Advanced Spinal Manipulation Elective.
Spring Term 2013 - Weekly sessions of advanced spinal manipulation techniques.
The BSO being well-known for its structural take on osteopathy, manipulation is probably one of the fields in which the education here is best. To attend the advanced manipualtion elective was an obvious choice, in order to make the most of the structural education at the BSO.
This site will provide an summary of our progress with the course and some reflections on my experiences there and with the application of the techniques in clinic.
The BSO being well-known for its structural take on osteopathy, manipulation is probably one of the fields in which the education here is best. To attend the advanced manipualtion elective was an obvious choice, in order to make the most of the structural education at the BSO.
This site will provide an summary of our progress with the course and some reflections on my experiences there and with the application of the techniques in clinic.
LOG.11/02/2014 The second class on the junctional areas, the O/A proved to be even harder than the T/L. I don't think anyone got a cavitation out of it, but palpation-wise I think we're all making progress. 04/02/2014 Having dealt with all the 'normal' areas in the spine, we are now paying attention to the junctional areas. There was again a nice lecture on the mechanical specialties of the minimal-lever manipulation. We're getting it now - all it now takes is practice... 28/01/2014 Moving on to the cervicals, the palpation is still difficult. On occasion, we score a lucky hit, but getting used to this is really not easy. I feel, however, that a hightened palpatory awareness will gradually develop and some of the exercises we're doing - quickly grabbing a coin out of a colleagues hand with a fast twitching into pronation - are gonna have beneficial effects on all our manipulations anyway. 21/01/2014 It's all about applying the principles now. I just can't seem to get used to the palpation of the new 'barrier', or point of maximum tension, rather. Today we did the lumbar spine. We need practice. 14/01/2014 Second class: Mr Herbert is really drilling his principles in and making quite clear what the difference is between the usual long-lever HVLA thrust and his Mid Range Minimal Lever approach: Compress, segment-specific, and combine multiple levers. It won't be until next week that we actually go through with a manipulation, but I really like Mr Herbert's way of lecturing and acquainting us with this much gentler but also much more complicated way of joint manipulation. Until next week we will be practising the thrust, thumping away on the backside of our colleagues. I sometimes wish I had studied martial arts in my (not yet past) youth. They seem to find that immediate fast-twitch much easier. But then, being out on the track with my mates from athletics was much cooler. 07/01/2014 The first session was mainly an introductory one. By now we've all got a good year an a half of experience with HVLA techniques, most of us hopefully feeling quite confident with manipulating most areas on the spine. With that experience in the background it was useful to go over a few basics and a number of refinements again, which are essential for sucessful, gentle and effective thrust techniques. Amongst such figured posture - stance and balance, positioning of the arms, body tension etc - and handling - this including protecting your own body and making use of the patient's body weight and position. These are the things that easily slip my mind when I am manipulating. Most of them are ingrained into my subconscious, yes. I don't think I struggle with my posture, for example. But at the same time, these are the things you need to modify in more complicated situations and being reminded of all the things that can be done was useful. I hope that this course will again make me more aware of my technique and help me to leave the BSO with a certain level of expertise in the field of manipulation. We've practised the stuff the very same afternoon in clinic. |
Experience and Practice.Rarely I found the acquisition of a new skill so frustrating an experience as in this case. (Maybe kite-surfing was, with all those days in the water and not even able to get out of the water and onto the bloody board... Never mind that now.) What did the trick, as always, was persistence and practice. (Not with kite-surfing. I gave that up.) The really frustrating thing about minimal lever thrusts is, that you don't feel an actual 'barrier', which means that you can't even tell how close you are to getting it to work. Also, some areas of the spine are much more difficult than others, especially attempting minimal lever manipulations.
In clinic, stubborn persistence got my thoracic manipulations to a reasonable level and I'm now on a good success rate. The lumbar techniques, in contrast, are getting a little bastardised by me: In difficult and very loose spines, I find them useful. When patients are a little anxious and tense up quickly, I often haven't got the time and patience necessary to test and re-test the primary lever over and over again. I then just use small additional levers (in particular segmental compression and side-bending) with a generally large combined lever approach. That seems to work and I hope to be able to further-diminish the large lever elements... My personal favourite in terms of clinical practice are cervical minimal lever thrusts. When they go they are very satisfying exactly because there was no previous tension there to indicate that they might. The wind-up is very subtle and comfortable. As such, a very pleasing experience for both patient and practitioner. On the downside, however, I can only get about one in four with them at the moment. But even so, they are non-invasive to try and I can simply resort to combined lever techniques if unsuccessful. In summary, this class has really challenged my cognitive understanding of thrusts and my subjective palpatory skills. I am resolved to continue to practice them and thus further improve my techniques. |