Manual Therapy Online - Articles

Severe Sudden Pain - Flowchart

Article Excerpt

"The purposes of this flow chart on the sudden onset of severe posttraumatic pain is to remind you that not all severe pathologies are investigated appropriately by referrers, that in most areas you are able to see patients straight from the accident scene without a physician referral and that it is better to be safe than regret lack of action for the rest of your professional life. ..."
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Vertebrobasilar Insufficiency - Dizziness

Article Excerpt

"This essay will look at the most common symptom of VBI, dizziness and how to start to gain an appreciation of how indicative it is of a serious central neurological problem and how it can be used together with the presence of headache and neck pain to make a presumptive diagnosis of VBI and avoid moving the patient’s neck at all..."
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Vertebrobasilar Anatomy and Physiology

Article Excerpt

"The vertebrobasilar’s anatomy is not very consistent, in fact the likelihood of the classical system as described by anatomy texts actually being present in any individual is probably very very low. For example, only 40% of the population have equal sized vertebral arteries so already “abnormal” is more common than “normal”..."
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VBI and the “5 Ds”: Dim, Dopey, Dumb, Dumber and Dumbest

Article Excerpt

"This is the first in a series of essays on VBI that outline a logical and scientifically based system of clinical assessment. I am more and more frequently hearing about the 5Ds as the diagnostic criteria for vertebral basilar ischemia in both Canada and the USA and and I am more and more frustrated and annoyed at the dumbing down of what is an extremely important and complex clinical diagnosis...."
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Facilitated Segments: A Critical Review

Article Excerpt

"A very interesting critique of segmental facilitation. It reviews the original research carried out by Korr, Price, Wright, Denslow and others in the 1940s-1960 but more importantly it criticizes the interpretation of these studies by osteopaths and other manual therapy professions..."
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Script Focused Deduction: Mimicking the Expert

Article Excerpt

"For the most part teachers of manual therapy, and I include myself here, tell the student to gather as much information as possible before coming to a solution or a decision. On the face of it this seems sensible but when we say this we completely ignore the fact that this is the exact opposite of what we do in the clinic. When faced with a clinical problem the expert, and it seems only reasonable to assume that all teachers are experts to some extent...."
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Clinical Reasoning; Methods and Tools

Article Excerpt

"Most everyday problems are solved without given much thought to how they are solved. Many are solved by pattern recognition, in effect the person involved in solving the problem is an expert, having come across the problem on such a frequent basis that sometimes it doesn’t even seem like a problem any longer. Humans are pattern-recognizing beings, so much so that we see patterns and form conclusion where none exist and none are warranted...."
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Heuristics and Axioms

Article Excerpt

"Heuristics are devices for reducing the complexity of problem solving to experience based techniques such as rule of thumb, common sense, intuition, “logic” etc.. Using lateral elbow pain as an example based on common sense it would be reasonable to assume that the pain is from the elbow rather than referred from elsewhere given that then the most likely condition based on prevalencies is tennis elbow. The exhausting effort of a full examination is avoided by this heuristic but you can immediately see the problem of completely trusting in it...."
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Methods of Clinical Reasoning

Article Excerpt

"Each of these methods has its place according to the expertise and experience of the clinician, the patient and his/her problem, which signs and symptoms occur first in the examination. No one method will work for every clinician or every problem at all times. For example pattern recognition can only occur when the problem that is encountered has been seen in sufficient numbers by the clinician..."
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The Pathoanatomical Diagnosis

Article Excerpt

"The pathoanatomical diagnosis requires a statement based on integrating and analyzing the particulars of a given case (signs and symptoms), the clinician’s experience and previously learned formal and informal knowledge and even metacognition in the process of critical (clinical reasoning); the statement must include the anatomical structure and the pathology affecting it. Confirmation of the diagnosis can really only be absolute...."
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Locking and Specificity

Article Excerpt

"The question posed is this; is it possible to make the force of a manipulation specific to a given segment. But more than this we should ask is it necessary to do so. It calls to question the purpose and the need for specific and axial locking in manipulation. There is debate going on about whether it is necessary to lock joints prior to manipulating or whether a regional approach to manipulation is not only simpler but adequate..."
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