Spinal manipulation - Evidence for physiotherapist delivery of effective procedures

Learning objectives: 1. Demonstrate an increased understanding of the evidence for the use of spinal manipulation in the management of musculoskeletal conditions. 2. Demonstrate an increased understanding of the required screening procedures to provide safe practice of spinal manipulation. 3. Demonstrate an increased understanding of the required screening procedures to provide safe practice of spinal manipulation.
Description: Spinal manipulative techniques particularly those with using high velocity thrust (HVT) have become an integral part of treatment for those physiotherapists involved in the management of musculoskeletal conditions. These techniques are employed in both the peripheral and spinal areas of the body. The evidence for the use of such techniques is variable; however the evidence for their effectiveness is growing, particularly for conditions such as cervicogenic headache and acute low back pain there is good evidence for effectiveness. However in some areas, particularly the cervical spine there is an element of risk associated with the delivery of manipulative techniques particularly those involving quick movements. Some authors have suggested that the evidence for effectiveness of such techniques is not yet sufficient to warrant the use of such techniques.Other areas of physiotherapy have developed guidelines to try and recognise and screen for patients who may be at risk from such a procedure. Yet other therapists have refined techniques that purport to be safer and place less stress on the spine.For a number of years other professions such as Chiropractic have endeavoured in some countries to legislate that HVT should only be the domain of that profession. These cases have been resisted strongly by the physiotherapy profession and in many cases the right to perform HVT on patients has been upheld in favour of the physiotherapy profession.However within the physiotherapy profession there is still some debate as to the placement of teaching these techniques. In some countries upon graduation registered physiotherapists are legally able to manipulate the spine, whereas in others this is not the case. Further in some countries these high level skills remain the domain of post graduate level education.The International Federation of Orthopaedic Manipulative Physical Therapists (IFOMPT) is the largest subgroup of the WCPT. This group oversees the standards of manual and manipulative physiotherapy post graduate education within the 22 member organisations (MO). All MO's must deliver a programme of education that meets the IFOMPT standards. The delivery of manipulation training which includes HVT is an integral part of these programmes and graduates of these programmes must demonstrate the required skills in the application of HVT into their patient management. The Executive committee of IFOMPT feel the topic of HVT manipulative techniques in physiotherapy is worthy of discussion and debate. The purpose of this symposium is to provide information on the current efficacy of spinal manipulation in the management of a range of musculoskeletal conditions, to provide information on the current screening procedures to reduce risk and the provide information on current trends in the delivery of such techniques in undergraduate and post graduate curricula. Following delivery of these topics there will be opportunity for discussion of these key issues from the assembled audience.
Discussion: The discussion will explore different experiences of Spinal manipulation, the challenges in teaching safe practice and evidence for clinical effectiveness.
Implications/conclusions: Current evidence has demonstrated the need for increased education in the use of spinal manipulation techniques in educational programmes. Failure of programs to adapt to the current and emerging evidence will result in patients receiving sub- optimal treatments and may result in increased use of higher risk pharmaceutical or surgical interventions for their musculoskeletal conditions.