Talk:Joint manipulation

message: You know there are a lot of Mixed martial arts people who would be rather suprised at the defintion given here.Geni 23:57, 5 November 2006 (UTC)
replies: text: Yes, I'm aware of that. The title is chosen because it's common medical terminology, and the martial arts people may have been aware of that and have made their own article. Maybe there should be a disambiguation link for them. -- Fyslee 00:04, 6 November 2006 (UTC)
replies: text:  Now they have a link. -- Fyslee 06:10, 6 November 2006 (UTC)
thread_title:  Not [[Small joint manipulation]] from martial arts 

message: I had understood these to be (thought to be) cavitation, with the sound being produced not by the opening up of a void, but the snapping shut of it.  Some popping or cracking noises are thought to be due to assorted bits of "string" twanging past bits of bone, also.   Midgley 01:42, 6 November 2006 (UTC)
replies: text: Cavitation states that noises are caused by the bubbles collapsing.  That seems intuitively sensible, doesn't it?  There are references there, i'd suggest that that is a good place for them, and that describing some joint popping as being ascribed to cavitation is more sensible than importing the whole explanation of a physical process into this article as well.  Midgley 09:23, 22 November 2006 (UTC)

text: The (abstract of the) reference offered (Brodeur R., J Manipulative Physiol Ther. 1995 Mar-Apr;18(3):155-64.) looks to me highly unconvincing.  Suggesting that there is enough CO2 dissolved in the synovial fluid to provide 80% of 15% of the (increased) joint volume, rather than the bubble being mainly Nitrogen, with CO2 being present at around 4% and N2 at 80% of the total of partial pressures surprises me.  (Also as a reference for the bubbles being Nitrogen it is probelmatic, unless th eabstract is inaccurate with respect to the paper.  Midgley 01:51, 6 November 2006 (UTC)
replies: text:  That part is taken directly from the chiropractic specific (although it unnecessarily covers general principles about manipulation, which are now covered here) article on spinal adjustment. There the paragraph is just stated, without any source at all. This is the best one I found, but if you have better ones, or if this theory is inaccurate, please provide more information or sources so we can correct this. -- Fyslee 05:41, 6 November 2006 (UTC)
replies: text: The arithmetic is wrong.  The physical chemistry is wrong.  The gas dissolved in joint fluid is that in tissue fluid which is that in equilibrium with the body and, via some steps, the atmosphere.  CO2 comes out of fizzy drinks when they are shaken, but body fluids release nitrogen.  That is why the astronauts degas themselves of nitrogen by breathing pure O2, and why one of the Mercury or Gemini astronauts got knee pain - effectively a low pressure bends.  Midgley 09:19, 22 November 2006 (UTC)

text: And a reference which says "The bubble gas is CO2" isn't very supportive of a statement in the article that says "the bubble gas is N2".  Unfair criticism there? Midgley 09:25, 22 November 2006 (UTC)
replies: text: Don't disagree with you at all.  Made some changes  that more accurately cite the sources that I saw.  It could still use some work, especially the gas "bubble" wording. --Dematt 18:30, 22 November 2006 (UTC)
thread_title:  Pop sounds 

message: Hey guys, this is what is on the Chiropractic Page:
*"The International Chiropractic Association (ICA) suggests that chiropractic is one of the safest health professions and chiropractors have some of the lowest malpractice insurance premiums in the health care industry.ICA website As with all interventions, there are risks associated with spinal manipulation. According to Harrison's, these include vertebrobasilar accidents (VBA), strokes, spinal disc herniation, vertebral fracture, and cauda equina syndrome. A 1996 Danish chiropractic study confirmed the risk of stroke to be low, and determined that the greatest risk is with manipulation of the first two vertebrae of the cervical spine, particularly passive rotation of the neck, known as the "master cervical" or "rotary break."  Estimates of serious complications range from 1 in 400,000 manipulations to 0 in 5 million manipulations. In comparison, there is a 3-4% rate of complications for cervical spine surgery, and 4,000-10,000 deaths per million neck surgeries. Coulter ID, Hurwitz EL, Adams AH, et al. (1996) The appropriateness of manipulation and mobilization of the cervical spine 'Santa Monica, CA, Rand Corp: xiv [RAND MR-781-CCR]. Current linkLauretti W "What are the risk of chiropractic neck treatments?" retrieved online 08 028 2006 from www.chiro.org"
Is there anything wrong with just making a statement similar to this? --Dematt 15:24, 8 November 2006 (UTC)
replies: text: I think that is fine, but perhaps it should be less tailored toward chiropractic adjustments and more tailored toward joint manipulation generally. However, the amount of content seems about perfect. Again, I don't think this is big enough of a risk/issue to dedicate 3/4 of the article to... especially when there is so much more to get into with Joint Manipulation. A simple paragraph, as done on the chiropractic article, should be plenty. Levine2112 17:43, 8 November 2006 (UTC)
replies: text: I'd agree with that, but there is still too much emphasis on spinal adjusting and nothing on all the other forms of joint manipulation.--Hughgr 18:29, 8 November 2006 (UTC)
replies: text: Do you have any specifics? --Dematt 18:50, 8 November 2006 (UTC)
replies: text:  The article is still developing, and the way forward is not to delete, but to add what is missing. There can be added more information on techniques, indications, contraindications, etc.. One thing to keep in mind....since this isn't specifically about chiropractic adjusting, there aren't a whole lot of technique names, since other professions (at least medicine and physical therapy) haven't had a history of technique wars   and more or less "patented" methods. The education simply concentrates on applying principles and manual skills to the joint biomechanics involved in each case, guided by indications, contraindications, and whatever other modalities might be useful, all done without necessarily using a whole lot of specific names for the originator or whatever. This is where the chiropractic article on spinal adjustment reveals a whole arsenal of specifically branded techniques, some of which don't even affect joint position at all, and yet are called "adjustments." Instrument adjusting is another area of difference. PTs do it the original Palmerian way - by hands only. -- Fyslee 23:11, 8 November 2006 (UTC)
replies: text: Moving forward will involve adding as well as deleting. The main contention here is that there is too much discussion about one specific kind of manipulation's extremely rare risk factor. This seem like too broad of an article to get that heavy into the specifics of one kind of manipulation which already has its own article. So either before or after we more information that deals with joint manipulations in general, the over-abundance of spinal manipulation information may be deleted. Certainly, as there is a Spinal adjustment article already specifically dedicated to chiropractic's core manipulation, the mention of chiropractic in this article should be breif and lead readers to the Spinal adjustment article for more specific information. I'm not sure of the point you are attempting to make with bringing up techniques and what-not, so let's not go on that tangent and instead concentrate on keeping this article focused on the general topic at hand... joint manipulation. Levine2112 23:40, 8 November 2006 (UTC)

text: That is what I was trying to say.  I went ahead and created a see also for the safety section in spinal adjustment to the spinal manipulation article. --Dematt 00:16, 9 November 2006 (UTC)
replies: text: I think that may be the best option proposed thus far. Levine2112 00:20, 9 November 2006 (UTC)
replies: text: That's what I meant.  All this belongs with spinal manipulation.  We're getting closer, but we still have to consolidate this information into a well packaged article. --Dematt 00:30, 9 November 2006 (UTC)
replies: text: That's what Arthur was saying as well.  So lets clean out the chior stuff and see what is left. --Dematt 00:43, 9 November 2006 (UTC)
replies: text: Okay, I cleaned as much chiropractic out as practical, but it looks a little lean so we need to build from here. --Dematt 02:16, 9 November 2006 (UTC)
thread_title:  Condensed safety issues 

message: Are we sure that Mobilisaton shouldn't have its own article? --Dematt 01:47, 9 November 2006 (UTC)
replies: text: I found the reference.  So I think I see where you're coming from. --Dematt 02:16, 9 November 2006 (UTC)
replies: text:  Mobilisation could have its own article if anyone is interested. I've got enough to do already. I'm not sure where I found it, but that document is interesting reading. BTW, what is the preferred spelling nowadays - with "s" or "z"? Generally "z" is American and "s" is British, but there are exceptions when it comes to esoteric terminology like medical terms.. -- Fyslee 19:54, 9 November 2006 (UTC)
thread_title:  Mobilisation 

message: There are also concerns about overuse, specifically about the use of cervical manipulation for conditions in which it is not considered appropriate.
There are concerns of overuse of manipulation? Whose concerns are these? Who doesn't consider the conditon for use appropriate? Basically this sentence is a poor summary of what is to follow. Let's let the text speak for itself. And considering that none of us have given a clear explanation of this, I don't think a summary is appropriate. Overall, I agree with Dematt above. We should not use this confused study at all. Levine2112 04:04, 28 November 2006 (UTC)
thread_title: Overuse?

message: "The contents of the resultant gas bubble are thought to be mainly nitrogen." according to the Cracking Joints page.
"The contents of this gas bubble are thought to be mainly carbon dioxide." according to this page.
Both are referenced.
Both reference "# ^ Unsworth A, Dowson D, Wright V. (1971). "'Cracking joints'. A bioengineering study of cavitation in the metacarpophalangeal joint.". Ann Rheum Dis 30 (4): 348–58. . " specifically.
I'm, not going to go read a medical whitepaper... So which is it?96.225.201.101 (talk) 08:11, 31 March 2009 (UTC)
thread_title:  Which gas? 

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thread_title:  External links modified