Steadman Hawkins Sports Medicine Lecture Series: Chiropractic (2006)
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This is a lecture presented to the Steadman Hawkins Sports Medicine Foundation's Orthopedic Lecture Series a few years back.
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Steadman Hawkins Sports Medicine Lecture Series: Chiropractic (2006)
- 12. Why is there variability in how chiropractors practice? Variability in Treatment
- 14. What training do chiropractors have? Chiropractic Training
- 16. Assessment and treatment Rationale for Chiropractic Treatment
- 23. Force Magnitudes with Manipulation Treatment Herzog 2001 Kirstukas et al. 1999 238 1044 23.8 310 Thoracic Spine Herzog 2000 107 27 Cervical Spine Triano and Shultz 1997 384-515 ? Lumbar Spine Herzog 2000 328 88 SI Study Peak Contact Force (N) Preload (N) Region
- 31. Risk / Benefit Ratio Risk
- 34. Evidenced Based? How Evidence Based is Chiropractic? Q
- 37. Summary Summary www.vailhealth.com www.markjpitcher.com
Editor's Notes
- Chiropractors certainly did not INVENT manipulation, but they did hone it into a well crafted art and more recently subjected it to scientific scrutiny. Spinal Manipulation predates chiropractic. Palmer “WESTERNIZED IT”
- Coulter I, et al. Patients using chiropractors in North America: Who are they, and why are they in chiropractic care? Spine 2002; 27(3):291-298.
- 328 newton = 74 pound-force
- Manipulative Physiol Ther. 2002 May;25(4):251-62. Related Articles, Links Mechanisms and effects of spinal high-velocity, low-amplitude thrust manipulation: previous theories. Evans DW . British School of Osteopathy, London, United Kingdom. OBJECTIVES: When the clinical efficacy of spinal manipulative treatment for spinal pain has been assessed, high-velocity low-amplitude thrust (HVLAT) manipulation and mobilization have been regarded as clinical interventions giving identical and equivalent biologic effects. The objective of this review is to critically discuss previous theories and research of spinal HVLAT manipulation, highlighting reported neurophysiologic effects that seem to be uniquely associated with cavitation of synovial fluid. DATA SOURCE: The biomedical literature was searched for research and reviews on spinal manipulation. MEDLINE and EMBASE databases were used to help find relevant articles. STUDY SELECTION: All articles relevant to the objectives were selected. DATA EXTRACTION: All available data were used. DATA SYNTHESIS: The main hypotheses for lesions that respond to HVLAT manipulation were critically discussed: (1) release of entrapped synovial folds or plica, (2) relaxation of hypertonic muscle by sudden stretching, (3) disruption of articular or periarticular adhesions, and (4) unbuckling of motion segments that have undergone disproportionate displacements. RESULTS: There appear to be 2 separate modes of action from zygapophyseal HVLAT manipulation. Intra-articular "mechanical" effects of zygapophyseal HVLAT manipulation seem to be absolutely separate from and irrelevant to the occurrence of reported "neurophysiologic" effects. Cavitation should not be an absolute requirement for the mechanical effects to occur but may be a reliable indicator for successful joint gapping. CONCLUSIONS: It is hoped that identification of these unique neurophysiologic effects will provide enough theoretical reason for HVLAT manipulation and mobilization to be assessed independently as
- Purported relationship to cervical SMT ranges by orders of magnitude 1 : 20,000 manipulations (Schievink) 1 : 1,000,000 (RAND) 1 : 400,000 cervical manipulations (the Swiss Survey) 1 : 414,000 cervical manipulations using rotation techniques (Dutch Study) 1 : 5,850,000 cervical manipulations (CCPA study)
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