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M Swanepoel
12-08-1998, 07:57 PM
Hello All,

I am amazed that this discussion still continues! If the discussion
is to be meaningful then it must be scientific. Neil Tuttle stated that
" The resting position of vertebrae do alter; which can readily be
palpated." Does this mean that:

1 It has been proven that the relative positions of vertebral bodies
can be palpated so accurately that changes in their positions
can be ascertained on different occasions over the course of several days,
weeks, months or years, when the body itself has been immobilised
securely in exactly the same position on each occasion?

2 The subjective assessment of the person doing the palpation agrees
to a statistically significant extent with objective measurements of
vertebral positions performed concurrently by a visualisation
technique that affords us submillimetric measurements, utilising
well-defined anatomical markers?

If so, where are the references to the scientific experiements that
prove the paranormal abilities of these wondrous individuals,
whose subjective assessments of relative vertebral positions are so good?

Neil continues: "The movement patterns of vertebrae do alter..."
Yes, they do, e.g. with age in the same individual, or with the
type of movement being performed. But what was the intended meaning?
That the relative movements of vertebrae change in the same individual
when performing exactly the same motion, from day to day? Week to
week? Month to month? Merely during the initial motor conditioning
period for the movement studied (i.e. during the "learning curve"?)
How were these measurements made? What was measured? Method?
Instruments?

Neil Tuttle also wrote: "There are no magical differences in the
joint structures in the spine that make them follow different laws to
the rest of the body". Having dissected 27 spinal motion
segments, three quadraped lumbar spines, and several knee and ankle
joints - I protest. Each joint is adapted to bear different
loads, imposed at different rates and repetition frequencies, and each
joint has a different range of motion. A conclusion drawn
about intervertebral joints from the elbow or knuckle is gobbledeygook
befitting the world of Galen, not the current era. The intervertebral
joint is unique ("magical" if you are an incurable romantic) because:

1 Relative movement of the articulating bones (vertebrae) is
governed by a triad of joints - the intervertebral disk
anteriorly and facet joints posteriorly, plus several spinal
ligaments.

2 The main load bearing element, the intervertebral disk,
is composed of soft connective tissues, and not cartilage or bone.
The hydrophilic proteoglycan-rich core, the nucleus pulposus, is
surrounded by multiple concentric containing walls (lamellae) of
"cross-ply" collagen, that tie the vertebrae together and contain the
nucleus pulposus - this containing structure is the annulus fibrosus.
This structure does not occur elsewhere in the body.

3 For most of a person's life by far the major part of the load
borne by the intervertebral disk is postural i.e. due to the weight
of the body rather than dynamic forces, (except in a few cases
where repetitive intervertebral loading is induced by the
individual's occupation, e.g. furniture removals and
weightlifting.) Dynamic loads are dominant in other joints.

4 The facet joints serve to restrict motion, and not to enable it.
If the facet joints are removed, the intervertebral range of
rotation increases dramatically. All other synovial joints enable
motion as a primary function.

5 The intervertebral articular triad houses the spinal cord, and
the spinal nerve roots emanate from the intervertebral
foramina. Pathological positions of adjacent vertebrae, and
neoplasms such as osteophytes can therefore exercise a major
influence on bodily functions.

One may think from (5) that spinal manipulations have a valid role
based purely on physical reasoning. Having dissected lumbar motion
segments I guarantee that the forces required to rupture stabilizing
ligaments, to tear the annulus fibrosus, and to cause fractures are so
great, that any significant non-congenital pathological displacement of
adjacent vertebrae must be ascribed to such injuries. Come on, all
you chiropracters out there, does spinal manipulation:

1 Cure muscular inflammation?
2 Cure torn paraspinal musles?
3 Cure torn spinal ligaments?
4 Cure torn facet joint capsules?
5 Cure a tear in the annulus fibrosus and IV disk prolapse?
6 Remove osteophytes impinging on nerve roots?
7 Cure marginal fractures of the facet joints?
8 Cure vertebral endplate fractures?
9 Permanently cure intervertebral subluxation by arresting age-related fibrosis
of the nucleus pulposus and the concomitant dehydration?
10 Cure congential malformations of the spine?
11 Cure facet joint osteoarthrosis and subsequent arthrodesis?
12 Cure metastases of malignant cancers?
13 Cure primary spinal cancers?
14 Permanently cure L5/S1 spondylolisthesis?
15 Cure bacterial spinal infections, such as tuberculous spines?
16 Cure HLA 27-related disorders, ankylosing spondylitis and
scoliosis?
17 Cure spinal vascular restrictions?

I beg chiropracters to answer these questions, to prove that their
manipulations do not exacerbate matters in most, and to
provide the supporting references. (Naturally one should also bear
in mind that the rates of remission from cancer at Lourdes are equal
to those occurring anywhere else.)

The only condition that I know of that may be "cured" by chiropractic
manipulation, and this is unproven, is nipping of facet joint villi
between the articulating surfaces. Spinal traction provides temporary
relief of compressive spinal conditions, and provides temporary
stabilization of most spinal fractures - your local paramedics
know and apply this from day to day.

It is a pointless waste of time to list all the papers which have examined
spinal motion, although I have already sent lists of references to a
few people who actually wished to see the scientific evidence.
Having examined the facet joints, I believe (no, I am certain!) that
vigorous rotational movements of vertebrae seriously damage the
articular cartilage, which is usually soft and in a state of "bad
repair" anyway. (Swanepoel MW, Adams LM, and Smeathers JE, Human
lumbar apophyseal joint damage and intervertebral disc degeneration,
Ann Rheum Dis, 1995, 54, 182-188). The role of the lumbar
facet joints is to prevent significant intervertebral rotation, and
to act against this by applying vigorous rotational impulses from
without the body, is folly. (I would support gentle twisting
exercises with an extended spine, however, as a means of
strengthening these joints and their cartilage.)

It has been suggested that connections between spinal nerves mean
that spinal manipulation is in fact addressing CNS-sourced pain (I
apologize to the author of this - I cannot remember your name).
Both damping and resonant spinal nervous feedback loops exist, as do
"crossed wires". However it seems likely to me that
laying-on of the hands induces a state of well-being in much the same
way that a dog responds to petting - a complex phenomenon that
has been exceptionally poorly researched.

I suggest a controlled experiment is conducted in which about 200 patients
suffering from non-specific (undiagnosed?) chronic back pain,
(say one year after initial consultation),
are divided into five groups. One group receives no treatment except
bedrest, a second group is referred to orthopaedic consultants
who apply placebo treatment, a third group is treated by qualified
physiotherapists, a fourth group is treated by masseurs, and a fifth
group is treated by chiropracters. As part of this study I suggest
that the mental and pain states of each patient are assessed by psychiatrists
before and after at least one treatment session, and that if possible some
physiological measures of well-being are also measured - (pulse rates
and blood pressures before and after treatment?)

Further I suggest that the therapists are blind to the fact that they
are participating in such a study. (Are those howls of protest I hear,
carried by the wind?)

Mark W Swanepoel
School of Mechanical Engineering
University of the Witwatersrand
Johannesburg
South Africa
Tel: 0927 (0)11 716 2578/58
Fax: 0927 (0)11 339 7997

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