Specificity of Manipulation

Julie Fritz passed around this article a few days ago.

Download Ianuzzi-SpineJ-2005-ManipNotSpecificCadaver.pdf

It is a cadaveric study, but it adds to the emerging evidence on the lack of specificity with manipulation. In case you're interested, a sampling of the evidence questioning our ability to localize manipulation to a specific area is included below. The good news is that it doesn't appear to matter much. I am not suggesting that attempting to be specific in your approach is futile. We just have to be careful not to let fanciful mechanistic "stories" become the explanation for the observed effect. Much more research is needed to clarify why manipulation is effective for a subgroup of patients. In the meantime, busy clinicians will be well served by just adhering to Tim Flynn's advice to "move it and move on".

John

Beffa R, Mathews R. Does the adjustment cavitate the targeted joint? An investigation into the location of cavitation sounds. J Manipulative Physiol Ther. 2004; 27(2):e2.

Chiradejnant A, Latimer J, Maher CG, Stepkovitch N. Does the choice of spinal level treated during posteroanterior (PA) mobilisation affect treatment outcome? Physiotherapy Theory and Practice. 2002; 18:165-174.

Chiradejnant A, Maher CG, Latimer J, Stepkovitch N. Efficacy of "therapist-selected" versus "randomly selected" mobilisation techniques for the treatment of low back pain: a randomised controlled trial. Aust J Physiother. 2003; 49(4):233-241.

Haas M, Groupp E, Panzer D, Partna L, Lumsden S, Aickin M. Efficacy of cervical endplay assessment as an indicator for spinal manipulation. Spine. 2003; 28(11):1091-1096.

Ianuzzi A, Khalsa PS. Comparison of human lumbar facet joint capsule strains during simulated high-velocity, low-amplitude spinal manipulation versus physiological motions. Spine J. 2005;5:277-90.

Ross JK, Bereznick DE, McGill SM. Determining cavitation location during lumbar and thoracic spinal manipulation: is spinal manipulation accurate and specific? Spine. 2004; 29(13):1452-1457.

Comments

[Jason Silvernail]

Here I go again...
This is a special interest area for me.

I have long questioned the diagnostic models used (esp motion palpation type stuff) in both our academic training and third party organizations that teach and "certify" manual therapists. I don't want to mention any names specifically, but everyone knows the groups are out there. One can spend lots of money, take their series of courses, and be "certified" in their techniques, to include nifty letters after your name.

Much of the training done by these organizations has to do with precise diagnosis of a supposed movement problem at individual spinal joints, and resolving those through specific techniques. Given the growing amount of evidence that these techniques we are using are not specific and the diagnosis we are making has poor reliability and face validity, are we as a profession going to change the way manual and manipulative therapy (of the spine specifically) is taught? Are we going to require the sorts of standards of evidence for those CEU courses and certifying organizations that we are talking about applying to other courses outside of manipulative therapy?

Are we really an evidence-based profession if schools and manual therapy groups are still teaching people how to diagnose and correct an ERS Right at L4/5?
J