well if you have given your physio a good go and you are getting worse its hard to see that you will get improvement i have been to somthig like 30 different therepists including physical therapists chiros and osteos the vast majority made we worse and with hindsight i would say that they really did not know what they were doing and they would have kept on treating me and getting paid a fee for years and years the only thing that stopped them was me not going anymore

I want to venture saying that physio, would truely only be usefull after a major incedent where the patient has been in a hospital bed for an extended period or any other incedent where the recovery of the patient requires physical manipulation of the joints and/or muscles.

Getting physio done on degenerating joints, in my book, is a serious no no. I had a dislocated knee, which required me to be in a closed reduction cast for almost two months. I HAD to go to physio in order to get my mobility back and the physio-therapist told me he wanted to do as little as possible, to get me up and walking due to my physical problems with my knee joints and he was concerned that he might damage the joint if he did too much work on it.

At one stage, I was seeing a physio for a muscle-spasmism in my shoulder. I was at a GP for an unrelated issue but when he learnt of the fact that I was seeing a Physio, he became furious. I have a connective tissue disorder, which makes me susceptable to joint problems and he told me to immediately stop the treatment as they could seriously damage my joints.

Physio therapy has it's place and in some circumstances, it is vital to receive treatment for muscles/joints that needs tlc but when it comes to joints that is grinding them selves down, forcefull manipulation can do more harm than anything else.

I'm not sure what you mean when you say joint mobility techniques that your physio is using on you.

What I can say is that conservative treatments for degenerative facets is a course of physical therapy that includes exercises to strengthen core muscles, learning proper body mechanics and proper movement.
Also used can be anti-inflammatory medications as well.

There are both minor and major surgical procedures that can also be done to alleviate the pain, but those are considered only after all conservative measures have been tried and failed.

I would suggest that you get another opinion or both your diagnosis and treatment from a different spine surgeon before continuing with the PT that you are using now.

It is not uncommon to have some increased discomfort following PT but it should not last nor should it make your pain worse after a session.

Please seek another opinion from another spinal surgeon.

Fran

i dont think there is anything particully bad about joint mobilization techniques its more a matter is the treatment appropriate for the condition you have and is your therepist applying the treatment skillfully and correctly



Efficacy of spinal manipulation and mobilization for low back pain
and neck pain: a systematic review and best evidence synthesis
Gert Bronfort, PhD, DCa, Mitchell Haas, DC, MAb, Roni L. Evans, DC, MSa,
Lex M. Bouter, PhDc

Abstract BACKGROUND CONTEXT: Despite the many published randomized clinical trials (RCTs), a
substantial number of reviews and several national clinical guidelines, much controversy still remains
regarding the evidence for or against efficacy of spinal manipulation for low back pain and neck pain.
PURPOSE: To reassess the efficacy of spinal manipulative therapy (SMT) and mobilization (MOB)
for the management of low back pain (LBP) and neck pain (NP), with special attention to applying
more stringent criteria for study admissibility into evidence and for isolating the effect of SMT
and/or MOB.
STUDY DESIGN: RCTs including 10 or more subjects per group receiving SMT or MOB and
using patient-oriented primary outcome measures (eg, patient-rated pain, disability, global improvement
and recovery time).
METHODS: Articles in English, Danish, Swedish, Norwegian and Dutch reporting on randomized
trials were identified by a comprehensive search of computerized and bibliographic literature databases
up to the end of 2002. Two reviewers independently abstracted data and assessed study
quality according to eight explicit criteria. A best evidence synthesis incorporating explicit, detailed
information about outcome measures and interventions was used to evaluate treatment efficacy. The
strength of evidence was assessed by a classification system that incorporated study validity
and statistical significance of study results. Sixty-nine RCTs met the study selection criteria and
were reviewed and assigned validity scores varying from 6 to 81 on a scale of 0 to 100. Fortythree
RCTs met the admissibility criteria for evidence.
RESULTS: Acute LBP: There is moderate evidence that SMT provides more short-term pain relief
than MOB and detuned diathermy, and limited evidence of faster recovery than a commonly used
physical therapy treatment strategy.
Chronic LBP: There is moderate evidence that SMT has an effect similar to an efficacious prescription
nonsteroidal anti-inflammatory drug, SMT/MOB is effective in the short term when compared
with placebo and general practitioner care, and in the long term compared to physical therapy.
There is limited to moderate evidence that SMT is better than physical therapy and home back
exercise in both the short and long term. There is limited evidence that SMT is superior to sham
SMTin the short term and superior to chemonucleolysis for disc herniation in the short term.However,
there is also limited evidence that MOB is inferior to back exercise after disc herniation surgery.
Mix of acute and chronic LBP: SMT/MOB provides either similar or better pain outcomes in the
short and long term when compared with placebo and with other treatments, such
as McKenzie therapy, medical care, management by physical therapists, soft tissue treatment and
back school.