cervical disc herniation

[CenteredHealth]

sharileedahl

Thank you very much for your informative thoughts. I couldn't have said things more eloquently myself.

EBP is a necessary part of our field for various reasons, most of which you have pointed out. And as you said, the research has to start somewhere; typically with a new treatment technique, new philosophy, or so on. There will always be pioneers in our field (and every other for that matter) who push the envelope and develop new thoughts, ideas and treatment approaches. Again as sharileedahl put it "Your unproven theories may become the outcome of the next body of research."

Thanks again.

[jesspt]

I should clarify my previous post. I read Centered's previous post quickly, and at first blush, I thought that s/he was imlpying that s/he had researched or reviewed literature that implicated the resorbption of cervical HNP after application of osteopathic therapy princliples. I requested a reference because I was unfamiliar with data that supported this in the cervical spine.

Centered -
I'm familiar with Mitchell and Fryette's work. In the interest of full disclosure, and at the risk of being unpopluar and sounding inflammatory, I can't say that I find the osteopathic approach overly usefull, and that's primarily for it's strict allegiance/reliance on Fyrette's laws and palpatory positional diagnosis. But, that's a discussion for another post, probably.


sharileedahl -
I'm in no way saying that we can entirely discredit what an individual is saying if they are unable to provide a reference that suports their position. But, we should keep what they say in appropriate perspective. Using Sackett's hierarchy of evidence, what Centered says (or what I say, for that matter) falls under the heading of expert opinion (3.B) at best, and more likely under personal communication (4). See the link below:
A Hierarchy of Evidence
I certainly don't have evidence for everything I do in the clinic. If I stuck only to those interventions that were well researched and with outcomes data, I'd be twiddling my thumbs for about 70%-80% of the day. But, if there is evidence regarding a particluar intervention's efficacy, and it is applicable to the patient I'm treating, that is always the first intervention I use. I try to use EBM as Sackett has proposed, which does not rule out using interventions that have not been studied in formal, blinded, randomized, controlled trials, but does require us to use these types of interventions as a secondary or tertiary method of treatment when other treatments with a larger body of evidence supporting their efficacy exist.
I think this is where people start to bristle when discussing EBM - they think that if it hasn't been studied, the EBM police will come and chastise them. EBM practitioners use treatments that don't meet the highest level of evidence all the time. They probably just don't use it as a first line of treatment.