a lateral thinker and/or a physio switched on to spinal treatments that really work. WE all benefit from cross fertilization .