Jeannett A Martin (EMCU) 6236 wrote:
>
> The Medical Research Council(MRC) General Practice Research
> Framework(GPRF) and the University of York will be undertaking a
> randomised controlled trial in 1999 on the management of back pain.
> This trial will involve 1,200 sub acute and chronic back pain
> sufferers and is funded by the MRC.
>
> Participants who agree to take part will be randomised to either
> normal care
> exercise
> manipulation
> exercise and manipulation combined
>
This should be an interesting study, but one from which geography at
least would seem to prohibit my participation. As a point of interest
expressed by someone utilizing manipulation as one of the treatment
modalities in General Practice, however, a couple of questions.
What type of 'manipulation' and delivered by whom?
This could range from 10 minutes of soft tissue manipulation (good
massage) delivered by a physiotherapist to a standardized nonspecific
high velocity, low amplitude thrusting technique (some of our allopathic
brethern over here have learnt this from us - often the orthopedic
fellows) to a specific structural diagnosis followed by the application
of one of several specific corrective techniques. This last choice is
(pretty much of necessity) performed by someone professionally committed
to structural diagnosis and correction, such as (ahem) an osteopath. I
would submit that this last is, however, the most effective form of
manipulation and the most worthy of evaluation.
Setting up a treatment protocol to answer a specific clinical research
question such as you have posed is easier when the treatment modality is
standardized (eg 10 minutes of massage to the low back - by the clock).
However, if the question is whether manipulation per se is useful as a
primary therapeutic modality or as an adjunct to other modalities, using
the most practiced hands available would seem to offer a better chance
at a definitive answer. I confess to knowing little of British
osteopathy, save that lacking full medical practice licenses and
depending therefore more on manipulation than we seem to, their skills
should be better than mine!
This answer is of some professional interest to me, since I must confess
to using multiple modalities (manipulation, NSAIDs, microwave diathermy,
exercise) in this problem. (No purist I!)
I hope you will post some results here on GO-UK when they come in...
--
Philip G. Dunlap, D.O., M.P.H., Ph.D.
4 Bailey Hill Road
Natick, MA, 01760, USA
[log in to unmask]
(508) 650-9097 - voice
(508) 650-9152 - fax
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