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Slightly off the podiatry track but interesting none the less; The Lancet reported on a trial of manipulation for back pain today:

http://www.thelancet.com/journals/la...16869/abstract

Here's how the Daily Mail reported it:
http://www.dailymail.co.uk/pages/liv...page_id=17 74

Note the responses by the clinicians.

Better still read the comments from readers! (bet none of them are chiropractors ;-))

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Related threads:
The researcher vs the clincian
Acupuncture versus Physiotherapy
This will get some "backs" up

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In the thread linked by Andy on This will get some backs up, I wrote this I guess its still applicable

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Craig Payne
Department of Podiatry
La Trobe University
Melbourne, Australia
http://www.latrobe.edu.au/podiatry
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God put me on this earth to accomplish a certain number of things - right now I am so far behind, I will never die.
The views expressed above are those of the author and not that of La Trobe University
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I read the abstract, but it didn't say whether the patients were referred to a chiropractor or another manipulative practitioner. Neither did it say how the patient was evaluated, the technique, or anything else that would be pertinent to knowing whether the manipulation was done by someone who is knowledgeable.
It did say that the patient was referred by the primary care M.D. (which usually does not refer to a chiropractor)
This may be similar to our gripes about the studies comparing custom orthotic devices with a premade device. We are always asking who made it and how.

Stanley

I thought the clinicians' responses were fair and reasonable.


This is evidence-based-practice at its best. Instead of taking 'us' all forward, in clinical terms, from 1995-2015, it will one of the most counter-productive influences in health care.


Acute back pain? A good chiro/physio/osteo should be able to handle this presentation pragmatically with the rare/minimal need for mobilisation. As the condition improves beyond the acute stage, well then such interventions could be considered.

Acute back pain? A good analogy for those that are interested in foot/ankle is an acute ankle sprain. Who the hell mobilises the typical acute ankle sprain into inversion at initial presentation? When you have a tensile stress causing a partial or full tear in the lateral ligament complex; and it presents inflammed tender and puffy; common sense tells you that for the short-term, one should remove/avoid tensile stress to the pathology.




So here we go again. Another bit of useless research that actually confuses students, the medical & paramedical professions, and the public; just because some researcher hasn't the clinical nous to see the big picture.



Ron

Ron,

I have manipulated ankles in the past for ankle sprains, and yes the manipulation works very well in reducing pain. But inversion is not the direction to manipulate it. The most common directions to manipulate is either anteriorly or posteriorly. Currently, I correct the soft tissues so that I don't need to manipulate, but manipulation can be an effective therapy.
This goes to show that the correct manipulation will have a completely different result than an incorrect one. Just like an orthosis made by someone on this listserve may have a different result than one made by someone who is not as knowledgeable.
After rereading the article, it appears that a physiotherapist did the manipulation.
In the US, it is illegal for a physical therapist to do high velocity manipulations. If it is the same way where the study was done, then what are they comparing?
In the spine, there are manipulations that are specific for: fixations, subluxations, and decompressing the disc. None of these are done by a physical therapist.
Another way to put this is: If I were to perform brain surgery, I would get equally poor results as a brain surgeon making orthoses.

Regards,

Stanley

I have no experience of this, but do hear it being used more and more. It came up in this post and this post in the previous manipulation thread. There was also this: Immediate manipulation for ankle sprain

__________________
Craig Payne
Department of Podiatry
La Trobe University
Melbourne, Australia
http://www.latrobe.edu.au/podiatry
__________________________________________________ ___________________________________
God put me on this earth to accomplish a certain number of things - right now I am so far behind, I will never die.
The views expressed above are those of the author and not that of La Trobe University
This is where I am, where are you?

You may need to check your facts, Physical Therapist in the US CAN legally perform grade V mobilizations. If you are unsure then please look at the APTA website.

Ptpatroller,

Your comment is somewhat ambiguous in my opinion. The question is not 'can a licensed PT perform Grade V mobilizations", the question is one of scope, training and direct access to care by state. If you look at the various states (and I am mainly concerned with California as I practice there). The laws regarding spinal manipulation are vastly different than the extremities, as are the CPT codes a DC vs. a PT can bill for.

There are a number of DPM's that focus on foot and ankle manipulation and I have met a few who are very accomplished at extremity treatment via manipulation. I can also understand the viewpoint of those Podiatrists who shun much of it as 'unscientific' and who decry the fantastic advertising that goes along with some of it.

In California a PT requires a referral from a licensed MD, DO, DPM, DC etc to provide these services. It is the same in most of the states in the US. I doubt that a DC will refer a spinal patient to a PT for a high-velocity manipulation, although I do refer to PT's for various other rehabilitative needs that I do not offer in my office (and that I feel that PT's are better trained to deliver).

What are the laws in your state (which is?) regarding manipulation of the spine as opposed to the extremities. Do PT's perform a high-velocity thrust into the paraphysiologic joint space of the spine or the extremities?

Since Simon's original post was regarding low back pain I read this that you were referring to spinal manipulation. I could have misunderstood though.

Is that your understanding of the issue? This inter-professional debate is interesting to me. Should a PT be able to perform what we as a profession (Chiropractic) have adopted and perfected and likewise should we be able to offer the same services that PT's do? In most states DC's are able to provide and be reimbursed for many of the services that PT's provide. Is it any wonder that these two professions are perpetually dueling over scope of practice issues?

As a Pedorthist I provide services for the podiatry profession but in a very limited sense obviously. The DPM's who refer to me do not offer orthoses, diabetic depth shoes and AFO's in their practice and as such are hopefully pleased to have a local provider that they feel comfortable with.

There is a lot of professional overlap these days and a lot of turf battles ensuing from that. Instead of arguing over who can do what and who has the right to do it, I prefer to extend my hand to the providers in my area and learn what they specialize and focus in and refer accordingly. Hopefully they have learned a little more about my practice focus and respond in kind.

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David G. Wedemeyer, D.C., C.Ped.

Mr. Wedemeyer,
Thank you for responding to my earlier response. I am planning on responding to you in a more indepth manner (as you deserve), I feel that the exchanging of information and ideas is important between disciplines. I plan on writing back to you with further information, but I wont be able to until tomorrow evening. Keep the communication open, and thank you for your response.

PTpatroller

Amen and thank you. I look forward to your response.

Trust me when I offer that how you perceive scope of practice and the market for your services (no matter the discipline) while in college and after you have been in practice for a few years is will change dramatically.

I also noted that you are searching for papers relevant to prefabricated vs custom made foot orthoses. I believe that I have a few on my office computer and would be willing to share these for any that I may have missed that you may have.

Regards,

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"If we all worked on the assumption that what is accepted as true is really true, there would be little hope of advance." - Orville Wright

David G. Wedemeyer, D.C., C.Ped.

Dr. Wedemeyer,
Thank you for your response. My systematic review is on the effectiveness of orthotics (prefabricated or custom) for the treatment of plantar fasciitis. I am trying to limit my research articles to RCT; but I am also exploring other types to gain further information. I am hoping my systematic review will help streamline treatment for our patients with PFS. If you have any insight or additional articles that would be of interest I would appreciate if you could forward them to me.

Thank You,
Kristin Helling, SDPT, P.T.A