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Facilitated Segments: A Critical Review

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. These criticisms were for the most part based on information known at the time but ignored by the researchers.

“The criticism in this article is not about the quality of the research but the interpretations of the results and the far-reaching conclusions that were drawn.”

But the following quote regarding their research is interesting and provocative:

“Overall in their studies, Korr, Denslow and their co-workers did not demonstrate the facilitation phenomenon.”

However, in the “Way Forward” section of the article with the authors essentially saying that segmental facilitation was unproven went on to say that neurophysiological process need to be better understood and integrated into treatment. It was a bit of a non sequitur as to the topic under discussion and almost a mandatory statement in all research and review articles. It seems likely that it will not be possible to clump all abnormal physiological states under a single label. Central sensitization is too broad a term especially as we believe we see different pathological neurophysiological effects under differing circumstances (segmental facilitation, reflex inhibition to name but two).

My thought is that segmental facilitation is still a worthwhile model whether or not true (and it is not necessary for a scientific model to be true) providing we understand that segmental facilitation is not a condition in itself but the result of a condition and that mostly the problem can be dealt with by treating the cause rather than treating the facilitation itself. I also think that the most relevant musculoskeletal effects whatever the neurophysiological state that we understand to be segmental facilitation (hypertonicity and weakness) are not as important as as most clicians believe.

The article is worth a read and can be found at:

http://www.cpdo.net/res/page15.html

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