What exactly is the POP sound in HVLA?

[Doc Hef]

Hey you all,

I'm just wondering.. What exactly makes the popping sound of the joint during HVLA? I've been told that it is releasing dissolved nitrogen from the joint. Some say that it is a ligament snapping into place. I guess that I buy the first one, but I wonder why some people can repeatedly pop a joint, like a PIP, over and over - every few seconds. But you can pop a lumbar and it won't pop again for quite a while. Are these two different sounds? Has anyone actually done any research on this?

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[Jason_AZCOM]

No one knows.

 

[Doc Hef]

Nooooo. I must find out! I do think it terrible that half of the practicing DO's that I've asked this question were unsure of their answer.

 

[LukeWhite]

I think it's a bit more worrisome that half of the practicing DO's you spoke to WERE sure of their answer.

 

[Doc Hef]

I think it's a bit more worrisome that half of the practicing DO's you spoke to WERE sure of their answer.

Truly, half kinda beat around the bush and the rest said it was dissolved N being released - but they still didn't sound sure about it.
Anyway, I don't know about you guys, but I want to be pretty sure about what I'm doing to my patients. If I'm in surgery and the doc says "I don't know how this works... but it does!" I'm going to be a bit scared. If one of the foundations of osteopathy, OMM, doesn't have a decisive reason for it's action, then I'm quite worried about what I've been doing to my friends, classmates, and fam members. Yeah, I've seen OMM work... but do you mean to tell me that nobody really knows what is going on when it does? (Just the pop, I mean) The docs seem to kinda blow it off when I ask them, but I think that it's something pretty important.

 

[Idiopathic]

Just tell them its evidence-based medicine. "We do it because it works."

 

[LovelyRita]

Joint pop=osteogasm, a common occurence following osteobation.

 

[Ypo.]

Nooooo. I must find out! I do think it terrible that half of the practicing DO's that I've asked this question were unsure of their answer.

Its because no one knows, truly. If you are that uncomfortable with not knowing, you should either find out what it is and then explain it to the rest of the world, or else choose to not use OMM on your patients.

P.S., MD's don't know what it is either.

 

[Doc Hef]

Joint pop=osteogasm, a common occurence following osteobation.

Uhh.. wow.

 

[Doc Hef]

Its because no one knows, truly. If you are that uncomfortable with not knowing, you should either find out what it is and then explain it to the rest of the world, or else choose to not use OMM on your patients.

P.S., MD's don't know what it is either.

Have you ever been told by a DO that practiced OMM that they truly didn't know? I've asked quite a few - I've been told shaky answers, but never told that they didn't know.

 

[Ypo.]

Have you ever been told by a DO that practiced OMM that they truly didn't know? I've asked quite a few - I've been told shaky answers, but never told that they didn't know.

Yes, I've been shadowing an FP DO who uses a lot of OMM. I asked him what the popping noise is and he gave me several theories, but he definitely said that it just is not known for sure. My mom is an FP MD and she also says it just isn't known.

The truth is we also don't know how a lot of the drugs we prescribe "work", we just know that they do, and that the symptoms and side effects seem to be worth the risk in the short term. But no one knows if it will cause some horrible cancer 20 years down the road. OMM has been around a lot longer than many modern medicines. All I know is that sometimes I need to crack my back, d@mn it, and there ain't nothing else that can fix it.

 

[Doc Hef]

I know what you mean about meds that have an unknown mechanism. I wonder though if it has ever been tried to recreate the procedure - like taking a dissected vertebral column and seeing if a popping sound could be reproduced. Sounds sick, but I'm sure somebody has tried it.

 

[Sessamoid]

P.S., MD's don't know what it is either.

Quite right, at least from this MD. I pop my neck and back all the time. I have no idea what causes the noise. I remember hearing somebody was trying to come up with a study to figure it out, but basically failed to do so.

 

[Doc Hef]

Quite right, at least from this MD. I pop my neck and back all the time. I have no idea what causes the noise. I remember hearing somebody was trying to come up with a study to figure it out, but basically failed to do so.

Being in OMM class a lot, I get popped a lot. But I have also always popped my own back and neck. Our prof's say the it is bad for us to do it to ourselves - but then we crack each other. Somehow these two processes are different. I think they are vitually the same. We may not be able to get as many to pop when we do it ourselves, but it seems to be no different when I can get only a couple to pop on a patient.

 

[Dartos Vader]

Being in OMM class a lot, I get popped a lot. But I have also always popped my own back and neck. Our prof's say the it is bad for us to do it to ourselves - but then we crack each other. Somehow these two processes are different. I think they are vitually the same. We may not be able to get as many to pop when we do it ourselves, but it seems to be no different when I can get only a couple to pop on a patient.

the difference between popping yourself and a physician treating you is the physician diagnoses you and does specific treatment while you popping your own back isn't necessarily helping anything. And the popping noise has been researched, the thing that causes the noise is...Osteogasm. It was just a theory before, but now it's scientific fact. That's why OMM makes you sleepy.

 

[Doc Hef]

Half the docs that have treated me just pop it all, and on both sides. That may not be the norm, but that is mostly what I've experienced.

 

[obecalp]

Joint pop=osteogasm, a common occurence following osteobation.

What the... huh?
I guess I missed that Treffer lecture

 

[Ypo.]

All I know is it feels good.

 

[Drfting Sun]

Truly, half kinda beat around the bush and the rest said it was dissolved N being released - but they still didn't sound sure about it.
Anyway, I don't know about you guys, but I want to be pretty sure about what I'm doing to my patients. If I'm in surgery and the doc says "I don't know how this works... but it does!" I'm going to be a bit scared. If one of the foundations of osteopathy, OMM, doesn't have a decisive reason for it's action, then I'm quite worried about what I've been doing to my friends, classmates, and fam members. Yeah, I've seen OMM work... but do you mean to tell me that nobody really knows what is going on when it does? (Just the pop, I mean) The docs seem to kinda blow it off when I ask them, but I think that it's something pretty important.

Umm... I'm a first-year here, and I see you're a year ahead of me, but forgive me ahead of time for saying this:

The "pop" isn't the objective, and there are even times when there is *no* pop. Moving through barriers is the objective in HVLA, a passive direct form of manipulation. Thus, your statement, "If one of the foundations of osteopathy, OMM, doesn't have a decisive reason for it's action..." is an inherently-flawed logic progression; OMM, specifically HVLA, isn't founded on the "pop," rather on returning normal motion to a joint.

I am, by no means, an expert and have little "under my belt" with formal training and experience; therefore, I present with only the fundamental concepts to dispel the confusion here that the "pop" is vital to HVLA.

Now that we know that the "pop" isn't required for HVLA to work, let's address a few more points:

1) If the "pop" is so terribly an interesting issue for you, your school has extensive journals to which it subscribes, and probably a kick-booty librarian who can help you navigate. Why don't you take the time you're writing on the SDN and read the literature, find a synthesis of what you read, form a hypothesis and try to get someone to help you do research.

2) Maybe the "pop" is detrimental. Delivering babies without washing your hands after performing an autopsy wasn't connected with an increase in maternal deaths until someone observed, kept records, investigated and, on top of it, made people aware of what was going on. My point? Sitting and guessing, asking people who obviously don't know, and criticizing something you (erroneously) equate with a fundamental of OMM isn't helping anyone.

3) Maybe the "pop" is beneficial.

4) Maybe the "pop" is an anatomical adjustment.

5) Maybe the "pop" does nothing to the structure.

6) Maybe...just maybe...the literature has a definitive answer, and it hasn't propogated to the "mainstream."

7) If none of us are motivated to continue ON beyond the questions, balancing our course loads with our free/social time and throwing in a bit of inquisitive reading and synopsis, questions like these will continue to go unanswered, disputed, uncertainly-propogated to the public, etc.

 

[Doc Hef]

I just wondered if someone already had an answer to all those "maybe"s. If so, then I wouldn't have to go do the research. Since you had the time to write a mini dissertation - maybe you could take a gander on the subject and balance your free/social time (I for one have none - I sit and read all day and type occassionally for a study break). And also, I'm not saying that the "pop" is a foundation or an essential to HVLA. It is just something that happens while performing this "foundation" of osteopathy - OMM. Anyway, it sounds as though we are on the same page - we don't know why it happens - we want to know why.

 

[LovelyRita]

What the... huh?
I guess I missed that Treffer lecture

ASK TREFFER ABOUT IT!!

 

[obecalp]

ASK TREFFER ABOUT IT!!

Ummm... NO! I just figured out what your originally posted !
It took me a while, but I figured it out

jp

 

[IlliniDO]

This fact is based on speculation and theory:

Suppose one were doing a Kirksville Krunch on T6. The "Popping" noise is actually the sound of the patient's T6 vertebrae breaking the sound barrier!

 

[LovelyRita]

Ummm... NO! I just figured out what your originally posted !
It took me a while, but I figured it out

jp

I got the term osteobation from him. And Dyck. No joke. Ask them if they know what it means.

 

[obecalp]

I got the term osteobation from him. And Dyck. No joke. Ask them if they know what it means.

For real??? Ummm...Mary, I think you're just trying to get me in trouble. Either that or our whole OMM department are a bunch of dirty old men.

 

[Green912]

Copied from a non-medical site. Take it for what it's worth.

If you've ever laced your fingers together, turned your palms away from you and bent your fingers back, you know what knuckle popping sounds like. Joints produce that CRACK when bubbles burst in the fluid surrounding the joint.
Joints are the meeting points of two separate bones, held together and in place by connective tissues and ligaments. All of the joints in our bodies are surrounded by synovial fluid, a thick, clear liquid. When you stretch or bend your finger to pop the knuckle, you are causing the bones of the joint to pull apart. As they do, the connective tissue capsule that surrounds the joint is stretched. By stretching this capsule, you increase its volume. And as we know from chemistry class, with an increase in volume comes a decrease in pressure. So as the pressure of the synovial fluid drops, gases dissolved in the fluid become less soluble, forming bubbles through a process called cavitation. When the joint is stretched far enough, the pressure in the capsule drops so low that these bubbles burst, producing the pop that we associate with knuckle cracking.

It takes about 25-30 minutes for the gas to redissolve into the joint fluid. During this period of time, your knuckles will not crack. Once the gas is redissolved, cavitation is once again possible, and you can start popping your knuckles again.

As for the harms associated with this habit, according to Anatomy and Physiology Instructors' Cooperative, only one in-depth study regarding the possible detriments of knuckle popping has been published. This study, done by Raymond Brodeur and published in the Journal of Manipulative and Physiological Therapeutics, examined 300 knuckle crackers for evidence of joint damage. The results revealed no apparent connection between joint cracking and arthritis; however, habitual knuckle poppers did show signs of other types of damage, including soft tissue damage to the joint capsule and a decrease in grip strength. This damage is most likely a result of the rapid, repeated stretching of the ligaments surrounding the joint. A professional baseball pitcher experiences similar, although obviously heightened, effects in the various joints of his pitching arm. But assuming you haven't signed a multimillion dollar contract to constantly pop your knuckles, it hardly seems worth the possible risk to your joints.

On the positive side, there is evidence of increased mobility in joints right after popping. When joints are manipulated, the Golgi tendon organs (a set of nerve endings involved in humans' motion sense) are stimulated and the muscles surrounding the joint are relaxed. This is part of the reason why people can feel "loose" and invigorated after leaving the chiropractor's office, where cavitation is induced as part of the treatment. Backs, knees, elbows and all other movable joints are subject to the same kind manipulation as knuckles are.

 

[dcratamt]

Doc Hef,
You are wise to ask of the workings of HVLA especially when you see other physicians using it and they can't explain it. I assume that something tells you that this technique is a bit barbaric especially when they snap both sides of the joint. Are your teachers diagnosing the specific dysfunction before they treat and also are they diagnosing the type of restrictive barrier(fibrotic, osteoarthritic, muscle spasm, edema etc.) before using HVLA. It should be used only when matched with a chronic fibrotic end feel. Anyway I go to PCSOM and Dr. Stiles is pretty good at OMM as well as explaining it's effectiveness to MD's, insurance companies etc. I will try to get an answer from him tomorrow. In the meantime go with your gut feeling as to what is right for your pt's.

 

[Doc Hef]

Are your teachers diagnosing the specific dysfunction before they treat and also are they diagnosing the type of restrictive barrier(fibrotic, osteoarthritic, muscle spasm, edema etc.) before using HVLA. It should be used only when matched with a chronic fibrotic end feel.

My teachers diagnose, but I have never seen them address the certain type of restrictive barrier before using HVLA. We have never looked for a "chronic fibrotic end feel." I'm interested in learning more about this.

Also, thanks for asking your professor. I'm looking forward to hearing what you find out.

 

[dcratamt]

Doc Hef,
Dr. Stiles said that Phil Greenman has taken some sort of imaging of joints after HVLA and a "density" is present for about 18 secs. This density supposedly correlates to Nitrogen, as others have told you. Dr. Stiles himself believes that the pop is due to the creation of a vacuum in the synovial fluid when the thrust is performed. Anyway that is the best i could do. THe only other advice i have is that if the physician does a correct positional diagnosis(FRSL/ERSR) and is treating the area of greatest restriction for that particular pt. then there should be no need to regularly "crack" both sides of a joint. And as I said before HVLA should be performed when a simple chronic fibrotic endfeel is found, not just whenever the Doc feels like it. The operator should also get a physiological lock(muscle, fascial lock) using type III spinal mechanics. Find "feather edge" of restrictive barrier) A bony anatomical lock is not recommended as ligaments and other structures can be damaged. In closing I would like to point out that I don't think we perform HVLA in the cervical spine at all so use your judgment. HVLA should be able to be performed gently if performed correctly. Hope this helps and I don't come off as being a know it all. Just trying to share the knowledge I have acquired because I think if taught properly many more people would use and see the relevance of OMM, and we would achieve better clinical results. Later.
Dennis

 

[Doc Hef]

In closing I would like to point out that I don't think we perform HVLA in the cervical spine at all so use your judgment.

Thanks so much for checking this out. A lot to think about. I would like to read more into this study that was done by Phil Greenman. Know where I could find the info? Also, you said that you dont do cervical HVLA? So you guys don't learn it at all? We were taught cervical HVLA during 2nd sem 1st yr. And we review it repeatedly now. Why does your school not do cervical HVLA? thanks

 

[DOnut]

Joint pop=osteogasm, a common occurence following osteobation.

That's pretty damn funny "POP" OK I'm done.

 

[DOrk]

I'm not sure what the pop is either.....Somebody should do a study and publish it in the JAOA....It will probably be the most substantive study published in that journal in years

 

[Doc Hef]

I'm not sure what the pop is either.....Somebody should do a study and publish it in the JAOA....It will probably be the most substantive study published in that journal in years

yeah really Although I do wonder if studies have already been done, but they just didn't really like what they found...

 

[dcratamt]

Thanks so much for checking this out. A lot to think about. I would like to read more into this study that was done by Phil Greenman. Know where I could find the info? Also, you said that you dont do cervical HVLA? So you guys don't learn it at all? We were taught cervical HVLA during 2nd sem 1st yr. And we review it repeatedly now. Why does your school not do cervical HVLA? thanks

I believe that we don't perform HVLA to the cervical spine because of the risk of injuring the vertebral artery; especially in pts. with other disease factors. We only use functional, muscle energy, myofascial release or strain/counterstrain in c-spine. As for Dr. Greenman's study I don't know where to find it. You could try his book Principles of Manual Medicine. Your school probably carries it.

 

[Doc Hef]

I find it kind of frustrating that there are so many conflicting points of view in manipulation. I know that there will always be many conflicts in all areas of medicine, but when it comes to manipulation - one of the foundations of osteopathy - there are just so many different opinions out there. Our professors tell us that you have a better chance hurting your neck by looking back at someone who just called your name than you do during cervical HVLA. Then your school says that there is a risk of injuring the vertebral artery with cerv HVLA. I just wish that this were truly looked into before it became such a widespread practice of OMM. I'll have to look into Dr. Greenman's book. He sounds like one of the few who, like us, cares about whether or not what he's performing on patients is good for them or not.

 

[dcratamt]

I find it kind of frustrating that there are so many conflicting points of view in manipulation. I know that there will always be many conflicts in all areas of medicine, but when it comes to manipulation - one of the foundations of osteopathy - there are just so many different opinions out there. Our professors tell us that you have a better chance hurting your neck by looking back at someone who just called your name than you do during cervical HVLA. Then your school says that there is a risk of injuring the vertebral artery with cerv HVLA. I just wish that this were truly looked into before it became such a widespread practice of OMM. I'll have to look into Dr. Greenman's book. He sounds like one of the few who, like us, cares about whether or not what he's performing on patients is good for them or not.

I know what you mean. The only thing that i can say is that i came to Pikeville because Dr.Stiles was here and I agree with how he says OMM should be performed and when it should be performed. Dr. Stiles has used OMM in the hospital setting and is very much a "physician." He knows when surgery and medicine are needed and has prescribed them often. That said, he is also very good at knowing when to use OMM and where. I am a P.T. and his concepts make good anatomical and physiological sense. As far as HVLA in the c-spine goes I believe that more gentle techniques should be utilized due to the anatomy in this area; especially in older pts. and pts. with atherosclerotic disease and small vessel disease. It may be true that there is little chance of injury, but I also know that it may happen more than people think because it is hard to prove that a stroke or other vascular compromise has been caused by manipulation. Many Chiropractors perform this manipulation all the time, and they are not being closed down due to killing thousands of people each year. That being said however, I have heard stories of people's cervical spines being injured with high velocity. These stories coupled with my knowledge of anatomy (I know that the vertebral artery is vulnerable in the transverse foramen of the c-spine especially with the degree of rotation between atlas and axis.) In the future I will probably use OMM in the hospital setting. I will likely deal with many older folks and others with serious vascular problems. I do not want to be performing a technique that has even a remote chance of being dangerous. I would have a difficult time justifying this technique to my colleagues and pt's when in my own mind i feel that it could have adverse side effects. Sorry to ramble, but in closing I guess i have never felt that cracking and popping the joints with HVLA is a good thing, so when I found a very successful D.O. that agreed with my gut feeling, then it seems like the right stance from a personal and an anatomical view. Also something to think about.....Dr. Stiles performs a gentler form of HVLA and if he still will not use these techniques in the cervical spine then it scares me as to what some people are doing with these bony locks and big pops in the c-spine. Hope this helps a bit. Later.

 

[phd2b]

Dennis,

We do learn cervical HVLA at PCSOM. We don't practice it for C1-C2, however. The 'pop' is typically the sound of opening joints (like facets), and probably not closing them (biomechanically). I agree with what you said about the nitrogen-transient gaseous theory, though I'll have to check my notes about timing (I believe that the experiements were confirmed via radiography and therefore 18 minutes sounds a little more realistic than 18 seconds). Also, many times the 'pop' is the sound of the hypermobile joint moving, which is typically not the one we want to treat (which of course, is the reason that we take such care in proper positioning before attempting HVLA in the first place).

HVLA has its place in the 'toolbelt' of OMT, of course, but at PCSOM we're taught that it is not the first tool of choice (except for simple fibrotic processes, of course). I guess if you only had a hammer in your toolbelt, everything starts looking like a nail!

Your mileage may vary...

I know what you mean. The only thing that i can say is that i came to Pikeville because Dr.Stiles was here and I agree with how he says OMM should be performed and when it should be performed. Dr. Stiles has used OMM in the hospital setting and is very much a "physician." He knows when surgery and medicine are needed and has prescribed them often. That said, he is also very good at knowing when to use OMM and where. I am a P.T. and his concepts make good anatomical and physiological sense. As far as HVLA in the c-spine goes I believe that more gentle techniques should be utilized due to the anatomy in this area; especially in older pts. and pts. with atherosclerotic disease and small vessel disease. It may be true that there is little chance of injury, but I also know that it may happen more than people think because it is hard to prove that a stroke or other vascular compromise has been caused by manipulation. Many Chiropractors perform this manipulation all the time, and they are not being closed down due to killing thousands of people each year. That being said however, I have heard stories of people's cervical spines being injured with high velocity. These stories coupled with my knowledge of anatomy (I know that the vertebral artery is vulnerable in the transverse foramen of the c-spine especially with the degree of rotation between atlas and axis.) In the future I will probably use OMM in the hospital setting. I will likely deal with many older folks and others with serious vascular problems. I do not want to be performing a technique that has even a remote chance of being dangerous. I would have a difficult time justifying this technique to my colleagues and pt's when in my own mind i feel that it could have adverse side effects. Sorry to ramble, but in closing I guess i have never felt that cracking and popping the joints with HVLA is a good thing, so when I found a very successful D.O. that agreed with my gut feeling, then it seems like the right stance from a personal and an anatomical view. Also something to think about.....Dr. Stiles performs a gentler form of HVLA and if he still will not use these techniques in the cervical spine then it scares me as to what some people are doing with these bony locks and big pops in the c-spine. Hope this helps a bit. Later.

 

[Doc Hef]

HVLA has its place in the 'toolbelt' of OMT, of course, but at PCSOM we're taught that it is not the first tool of choice (except for simple fibrotic processes, of course). I guess if you only had a hammer in your toolbelt, everything starts looking like a nail!

Wow, that sure is the truth. I've seen many who have lots of tools, but just use the "hammer" a lot b/c it's the easiest and fastest.

 

[dcratamt]

Thanks for the correction Phd2b. That makes sense with C1-C2. By the way it is 18 mins for the nitrogen thing. Its' in Greenman's book. Later.

 

[DOtobe]

Joint pop=osteogasm, a common occurence following osteobation.

For some reason, I just noticed this response and laughed my head off at it

I miss having HVLA done on my neck (it's always out of whack). I haven't had an osteogasm in a long time

 

[Insert]

I have a question about HVLA on the cervical spine. Is it possible to actually move the cervical vertebrae into misalignment by an incorrect diagnosis of the C vertebrae? By that I mean you do the HVLA on the cervical spine but it messes up the neck more by misaligning the vertebrae. Is that possible?

I'm also wondering how much movement you get from the vertebrae when doing HVLA.

 

[DOSouthpaw]

Not really. While Chiros will say things are out of place, the vertebra are actually restricted by tight inerossi muscles or fascia from going through their normal range of motion. If something is truely subluxated in the C-spine, you're looking at having a cord problem very soon.

I guess if you took the neck into its anatomical barrier and thrust, then yes you could misalign the c-spine, but then the lawyers would be calling.

If you put too much force into the thrust, then you could cause trauma to the tissue which could further restrict motion.

In most situations, if you misdiagnose a c-spine lesion, you're not going to get a good physiological lock when you go to treat it. So you're just going to be thrusting into a nice springy barrier which should lead you to the conclusion that you have done something wrong and you should recheck your diagnosis.

Hope that helps!

 

[coreyw]

Not really. While Chiros will say things are out of place, the vertebra are actually restricted by tight inerossi muscles or fascia from going through their normal range of motion. If something is truely subluxated in the C-spine, you're looking at having a cord problem very soon.

I guess if you took the neck into its anatomical barrier and thrust, then yes you could misalign the c-spine, but then the lawyers would be calling.

If you put too much force into the thrust, then you could cause trauma to the tissue which could further restrict motion.

In most situations, if you misdiagnose a c-spine lesion, you're not going to get a good physiological lock when you go to treat it. So you're just going to be thrusting into a nice springy barrier which should lead you to the conclusion that you have done something wrong and you should recheck your diagnosis.

Hope that helps!

The term 'misalignment' also misses the important point that joint dysfunction is dynamic, not static. It's not so much that the vertebrae aren't misaligned, it's more that the word just doesn't accurately describe what's going on.

IMHO The notion that the practitioner is 're-aligning' the vertebrae also gives rise to over-reliance (by chiropractors especially) on the HVLA technique in treatment prescriptions. The fact is that every human spine will, at some point or other and to some degree, harbour joint dysfunction. It's a by-product of being human and alive.

Whether that dysfunction leads to discomfort, pain, lowered quality of life, or even leads to dysfunction in other body systems, and hence the role of manual medicine in treating or co-treating those conditions - these are the key questions.

In this sense, it is less important to fixate (if you'll pardon the pun!) on joint dysfunction itself than on its consequences. No matter how large the army of spinal manipulative therapists, of whatever stripe, we will never (as a chiropractor once remarked to me) "rid the world of subluxations." (In much the same way, not all microbes are pathogenic and not all people respond the same way to a particular bug.)

Someone once said that if you wake up in the morning and find that you feel no pain or discomfort whatsoever, you can be quite sure that you're dead.

 

[DOSouthpaw]

I never said that the spine that is lesioned by somatic dysfunction is misaligned, I said that if one were to thrust into the anatomical barrier, then the spine would become misaligned because you have already went past the joint capsule and are thrusting bone on bone. This would cause boney damage (a real subluxation), fracture, and possible cord damage.

With somatic dysfunction you get restriction in ROM and facilitation of the cord.

 

[coreyw]

I never said that the spine that is lesioned by somatic dysfunction is misaligned, I said that if one were to thrust into the anatomical barrier, then the spine would become misaligned because you have already went past the joint capsule and are thrusting bone on bone. This would cause boney damage (a real subluxation), fracture, and possible cord damage.

With somatic dysfunction you get restriction in ROM and facilitation of the cord.

I wasn't disagreeing with you.

 

[Chisel]

Just some food for thought............

I too agree that Somatic Dysfunction is inherent in everyone. It is the presence of recurring SD that allows Chiropractors to see their patients every few weeks for an adjustment.

But if Somatic Dysfunction is present in everyone, then does that not make it functional and not "dysfunctional".

I am not trying to start an argument, but rather to get some other MS's opinion on this matter.

Chisel
PCOM 2006

 

[Doc Hef]

Hmmm... very good point. But I wouldn't take it too far. Dysfunction just means bad function. Regular Function in humans is what we do normally. So dysfunction cannot = function. If you eat too many twinkies everyday - you end up getting fat. Getting fat is bad function corrected by exercise and no twinkies. Everyday dysfunction can be from everyday insults to our body - corrected by omm. But without the insults - no dysfunction - no need for omm. I don't know if I made any sense... Good point though, Chisel.

 

[BrooklynDO]

also, not all somatic dysfunctions need be treated. Most are going to be a physiological compensatory pattern. IF your patient presents with complaints that seem to involve a specific dysfunction, either directly or through a facilitation/reflex etc, THEN you treat it.

Someone on here also said or suggested that we shouldnt use treatment modalities for which we do not know the exact mechanism (usually because there are two or three theories being brought forward)... One should keep in mind that not a few of the drugs we perscribe actually list "unknown mechanism" under the mechanism of action section of the big bad pharm book. So just keep that in mind when talking about OMM... somehow I seem to see that people think that OMM needs to offer more evidence for itself then pharmacotherapy does...

 

[Ypo.]

also, not all somatic dysfunctions need be treated. Most are going to be a physiological compensatory pattern. IF your patient presents with complaints that seem to involve a specific dysfunction, either directly or through a facilitation/reflex etc, THEN you treat it.

Someone on here also said or suggested that we shouldnt use treatment modalities for which we do not know the exact mechanism (usually because there are two or three theories being brought forward)... One should keep in mind that not a few of the drugs we perscribe actually list "unknown mechanism" under the mechanism of action section of the big bad pharm book. So just keep that in mind when talking about OMM... somehow I seem to see that people think that OMM needs to offer more evidence for itself then pharmacotherapy does...

This is a point I have brought up before. In fact one way the pharmaceutical companies get around testing by the FDA is to market/promote their "off-label" drugs-ie. promote its use in a way that has not been tested, such as prescribing neurontin (a supplemental anti-convulsant for epilectics) for bipolar disorder. It is illegal for drug companies to actively promote such "off-label" medications, but most of them do so behind the scenes anyway, since its much easier to do this than to undergo FDA tests.

 

[DrOctagon]

It takes about 25-30 minutes for the gas to redissolve into the joint fluid. During this period of time, your knuckles will not crack. Once the gas is redissolved, cavitation is once again possible, and you can start popping your knuckles again.

im pretty sure this isnt true. i for one, am able to crack my ankles on command. im sure most of u are familar with this. (remember back in high school when u try to quietly sneak into the house while ur parents are sleeping but as u walk up the stairs, ur joints in your ankle keeps on cracking with each step). or maybe it was just my messed up feet.

im sleepy.