Talk:Spinal adjustment

Opening statements need refinement

My apologies for previously editing in an improper manner. My intent was to discuss the opening statements and I errantly thought some of the previous statements made here in the talk forum were current and undebated (which I realize is false). I will follow proper formatting to the best of my knowledge now. Here is my intended improvement:

To change "Chiropractic techniques were invented in the 19th century by Daniel David Palmer, a "magnetic healer". There is no good evidence that it is effective against disease.[1]" to "D. D. Palmer invented the initial technique, and it has been advanced by notable chiropractors such as B. J. Palmer, Clarence Gonstead, J. Clay Thompson, and Burl Pettibon. "

My reasons for this are:

1) D.D. Palmer did not invent all chiropractic techniques, he made a single technique. Thus, at the least the plural should be removed.

2) Current techniques are a collection of unique techniques, each created by an individual.

3) To include the other inventors of major techniques. Certainly B.J. Palmer belongs on this list, as he developed upper cervical adjusting. Clarence Gonstead also belongs on this list, as it is unique and a clear advancement of earlier chiropractic technique. J. Clay Thompson invented the Thompson or drop technique which is rare outside of DC practices. Burl Pettibon invented the Pettibon technique which has many unique movements involving lateral flexion and y-axis distraction.

4) Upon further thought Deed (and maybe Don) Harrison should probably be added for Chiropractic Biophysics mirror image adjusting, which utilizes a unique multi-drop table and combines it with concept of patient placement mirroring that of their postural distortions.

5) Ideally pages would be created for each individual on the list who does not have a technique or personal wiki. This would allow future users easy access to the main techniques utilized today.

6) The modifying statement that D.D. Palmer is a "magnetic healer" is not neutral tone. D.D. Palmer was a magnetic healer in the late 1800's, and this seems strange to modern readers. It does not enlighten anyone about spinal adjustments, and is already discussed on D.D. Palmer's wiki page. Since his name is literally linked to his page this is twice unnecessary.

7) The seemingly random statement that "There is no good evidence that it is effective against disease" is inappropriately placed at the least. And obviously would belong in the effects or safety sections. The argument about the effectiveness of spinal adjustments on visceral disease is moot anyways, as the proportion of patients seeking chiropractic care are doing so for musculoskeletal (MSK) issues (usually neck and low back pain). See number 8 for evidence.

8) "More than 70% of patients specified back and neck problems as their health problem for which they sought chiropractic care." PMID 11805694

9) So for the large majority of patients seeking chiropractic care, their concern is whether or not it is effective at treating their chief complaints of MSK pain. There is clear evidence that it is: "Several RCTs have been conducted to assess the efficacy of SMT for acute LBP using various methods. Results from most studies suggest that 5 to 10 sessions of SMT administered over 2 to 4 weeks achieve equivalent or superior improvement in pain and function when compared with other commonly used interventions, such as physical modalities, medication, education, or exercise, for short, intermediate, and long-term follow-up. Spine care clinicians should discuss the role of SMT as a treatment option for patients with acute LBP who do not find adequate symptomatic relief with self-care and education alone." PMID 20869008

10) Thus these improvements would improve the content by expanding and clarifying who is partially responsible for aspects of spinal adjusting, and removing non-neutral tone and frivelous statements which do not reflect the outcome of the majority of patients seeking chiropractic care.

Pacmann117 (talk) 05:15, 29 August 2014 (UTC)

Thanks for the very helpful and nicely numbered list. That makes it easier! We'll start working on it a bit at a time. I have to go now, but Wikipedia will still be around. There is no rush. -- Brangifer (talk) 05:49, 29 August 2014 (UTC)

Any progress here? Would love some feedback/discussion. Pacmann117 (talk) 12:33, 3 September 2014 (UTC)

Sorry for the delay. Too much going on. Let me take a poke at the above:

1. You are basically correct. Spinal manipulation has existed for thousands of years, and osteopaths were already using and teaching various techniques before Palmer started. He learned from them and then made his own claims about mechanisms and cures. He claimed to have pioneered the basis for short lever techniques, but even that claim is dubious and unproven. It is his claim. I don't doubt that he did some pioneering work, and other chiropractors expanded on that and invented other adjusting techniques. Because this article is about "spinal adjustment", and not all chiropractic techniques, we need to keep that in focus. We could make this change:

1.a. Original: "Chiropractic techniques were invented in the 19th century by Daniel David Palmer, a "magnetic healer"."

1.b. New: "In the late 19th century, Daniel David Palmer developed some spinal adjustment techniques, and other chiropractors followed in his footsteps." More is needed after this, to describe and sum up the body.

I have to go again. We really need to rewrite the lead so it truly sums up the body. Take a look at this essay and see if you can develop a lead which does that: WP:How to create and manage a good lead section. -- Brangifer (talk) 05:49, 4 September 2014 (UTC)

simplifying the adjustment/manipulation section

There seems to be an excessive amount of comparison between spinal manipulation and spinal adjustment. I believe this is from the lack of the actual technical distinctions between the HVLA thrust and its corresponding components when utilized by DCs vs PTs/MDs and most DOs. The introduction of the concepts of long and short lever thrusting techniques is central to this distinction. Both produce the desired joint cavitation/gapping but attain this by different means.

The short lever move is done with the contact hand as close as possible to the segment to be thrusted upon. Typically the practitioner's thrusting hand contacts the spinous or transverse process of a vertebra. Thus the thrust is delivered directly to the desired vertebra with the intent of affecting one or more of the facet joints. These moves typically require extensive practice to produce meager results. The short lever move is also typically performed in the more or less loose pack position of the joint.

The long lever move is done by rotating portions of the body opposite one another in order to produce tension across multiple vertebral levels. The HVLA thrust is delivered when the joint slack has been removed, and the tissues are at tension. This causes cavitation of multiple facets, and is not as specific in nature as the short lever move. These moves generally require less practice to produce cavitation at a vertebral level when compared to their short lever alternative.

This is present in the literature and is central to many chiropractic techniques.

The article "Chiropractic: Origins, Controversies, and Contributions" presents this distinction as an important pillar of chiropractic technique:

"The vertebrae can be moved by direct contact—the "short-lever" technique—or through a distant linkage, or the "long-lever" method. The latter method is used, for example, when a dynamic thrust of the thigh moves a vertebra in the lower spine. "Amplitude" refers to the depth or distance traveled by a practitioner's thrust. When joints are less accessible or when a long lever is involved, the amplitude increases. The degree of force applied is yet another variable."

Also the initial statement in this section is the opinion of two people. However legitimate this opinion may be, it does not explain the technical distinctions. So the reader is still unaware that spinal manipulation and adjustment are both HVLA techniques that differ in their finer points.

Pacmann117 (talk) 06:15, 29 August 2014 (UTC)

References

Review finds spinal manipulation no more effective than exercise for chronic low back pain

Review finds spinal manipulation no more effective than exercise for chronic low back pain

An analysis of studies that compared spinal manipulation and prescribed exercise for patients diagnosed with chronic low back pain has concluded that no conclusive evidence favors one over the other. Only three randomized controlled trials met the inclusion criteria of the review. One favored manipulation, one favored exercise, and the third study judged them equal. The authors called for more studies to determine which intervention is more effective.

Merepeza A. Effects of spinal manipulation versus therapeutic exercise on adults with chronic low back pain: a literature review. Journal of the Canadian Chiropractic Association 58:456-466, 2014

Definitely a MEDRS compliant source about chiropractic spinal manipulation. -- Brangifer (talk) 15:42, 19 January 2015 (UTC)

Old study used as source

The page used an 18 year old paper for many of the citations. Can we update this?--Akrasia25 (talk) 02:50, 8 January 2019 (UTC)

References