Monthly Archives: January 2014


An interesting post with some useful links at the end for those interested in the physiological effects of manual therapy. Dare you listen, via the link, to find out how the Piddingtons were able to do their trick…?

Keith's Korner

I recently listened to a segment of Radiolab, titled, ‘You Are The Judge.” It featured the story of Sydney and Lelsy Piddington. Apparently, they were a big deal on British radio 60 years ago.

The Piddingtons purported to be mentalists: he would be on stage somewhere in front of a live audience while she was somewhere else altogther. A call would be placed to Lesley by an operator and she would read Syndey’s mind. You will need to listen to the podcast to appreciate the drama and mystery of their trick.

It was produced incredibly well and there are 2 episodes of their show that have survived. In one episode, Sydney was able silently convey to his wife the full line of text of a book randomly selected by an audience member from a pile of random books on stage – while she was in a building miles…

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Neck Pain Best Practice: Treatment-Based Classification

Nice summary of the evidence for treatment-based classification for neck pain. While promising, the jury is still out on clinical prediction rules for low back pain
and there’s even less evidence for neck pain. More validation required.

Orthopedic Manual Physical Therapy

The following is another article written for the online, video-based physical therapy continuing education company MedBridge Education

Among one of the most common musculoskeletal complaints, neck pain has been estimated to effect between 22% and 77% of individuals in their lifetime according to the Neck Pain Clinical Practice Guidelines published by Childs et al. While this pain is typically self-limiting and resolves with time, Bovim et al found that 30% of patients reporting neck pain will ultimately develop chronic symptoms of greater than 6 months in duration. In addition to this study, researchers also found that between 37% (Cote et al) and 44% (Hurwitz et al) of those who experience neck pain will report lingering symptoms for at least 12 months. Unfortunately, even after successful treatment, there has been a reported recurrence rate of 50-85% within the first 1-5 years following resolution of symptoms (Halderman…

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Is spinal manipulation associated with changes in cervical inter-vertebral motion? @bournemouthuni

I will be answering this question (as best as I can!) in my presentation at the 6th PGR Conference at Bournemouth University. I’ve been researching the association between spinal manipulation for neck pain and changes in cervical inter-vertebral motion (and the relationship with patient improvement) for the last three years for my PhD. This is my first opportunity to share the results at a conference with my peers. My presentation is on Thursday 23rd January 2014 (10.10am) if you can make it – please come along! Click here to book a space and here’s the programme: BU PGR Conference Programme 2014. See you there!

Leonardo da Vinci c.1515

Leonardo da Vinci c.1515

In Pursuit of Understanding, Pt. 6

A thoughtful argument on why we ought to be humble in attributing patient improvement only to our intervention; it’s more complicated (or should that be complex?), than that…

Keith's Korner

A Closing Note to the Clinician:

I get it. We went to school to look at a patient as a complicated system. We were taught to find something that is wrong and to fix/change it; the patient will feel better as a result. But we have to know better now. It is time to stop thinking about the patient as a complicated machine some of the time and a complex system – with variables beyond our control – only when it is convenient. It is time to move the profession forward.

Some patient’s pain complaints will improve. Sometimes it will be (in part) due to your intervention, other times it is an illusion (in which case, get over yourself, they were going to get better anyway). And here is another newsflash: even when the patient does get better, it is unlikely to be for the reason why you think they…

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Let’s Talk Spinal Manipulation (Thrust, Grade 5, or whatever else you wanna call it)…

Interesting thoughts on the effects that spinal manipulation might have on skin and muscle. Good point that many often think only of the vertebrae regarding the mechanism of manipulation, however there must be a mediating effect of changes in the soft tissues for joint motion to be changed, yes? (Assuming that manipulation actually achieves joint motion changes – I’m trying to find this out. Results very soon!)

Forward Thinking PT

Spinal manipulation is an intervention we commonly employ as Physical Therapists.   We have several names for it (because of inter-professional turf wars) and loads of RCTs (supposedly) supporting its use.   In addition, there are loads of continuing education courses and certifications, each claiming to teach you (more) effective ways to manipulate the spine.  For gosh sakes,  I get a new pamphlet every other day.  But in all of this hype, what do we truly know about the effects of spinal manipulation?  Can we truly design one more RCT to measure its effectiveness if we barely know the potential physiological mechanisms behind its effectiveness(ok I stole this idea from Jim Meadows at the AAOMPT conference this year, but it is just so good)?  Should we simply employ a rule, when we don’t understand the process?  I am not sure…but lets dig a bit deeper.  Let’s attempt to understand the complexity of spinal manipulation.

Basic Anatomy/Physiology/and other…

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