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Michael Orendurff
10-26-1998, 05:33 AM
Dear All:
This is an interesting area for discussion and all
opinions are worth reading. Would it be possible for
people to please cite the research they are discussing?
This way we can review the literature for ourselves. Thank
you.

Sincerely,

Michael

On Sun, 25 Oct 1998 23:52:19 -0500 (EST) "john
triano(Texas Back Institute)" wrote:

> In a message dated 10/24/98 2:32:50 PM Central Standard Time, Mcsiff@AOL.COM
> writes:
>
> the
> article which could be sent out via email? It would be interesting to read
> it.
> If anyone else has read the full article, any views? Any comments by other
> therapists or researchers on the last sentence, especially the entire
> philosophy of mechanical manipulation of the spine to relieve alleged
> subluxations or other stresses accumulated by the misdemeanours of daily
> life?
>
> Have any models or studies been devised which adequately explain the
> allegedly
> beneficial effects of regular spinal manipulation. Theories are bandied about
> which attribute the 'popping' sound sometimes elicited during manipulation to
> the release of nirogen bubbles in the joints, others talk about sudden
> release
> of accumulated tension in soft tissues, yet others refer to the reduction of
> subluxations, but few seem to establish a causal link between specific
> ailments and subtle mechanical stresses and pressures.
>
> The article follows below:
>
> Dr Mel C Siff
> Littleton, Colorado, USA
> mcsiff@aol.com
>
> ---------------------------------------------------------------
>
> Magazine Readers Warned About Chiropractors
>
> The January issue of Smart Money informed readers of "Ten Things Your
> Chiropractor Won't Tell You." Writer John Protos explores the "nutty
> theories"
> of many chiropractors, the absurdity and expense of repeated (if not
> indefinite) visits for "adjustments," the availability of physical medicine
> from other professionals, the risks of chiropractic manipulation
> (particularly
> of forceful maneuvers of the cervical spine), the spotty insurance coverage
> of
> chiropractic, and the profit-driven efforts of many chiropractors to draw in
> children (the manipulation is whom can be dangerous), sell vitamins, and take
> X-rays.
>
> Finally, he notes that scientific studies have repeatedly found that, no
> matter what is done about low back pain, most people will get better on their
> own with over-the-counter analgesics and the use of heat and cold
> applications. >>
>
> 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
> nothing.
>
> 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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----------------------
Michael Orendurff, MS
Clinical Biomechanist
Gait Analysis Laboratory
Portland Shriners Hospital
MSO@shcc.org

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