To cavitate or not to cavitate......that is the question.

[Guest guest]

Listmates,

A couple weeks ago, there was a discussion about whether or not SMT should have a cavitation in order to be the Chiropractic gold standard. I know this is a touchy subject and I would ask that you all keep an open mind on the research currently available. Although this research is dated, it is published by JMPT, a respected (IMHO) source. Altho I'm not at liberty to give details on upcoming research currently underway, rest assured, the subject of cavitation is being studied and updated as it relates to low velocity adjusting.

Change is always difficult. I'm not saying that low velocity is any better than HVLA, nor am I suggesting that we abandon HVLA. Contrare. I love the healing aspects of our profession. I put a lot of time into preserving and maintaining our economic and credible survival. For those who've felt that the sound of a crack is the only way to elicit a 'true chiropractic adjustment' ; I would ask that you keep an open mind as you read these studies. I used to be among you!

Study #1 Brodeur - as you read this, look at pg 5 underneath figure #7.

"This indicates that another mechanism is probably responsible for snap-back." ...."Critical velocity for biologic joints is so low that seperations of a fraction of a mm/minute would elicit cavitation..."

Although this exact study has not been reproduced with hand-held instruments, there are studies that show instruments such as an Activator can move the joints fractions of a mm/minute. You may find these on the Activator website.

pg 7 " et al suggests the force needed to cause cavition is also dependant on conditions within the joint capsule and loads acting on the capsular ligaments."

This could explain why some patients do well with low velocity and others better with HVLA. It could also explain why Activator doctors who put patients in traction and apply the device get excellent results. I know my hypothesis is not proven, but I believe it the findings allow for professional speculation.

pg 9 #6 "...the jerk on the ligaments and other periarticular structures causes firing of high threshold mechanoreceptors....(not cavitation)." "Activator adjusting guns and other tools may also provide.... the same result."

Study #2 Herzog 1996 - as you read this look at pg 3, 4: starting a #12

EMG reflex - (electromyographical)

"The initial EMG response and electromechanical delay are independant of cavitation...it seems unlikely that cavitation causes reflex repsonses in spinal musculature."

Study #3 Herzog1995 JMPT

"...fast treatment thrusts elicit muscle activation" "...muscle spindles activate EMG not cavitation..."

WOW. how about that? pretty amazing. It does not invalidate chiropractic to say that it's not the cavitation that's producing the decreased pain and increased ROM. This study just goes on to say that the EMG reflex is most likely in the muscle spindle activation mechanism. And certainly an HVLA will affect the muscle spindles, as will hand-held mechanisms. However, for the body to react by decreasing pain and increasing ROM, the procedure must be done rapidly. Because Activator and some other mechanical devices are more rapid than the manual application, the authors are hypothesizing their effectiveness. This means that whether you use HVLA (with rapid manuever) or Activator, you will most likely affect the muscle spindle and get the same results.

At least it means that we should keep an open mind to the possibility that chiropractic has many ways to help the public. Let's work together on it, by offering diverse means to correct subluxation without saying that one works better than another. In my mind, they are simply different ways of getting to the same goal.

Thanks,

Minga

ps- BTW, there is an Activator seminar in Portland in, I think, Spring 2012. I do not work for Activator, I do not get any $ benefit from mentioning this. It's been a viable option for me as I age and because I'm vertically challenged and weigh less than most of my patients. And I apologize in advance for typos and any (hopefully) minor mistyping in my quotes. I tried to be as exact as possible.

3 of 3 File(s)

Herzog,_et_al_JMPT_1995_18(4)_233-6.pdf

Brodeur_JMPT_1995_18(3)_155-64.pdf

Herzog_JMPT_1996_19(30_216-8.pdf

[Guest guest]

Joe, this conversation doesn't seem to be about eliminating the HVLA....just possible tempering its use. Seems to me, that move does more to keep people out of our offices than anything we do or don't do. If people learn that it is only one of our tools, they might be abit more comfortable. Sunny Sunny Kierstyn, RN DC Fibromyalgia Care Center of Oregon 2677 Willakenzie Road, 7CEugene, Oregon, 97401541- 654-0850; Fx; 541- 654-0834www.drsunnykierstyn.com AboWoman@...; ; jbrimhall@...From: spinetree@...Date: Fri, 22 Jul 2011 06:58:15 -0700Subject: Re: To cavitate or not to cavitate......that is the question.

I think when "light force" folks suggest that our schools should cease teaching and doctors discontinue utilizing HVLA and we all go the way of the activator and such, there will be considerable backlash. I believe this conversation began with just that proposal. Lets not forget that at times a joint just isnt going to cavitate. This doesn't mean the adjustment wasnt successful, but the bone has to be moved.....thats chiropractic.Joe Medlin DC----- Reply message -----From: AboWoman@...Date: Thu, Jul 21, 2011 3:07 pmSubject: To cavitate or not to cavitate......that is the question. [3 Attachments]< >, <jbrimhall@...>Listmates,A couple weeks ago, there was a discussion about whether or not SMT should have a cavitation in order to be the Chiropractic gold standard. I know this is a touchy subject and I would ask that you all keep an open mind on the research currently available. Although this research is dated, it is published by JMPT, a respected (IMHO) source. Altho I'm not at liberty to give details on upcoming research currently underway, rest assured, the subject of cavitation is being studied and updated as it relates to low velocity adjusting. Change is always difficult. I'm not saying that low velocity is any better than HVLA, nor am I suggesting that we abandon HVLA. Contrare. I love the healing aspects of our profession. I put a lot of time into preserving and maintaining our economic and credible survival. For those who've felt that the sound of a crack is the only way to elicit a 'true chiropractic adjustment' ; I would ask that you keep an open mind as you read these studies. I used to be among you!Study #1 Brodeur - as you read this, look at pg 5 underneath figure #7. "This indicates that another mechanism is probably responsible for snap-back." ...."Critical velocity for biologic joints is so low that seperations of a fraction of a mm/minute would elicit cavitation..."Although this exact study has not been reproduced with hand-held instruments, there are studies that show instruments such as an Activator can move the joints fractions of a mm/minute. You may find these on the Activator website. pg 7 " et al suggests the force needed to cause cavition is also dependant on conditions within the joint capsule and loads acting on the capsular ligaments."This could explain why some patients do well with low velocity and others better with HVLA. It could also explain why Activator doctors who put patients in traction and apply the device get excellent results. I know my hypothesis is not proven, but I believe it the findings allow for professional speculation. pg 9 #6 "...the jerk on the ligaments and other periarticular structures causes firing of high threshold mechanoreceptors....(not cavitation)." "Activator adjusting guns and other tools may also provide.... the same result." Study #2 Herzog 1996 - as you read this look at pg 3, 4: starting a #12EMG reflex - (electromyographical) "The initial EMG response and electromechanical delay are independant of cavitation...it seems unlikely that cavitation causes reflex repsonses in spinal musculature." Study #3 Herzog1995 JMPT"...fast treatment thrusts elicit muscle activation" "...muscle spindles activate EMG not cavitation..."WOW. how about that? pretty amazing. It does not invalidate chiropractic to say that it's not the cavitation that's producing the decreased pain and increased ROM. This study just goes on to say that the EMG reflex is most likely in the muscle spindle activation mechanism. And certainly an HVLA will affect the muscle spindles, as will hand-held mechanisms. However, for the body to react by decreasing pain and increasing ROM, the procedure must be done rapidly. Because Activator and some other mechanical devices are more rapid than the manual application, the authors are hypothesizing their effectiveness. This means that whether you use HVLA (with rapid manuever) or Activator, you will most likely affect the muscle spindle and get the same results. At least it means that we should keep an open mind to the possibility that chiropractic has many ways to help the public. Let's work together on it, by offering diverse means to correct subluxation without saying that one works better than another. In my mind, they are simply different ways of getting to the same goal. Thanks,Mingaps- BTW, there is an Activator seminar in Portland in, I think, Spring 2012. I do not work for Activator, I do not get any $ benefit from mentioning this. It's been a viable option for me as I age and because I'm vertically challenged and weigh less than most of my patients. And I apologize in advance for typos and any (hopefully) minor mistyping in my quotes. I tried to be as exact as possible.

[Guest guest]

Joe,

my current post was not about :

"suggest that our schools should cease teaching and doctors discontinue utilizing HVLA and we all go the way of the activator and such, "

I would like to see low velocity adjusting incorporated into core curriculum at my alma mater. It is included in other chiro colleges in the nation. My current post was just to present material that shows how an EMG is measured in relation to HVLA and Low velocity adjusting. I believe the discussion began when I related the story of my grandfather dying within 2-3 hours of a lumbar roll. Cause of death recorded at the hospital for that problem was a ruptured abdominal aneurysm. Because he had diabetes, high blood pressure and high cholesterol and neither he nor my grandma were informed of possible side effects; I proposed better informed consent for HVLA on high risk patients. then it was flippantly suggested, "what do you want us to do, Minga, tell people our treatments will kill them." or some such thing. I hope you all understand that I'm in favor of written and verbal informed consent to protect not only the patients, but doctors as well. I was only making a point that if a family member ever dies after a medical procedure, you will look at it with more scrutiny and try to find ways to decrease the risk.

In my current post, I'm only presenting research that shows the effectiveness of chiropractic adjusting in both forms. Please don't read more into my post. I have no agenda to cease teaching HVLA anywhere. I serve on the Board of Trustees for UWS and love my alma mater.

Minga Guerrero DC

To cavitate or not to cavitate......that is the question. [3 Attachments]

< >, <jbrimhall@...>

Listmates,

A couple weeks ago, there was a discussion about whether or not SMT should have a cavitation in order to be the Chiropractic gold standard. I know this is a touchy subject and I would ask that you al l keep an open mind on the research currently available. Although this research is dated, it is published by JMPT, a respected (IMHO) source. Altho I'm not at liberty to give details on upcoming research currently underway, rest assured, the subject of cavitation is being studied and updated as it relates to low velocity adjusting.

Change is always difficult. I'm not saying that low velocity is any better than HVLA, nor am I suggesting that we abandon HVLA. Contrare. I love the healing aspects of our profession. I put a lot of time into preserving and maintaining our economic and credible survival. For those who've felt that the sound of a crack is the only way to elicit a 'true chiropractic adjustment' ; I would ask that you keep an open mind as you read these studies. I used to be among you!

Study #1 Brodeur - as you read this, look at pg 5 underneath figure #7.

"This indicates that another mechanism is probably responsible f or snap-back." ...."Critical velocity for biologic joints is so low that seperations of a fraction of a mm/minute would elicit cavitation..."

Although this exact study has not been reproduced with hand-held instruments, there are studies that show instruments such as an Activator can move the joints fractions of a mm/minute. You may find these on the Activator website.

pg 7 " et al suggests the force needed to cause cavition is also dependant on conditions within the joint capsule and loads acting on the capsular ligaments."

This could explain why some patients do well with low velocity and others better with HVLA. It could also explain why Activator doctors who put patients in traction and apply the device get excellent results. I know my hypothesis is not proven, but I believe it the findings allow for professional speculation.

pg 9 #6 "...the jerk on the ligaments and other periarticular struct ures causes firing of high threshold mechanoreceptors....(not cavitation)." "Activator adjusting guns and other tools may also provide.... the same result."

Study #2 Herzog 1996 - as you read this look at pg 3, 4: starting a #12

EMG reflex - (electromyographical)

"The initial EMG response and electromechanical delay are independant of cavitation...it seems unlikely that cavitation causes reflex repsonses in spinal musculature."

Study #3 Herzog1995 JMPT

"...fast treatment thrusts elicit muscle activation" "...muscle spindles activate EMG not cavitation..."

WOW. how about that? pretty amazing. It does not invalidate chiropractic to say that it's not the cavitation that's producing the decreased pain and increased ROM. This study just goes on to say that the EMG reflex is most likely in the muscle spindle activation mechanism. And certainly an HVLA will affect the muscle spindles, as will hand-held mechanisms. However, for the body to react by decreasing pain and increasing ROM, the procedure must be done rapidly. Because Activator and some other mechanical devices are more rapid than the manual application, the authors are hypothesizing their effectiveness. This means that whether you use HVLA (with rapid manuever) or Activator, you will most likely affect the muscle spindle and get the same results.

At least it means that we should keep an open mind to the possibility that chiropractic has many ways to help the public. Let's work together on it, by offering diverse means to correct subluxation without saying that one works better than another. In my mind, they are simply different ways of getting to the same goal.

Thanks,

Minga

ps- BTW, there is an Activator seminar in Portland in, I think, Spring 2012. I do not work for Activator, I do not get any $ benefit from mentioning this. It' ;s been a viable option for me as I age and because I'm vertically challenged and weigh less than most of my patients. And I apologize in advance for typos and any (hopefully) minor mistyping in my quotes. I tried to be as exact as possible.

[Guest guest]

Thank you, Joe. Couldn't agree with you more .... which is why ALL of our techniques need to be taught. When will the university be adding classes in SOT? I would be pleased and honored to participate witht those should you need someone. Sunny Sunny Kierstyn, RN DC Fibromyalgia Care Center of Oregon 2677 Willakenzie Road, 7CEugene, Oregon, 97401541- 654-0850; Fx; 541- 654-0834www.drsunnykierstyn.com From: JBrimhall@...To: skrndc1@...; spinetree@...; abowoman@...; Subject: RE: To cavitate or not to cavitate......that is the question.Date: Mon, 25 Jul 2011 13:52:49 +0000

Sunny,

Thank you for the clarification. From a personal perspective, I have never thought that HVLA was the only way to adjust the spine. From an educational

view, our students need access to as many legitimate tools as there are available. Only then can they evaluate the effectiveness and appropriateness of the available techniques, modalities and procedures. It should not be the job of the educational institution

to decide which approach is best—that is left up to the individual doctor.

Joe

ph Brimhall, D.C.

President

University of Western States

“Integrating Health and Science”

2900 NE 132nd Avenue

Portland, Oregon 97230

503-251-5712

JBrimhall@...

The information contained in this email communication is privileged and/or confidential information intended only for the use of the individual or entity named above. If the

reader of this email is not the intended recipient, you are hereby notified that any dissemination, distribution or copying of the communication or the information contained in this communication is strictly prohibited. If you have received this communication

in error, please immediately notify me and delete the email. Thank you.

From: Sunny Kierstyn [mailto:skrndc1@...]

Sent: Friday, July 22, 2011 8:17 AM

joe medlin; Minga Guerrera DC; ; ph Brimhall

Subject: RE: To cavitate or not to cavitate......that is the question.

Joe,

this conversation doesn't seem to be about eliminating the HVLA....just possible tempering its use. Seems to me, that move does more to keep people out of our offices than anything we do or don't do. If people learn that it is only one of our tools, they

might be abit more comfortable.

Sunny

Sunny Kierstyn, RN DC

Fibromyalgia Care Center of Oregon

2677 Willakenzie Road, 7C

Eugene, Oregon, 97401

541- 654-0850; Fx; 541- 654-0834

www.drsunnykierstyn.com

To:

AboWoman@...;

; jbrimhall@...

From: spinetree@...

Date: Fri, 22 Jul 2011 06:58:15 -0700

Subject: Re: To cavitate or not to cavitate......that is the question.

I think when "light force" folks suggest that our schools should cease teaching and doctors discontinue utilizing HVLA and we all go the way of

the activator and such, there will be considerable backlash. I believe this conversation began with just that proposal.

Lets not forget that at times a joint just isnt going to cavitate. This doesn't mean the adjustment wasnt successful, but the bone has to be moved.....thats chiropractic.

Joe Medlin DC

----- Reply message -----

From: AboWoman@...

Date: Thu, Jul 21, 2011 3:07 pm

Subject: To cavitate or not to cavitate......that is the question. [3 Attachments]

< >, <jbrimhall@...>

Listmates,

A couple weeks ago, there was a discussion about whether or not SMT should have a cavitation in order to be the Chiropractic gold standard. I know this is a touchy subject and I would ask that you all keep an open mind on the research currently available. Although

this research is dated, it is published by JMPT, a respected (IMHO) source. Altho I'm not at liberty to give details on upcoming research currently underway, rest assured, the subject of cavitation is being studied and updated as it relates to low velocity

adjusting.

Change is always difficult. I'm not saying that low velocity is any better than HVLA, nor am I suggesting that we abandon HVLA. Contrare. I love the healing aspects of our profession. I put a lot of time into preserving and maintaining our economic and credible

survival. For those who've felt that the sound of a crack is the only way to elicit a 'true chiropractic adjustment' ; I would ask that you keep an open mind as you read these studies. I used to be among you!

Study #1 Brodeur - as you read this, look at pg 5 underneath figure #7.

"This indicates that another mechanism is probably responsible for snap-back." ...."Critical velocity for biologic joints is so low that seperations of a fraction of a mm/minute would elicit cavitation..."

Although this exact study has not been reproduced with hand-held instruments, there are studies that show instruments such as an Activator can move the joints fractions of a mm/minute. You may find these on the Activator website.

pg 7 " et al suggests the force needed to cause cavition is also dependant on conditions within the joint capsule and loads acting on the capsular ligaments."

This could explain why some patients do well with low velocity and others better with HVLA. It could also explain why Activator doctors who put patients in traction and apply the device get excellent results. I know my hypothesis is not proven, but I believe

it the findings allow for professional speculation.

pg 9 #6 "...the jerk on the ligaments and other periarticular structures causes firing of high threshold mechanoreceptors....(not cavitation)." "Activator adjusting guns and other tools may also provide.... the same result."

Study #2 Herzog 1996 - as you read this look at pg 3, 4: starting a #12

EMG reflex - (electromyographical)

"The initial EMG response and electromechanical delay are independant of cavitation...it seems unlikely that cavitation causes reflex repsonses in spinal musculature."

Study #3 Herzog1995 JMPT

"...fast treatment thrusts elicit muscle activation" "...muscle spindles activate EMG not cavitation..."

WOW. how about that? pretty amazing. It does not invalidate chiropractic to say that it's not the cavitation that's producing the decreased pain and increased ROM. This study just goes on to say that the EMG reflex is most likely in the muscle spindle activation

mechanism. And certainly an HVLA will affect the muscle spindles, as will hand-held mechanisms. However, for the body to react by decreasing pain and increasing ROM, the procedure must be done rapidly. Because Activator and some other mechanical devices are

more rapid than the manual application, the authors are hypothesizing their effectiveness. This means that whether you use HVLA (with rapid manuever) or Activator, you will most likely affect the muscle spindle and get the same results.

At least it means that we should keep an open mind to the possibility that chiropractic has many ways to help the public. Let's work together on it, by offering diverse means to correct subluxation without saying that one works better than another. In my mind,

they are simply different ways of getting to the same goal.

Thanks,

Minga

ps- BTW, there is an Activator seminar in Portland in, I think, Spring 2012. I do not work for Activator, I do not get any $ benefit from mentioning this. It's been a viable option for me as I age and because I'm vertically challenged and weigh less than most

of my patients. And I apologize in advance for typos and any (hopefully) minor mistyping in my quotes. I tried to be as exact as possible.

[Guest guest]

Hi Minga, not trying to read anything more into your post.

Maybe I’m getting confused, but I thought your grandfather post was after Dr. Freeman’s suggestion that we abandon HVLA. Nonetheless, at my alta mater Activator, SOT, Biophysics and others were among core electives in which you were to choose one (strangely NUCCA was required). There is no doubt as to the effectiveness of these techniques.

In regards to the “risk†of HVLA, I think the numbers speak for themselves. However, I can empathize with your position and agree that informed consent is a good thing and have implemented it into my practice.

ph Medlin D.C.

From: AboWoman@...

Sent: Friday, July 22, 2011 8:39 AM

Subject: Re: To cavitate or not to cavitate......that is the question.

Joe,

my current post was not about :

"suggest that our schools should cease teaching and doctors discontinue utilizing HVLA and we all go the way of the activator and such, "

I would like to see low velocity adjusting incorporated into core curriculum at my alma mater. It is included in other chiro colleges in the nation. My current post was just to present material that shows how an EMG is measured in relation to HVLA and Low velocity adjusting. I believe the discussion began when I related the story of my grandfather dying within 2-3 hours of a lumbar roll. Cause of death recorded at the hospital for that problem was a ruptured abdominal aneurysm. Because he had diabetes, high blood pressure and high cholesterol and neither he nor my grandma were informed of possible side effects; I proposed better informed consent for HVLA on high risk patients. then it was flippantly suggested, "what do you want us to do, Minga, tell people our treatments will kill them." or some such thing. I hope you all understand that I'm in favor of written and verbal informed consent to protect not only the patients, but doctors a s well. I was only making a point that if a family member ever dies after a medical procedure, you will look at it with more scrutiny and try to find ways to decrease the risk.

In my current post, I'm only presenting research that shows the effectiveness of chiropractic adjusting in both forms. Please don't read more into my post. I have no agenda to cease teaching HVLA anywhere. I serve on the Board of Trustees for UWS and love my alma mater.

Minga Guerrero DC

To cavitate or not to cavitate......that is the question. [3 Attachments]< >, <jbrimhall@...>Listmates,A couple weeks ago, there was a discussion about whether or not SMT should have a cavitation in order to be the Chiropractic gold standard. I know this is a touchy subject and I would ask that you al l keep an open mind on the research currently available. Although this research is dated, it is published by JMPT, a respected (IMHO) source. Altho I'm not at liberty to give details on upcoming research currently underway, rest assured, the subject of cavitation is being studied and updated as it relates to low velocity adjusting.Change is always difficult. I'm not saying that low velocity is any better than HVLA, nor am I suggesting that we abandon HVLA. Contrare. I love the healing aspects of our profession. I put a lot of time into preserving and maintaining our economic and credible survival. For those who've felt that the sound of a crack is the only way to elicit a 'true chiropractic adjustment' ; I would ask that you keep an open mind as you read these studies. I used to be among you!Study #1 Brodeur - as you read this, look at pg 5 underneath figure #7. "This indicates that another mechanism is probably responsible f or snap-back." ...."Critical velocity for biologic joints is so low that seperations of a fraction of a mm/minute would elicit cavitation..."Although this exact study has not been reproduced with hand-held instruments, there are studies that show instruments such as an Activator can move the joints fractions of a mm/minute. You may find these on the Activator website. pg 7 " et al suggests the force needed to cause cavition is also dependant on conditions within the joint capsule and loads acting on the capsular ligaments."This could explain why some patients do well with low velocity and others better with HVLA. It could also explain why Activator doctors who put patients in traction and apply the device get excellent results. I know my hypothesis is not proven, but I believe it the findings allow for professional speculation. pg 9 #6 "...the jerk on the ligaments and other periarticular struct ures causes firing of high threshold mechanoreceptors....(not cavitation)." "Activator adjusting guns and other tools may also provide.... the same result." Study #2 Herzog 1996 - as you read this look at pg 3, 4: starting a #12EMG reflex - (electromyographical) "The initial EMG response and electromechanical delay are independant of cavitation...it seems unlikely that cavitation causes reflex repsonses in spinal musculature." Study #3 Herzog1995 JMPT"...fast treatment thrusts elicit muscle activation" "...muscle spindles activate EMG not cavitation..."WOW. how about that? pretty amazing. It does not invalidate chiropractic to say that it's not the cavitation that's producing the decreased pain and increased ROM. This study just goes on to say that the EMG reflex is most likely in the muscle spindle activation mechanism. And certainly an HVLA will affect the muscle spindles, as will hand-held mechanisms. However, for the body to react by decreasing pain and increasing ROM, the procedure must be done rapidly. Because Activator and some other mechanical devices are more rapid than the manual application, the authors are hypothesizing their effectiveness. This means that whether you use HVLA (with rapid manuever) or Activator, you will most likely affect the muscle spindle and get the same results. At least it means that we should keep an open mind to the possibility that chiropractic has many ways to help the public. Let's work together on it, by offering diverse means to correct subluxation without saying that one works better than another. In my mind, they are simply different ways of getting to the same goal. Thanks,Mingaps- BTW, there is an Activator seminar in Portland in, I think, Spring 2012. I do not work for Activator, I do not get any $ benefit from mentioning this. It' ;s been a viable option for me as I age and because I'm vertically challenged and weigh less than most of my patients. And I apologize in advance for typos and any (hopefully) minor mistyping in my quotes. I tried to be as exact as possible.

[Guest guest]

Agreed Minga and Joe as per both a written and verbal consent with the PARQ conf noted in the chart.  Joe you are correct much of the subsequent discussion was following Herb’s comment that once the school’s drop HVLA adjustments and move to instrument adjustments/manipulations things for us will be better…e.g., PR-wise, media?  Which I strongly disagree with and based on the current world’s evidence as per the efficacy of HVLA spinal manipulation/adjustments and my personal experience using both for 30 years and counting…..Vern Saboe From: [mailto: ] On Behalf Of ph MedlinSent: Monday, July 25, 2011 8:54 AM ; AboWoman@...Subject: Re: To cavitate or not to cavitate......that is the question. Hi Minga, not trying to read anything more into your post. Maybe I’m getting confused, but I thought your grandfather post was after Dr. Freeman’s suggestion that we abandon HVLA. Nonetheless, at my alta mater Activator, SOT, Biophysics and others were among core electives in which you were to choose one (strangely NUCCA was required). There is no doubt as to the effectiveness of these techniques. In regards to the “risk†of HVLA, I think the numbers speak for themselves. However, I can empathize with your position and agree that informed consent is a good thing and have implemented it into my practice. ph Medlin D.C. From: AboWoman@... Sent: Friday, July 22, 2011 8:39 AM Subject: Re: To cavitate or not to cavitate......that is the question. Joe,my current post was not about : " suggest that our schools should cease teaching and doctors discontinue utilizing HVLA and we all go the way of the activator and such, " I would like to see low velocity adjusting incorporated into core curriculum at my alma mater. It is included in other chiro colleges in the nation. My current post was just to present material that shows how an EMG is measured in relation to HVLA and Low velocity adjusting. I believe the discussion began when I related the story of my grandfather dying within 2-3 hours of a lumbar roll. Cause of death recorded at the hospital for that problem was a ruptured abdominal aneurysm. Because he had diabetes, high blood pressure and high cholesterol and neither he nor my grandma were informed of possible side effects; I proposed better informed consent for HVLA on high risk patients. then it was flippantly suggested, " what do you want us to do, Minga, tell people our treatments will kill them. " or some such thing. I hope you all understand that I'm in favor of written and verbal informed consent to protect not only the patients, but doctors a s well. I was only making a point that if a family member ever dies after a medical procedure, you will look at it with more scrutiny and try to find ways to decrease the risk. In my current post, I'm only presenting research that shows the effectiveness of chiropractic adjusting in both forms. Please don't read more into my post. I have no agenda to cease teaching HVLA anywhere. I serve on the Board of Trustees for UWS and love my alma mater. Minga Guerrero DC To cavitate or not to cavitate......that is the question. [3 Attachments]< >, <jbrimhall@...>Listmates,A couple weeks ago, there was a discussion about whether or not SMT should have a cavitation in order to be the Chiropractic gold standard. I know this is a touchy subject and I would ask that you al l keep an open mind on the research currently available. Although this research is dated, it is published by JMPT, a respected (IMHO) source. Altho I'm not at liberty to give details on upcoming research currently underway, rest assured, the subject of cavitation is being studied and updated as it relates to low velocity adjusting.Change is always difficult. I'm not saying that low velocity is any better than HVLA, nor am I suggesting that we abandon HVLA. Contrare. I love the healing aspects of our profession. I put a lot of time into preserving and maintaining our economic and credible survival. For those who've felt that the sound of a crack is the only way to elicit a 'true chiropractic adjustment' ; I would ask that you keep an open mind as you read these studies. I used to be among you!Study #1 Brodeur - as you read this, look at pg 5 underneath figure #7. " This indicates that another mechanism is probably responsible f or snap-back. " .... " Critical velocity for biologic joints is so low that seperations of a fraction of a mm/minute would elicit cavitation... " Although this exact study has not been reproduced with hand-held instruments, there are studies that show instruments such as an Activator can move the joints fractions of a mm/minute. You may find these on the Activator website. pg 7 " et al suggests the force needed to cause cavition is also dependant on conditions within the joint capsule and loads acting on the capsular ligaments. " This could explain why some patients do well with low velocity and others better with HVLA. It could also explain why Activator doctors who put patients in traction and apply the device get excellent results. I know my hypothesis is not proven, but I believe it the findings allow for professional speculation. pg 9 #6 " ...the jerk on the ligaments and other periarticular struct ures causes firing of high threshold mechanoreceptors....(not cavitation). " " Activator adjusting guns and other tools may also provide.... the same result. " Study #2 Herzog 1996 - as you read this look at pg 3, 4: starting a #12EMG reflex - (electromyographical) " The initial EMG response and electromechanical delay are independant of cavitation...it seems unlikely that cavitation causes reflex repsonses in spinal musculature. " Study #3 Herzog1995 JMPT " ...fast treatment thrusts elicit muscle activation " " ...muscle spindles activate EMG not cavitation... " WOW. how about that? pretty amazing. It does not invalidate chiropractic to say that it's not the cavitation that's producing the decreased pain and increased ROM. This study just goes on to say that the EMG reflex is most likely in the muscle spindle activation mechanism. And certainly an HVLA will affect the muscle spindles, as will hand-held mechanisms. However, for the body to react by decreasing pain and increasing ROM, the procedure must be done rapidly. Because Activator and some other mechanical devices are more rapid than the manual application, the authors are hypothesizing their effectiveness. This means that whether you use HVLA (with rapid manuever) or Activator, you will most likely affect the muscle spindle and get the same results. At least it means that we should keep an open mind to the possibility that chiropractic has many ways to help the public. Let's work together on it, by offering diverse means to correct subluxation without saying that one works better than another. In my mind, they are simply different ways of getting to the same goal. Thanks,Mingaps- BTW, there is an Activator seminar in Portland in, I think, Spring 2012. I do not work for Activator, I do not get any $ benefit from mentioning this. It' ;s been a viable option for me as I age and because I'm vertically challenged and weigh less than most of my patients. And I apologize in advance for typos and any (hopefully) minor mistyping in my quotes. I tried to be as exact as possible.