View Full Version : spinal "adjustment"

Neil Tuttle
11-14-1998, 09:45 AM
I am hesitant to enter this discussion as I fear it is being used by some to
push their own barrows so to speak rather than to further understanding. I
have worked as a physiotherapist in spinal work for over 25 years using
mobilization, manipulation,and "adjustments." I have recieved treatments
from more than 30 practitioners for academic interest rather than symptoms
(The differences between manipulations and adjustments or microadjustments
seem more a matter of degree and more in the minds of the practitioners than
in the techniques or their effects)
There are a few concepts that I feel need addressing. Firstly the whole
question of vertebral allignment. Xrays are still images. Deducing from a
still image the allignment of a vertebrae is analagous to deducing from a
photograph of someone winking that there is a malalignment of their eyelid.
The resting position of vertebrae do alter; which can readily be palpated.
The movement patterns of vertebrae also alter. If an elbow lacks 50% of its
normal extension, its resting position is going to be altered. Does this
mean that it is out of allignment, or that it is stiff? There are no magical
differences in the joint structures in the spine that makes them follow
different laws than the rest of the body. Craking your knuckles does not
mean their are, or were, "out of" or "in" place.
Secondly there are a multitude of systems which aim to improve a person's
function or symptoms which advertantly or inadvetantly alter their segmental
spial mobility. In spite of years of research and multitudes of conflicting
claims, it is unclear what the factor or factors are that limit this
movement; whether it is muscular, structural, or some other factor or
combination.e We know if we apply treatment modalities these patterns
change, and that people's symptoms can be reduced and mobility restored. The
effective treatment modalities include the above and other manual
techniques, some electrotherapies, acupuncture, hypnosis, ice, heat, and
many others. Each on occaison produces seemingly miraculous results on
previously unresponsive symptoms. On average (as in controlled studies) a
significant difference may be hard to detect between different modalities or
systems, but for an individual, one system is often more effective than
Belief in what we do goes a long way towards enchancing its effectiveness.
It is part of the theraputic process that the practitioner believes in what
he is doing. I am sure that the vast majority of practitioners are sincerely
interested in the welfare of their clients, but I am also sure that there
are many who provide unduly expensive, ineffective, or potentially harmful
interventions. How many clients if they were told that they had even one
chance in a million of having a CVA after having their cervical spine
treated would have it done. (There is no evidence that the tests intended to
reduce this incidence or the elimination of certain techniques has produced
the desired results.) Needless to say I am sure there are always other ways
of effectively treating neck problems without the risks that accompany
manipulations or adjustments.
Please address replies to me and I will forward a summary so those not
interested in this discussion will only have to delete one more message.

Neil Tuttle

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