5th Biennial Conference 2003 - Contemporary Practice
Review
By Neil Orr

COCA’s 5th Biennial Conference titled “Contemporary Practice” was recently held in the Avillion Hotel, Sydney during the weekend of Friday 17th to Sunday 19th of October. It proved to be an extremely informative and thought provoking 3 days. The conference included presentation from leading internationally renowned researchers in chiropractic and spinal manipulation. The conference began on Friday with a paediatric workshop run by Dr Randy Ferrance. Over the next 2 days of the seminar, delegates were treated to an in depth coverage of specific issues relating to spinal manipulative therapy.

Dr. John Triano began the Saturday session with a presentation on “Bare Bones of Subluxation: Modern Evidence on behaviour and mechanisms”. This presentation featured a critical view of traditionally held hypotheses on the mechanisms of the spinal subluxation or dysfunction and how this approach has been essentially held over many decades without change. A mechanical model of subluxation presented as “spinal buckling” was put forth as a mechanism for some spinal pain syndromes that are seen in clinical practice.

From left: Dr. John Triano, Dr. Marion McGregor & Dr. Randy Ferrance

This view holds:

• The spine experiences prolonged static posture followed by an additional small loading.
• Rapid loading of the spine occurs at a rate of 500 lb/sec or more.
• Vibration facilitates buckling by lowering the threshold at which it occurs and further more decreases the ability of the intrinsic muscles to respond effectively to stretch.

Dr. Triano presented parts 1 and 2 of “Skill in Spinal Manipulation: Improving clinical Effectiveness”. This in depth approach to spinal loading during high velocity low amplitude type manipulation, highlighted the variations while administrating this technique. Figures compared loads in the spine during techniques such as continuous passive motion or techniques which typically depend on high velocity, to techniques which use combined/motion assisted procedures. These techniques utilise a summation effect of motion and load through the spine and it was indicated that a total decrease in load is required for the later procedures.

Dr. Randy Ferrance who has the dual qualifications as a chiropractor and medical doctor, provided a reminder that although the majority of LBP conditions that we see as osteopaths and chiropractors are mechanical in nature, there can be serious underlying pathology. The practitioner must take the appropriate case history and be alerted to those symptoms that tend to be of non-mechanical origin.

Dr. Ferrance’s second presentation was “No Patient Left Behind: Avoiding the pitfalls of praying at the altar of evidence-based practice(EBP)”. This presentation highlighted measures that can be taken to include EBP in the clinical setting, the problems associated with acceptance of this paradigm shift and methods to help amalgamate EBP with clinical practice.

EBP should be viewed with the following in mind:

• All evidence is sought and examined systematically
• Best evidence is quantified (whenever possible)
• Evidence is considered in all decisions in healthcare
• Evidence doesn’t make decisions, human beings do
• A guide to help us sort out how the limited health care dollars should be spent
• One component of decision making

Dr. Ferrance presented his final topic on “Build Bridges Between Health Professionals” and in doing so provided data on various aspects that can be taken on board by the clinician to assist in fostering a higher level of rapport with general practitioners.

Dr. Marion McGregor covered complications of spinal manipulation and “Core vs Complementary Chiropractic: Evidence on professional priorities”. Complications presented were the more common iatrogenically induced trauma associated with spinal manipulation.

These included and provided further evidence on the frequency of:

• Vertebrobasilar artery dissection after high velocity low amplitude manipulation to the cervical spine - a rare and unpredictable event.
• Fractures, in particular rib fractures.
• Aggravation or causing disc herniation.

Dr. McGregor suggests, “As the multiplicity of competing adjustment techniques is a concern for health care professionals who may choose to refer to chiropractic, there is evidence that even the relatively supportive public is unsure of exactly what chiropractic does”.

An examination of 16 chiropractic colleges in the United States during the period of 1997-2000 was performed to investigate what are “core” chiropractic treatment procedures and highlighted the percentage of colleges that include these techniques:

• Diversified 100%
• Extremity 94%
• Gonstead and Thompson 56%

Percentage of time of exposure during these courses to these various techniques were:

• Diversified 49%
• Extremity Techniques 16%
• Gonstead 12%
• Thompson 3.5%

There were a number of quality presentations from practitioners; “The Evolution of the Australian Medical Association’s Exclusive Dogma Policy on Chiropractic” by J. Keith Simpson; “The Relationship of the Workplace factors to Neck pain or Headache” by Peter Tuchin and Vanessa Billenko; Visual Field Examination in the Validation of the effect of Spinal Manipulation on Brain Function” by Richard F. Gorman; and “ A Comparative Study of Two Backpacks on Adolescent Australian School Childrren” by Andrew Vitiello.

Look forward to seeing you in Melbourne for the 2004 National Conference.