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  • And here I just thought it was for attention.
    Jason Silvernail DPT, DSc, FAAOMPT
    Board-Certified in Orthopedic Physical Therapy
    Fellowship-Trained in Orthopedic Manual Therapy

    Certified Strength and Conditioning Specialist


    The views expressed in this entry are those of the author alone and do not reflect the official policy or position of the Department of the Army, Department of Defense, or the US Government.

    Comment


    • Originally posted by TexasOrtho View Post
      Bob as much as I am fundamentally opposed to MFR as a concept, if this intervention lead to consistent and reproducible results, I'd have no room but to consider it as an option if my approach was not working.
      Why wait to see if your approach is not working. In my experience...no test data as of now, this procedure decreases pain significantly, encourages painfree movement and promotes therapist patient cooperation.


      If Barrett and Diane perform the same technique with the same result but call it something different, I think it might be a first class example of our language problem interfering with progress as a profession. Instead of three separate "treatments" and outcomes - you'd have three times the evidence supporting a specific treatment in the management of a flexion contracture.
      I didn't mention contracture. This technique will prevent contracture by encouraging movement . The scientific minds spoke volumes on that word, but said nothing about the procedure I described. Wow what does that imply?
      The neurological holding pattern can be broken with hands on technique. Keep pushin on Rod...Roll with the changes and ride the storm out.
      Bob

      Comment


      • The scientific minds "said nothing about the procedure I described. Wow what does that imply?"

        Mmh. They did not say anything about the little green men on Mars either.....What does that imply?

        What on earth do you mean? That scientific minds are narrow minded and do not think outside the box - or that the procedure is of such poor construct that it deserves no attention.....
        We don't see things as they are, we see things as WE are - Anais Nin

        I suppose it's easier to believe something than it is to understand it.
        Cmdr. Chris Hadfield on rise of poor / pseudo science

        Pain is a conscious correlate of the implicit perception of threat to body tissue - Lorimer Moseley

        We don't need a body to feel a body. Ronald Melzack

        Comment


        • No Bas,
          You just like to argue too eh? Everyone gravitated to the contracture statement by Rod. No one commented on the described technique. I can only ASS U ME that they might agree with it. Where did you see a post on little green men? I'd like to read that.
          Where is the latin here Bas?
          Bob

          Comment


          • No Bobby - I just do not like poor debate techniques, poor science and poor arguments. That's all.
            We don't see things as they are, we see things as WE are - Anais Nin

            I suppose it's easier to believe something than it is to understand it.
            Cmdr. Chris Hadfield on rise of poor / pseudo science

            Pain is a conscious correlate of the implicit perception of threat to body tissue - Lorimer Moseley

            We don't need a body to feel a body. Ronald Melzack

            Comment


            • Which debate technique is it that switches the topic from the question asked?
              Avoidence perhaps?
              Bobby

              Comment


              • Originally posted by TexasOrtho
                It only means they are treating patients with the best treatment they have available within their skill set.
                Rod,

                I put a cynic reply here but haven't had yet a comment from your own. Does that mean the internist do not follow the best available treatment available or that he is focused onto an outcome result saying that a blood level had changed?

                In this precise case (where the patient eats too much salt), what is the best treatment: avoid salt or take a thing that lowers the tension?
                Simplicity is the ultimate sophistication. L VINCI
                We are to admit no more causes of natural things than such as are both true and sufficient to explain their appearances. I NEWTON

                Everything should be made as simple as possible, but not a bit simpler.
                If you can't explain it simply, you don't understand it well enough. Albert Einstein
                bernard

                Comment


                • Here is a perfect example of the point I made regarding the utility of CPRs in post #364 (Thanks Jon)-

                  May S, Rosedale R. J Manipulative Physiol Ther. 2007 Sep;30(7):539-42.

                  A case of a potential manipulation responder whose back pain resolved with flexion exercises.

                  OBJECTIVE: Researchers have begun to investigate the value of subgrouping patients with back pain to improve clinical outcomes; one method is the development of clinical prediction rules. To be of clinical value, it is important that subgroups identify distinct categories of patients with an associated optimal treatment. This case study raises the suggestion that subgroups identified in this way may not represent distinct categories. CLINICAL FEATURES: A patient with sudden-onset back pain, who had 4 of 5 criteria for a clinical prediction rule said to identify responders to manipulation, was successfully treated using repeated flexion in lying exercises. OUTCOMES: Pain numeric score and Roland-Morris Disability Questionnaire were used to measure changes in pain and function. Pain score changed from 9/10 to 0/10 and disability score from 19/24 to 0/24 after 1 week and at 1 and 6 months of follow-up. CONCLUSION: We have presented a case study that was positive for 4 of 5 items of the clinical prediction rule for manipulation responders, but this patient was successfully treated with flexion exercises. The clinical prediction rule may not represent a discrete subgroup but may include patients who can be effectively managed in other ways.
                  Luke Rickards
                  Osteopath

                  Comment


                  • ...And the castle falls out of the sky.
                    Nice point you make Luke.
                    Diane
                    www.dermoneuromodulation.com
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                    "Rene Descartes was very very smart, but as it turned out, he was wrong." ~Lorimer Moseley

                    “Comment is free, but the facts are sacred.” ~Charles Prestwich Scott, nephew of founder and editor (1872-1929) of The Guardian , in a 1921 Centenary editorial

                    “If you make people think they're thinking, they'll love you, but if you really make them think, they'll hate you." ~Don Marquis

                    "In times of change, learners inherit the earth, while the learned find themselves beautifully equipped to deal with a world that no longer exists" ~Roland Barth

                    "Doubt is not a pleasant mental state, but certainty is a ridiculous one."~Voltaire

                    Comment


                    • Here is a useful page on understanding the validation of CPRs and the hierarchy of evidence for CPR research.

                      Obviously, the case study above does not invalidate the manipulation CPR, but it does highlight a few of the issues present in moving it up the hierarchy.

                      With all of the controversy surrounding this thing, it would be interesting to see the outcomes of a well executed impact analysis. Even if good outcomes from using the CPR continue to be evident, continued use of other treatments which produce similar benefits, use of manipulation by practitioners who employ alternative clinical reasoning or do it on most patients anyway in conjuction with other interventions, and practitioner or patient preference not to do or receive manipulation, may all combine to make the rule fairly impotent.

                      It will be interesting to see the results of Child's current study.

                      ..anyway, back to the Core..
                      Luke Rickards
                      Osteopath

                      Comment


                      • It will be interesting to see the results of Child's current study.
                        I agree Luke. It looks like it should shed some light on questions I've had.
                        "I did a small amount of web-based research, and what I found is disturbing"--Bob Morris

                        Comment


                        • Clearly the cpr's cannot be seen as the 'be all end all treatment for LBP. However, in terms of an evidence based approach to the treatment of LBP they are very useful. I have had great success with these cpr's. I don't think it's safe to say 'the castle has fallen' based on a case study of one patient that responded to flexion that also met the cpr's for manipulation.

                          However, one aspect of the treatment based classification system that is not well defined is the patients with high FABQ. They are suggested to perform a graded exercise program that has research to support this approach. I do find this forum helpful in explaning properly to a patient why they have pain and why I recommend a graded exercise program. Perhaps it is the education of pain and not the graded exercise program that is of benefit.

                          Comment


                          • i attended a seminar today with paul hodges. he shared many thoughts expressed here. here we go.... he is against a strong muscular contraction maintained that will keep the column rigid. it will prevent the dissipation of forces. it will cause too much compression on the articulations. and it will cause problems with the breathing pattern and might cause incontinence. so the goal with the exercises is increasing control; not stiffen the column. this means that he suggest neuromuscular - motor learning - exercises, not strengthening. studies showed that motor control can be changed with exercises and the improvements are maintained in the long term. but it is not enough to do muscular contraction exercises. the exercises require precision. but here he doesnt explained exactly the exercises he promoted - too little time.... an other interesting point: studies showed a shift in the motor cortex area activated with chronic LBP patients regarding postural control. and after those 'shifted' patients did some exercises, the motor cortex take back his original configuration... a nice exemple of plasticity. Tsao H, Galea MP, Hodges PW. Reorganization of the motor cortex is associated with postural control deficits in recurrent low back pain. Brain. 2008 Aug;131(Pt 8):2161-71. Epub 2008 Jul 18.
                            physiotek.com ------ __@
                            Eric aka pht3k ---- _`\<,_
                            ----------------- (*)/ (*)

                            Comment


                            • Thanks, pht.
                              Hodges was obviously one of the original stabilization crew.
                              I think anyone who is reading the literature realizes that this is a motor control issue and not a strength issue.
                              Having said that, I think we are still left with the "defect vs defense" concept and whether it is appropriate to pursue this as a method of pain relief.
                              I have to say I use it primarily for the beginning of the reconditioning process when the pain is largely gone.

                              I think using this as the primary intervention for a person in acute pain is difficult to support.
                              Jason Silvernail DPT, DSc, FAAOMPT
                              Board-Certified in Orthopedic Physical Therapy
                              Fellowship-Trained in Orthopedic Manual Therapy

                              Certified Strength and Conditioning Specialist


                              The views expressed in this entry are those of the author alone and do not reflect the official policy or position of the Department of the Army, Department of Defense, or the US Government.

                              Comment


                              • Originally posted by Jason Silvernail View Post
                                I have to say I use it primarily for the beginning of the reconditioning process when the pain is largely gone.
                                I think using this as the primary intervention for a person in acute pain is difficult to support.
                                same for me...
                                physiotek.com ------ __@
                                Eric aka pht3k ---- _`\<,_
                                ----------------- (*)/ (*)

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