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Mel Siff
10-28-1998, 12:07 PM
In a message dated 10/28/98, "Jay M. Trennoche" wrote:

>Let me see what we can do. We do want to impress you. You seem open minded.

PREAMBLE

I would really appreciate as much information as possible on the mechanical
torsioning (the effects of tractioning are much better known) of the spine for
therapeutic purposes, since I would like to be more convinced about the
various theories and claims made for its efficacy. This is not to say that I
do not accept that spinal manipulation does not work in certain cases, but
that the reasons why or why it does not work are not as scientifically
convincing as they could be.

Dr Mark Swanepoel's recent thorough discussion on the biomechanics of
torsional loading of the relaxed spine is a very useful contribution in this
regard, but when I hear explanations that the 'pop' caused by manipulation is
due to the explosive release of nitrogen bubbles from the cerebrospinal fluid
and I recall the devastating effects that explosive or implosive events can
have on engineering structures, I am concerned to know how this catastrophic
type of event can be of benefit in the management of back pain or disability.

MANIPULATION UNDER ANAESTHESIA

In another post to one of the physical therapy user groups, I passed on a
message from an orthopedist who commented that manipulation under anaesthesia
(MUA) has been shown to be not as effective in managing pain or enhancing
mobility as conventional manipulation. I then posed the question that, if
that is the case, then does the conscious emotional state or the healer-
patient interaction also play an important role in the effectivess of
manipulation?

Then, of course, the healing system known as Therapeutic Touch (pioneered by
Dr Dolores Krieger) in which the therapist simply places the hands on or near
the body, has also had its successes. This system, too, has its powerful
detractors, but I have met many who claim that their lives have been changed
by this method. Of course, we can dismiss this as a consequence of the placebo
effect, but we often have no way of determining the extent to which the
placebo effect forms the part of any therapeutic intervention.

PLACEBO EFFECT

To what extent is the intensity of the placebo effect enhanced by a strategy
which appears, sounds or feels more dramatic? Shamans and medicine men
throughout history have always understood this principle by developing
impressive rituals, but even to this day we have failed to reproducibly
quantify this method in modern medicine.

As Mark stated, this does not diminish the value of the treatment - it simply
emphasizes that the current 'scientific' models are incomplete or
inappropriate.
Lest anyone feels that I doubt the efficacy of mobilisation, manipulation,
trigger point release, mysofascial release and other methods of mechanically
stressing the body for therapeutic reasons, I have witnessed too many
successful treatments like this to be that naive. What excites my interest is
applying biomechanics, physiology or any other appropriate science to really
understand how these mechanical therapies work.

Dr Mel C Siff
Littleton, Colorado, USA
mcsiff@aol.com

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