Stephen M. Levin
10-28-1998, 10:35 PM
Mel Siff wrote:
> 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.
> 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.
> 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.
> 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
I am an orthopedic surgeon that has been using manipulation for 30+
years and research in biomechanics for 20+ years. I use manipulation
because I find it a useful tool for certain musculoskeletal conditions.
I have no dogma that drives me. Manipulation works but not for
everything. Its major effects are local, mechanical, and predictable.
The systemic repercussions are secondary and often unpredictable. It is
a nonlinear event in the musculoskeletal system, like asthma, hives,
vomiting, sneezing, benign cardiac arrhythmia etc. are in their
respective systems and seems to be unrelated to Vercovian pathology as
we know it, which is linear and takes time to heal. Like the above
visceral events, the ‘maniputable lesion' (ML) is a disease of the
dynamics (1) and may be unrelated to the ‘pathology’ that we see in MRIs
etc.. The loss of joint play (2) is a constant and measurable
accompaniment of the ML. I am not sure if it is a cause or effect.
Manipulation restores joint play (a measurable fact). I am not sure what
else it does (a scientific statement). The rest is conjecture, wishful
thinking and pseudo science. I doubt if release of trapped gasses are
important. Boyle’s law is linear, manipulation is a nonlinear event (pay
References: 1. Koslow SH, Mandell AJ, Shlesinger MF, eds: Perspectives
in Biological Dynamics and Theoretical Medicine, Annals of the NY
Academy of Sciences V405, 1987.
2. Mennell J McM, Back Pain, Little Brown, 1960.
Steve Levin
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