Two papers on treating post-surgical (lumbar fusion) continued pain in patients with low back pain and the use of distraction manipulation...exciting as we are working to finish data collection from 51 chiropractors treating these conditions in their offices! It's in the hands of Drs. Gudavalli and Kruse at Keiser and their crew.
Management of patients with prior lumbar fusion: a cross-sectional survey of Veterans Affairs chiropractors' attitudes, beliefs, and practices.
Substantially less respondents indicated the use of thrust manipulation to the pelvic (n = 23, 39%) and lumbar (n = 10, 17%) regions on an always or frequent basis for patients following lumbar fusion. SPINAL MOBILIZATION AND FLEXION-DISTRACTION MANIPULATION WERE COMMONLY INCORPORATED TREATMENTS SELECTED ON AN ALWAYS OR FREQUENT BASIS.
Substantially less respondents indicated the use of thrust manipulation to the pelvic (n = 23, 39%) and lumbar (n = 10, 17%) regions on an always or frequent basis for patients following lumbar fusion.
LUMBOPELVIC/ABDOMINAL STABILIZATION EXERCISE (N = 38, 64.4%) PRESCRIPTION WAS MORE COMMONLY UTILIZED (SELECTED ALWAYS OR FREQUENTLY) THAN MECHANICAL DIAGNOSIS AND THERAPY (MCKENZIE METHOD) (N = 14, 23.7%) AND NEURODYNAMIC MOBILIZATION (N = 10, 16.9%). The least common approaches (selected always or frequently) included pelvic blocking (n = 0, 0%), and mindfulness meditation (n = 6, 10.2%).
THIS DIFFERED SOMEWHAT FROM A SURVEY OF CHIROPRACTIC TREATMENTS BY CLIJSTERS ET AL. WHICH IDENTIFIED THE PREFERRED TREATMENTS FOR LUMBAR CONDITIONS FOR PATIENTS WITHOUT PRIOR SURGERY AS DIVERSIFIED (THRUST) MANIPULATION, FOLLOWED BY DROP-TABLE ASSISTED AND INSTRUMENT-ASSISTED MANIPULATIVE TECHNIQUES.
and
DESPITE CHIROPRACTIC PROVIDERS COMMONLY BEING ASSOCIATED
WITH THRUST-TYPE MANIPULATIVE THERAPY, LESS THAN HALF OF THE PROVIDERS
REPORTED FREQUENTLY OR SOMETIMES PROVIDING THRUST-TYPE MANIPULATION
TO THE REGION IMMEDIATELY SURROUNDING THE FUSION (LUMBAR). DISTRACTION
MANIPULATION AND MOBILIZATION WERE AMONG THE MOST COMMONLY DESCRIBED MANUAL
TREATMENTS. THIS DIFFERED SOMEWHAT FROM A SURVEY OF CHIROPRACTIC TREATMENTS BY
CLIJSTERS ET AL. WHICH IDENTIFIED THE PREFERRED TREATMENTS FOR LUMBAR
CONDITIONS FOR PATIENTS WITHOUT PRIOR SURGERY AS DIVERSIFIED (THRUST)
MANIPULATION, FOLLOWED BY DROP-TABLE ASSISTED AND INSTRUMENT-ASSISTED
MANIPULATIVE TECHNIQUES.
case: SPINAL MANIPULATION AND THERAPEUTIC EXERCISES IN
TREATING POST-SURGICAL RESURGENT LUMBAR RADICULOPATHY IN A 42 Y/O MALE WHO
RECEIVED TWELVE TREATMENTS OF SPINAL MANIPULATION, IN ADDITION TO THERAPEUTIC
MCKENZIE METHODS EXERCISES. BY THE END OF THE TREATMENT PLAN, THE PATIENT WAS
ASYMPTOMATIC AND THREE-MONTH FOLLOW-UP, HE REMAINED STABLE. THIS CASE REPORTS A
SUCCESSFUL OUTCOME AND THE WORTHINESS OF CONSIDERING SPINAL MANIPULATION AND
THERAPEUTIC EXERCISES IN PATIENTS SUFFERING FROM RESURGENT LUMBAR
RADICULOPATHY, EVEN WHEN POST-SURGICAL CHANGES ARE PRESENT, IF THERE ARE NO
ABSOLUTE CONTRAINDICATIONS.
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