Manipulation of the Spine, Thorax and Pelvis: An Osteopathic Perspective

"This book is by far the best on the market of its kind at present!
What is most refreshing about this book is that the authors have not hidden away in the world of anecdote and hearsay, all to often seen in competing texts, and have embraced an approach informed by research evidence (where available) to the teaching of a subject that has been used for many years by a wide range of health professionals. Whilst the authors make it clear that they are osteopaths and their clinical background has informed their approach, their use of scientifically sound and generic terminology and concepts allows their work to be accessible and understood by readers from any discipline.
A masterstroke by the authors is their categorisation of manipulative techniques by the target joint in which synovial fluid cavitation is desired. Never mind the opinions of authors of less informed books about the relevance of joint cavitation. The scientific literature clearly shows that cavitation is what distinguishes high velocity-low amplitude thrust (HVLAT) manipulation from other interventions grouped under the generic 'spinal manipulative therapy' banner. These authors have taken a brave step in categorising techniques in this manner, adding clarity to a subject that is all too often obfuscated by wishy-washy opinion and an avoidance of robust empirical data.
By the same token, it is nice to see that the authors have emphasised the importance of spinal segmental kinematics in relation to the various phases of HVLAT manipulation. These important concepts are then used to aid explanation of each technique throughout the text in a consistent and logical manner.
The techniques included cover all regions of the spine, and represent an ample repertoire for any manipulative practitioner. The techniques are logically organised by anatomical region, are clearly illustrated, and a clear description of each phase of the technique is given in the text. The text is then complemented by videos of each technique on the accompanying CD-ROM, which is an extremely useful learning (and teaching) aid. It is worth bearing in mind that videos of manual therapy techniques have traditionally been very expensive, but this addition really makes this book good value when compared with the alternatives on the market.
What more can you ask for?"
~ Written on 2004-09-09

"There are several books on osteopathic technique, so when I looked at this one, my first question was “does it add anything new?” It is definitely an osteopathic perspective, in that it focuses entirely on high velocity low amplitude thrust techniques. This is something of a change from other recent titles, which tend to cover a wider range of methods.
The book is nicely laid out, with plenty of sub titling to make information easy to locate. This gives the information a “bite-sized-chunk” feel, resulting in easy reading.
The introduction is followed by several short chapters over viewing
Osteopathic philosophy and technique
Kinematics and coupled motion of the spine
Spinal positioning and locking
Safety and HVLA techniques
Rational for the use of HVLA techniques
Validation of clinical practice by research
In these chapters it appears the authors are trying not to make any definite statement, unless that statements can be validated by research. This results in chapters which call much into question, but provide little in the way of answers.
There are some interesting choices of statement that they do make though, particularly “The aim of HVLA techniques is to achieve joint cavitation that is accompanied by a popping or cracking sound.” This is not a minor statement pulled out of context either, techniques are described by the spinal level and side at which cavitation is to be produced, e.g. “. . . to produce cavitation at C4-5 on the right.”
This emphasis on the sound effects is in direct contrast to the thoughts of other authors such as Hartman1, Greenman2, Kappler3 and Bourdillon4.
In the chapter on research validation, the authors point out the problems caused by the lack of diagnostic conformity within osteopathy, and the difficulties this causes when designing clinical trials. To get round these problems, they suggest categorising spinal pain syndromes based on patterns of pain and associated symptoms, such as “back pain only”; “back pain with radiation into proximal limb”; “back pain with radiation into distal limb” etc.
This raises other problems, as the back pain with radiation into a distal limb could be a simple lumbar joint dysfunction with an associated Piriformis trigger point, or it could be a herniated lumbar disc. I don’t see how these two cases can be grouped together in any meaningful way.
This looks like yet another attempt to fit the various round, oval, triangular, octagonal and irregularly shaped individuals into a square hole, so we can produce a statistical result, that will still be of little help when confronted by the one, unique, individual patient sitting in front of you.
All those attempting to rectify the paucity of research on osteopathy appear to face the same problem. Traditional research methods are poorly suited to measure osteopathic outcomes, as both patients and practitioners are all stubbornly individual, so research ends up measuring something else, just because it is measurable.
The bulk of the book then deals with thirty five manipulative techniques, providing detailed instructions on their performance.
The techniques are clearly illustrated, with photographs showing details of pre thrust positioning and application of thrust. Graphics are including in the photographs to identify stabilisation contact, direction of thrust and direction of patient body movement.
The authors have stayed with the most commonly taught and used techniques, rather than going for the esoteric. The only surprise I found was the last technique, a per rectum HVLA thrust for the sacro-coccygeal joint.
Positional diagnosis of dysfunctions is not used, but the techniques are described in terms of the direction of glide desired at the joint, such as “rotational glide”, “extension glide” or “down slope gliding” in the case of a typical cervical joint.
Concepts of primary and secondary leverages are used to describe the techniques, these seem less sophisticated than concepts used by Hartman1, but this does make them a little easier to grasp.
The last section of the book covers “technique failure and analysis”, giving a structured guide to discovering why a technique might fail, so allowing reflection to guide skill improvement.
The book is accompanied by a CD-ROM containing video clips of all but the P.R. technique mentioned above. The clips are accompanied by a voice over commentary providing instructions, and a non-organic sounding “click” timed with the thrust.
I could not easily access all the clips on the CD-ROM, as only the first page of the index was visible, nor could I get back to the index (or anywhere else) without escaping the programme. Eventually I was able to view the rest of the clips by “exploring” the CD, and opening the file called “movie.”
There is an e-mail address provided for technical backup, but my message was returned undelivered. This may be a problem between the involved e-mail providers, rather than a problem on the part of the backup service.
Overall I feel the book provides clear and detailed instruction in the “bread and butter” HVLA techniques, and as such would be useful to students, and to those of us wishing to re-learn forgotten techniques, or refine remembered ones."
~ Written on 2003-11-09