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Re: Spinal Manipulation

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  • Re: Spinal Manipulation

    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?

    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

    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
    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
    South Africa
    Tel: 0927 (0)11 716 2578/58
    Fax: 0927 (0)11 339 7997

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