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Talk:Spinal manipulation

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Redirect for lack of a proper article

The redirect takes one to the chiropractic concept of Spinal adjustment, which is not exactly the same as spinal manipulation. The intent is very different. A separate article for scientifically justified Spinal manipulation is needed. MDs and PTs do not manipulate for the purpose of removing non-existent chiropractic vertebral subluxations, which is the chiropractic justification for using "adjustments." -- Fyslee 05:27, 23 August 2006 (UTC)

From Manipulation article

In the context of joints, manipulation is the skilled passive movement of a joint that is applied at varying speeds and amplitudes, including a small-amplitude/high velocity therapeutic movement or thrust. It can also refer to the process of bringing fragments of fractured bone or displaced joints into normal anatomical alignment (otherwise known as 'setting' the bone).

Manipulation does not imply specificity or the correction of the chiropractic subluxation, and therefore is not entirely synonymous with the chiropractic adjustment. -- Fyslee 20:31, 3 September 2006 (UTC)

POV issues

There are big issues in this article, most notably the recent dominant inclusions from Edzard Ernst who is not a specialist or expert in manipulation/chiropractic and the overall bad tone of the safety section, POV issues with attribution to chiropractic "strokes" when DCs were not involved as well as the underreporting which is challenged in physical med journals. Furthermore, there are major omissions in recent papers which have studied the stroke issue in depth by experts in SMT and stroke. CorticoSpinal (talk) 23:13, 25 April 2008 (UTC)

We disagree as to what the POV problems are. That's OK. What's not OK is your unsourced assertion that 90% of spinal manipulations are performed by chiropractors, even if you restrict yourself to manipulations in which the practitioner is trained. — Arthur Rubin (talk) 04:01, 26 April 2008 (UTC)
Before we begin, I just want to confirm that you're really the Arthur Rubin, mathematician extraordinaire, right? Good, now we've noted that, I would like to remind of you of a little something, I urge you to look at the scope of the article. Do you see that medical stub there? Well, that falls under my domain, my expetise. My expertise is chiropractic medicine and spinal manipulation is the characteristic treatment. Admin Baegis had some very good advice which he opined "If you struggled with passing calculus, don't go mucking about with the taylor series article.". That's some good advice, methinks.
So, here is the source you wanted, (there are more) and it is considered the authoritative source whose chapter on SMT alone would be extremely beneficial to include with the plethora of research into the neurophysiologal responses and proposed theories too. After all, chiropractors are the expert providers of spinal adjustment, manipulation and manual therapy. There are also tons more to add to the article from a scientific, cultural and historical POV whilst also addressing some severely biased POV issues. Here's another: Can you please explain to me rationally why this section here on further reading consists of texts from 2 MDs, 5 PTs, and 0 DCs. Because that seems rather odd when you factor than 90% of spinal manipulations are performed by DCs. Looking forward to working with you. CorticoSpinal (talk) 07:15, 26 April 2008 (UTC)
In the absence of evidence to the contrary, that seems a valid source for the statement, but please include the source. However, only (some) chiropractors understand the difference (if any) between spinal manipulation and chiropractic adjustment, so that it is still not the case that the chiropractic POV should dominate this article. Please do not add unsourced statements, but you probably should add more reading material. As an aside, you seem to be suggesting that this article is a POV fork of chiropractic adjustment, and should be merged into that article. I'm not sure I agree with that suggestion, but it seems to be what you are suggesting. — Arthur Rubin (talk) 15:00, 26 April 2008 (UTC)
I think you may be confused, or misinformed, Mr. Rubin. The chiropractic scientists who are publishing the texts are quite clear that SMT is interchangeable with adjustment and this is the position of the majority of the profession. I think you may be referring to the minority position amongst "ultra-straights" who may still carry some metaphysical interpretations; but this is the fringe position within the profession. I also never suggested that chiropractic POV should dominate the article; but they are the experts in manipulation. The article will be scientific; it's a medical procedure (it falls under the wikiproject medicine scope) and I shall bring it up to snuff so that it can become, in time, a FA. CorticoSpinal (talk) 18:17, 26 April 2008 (UTC)
Your editing style looks familiar. Have I worked with you before under another name?
In any case, as you assert that chiropractic adjustment and spinal manipulation are the same topic, you should be supporting merging the articles, before doing serious work updating one or the other.
You haven't said that the chiropractic point of view should dominate the article, but you've said that the scientific point of view should dominate (oddly enough, I disagree — most of the medical discussion of spinal manipulation is not scientific), and that the relevant scientists are chiropractors.
— Arthur Rubin (talk) 18:44, 26 April 2008 (UTC)
To be clear; you disagree the spinal manipulation is a medical procedure that does not have much scientific evidence? What exactly are you disputing here so we can iron out issues before I begin to bring the article up to wikipedia's project medicine standards? Thanks in advance. CorticoSpinal (talk) 19:50, 29 April 2008 (UTC)
Is that a double negative or a triple negative? In any case, I believe that it is not the case that spinal manipulation is a medical procedure which has scientific evidence. Because of disputes originated by chiropractors, it's not clear whether spinal manipulation is the same as chiropractic adjustment, and whether anyone can reliably distinguish between the two without knowing the intent of the practitioner. — Arthur Rubin (talk) 22:31, 29 April 2008 (UTC)

Hi Guys, if I may. It is widely regarded that chiropractors perform approx 90% of manipulations in the US, but not in the world. In fact, in the UK, the majority of manipulations are performed by osteopaths, who outnumber chiropractors by approx 2:1. As WP is a global source of information, I think it would be wise to note the limitations of the 90% statement (specifically that it relates only to the US). By the same token, spinal manipulation is the generic term for the intervention applied by chiropractors, osteopaths, and physiotherapists/physical therapists, etc. If the chiropractic profession insist on claiming that the term 'adjustment' includes other non-manipulation interventions *as they often appear to), then I would be very much against an article merge.Davwillev (talk) 15:29, 30 April 2008 (UTC) BTW, if we are being strict with sources here, we need a better source than a textbook for the 90% claim. This is secondary referencing unless the original piece of research is cited.Davwillev (talk) 15:58, 30 April 2008 (UTC)

I have no problem with changing to North America. The same situation applies in Canada where DCs do 90% of the manips. As for secondary sources, according to a strict interpretation of WP:MEDRS these are preferred; but if you want an actual paper, it's easy enough to fetch. I support the merger of spinal adjustment and manipulation; adjustment (as interpreted by the STRAIGHT DCs) is a subset of spinal manipulation, whereas the MIXERS view it essentially as synonymous with SMT. Waaaaaaaaay too much is being made behind of the 1910's philo of adjustment which is tenuously being guarded by the extreme fringe within the chiropractic profession. It's time to reflect the contemporary POV of manips (by the mainstream of DCs) It seems like people's beliefs system around here could use an adjustment! —Preceding unsigned comment added by CorticoSpinal (talk • contribs) 19:24, May 4, 2008
I've got a problem with that. It still seems improbable to me, and it's not sourced. As for an adjustment of your attitude, as you have been sanctioned for POV edits under another name, the mainstream scientific or medical point of view is what should be used, not the "mainstream" chiropractic point of view. As far as I can tell, the mainstream medical point of view on spinal manipulation is that it is frequently called chiropractic adjustment, but that no one, not even practicing chiropractors, can define the difference. — Arthur Rubin (talk) 17:42, 4 May 2008 (UTC)

Establishing context in the lead

People will be confused, as I was, if they read the lead of this article and there is no reference to chiropracty. There's a lengthy debate above over whether this should be merged into chiropractic adjustment. Clearly we should note chiropractic adjustment in the lead. II | (t - c) 22:45, 23 July 2008 (UTC)

Firstly, there are more professional groups than just chiropractic (please note proper term) that perform spinal manipulation, and have contributed to the research base on the subject. These include osteopaths, osteopathic physicians, and physical therapists. There is adequate provision to describe this usage in the section called 'Current Providers'. Furthermore, the 'Chiropractic' article clearly refers to this one. If we start referring to individual professional groups in the lead, then we would need to refer to the others - this would not be useful. I am therefore re-deleting your (ImperfectlyInformed) edits, and hope you don't persist with them.Davwillev (talk) 18:51, 24 July 2008 (UTC)

== WP:WEIGHT Safety, proposal to merge Spinal adjustment with Spinal manipulation ==

There is an eggregious amount of text dedicated to the safety of SMT with a lot of puffery, quotes and outdated studies. It can be more concise. Also, Spinal adjustment can be incorporated into this article with a a sub-section dedicates to the differences between 'adjustment' and 'manipulation' if any. As per WP:MEDRS, high quality research is required, not merely conjecture! Soyuz113 (talk) 19:08, 6 September 2008 (UTC)

Soyuz113 has "been blocked indefinitely from editing in accordance with Misplaced Pages's blocking policy for sockpuppetry, edit warring, disruption and block evasion." I have stricken his remarks, as striking or removal is customary in such situations. -- Fyslee / talk 06:16, 8 September 2008 (UTC)

Assendelft et al Cochrane Review

I have added a reference at Spinal manipulative therapy with a Cochrane Review by Assendelft et al "Spinal manipulative therapy for low-back pain". Could it contribute to this article too? If so, perhaps an active editor here could find the right place to add it.--papageno (talk) 19:48, 19 March 2009 (UTC)

NCCAM on SM

Spinal Manipulation for Low-Back Pain: What the Science Says. May 2012

Brangifer (talk) 15:21, 15 May 2012 (UTC)

Is Spinal Manipulation for Neck Pain Safe?

Here's something for the safety section. While some of this isn't MEDRS compliant for medical facts, it does refer to such sources, as well as documenting the controversy and public debate:

The UK National Health Service considers the debate notable enough to weigh in on the discussion with an analysis of the debate and some advice for the public:

They provided these links for further information:

Links to the headlines
Links to the science

Brangifer (talk) 14:18, 9 June 2012 (UTC)

Orphaned references in Spinal manipulation

I check pages listed in Category:Pages with incorrect ref formatting to try to fix reference errors. One of the things I do is look for content for orphaned references in wikilinked articles. I have found content for some of Spinal manipulation's orphans, the problem is that I found more than one version. I can't determine which (if any) is correct for this article, so I am asking for a sentient editor to look it over and copy the correct ref content into this article.

Reference named "NBCE_techniques":

Reference named "WHO-guidelines":

I apologize if any of the above are effectively identical; I am just a simple computer program, so I can't determine whether minor differences are significant or not. AnomieBOT⚡ 19:37, 3 February 2013 (UTC)

Something is missing...

Over the past year, glowing descriptions of the history of spinal manipulation have been added, but the definition has been lost. In addition, it has transformed from a general description of spinal manipulation to one about spinal manipulation in the context of chiropractic. The present article probably should be redirected to chiropractic, or comments about spinal manipulation as not seen in the context of chiropractic are restored. — Arthur Rubin (talk) 17:27, 17 February 2013 (UTC)

We can't do a re-direct because osteopaths and physical therapists also perform SM. This is the 'generic' page for SM so that it is inclusive all of type, techniques of spinal manipulation. It's also extremely hard to omit chiropractic from the SM entirely since they are the dominant provider of SM services. I can add the specific biomechanical characteristics (i.e. HVLA thrust). DVMt (talk) 17:40, 17 February 2013 (UTC)
I have done a few edits to address your concerns, specifically in the lead and generalizing chiro stuff to simply 'manual and manipulative therapy'. DVMt (talk) 17:51, 17 February 2013 (UTC)


Changes

These changes are more or less the ones made to the article on Chiropractic which have been rejected. As there are attempts to put the exact same content in both places we need to look at the issue of one page being a bit of a co tract of the other. Also seems like a lot of the discussion around safety disappeared in these edits. Doc James (talk · contribs · email) (if I write on your page reply on mine) 02:25, 23 February 2013 (UTC)

Safety clearly appears in the article. Per WP:BRD, please discuss what specific issues you prior to deleting secondary sources. DVMt (talk) 15:02, 23 February 2013 (UTC)
Edit update: As seen here safety is clearly covered. Also, please note that SMT≠Chiropractic. DVMt (talk) 15:06, 23 February 2013 (UTC)
Per WP:BRD I shall revert again. There is no consensus for your overly optimistic version. Doc James (talk · contribs · email) (if I write on your page reply on mine) 19:45, 23 February 2013 (UTC)
That's BRRD Doc. Overly optimistic? You have white-washed the whole article and deleted 24 additional references. This brings the total of deleted references of manual and manipulative therapy to over 100. Yes, you read that correctly. These reckless edits without any discussion when I asked you to list your grievances and you say "overly optimistic". This is suppression of evidence Doc James. It's not going to go unchallenged. There is no consensus for "your" preferred version. In fact you are edit warring (as an admin no less) but I shall be the bigger person and talk it through. DVMt (talk) 21:08, 23 February 2013 (UTC)
I look forwards to seeing the RfC you put together. Continuing to insulting others and the recent review articles that disagree with your personal position is not going to change much. Doc James (talk · contribs · email) (if I write on your page reply on mine) 21:22, 23 February 2013 (UTC)
Again, not addressing my primary concern which is the deletion of 100 research papers including dozens of systematic reviews, all written from 2005-2013) have disappeared in your editing at chiropractic, vertebral subluxation and spinal manipulative therapy. We can say you've made your point quite clear. Suppression of evidence regarding manual and manipulative therapies. My position is one of science and not relying on fringe, outlier papers on manipulative therapy that directly disagree with the Cochrane reviews. This is another point you have failed to address. Please address these concerns in your next post. DVMt (talk) 21:39, 23 February 2013 (UTC)
Look in the nicest terms possible there appears to be a lot of misinterpretation and selective usage of the literature in the edits I reverted. We seem to be using a different number system and talking a different language per Talk:Chiropractic. Create a RfC and get consensus. If you can convince the community that your edits are an improvement they will stick otherwise they will not. Continuing to call all the systematic reviews which disagree with you fringe will get you no were. Doc James (talk · contribs · email) (if I write on your page reply on mine) 21:47, 23 February 2013 (UTC)
I'm not opposed to the inclusion of specifically Ernst and Pozakski papers despite the fact that the Cochrane reviews completely disagrees with them. We agreed on this 2 weeks ago. The point is, you requested 5 specific papers be included (which is in the draft proposal) but you deleted 100 sources to do so. That's not right. DVMt (talk) 22:06, 23 February 2013 (UTC)
"we agreed" did we? can you provide a link. Doc James (talk · contribs · email) (if I write on your page reply on mine) 23:01, 23 February 2013 (UTC)
Yep. See chiropractic talk. This is minor however. I will ask you again why you deleted 100 sources to get 5 in? DVMt (talk) 23:46, 23 February 2013 (UTC)
So no link than. Not really anything more to say. Doc James (talk · contribs · email) (if I write on your page reply on mine) 00:02, 24 February 2013 (UTC)
You can comb through the links. Again, for the 4th time, and this is getting quite tendentious, why did you delete over 100 sources regarding basic sciences of spinal manipulation and joint dysfunction? You also deleted papers that relate to research pertaining specifically to spinal manipulation, chiropractic and joint dysfunction. DVMt (talk) 00:25, 24 February 2013 (UTC)
There is a misleading edit summary here which states the removal of 'promotional' material which is 23 additional citations on the generic topic of SMT that were WP:MEDRS compliant. Then there was this massive import here from Chiropractic inserts chiropractic specific material into the general spinal manipulation category. Why is Doc James trying to white-wash the spinal manipulation article with clear violations of point with respect to safety leading to problems with WP:UNDUE, WP:NPOV etc.

RfC Effectiveness of SMT for LBP

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Proposed wording:

"Scientific consensus suggests manual and manipulative therapies are equivalent to interventions such as standard medical care, exercise therapy or physiotherapy for LBP ." — Preceding unsigned comment added by DVMt (talk • contribs) 20:27, 24 February 2013‎

Evidence against SMT as a therapeutic intervention for LBP

  • SMT is not effective for LBP and it is a placebo. Authors: 2. Edzard Ernst, Paul Posadzki.
  • Journals: New Zealand Journal of Medicine (IF 0.6-0.7) and Pain Medicine (IF 2.346).
  1. This source written by Posadzki P, Ernst E. say "Collectively these data fail to demonstrate convincingly that spinal manipulation is an effective intervention for any condition."
  2. This source, also by Posadzki P. states "Collectively, these data fail to demonstrate that spinal manipulation is an effective intervention for pain management."

Represents the minority/outlier viewpoint. — Preceding unsigned comment added by DVMt (talk • contribs) 20:27, 24 February 2013‎

Evidence for SMT as a therapeutic intervention for LBP

  • SMT is equivalent to standard medical care, exercise therapy and physiotherapy, for LBP. Authors: 41. Rubenstein et al.
  • Journals cited: Spine (IF 3.290), Cochrane review (IF 5.715), Annals of Internal Medicine (IF 16.7), Journal of Electromyography and Kinesiology (IF 1.969), European Spine Journal (IF 1.96), Clinical Orthopaedics and Related Research (IF 2.533).
  1. This cochrane source "High quality evidence suggests that there is no clinically relevant difference between SMT and other interventions...in patients with chronic low-back pain." and the plain language summary expands to say: "...spine manipulation appears to be as effective as other common therapies prescribed for chronic low-back pain, such as, exercise therapy, standard medical care or physiotherapy."
  2. This secondary source concludes that spine manipulation achieves "equivalent or superior improvement in pain and function when compared with other commonly used interventions, such as physical modalities, medication, education, or exercise, for short, intermediate, and long-term follow-up."
  3. This cochrane review concludes "Combined chiropractic interventions slightly improved pain and disability in the short-term and pain in the medium-term for acute and subacute LBP. However, there is currently no evidence that supports or refutes that these interventions provide a clinically meaningful difference for pain or disability in people with LBP when compared to other interventions."
  4. This cochrane review cautiously concludes "SMT is no more effective in participants with acute low-back pain than inert interventions, sham SMT, or when added to another intervention. SMT also appears to be no better than other recommended therapies. Our evaluation is limited by the small number of studies per comparison, outcome, and time interval."
  5. This secondary source concludes "Therapies with good evidence of moderate efficacy for chronic or subacute low back pain are cognitive-behavioral therapy, exercise, spinal manipulation, and interdisciplinary rehabilitation."
  6. This secondary source found that manipulation is similar in effe to medical care with exercise.
  7. This 2012 systematic review supports the use of SMT in clinical practice as a cost-effective treatment when used alone or in combination with other treatment approaches.
  8. Combining spinal manipulative therapy with other interventions (multi-modal) are more beneficial than unimodal therapeutic approaches.
  9. There is evidence supporting the cost-effectiveness of the guideline-endorsed treatments of interdisciplinary rehabilitation, exercise, acupuncture, spinal manipulation and cognitive-behavioural therapy for sub-acute or chronic LBP.
  10. . Studies of nonoperative treatments demonstrated greater value for graded activity over physical therapy and pain management; spinal manipulation over exercise; behavioral therapy and physiotherapy over advice; and acupuncture and exercise over usual general practitioner care.
  11. Therapies with good evidence of moderate efficacy for chronic or subacute low back pain are cognitive-behavioral therapy, exercise, spinal manipulation, and interdisciplinary rehabilitation. From the American College of Physicians.

Represents the mainstream, majority viewpoint. Note the interdisciplinary consensus with 39 of 41 authors agreeing with a common , mainstream, majority viewpoint. — Preceding unsigned comment added by DVMt (talk • contribs) 20:27, 24 February 2013‎

Comments

  • I find it hard to believe that this is an exhaustive literature search, and not some cherry picked list of sources. People coming to this RfC should note that User:DVMt who opened this discussion is a WP:SPA (See http://wikidashboard.appspot.com/enwiki/User:DVMt ) to promote Chiropractic as not pseudoscience but mainstream medicine, and he also has a WP:COI being a chiropractor himself. What exactly is the proposed language for this RfC to consider? And what exactly is the dispute? RFC is a process for resolving something that normally can't be resolved via normal discourse and consensus in the article's talk space. — raekyt 21:10, 24 February 2013 (UTC)
First problem I have is "scientific consensus" there clearly isn't a consensus if there's reliable sources that are arguing against, and multiple of them. How is source #4 support your argument when it says SMT is no more effective than sham SMT, it's saying it's placebo effect at best. — raekyt 21:14, 24 February 2013 (UTC)
If you are concerned about the thoroughness of the list of secondary sources, feel free to suggest additions to the list. Otherwise please discuss proposed edits, and not editors. Source 4 still says no different from other therapies (i.e. standard medical care, exercise therapy or physiotherapy). DVMt (talk) 21:29, 24 February 2013 (UTC)
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