Re: Re: Orthopedic testing- provocation of extremities, why not the spine?

[Guest guest]

Welker said, "I don't need a peer reviewed journal article/published study...to confirm what I am saying."

YES YOU DO!!! What makes you better than your predecessors??? "You" don't need studies...what...I mean...what are you saying!? Why don't you need studies...?

If you don't "study" something, it's just a theory. BEFORE THEORIES ARE PUT INTO MAINSTREAM PRACTICE THEY ARE STUDIED!

Welker said, "Do you really think that amongst each technique and amongst each of the DC's with their fine touch we would not have discrepancy."

Do you really think that amongst ANY TECHNIQUE and amongst each of the M.D's/D.O's/D.M.D's/etc, etc, etc...we would not have discrepancy??? Have you never heard the term "second opinion?" What's your point? That Chiropractors--solely--should be capable of IN-HUMAN perfection??? Are you, personally, claiming to have super-human perfection in your technique??? Have you NEVER had to order an x-ray or MRI to find out what's wrong with your patients??? If so, then your technique if not perfect either. Case closed...

Welker said, "I remember looking around the room with the rest of the students, wondering what we were suppose to be feeling... Just how long do I need to be out before I begin to feel the elusive beast. Will it come to me in a dream or will I find it in the garden, lets be realistic."

Well, clearly, you felt like every DC/MD/DMD/PT/LMT/DO/NP STUDENT out there... If you still feel like that...than, yes, you are the one messed-up (as you suggest).

You're simply talking basic palpation skills, and understanding and being able to identify the 5 components of the subluxation complex (or 7 components...depending upon who you READ).

If you still can't THAT BEAST in practice...what are you doing in practice?

RR.

Orthopedic testing- provocation of extremities, why not the spine?> > > Orthopedic testing> > Orthopedic testing is meant to elicit or provoke a response so that we may determine what is irritated and to what extent. In school we are taught orthopedic testing to determine the state of the extremities and/or tissue but when it comes to the spine we learn motion palpation and alignment by way of palpation but no provocation. Does this seem strange? Maybe it is not strange if you think of the fact that we still follow alignment/misalignment or fixation. What happens when a joint, disc, capsule, tissue becomes irritated? The body becomes more sensitive and begins to guard the area. > > I always thought it strange that no 2 chiropractors could agree on what was misaligned or fixated. This is one of our weakest areas, this has been a point of contention not only amongst chiropractors but also amongst those within the manual therapy realm. This makes it easy for anyone to state their new technique is correct. Provocation on the other hand is fairly simple. Ever tested someone for Morton's Neuroma, lots of squirming, "yeah, that's it". Would be hard to miss this one I would hope. Not a lot of grey area. If you tore your external tissue it is sore to the touch, if I touched the open wound I would hope you would respond. Funny, no matter whom touches the wound the same reaction occurs. This we call interexaminer reliability. Ever provocated the spine? Not much different, you would be suprised as the reaction is about the same as any other provocation and consistent. Yes, I said consistent. This does not mean that we do not use the other orthopedic testing as I am sure some of you are thinking. What you will find is that it will all point in the same direction. You mean no more thermal scans to show heat distortions? I am sure I will hear plenty about this one.> > Let me know what you think,> > Brad Welker, D.C.>OregonDCs rules:1. Keep correspondence professional; the purpose of the listserve is to foster communication and collegiality. No personal attacks on listserve members will be tolerated.2. Always sign your e-mails with your first and last name.3. The listserve is not secure; your e-mail could end up anywhere. However, it is against the rules of the listserve to copy, print, forward, or otherwise distribute correspondence written by another member without his or her consent, unless all personal identifiers have been removed.

[Guest guest]

You are right. No 2 chiropractors are alike, (and no two pipe-fitters are

alike...) I remember the frustration you describe, " what the hell is he

talking about, I can't feel anything " . I would palpate so hard I could

bruise my classmate. But you know, with practice and time I did develop the

kinesthetic awareness to actually feel things. But the learning wasn't

done, and never is. The thinking brain must interpret the input. We don'

just palpate, we interpret. I've been adjusted by many chiropractors. Some

great, some good, some downright crappy. Some DC's can interpret great, but

can't adjust; some can " adjust " like a magician, but they just let " God sort

it out " . The point is, it takes many different skills to be a good

chiropractor, and you can be a great physician, but still be a crappy

adjuster. Many techniques I believe have developed because of personal

shortcomings. It doesn't mean the techniques are bad, but it does mean that

not all people can do all things. I love basketball, but I'll never perform

like Jordan. But over the years I have improved in the game. Maybe

you should open your mind and connect your senses to your brain. You sound

like someone who " gave up " because of frustration and decided to create your

own game because you were not good at the game everyone else was playing.

You may have something good to provide to the profession, but to arrogantly

imply that everything else is wrong-headed, and you are the possessor of the

" correct theory " is very inflammatory. Present your full case, your full

theory. Time will tell if you're correct. Regarding the concept you seem

to be proposing, that joints do not fixate, (I'm a motion man, not a static

misalignment man), I believe you are entirely wrong. Joints have juice,

they are designed to move. Stop moving and they wither and die. Old-school

trainers used to heat and strap ankles to the point of immobility after

sprains. These athletes would lose function of the ankle, with early onset

traumatic osteoarthritis. Real-world example.

I for one do differentially diagnose spinal strain from spinal sprain; spasm

from articular fixation. I use focal joint play, passive, active and

resisted active ROM testing, instrument testing for segmental stiffness and

plain old palpation. I do feel the differences. I feel restricted motion

in different planes. If you cannot, practice. If continued practice does

not improve your personal skills then maybe you are the problem. Like I

said, I'll never be Jordan, but it didn't piss me off to watch him

play.

Seitz, DC

Tuality Physicians

730-D SE Oak Street

Hillsboro, OR 97123

(503)640-3724

Re: Orthopedic testing- provocation of extremities, why

not the spine?

Dr. s,

Mr. Welker, subtle, I like that. None the less, I will still give

you respect and refer to you as Dr.

I am suprised you think the interexaminer reliability is so high. I

don't need a peer reviewed journal article/published study (although

they are out there, you should look) to confirm what I am saying. Do

you really think that amongst each technique and amongst each of the

DC's with their fine touch we would not have discrepancy. I am a DC,

I also went to school and have a private practice. I remember

looking around the room with the rest of the students, wondering what

we were suppose to be feeling. It is sad that many DC's say, " well,

you just haven't been out long enough! " . Just how long do I need to

be out before I begin to feel the elusive beast. Will it come to me

in a dream or will I find it in the garden, lets be realistic. Did I

really pay $100,000+ dollars to wait for the right moment of

enlightenment. Yeah, your right I am the one messed up. " I can feel

it! " , what is it? What is it exactly, what is it right, " there " .

No, no, no, right, " there " . Yeah, thats the right spot, just close

your eyes and imagine.

Thanks for your response, look forward to continued discussion.

Have a great day

Brad Welker, D.C.

>

> Mr. Welker,

>

> How do you KNOW " no 2 chiropractors could agree on what was

misaligned or fixated. " Did you conduct and publish a STUDY!? Did I

miss your peer reviewed journal article???

>

> I'm confused... What the heck are you talking about!?!? When did

you TEST EVERY SINGLE CHIROPRACTOR IN THIS STATE, to determine

that " no 2 chiropractors could agree on what was misaligned or

fixated. "

>

> Sudo-scientific statements like that are a serious WASTE of this

list serve's time...

>

> RR.

>

>

> Orthopedic testing- provocation of

extremities, why not the spine?

>

>

> Orthopedic testing

>

> Orthopedic testing is meant to elicit or provoke a response so

that we may determine what is irritated and to what extent. In

school we are taught orthopedic testing to determine the state of the

extremities and/or tissue but when it comes to the spine we learn

motion palpation and alignment by way of palpation but no

provocation. Does this seem strange? Maybe it is not strange if you

think of the fact that we still follow alignment/misalignment or

fixation. What happens when a joint, disc, capsule, tissue becomes

irritated? The body becomes more sensitive and begins to guard the

area.

>

> I always thought it strange that no 2 chiropractors could agree

on what was misaligned or fixated. This is one of our weakest areas,

this has been a point of contention not only amongst chiropractors

but also amongst those within the manual therapy realm. This makes

it easy for anyone to state their new technique is correct.

Provocation on the other hand is fairly simple. Ever tested someone

for Morton's Neuroma, lots of squirming, " yeah, that's it " . Would be

hard to miss this one I would hope. Not a lot of grey area. If you

tore your external tissue it is sore to the touch, if I touched the

open wound I would hope you would respond. Funny, no matter whom

touches the wound the same reaction occurs. This we call

interexaminer reliability. Ever provocated the spine? Not much

different, you would be suprised as the reaction is about the same as

any other provocation and consistent. Yes, I said consistent. This

does not mean that we do not use the other orthopedic testing as I am

sure some of you are thinking. What you will find is that it will

all point in the same direction. You mean no more thermal scans to

show heat distortions? I am sure I will hear plenty about this one.

>

> Let me know what you think,

>

> Brad Welker, D.C.

>

OregonDCs rules:

1. Keep correspondence professional; the purpose of the listserve is to

foster communication and collegiality. No personal attacks on listserve

members will be tolerated.

2. Always sign your e-mails with your first and last name.

3. The listserve is not secure; your e-mail could end up anywhere. However,

it is against the rules of the listserve to copy, print, forward, or

otherwise distribute correspondence written by another member without his or

her consent, unless all personal identifiers have been removed.

[Guest guest]

Hi Brad, Viola!  So you want to talk about guarding mechanisms.  This is a bigger picture than misalignment or fixation, granted.  Every injury elicits guarding: from the predominate tissue injury site to the surrounding musculature to the peripheral NS to the brain stem to the cerebral cortex to our view of ourself to our view of others to our view of our environment to our ability to focus clearly...  in a cycle that comes to define a person in that moment.  We are fully changed by protecting ourself from injury.  From insult as well, BTW.  To address only the tissue injury site is just the beginning of healing.  Unresolved, the tissue injury site evolves to the NS, hyperdynia and hyper-sensitivity, and beyond.  Even conservatively addressed, chronicity is likely.  We're still blind men describing the elephant (maybe it should be a donkey henceforth...?)  What to do?  I would love to talk about what I do, but I'd rather hear from you.Cheers. SearsNS PDXOn Nov 7, 2006, at 8:57 AM, correct_theory wrote:Dr. Sears,Thank you for keeping it brief. "Provoking the spine to the point of eliciting a painful response > mercifully yields to more subtle palpatory signs of guarding over > time."***I am glad we now agree the body is guarding and not misaligned. Unfortunately, the subtle palpatory signs of guarding may not give you the precise location of irritation, which is why we provocate. Example- Irritation of T8 left superior facet may lead to a guarding mechanism or modification of spinal joints to ease irritation but the guarding mechanism does not show you where the irritation is coming from. Is the irritation soft tissue, facet, capsule, disc?"Don't throw the baby out with the wash."***One big problem most chiropractors have had is trying to find the "subtle palpatory signs". This has confused more students and led to frustration amongst our profession. This is why most DC's have fallen back on thermal scans, sEMG, weight differentials, posture,x-ray for alignment, etc. in order to locate the elusive misalignment. I guess if I didn't believe or understand I could always attend a "seminar" to boost my confidence. No, don't throw the baby out with the bath water just make sure the water is clear enough you can see the baby.Thanks,Brad Welker, D.C. > > >> > Orthopedic testing> >> > Orthopedic testing is meant to elicit or provoke a response so that > > we may determine what is irritated and to what extent. In school > > we are taught orthopedic testing to determine the state of the > > extremities and/or tissue but when it comes to the spine we learn > > motion palpation and alignment by way of palpation but no > > provocation. Does this seem strange? Maybe it is not strange if > > you think of the fact that we still follow alignment/misalignment > > or fixation. What happens when a joint, disc, capsule, tissue > > becomes irritated? The body becomes more sensitive and begins to > > guard the area.> >> > I always thought it strange that no 2 chiropractors could agree on > > what was misaligned or fixated. This is one of our weakest areas, > > this has been a point of contention not only amongst chiropractors > > but also amongst those within the manual therapy realm. This makes > > it easy for anyone to state their new technique is correct. > > Provocation on the other hand is fairly simple. Ever tested > > someone for Morton's Neuroma, lots of squirming, "yeah, that's > > it". Would be hard to miss this one I would hope. Not a lot of > > grey area. If you tore your external tissue it is sore to the > > touch, if I touched the open wound I would hope you would respond. > > Funny, no matter whom touches the wound the same reaction occurs. > > This we call interexaminer reliability. Ever provocated the > > spine? Not much different, you would be suprised as the reaction > > is about the same as any other provocation and consistent. Yes, I > > said consistent. This does not mean that we do not use the other > > orthopedic testing as I am sure some of you are thinking. What you > > will find is that it will all point in the same direction. You > > mean no more thermal scans to show heat distortions? I am sure I > > will hear plenty about this one.> >> > Let me know what you think,> >> > Brad Welker, D.C.> >> >> >>