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Neil Tuttle
12-07-1998, 09:22 PM
Dear All
Please excuse my delay in posting the replies. My original posting is below
followed by the replies. I would like to thank all as it has provided much
of interest.
I also know of no studies which show palpation findings to correlate with
measurable parameters of movement or position.
I did not mean to suggest that non-thrust techniques were without risk, but
that the types of adverse reactions that do occur are not as severe as
strokes or fatalities.

> 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
> another.
> 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.
> Regards
> Neil Tuttle
Although you did not ask for this to be addressed I would like to
comment on the differences between adjustments and manipulations.
Although the chiropractic profession has developed definitions for both
terms through consensus process.(1) I personally believe the only
difference is in the mind of the person using the terms. Chiropractors
generally believe that manipulation (or thrusting in to joints not done
by chiropractors) is less specific than adjustments (thrusts performed
by chiropractors). I have read numerous papers by PTs, DOs and MDs
where they allege that the their method of manual treatment is more
specific then that used by chiropractors.

This is a situation that I would have thought could have only emanated
from the mind of a TV situation comedy writer, if it were not reality.
Both sides accuse the other of being non-specific in their treatments
while "knowing" that their method is most specific. Being a student of
these arts I would say that there are DCs, PTs, DOs and MDs who are
very specific manipulators and there are DCs, PTs, DOs and MDs who are
very gross and non-specific manipulators. Thus, the quality of one's
manual skills is not dependent on the profession one has studied but in
the hands that have done the studying. And finally we do not have any
data that I am aware of that shows that specificity is important. There
is however data which suggests that manipulation (Maitland Grade V) is
more effective than mobilization (Maitland