Saturday, April 07, 2007

Spinal Manipulation

This is why I don't like manipulation: It is a treatment system for people who don't know (yet, or ever) what else to do with their hands and with patients. It's a "put your hands here and do this" formulaic bunch of maneuvers designed to help unskilled hands/minds earn a living as human primate social groomers while simultaneously looking somehow like they deserve to. It's like learning to ride a bike using training wheels but never learning to not need them. It's a system by which the blind can lead those who can't see to go on to lead those who were born with no eyes.

And the "science" that is done in PT on manipulative therapy and overwhelmingly in chiropractic? Much of it is "training wheel-ology", studies done specifically to support the perseveration of said training wheels, science that never explores ways to move beyond. Those who would forever rely on such a crutch have quite a nerve suggesting that all manual therapists should do the same or else they are treating "suboptimally". They even have the nerve to go on to suggest that manual therapists who refuse to use manipulative techniques are being anti-scientific.

That is simply hubris, based on a huge pile of willful kinesthetic ignorance. We are primates! There were sensitive fingers used to feel for nits too small to be seen through fur on the bodies and heads of troopmates, hundreds of thousands of years before we humans came along with the big cerebral hemispheres! We have fingers and hands with kinesthesis which can be harnessed to feel physiology. Our minds have enough hard drive that we can "learn" to practically "see" these sensations. If we can learn to make sense out of Braille, we can learn to make sense out of tissue tensions and bumps we feel through skin; furthermore, these small issues in tissues change as we explore them. So exploring them becomes seamlessly blended into the treatment of them.

The only "danger", easily avoided, is in letting one's own mind drift off into perceptual fantasy to construct treatment hypotheses that completely exclude reality. (Don't go there. Stay boundaried, and stay with what is known. Stay with pain science and neuroscience.) There are no actual dangers to the patient's physicality the way there are with manipulation - anatomy is notoriously variable, especially the anatomy of physiological structures; there is NO WAY a manipulator can know in advance which patient has a A-V malformation in the vessels feeding the spinal cord, for example. Break one of those with a forceful "manipulation" and voilá! - you've just injured someone unnecessarily and perhaps permanently. Strokes are not unheard of.

The art of really riding a bicycle is gained through pitting one's own cerebellum against complex problems of momentum and balance and gravity, finally achieving effortlessness - not on remaining dependent on training wheels! Manual magic is achieved by learning as much as one can about the materials with which one has decided to work, letting go of metaphoric treatment training wheels, pitting oneself against the complex problems of placing one's own nervous system juxtaposed to another person's, observing the inevitable interaction, and allowing systems of treatment to evolve based on reason and critical thinking. No one in the human primate social grooming business should ever succumb to using training wheels forever, or developing an entire treatment culture based on their usage, or becoming enveloped forever by such a treatment subculture. Manipulation cults are a cop-out. Where would Lance Armstrong be if he had never learned to really, really ride that bike?