Myths of Manual Therapy Part 2: Spinal Manipulation | Modern Manual Therapy Blog

Myths of Manual Therapy Part 2: Spinal Manipulation


Time for my second sway on Myths of Manual Therapy! The topic this time is spinal manipulation. Hyper linked in the sway are some studies which will hopefully enlighten viewers that manipulation works, but probably not for the reason most think it does.

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Please share this post or click on the share link directly in the sway to spread the word! Remember, hearing a new concept that is very different than what you are accustomed to DOES NOT question your technique's efficacy, just the mechanisms behind why they work. Give it some thought.

Keeping it Eclectic....

6 comments:

  1. I liked this post. I definitely explain to patients that most of the major effects of manual therapy are neurological. However, I have found it very easy to explain SI and pelvic "rotations" to people in a way I think they can understand. Because most people are familiar with the concept of something being "out of place", I think it is easy and approachable for patients. I try to replace this with a new concept for them. The way I choose to explain innominate "rotation, upslip, downslip, etc" is as a mobility disfunction. It is not necessarily correct to describe the right ilium as being anteriorly rotated out of place, but it may be more correct to say that the R ilium is able to nutate better, while the L is better able to counter nutate. This does not indicated that the bones are out of place, but could merely reflect patterns of muscle activation. I think a good test to somewhat confirm this thought is the FMS active straight leg raise test. If a person has a discrepancy between mobility in the two legs, and a discrepancy between innominate mobility with manual testing, then perhaps the real problem is a combination of tightness, weakness, etc., in muscles surrounding the pelvis and the joints of the pelvis. In this way I am able to explain to patients that their bones are not out of place, and that I am not trying to adjust them back in, but instead they have a problem with movement, and by doing manual therapy, and muscle energy (really just targeted PNF) we can help correct this problem. With additional explanation of neurological effects, I think patients really grasp this, and also de-emphasize the pathoanatomical structures.

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  2. Great explanation. In explaining directional preference or position of ease, I use variability and that the nervous system "just doing it's job" tends to send out warning signals if you are doing too much of one thing and not balancing it out with an opposing movement or position. This prevents the flexion = disc bulge and extension = reduction. People get it. I use movement that provokes is +1 and directional preference is -1, balance it out, your brain gives a green light and pain and movement thresholds raise, enabling your to move and do more without threat or stretch perception.

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  3. Nice summary Dr. E! As a young chiropractor, I've lost patients to old-school docs because I don't give patients what they expect (they always think something's out of place). Maybe they think I didn't study anything, but I refuse to just make it up on the fly. I've noticed a trend that I'm sure you've spotted as well: These same patients go back every month for the same treatment, for the same problem. I hope to end that. I focus on combing modalities, such as manipulation, soft tissue release (Edge anyone?), and rehab. As soon as I can, I try to move them to the training end of the spectrum and find the pain seems to diminish once they grab some weights. I can only assume that means they are overcoming the fear that was initially instilled in them by Doc XYZ during the X-ray consult.

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  4. Thanks Matt! I think it's important we stick to our guns and I've lost patients who I used to beat on and bruise with my EDGE Tool to those who still believe they can break up fascia.

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  5. I hear you there. Earlier this week I talked to a college baseball player who asked me about Graston. I gave him my current view of the literature and my limited experience. Of course, he went on to tell me about his trips to the doc that involved much pain, bruising, and misery. It sounds like he improved, but you have to wonder if just 10% of that bruising treatment would've been enough.

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  6. More like 0 percent, I barely even cause redness now.

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