John Triano(texas Back Institute)
10-25-1998, 02:52 PM
In a message dated 10/24/98 2:32:50 PM Central Standard Time, Mcsiff@AOL.COM


Actual investigations of sudden joint distraction in the finger joints, used
as a model for the spinal facets, forms the basis of claim for the audible
release being a function of nitrogen release from solution. The result is a
gapping of the joint due to increased partial pressures within the joint that
lasts for 20 minutes as the gas is resorbed.

Sadly, the state of the art related to manipulation is equally as uncertain on
defining the pain generator as is the overall field of back pain in general.
Work has been done to quantify the loads necessary to obtain the audible
release (Herzog et al at the University of Calgary) and on the threshold loads
necessary to achieve biological changes in circulating substace P, tumor
necrosis factor and PMN respiratory bursting from manipulation in the lumbar
and thoracic spinal areas (Brennan et al at National College).

The scientific description of the lesion is in the same place that Diabetes
Mellitus was in the 1930's. We knew what the patient looked like and the
major symptomatic manifestations that, if not resolved through dietary
control, could lead to death. Yet, we could not identify the pathology in the
Islets of Langerhans cells. Regardless, we continued to offer the best
treatment available to these patients rather than throw up our hands and do

Research continues to quantify these lesions and their apparent co-morbidity
with other disorders like discopathy, arthropathy, spondylolisthesis,
stenosis, instability etc.. As Haldeman said in his exiting speech as
President of the North American Spine Society - The medical pathoanatomical
model has failed ot adequately describe spine pain. We are obligated to look
further. With the favorable benefits described in over 35 studies of
manipulation ( with 3, incluing a recent NEJM article yielding equivocal
differences in contrasting treatments ) this is a worthy and challenging area
of study for functional spinal lesions.

JTriano, DC, PhD.
Co-director, Conservative Medicine
Texas Back Institute and
Adjunct faculty, UT Southwestern Medical Center
Biomedical Engineering

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