Current Views of Chiropractic; What Do You See?

[Shnurek]

so no, chiropractics cannot be more rigorous in any fashion than medical school. for that to be true you are telling me that the kids who struggled to pass undergrad or skirted by with a 3.0 and got high teens on the MCAT are somehow and suddenly able to dance circles around me in a curriculum that I am currently busting my balls over

No health education is more rigorous than medical school. End of story.

My opto education is rigorous but I have time to enjoy a girlfriend and go paintballing and hiking and what not. My med school friends are completely MIA.

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[Rendar5]

You'd be surprised how malaligned a back can get without a serious neurologic compromise. radiculopathy's require foramenal narrowing, you have a lot of room for other malalignments without compromise. Severe lordosis, scoliosis, kyphosis, anterolistheses, etc. True neurologic compromise is quite rare even in badly diseased and stenosed backs, at least in the ER population. Radiculopathy is relatively common, but still the minority when it comes to l-spine complaints, perhaps comign a bit more to the fro in c-spine complaints

 

[SpecterGT260]

You'd be surprised how malaligned a back can get without a serious neurologic compromise. radiculopathy's require foramenal narrowing, you have a lot of room for other malalignments without compromise. Severe lordosis, scoliosis, kyphosis, anterolistheses, etc. True neurologic compromise is quite rare even in badly diseased and stenosed backs, at least in the ER population. Radiculopathy is relatively common, but still the minority when it comes to l-spine complaints, perhaps comign a bit more to the fro in c-spine complaints

but these are not the things that chiropractors usually treat, nor do they strictly describe a subluxation. you're right though, i was being too general. My focus was on disarticulated spinal joints, misalignment of synovial joints like the hip, and the claim that the bone arrangement is the source of the pain. (anecdote warning...) my mother was told by a chiropractor that she had a cervical vertebra which had turned sideways.

even with a massive spinal deformity like severe scoliosis, often back pain is a result of the muscles which are trying to compensate for a bad structure, and treatment of these muscles will give some relief - which is why chiro is akin to a massage. what I was addressing was the flaw in the underlying assumptions of chiropractic. the deformities you are talking about are intrinsic to the structure of these bones. but for the most part, our bones are at the mercy of our muscles. if we "treat the bones" like chiropractics (and some aspects of OMM... ) the muscles will just pull the bones right back where they were because THEY were the problem.

 

[mmmcdowe]

You'd be surprised how malaligned a back can get without a serious neurologic compromise. radiculopathy's require foramenal narrowing, you have a lot of room for other malalignments without compromise. Severe lordosis, scoliosis, kyphosis, anterolistheses, etc. True neurologic compromise is quite rare even in badly diseased and stenosed backs, at least in the ER population. Radiculopathy is relatively common, but still the minority when it comes to l-spine complaints, perhaps comign a bit more to the fro in c-spine complaints

Would you say that the force generated by a chiropractor is potentially sufficient to realign parts of the spine for a significant period of time, if not permanently?

 

[link2swim06]

Serious question why would a chiropractor ever be better than a DPT? As far as I can tell a DPT has more rigorous training, plus it is 100% evidence based.

 

[theseeker4]

Serious question why would a chiropractor ever be better than a DPT? As far as I can tell a DPT has more rigorous training, plus it is 100% evidence based.

For the same reason some people go to acupuncturists, homeopaths, naturopaths and faith healers before a real doctor for everything from feeling cold to having cancer?

 

[Rendar5]

Serious question why would a chiropractor ever be better than a DPT? As far as I can tell a DPT has more rigorous training, plus it is 100% evidence based.

most things in medicine aren't 100% evidence based.

as for someone who asked if the force generated by a chiropracter was enough to correct alignment permanently. You got me but it does pass the sniff test (i.e., doesn't smell like BS). I re-align fractures and dislocations myself, so it's easily possible to do that physically. as for whether or not there's lasting benefit, i don't think the evidence is strong in either direction.

 

[jesspt]

Guess I will chime an alternate opinion in here. I've had a very positive experience with a chiropractor. In college I suffered from lower back pain, it progressively got worse until the point where I couldn't drive in the car for more then one hour without an excruciating pain which started at my lower back and radiated down my left leg.

I didn't believe in chiropractors but my dad offered for me to see one and since it was free I opted to go. Well he manipulated me and adjusted my spine with HVLA and upon his thrust my entire lower spine cracked, about 6-8 cracks. I felt an electric pulse run down my leg and the pain was gone. I walked out of there pain free.

Now that I am in medical school I can adequately dx myself and I am confident that I had a hypertonic left sided psoas muscle pulling my lumbar vertebrae out of alignment causing secondary left sided sciatic pain. The HVLA maneuver realigned my vertebrae and released the compression on sciatic nerve.

The caveat to this story and concerns I have with chiropractors is this. First off, the chiropractor didn't dx me, he just heard left sided lower back pain and went into the technique. Additionally, he didn't treat the underlying pathology which was a hypertonic and shortened psoas muscle (and bilateral hypertonic and shortened hamstrings). Since he didn't address this issue sure enough after one year the back pain returned, less though.

My issue could have been addressed by a few week of soft tissue tech by a PT given an accurate dx, but I gotta say it was pretty awesome to walk in the office in pain and leave without pain.

And, exactly how does one diagnose a hypertonic and shortened psoas and bilaeterally hypertonic hamstrings? And how are you so "confident" that this was the "cause"? Perhaps the psoas spasm (if it truly existed at all) was a response to your back pain, not the cause of it. Not trying to start a fire here, but your idea that anyone can accurately diagnose one pain generator in most cases of LBP isn't consistent with the literature.

Also, you could have received the same treatment from a PT. All PT programs now are required to include HVLA into their curriculum in order to receive accreditation. However, they are (thankfully) not instructed in the psuedoscientific woo that is the pursuit of the mythical subluxation.

I would challenge you about your vertebra being pulled "out of alignment". ur a medical student so I assume you have played with a vertebral column. you just try to pull one of those suckers out of alignment... it really isn't happening, especially to the degree chiropractors would have you believe (at least not without SERIOUS neurological deficit).

in my mind, chiropractics is a musculoskeletal treatment where the practitioners are still stuck thinking they are a skeletal-nervous treatment. If you have issues with your psoas I would be surprised if you DIDNT have back pain... but the claim that this is due to subluxation is a fallacy. muscle strain is the primary cause of back pain. if you have neurological defects due to spinal alignment you will have more than pain... (im not trying to pick on u or call u out here, just make a point) mean, are we assuming your mis alignment was confined specifically to an area affecting the only dorsal root components which feed dorsal rami fibers? THAT would be impressive. if the spine was affecting dorsal root the pain would not be so local, and there would be motor weakness if we hit rami. the explanation of illness doesnt fit, and even if the treatment brings relief i think we are obligated to understand cause

Your theory re: muscle strain is the primary cause of back pain is way off the mark. A reference to support your position would be nice, but I'm pretty sure you won't find one.
For one thing, muscle strain doesn't even fit the primary onset of most episodes of low back pain. The vast majority of LBP onset is unknown/insidious. Muscle strain, by definition, is damage to muscle fibers, usually via a strong contractile force being created while a muscle is in an unadvantageous length (either maximally shortened or lengthened). How does that fit with most patients not being able to identify any precipitating incident that caused their LBP?

but these are not the things that chiropractors usually treat, nor do they strictly describe a subluxation. you're right though, i was being too general. My focus was on disarticulated spinal joints, misalignment of synovial joints like the hip, and the claim that the bone arrangement is the source of the pain. (anecdote warning...) my mother was told by a chiropractor that she had a cervical vertebra which had turned sideways.

even with a massive spinal deformity like severe scoliosis, often back pain is a result of the muscles which are trying to compensate for a bad structure, and treatment of these muscles will give some relief - which is why chiro is akin to a massage. what I was addressing was the flaw in the underlying assumptions of chiropractic. the deformities you are talking about are intrinsic to the structure of these bones. but for the most part, our bones are at the mercy of our muscles. if we "treat the bones" like chiropractics (and some aspects of OMM... ) the muscles will just pull the bones right back where they were because THEY were the problem.

Again, this whole muscle theory is just not consistent with current literature. And, you're assuming that HVLA has no effect on muscles. Perhaps a look at this reference which examines the effects of HVLA (done by PTs), might provide you with some insight.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2775050/

 

[jesspt]

And here is a nice editorial addressing the mechanism of action re: HVLA -


http://www.jospt.org/issues/articleID.1417/article_detail.asp

 

[kitsunepixie]

As a Neurosurg resident, I have seen more than my fair share of carotid and vertebral artery dissections following c-spine manipulations, but I've also had very good chiropractors refer patients to us who did have surgical problems...recently one picked up a kid with a jumped facet after a football injury who was referred to him by the kid's PCP. He promptly got x-rays and shipped him to us after the cause for his arm pain and weakness was found.

 

[PharmaTope]

a lot of chiropractors do good work. just because older ones have an idea of various modalities curing random things does not mean the newer ones believe that.

i think chiros do have a place in therapy and rehabilitation.

 

[SpecterGT260]

Again, this whole muscle theory is just not consistent with current literature. And, you're assuming that HVLA has no effect on muscles. Perhaps a look at this reference which examines the effects of HVLA (done by PTs), might provide you with some insight.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2775050/

reading comprehension, there dude/ette (hard to tell gender vs the car forums i usually ascribe to....)

i most certainly am NOT assuming HVLA has no effect on the muscle. in fact, THAT was my very point = HVLA does not treat bone alignment and therefore the underlying assumptions of chiropractics are bunk. chiropractic states that the body creates disease due to misalignments of the spinal column (subluxations)

Taken from Palmer's site
This philosophy holds that life is intelligent and that the human body possesses an inherent potential to maintain itself in a natural state of homeostasis through its innate/inborn intelligence. Moreover, the science of chiropractic emphasizes the relationship between structure and function, primarily that between the spinal column and the nervous system. Implicit within this statement is the significance of the nervous system to health and the effect of the subluxation complex upon the nervous system and, therefore, the body.

This is the underlying principle that allows some chiros to claim they can treat GI, Psych, and infectious diseases. simply - misalignment of spine creates faults in the body's communication which interrupts the body's natural healing ability. further - the body in its natural state is immune from disease or illness and these subluxations or dis-joints create figurative dis-jointedness in the body's protective mechanism.


your link was mostly useless. it states only that we are not sure of the mechanisms by which manual manipulations (as an umbrella term, not necessarily OMM) work and that current conjecture on the subject is not backed up by research.

I propose that this is because most people interested in providing a mechanism are also practitioners (you dont see many gastroenterologists vs chiropractors publishing work on the mechanisms of HVLA). what I was suggesting is that the reason these defenses for HVLA are lacking support is because those trying to support them have a bias towards a skeletal mechanism which coincides with their current philosophy.

and MY suggestion is that much of this pain is not associated with the bony anatomy, but is associated with muscle tension. even if we are triggering nerves in the bones, it is the muscles that need corrected so they "lay off" so to speak.

this paper supports that hypothesis
http://www.ncbi.nlm.nih.gov/pubmed?...actors in Patients With Chronic Low Back Pain


its treatment for CLBP is heat compresses. I really fail to see a mechanism by which a little heat works more towards bone than it does muscle. and again, the ONLY point that this is going to support is that the foundation of chiropractics is faulty and leads them towards dangerous conclusions such as the Omaha chiro a few years back who tried to adjust out his son's tetanus, or more current news is the ones who support that blow-hard jenny mccarthy and her anti-vaccine campaign. I think there is scientific use to the practices of chiropractics, but in the hands of people with such a skewed and pseudoscientific approach to medicine, we are unable to discern that use - or at the very least met with opposition while trying to do so



Jesspt, are u a current pt student? your line defining muscle strain is incredibly narrow. There are plenty of ways for a person to experience pain caused by muscles, not just eccentric contractions. muscle strain may not have been the blanket term i was looking for, but the point was not "back pain is caused by overworked muscles"
TL;DR
never said chiropractics was a faulty or worthless therapy. just said the rationale behind the therapy was faulty - look up treatments for hemochromatosis and tell me if this is a defense for bringing back bloodletting. 1 lucky shot doesnt justify all the potential and documented harm that false assumptions can cause

 

[SpecterGT260]

As a Neurosurg resident, I have seen more than my fair share of carotid and vertebral artery dissections following c-spine manipulations, but I've also had very good chiropractors refer patients to us who did have surgical problems...recently one picked up a kid with a jumped facet after a football injury who was referred to him by the kid's PCP. He promptly got x-rays and shipped him to us after the cause for his arm pain and weakness was found.

and these are the guys that are the saving grace of the practice. hell, some of them are cheaper than massage spas now, so why the hell not? the issue only arises when a practitioner steps beyond his or her training. I just think the foundation of chiropractic lends itself to this more than other disciplines do - after all, they are essentially told "I am handing you a medical swiss army knife, go forth and cure EVERYTHING"


EDIT: jesspt, didnt see ur first link. thought i clicked it but instead got the "why ask why" article. that study isnt bad and id like to see more dont on the subject. there is a really good chance that acupuncture works on similar principles but research is slow on both fronts due to cultural opposition.

 

[jesspt]

Specter,

i most certainly am NOT assuming HVLA has no effect on the muscle. in fact, THAT was my very point = HVLA does not treat bone alignment and therefore the underlying assumptions of chiropractics are bunk. chiropractic states that the body creates disease due to misalignments of the spinal column (subluxations)

I got your point. But, in fact, you had two - that the mythical subluxation cannot be the cause of all that ails us (which I wholeheartedly agree with), and that "muscle strain is the primary cause of back pain", which I find to be incredibly simplistic, and mostly wrong.

Quote:
Taken from Palmer's site
This philosophy holds that life is intelligent and that the human body possesses an inherent potential to maintain itself in a natural state of homeostasis through its innate/inborn intelligence. Moreover, the science of chiropractic emphasizes the relationship between structure and function, primarily that between the spinal column and the nervous system. Implicit within this statement is the significance of the nervous system to health and the effect of the subluxation complex upon the nervous system and, therefore, the body.
This is the underlying principle that allows some chiros to claim they can treat GI, Psych, and infectious diseases. simply - misalignment of spine creates faults in the body's communication which interrupts the body's natural healing ability. further - the body in its natural state is immune from disease or illness and these subluxations or dis-joints create figurative dis-jointedness in the body's protective mechanism.

Yup. This is utter and total nonsense. This type of subluxation is essentially this, and this, all rolled into one. It does not exist.

your link was mostly useless. it states only that we are not sure of the mechanisms by which manual manipulations (as an umbrella term, not necessarily OMM) work and that current conjecture on the subject is not backed up by research.

I see that you saw the correct link, so you've seen the references to the various types of manual care and the references to the relevant research regarding each type of technique.

I propose that this is because most people interested in providing a mechanism are also practitioners (you dont see many gastroenterologists vs chiropractors publishing work on the mechanisms of HVLA). what I was suggesting is that the reason these defenses for HVLA are lacking support is because those trying to support them have a bias towards a skeletal mechanism which coincides with their current philosophy

I totally agree with this. Way too many manual therapy practitioners are far to entrenched in what they are traditionally taught. and justifying the theory (or in tradtional chiro's case, pseudoreligion) behind it, rather than embracing a more likely, and relevant mechanism or mechanisms. I wish that Occam's razor cut a wider swath.

and MY suggestion is that much of this pain is not associated with the bony anatomy, but is associated with muscle tension. even if we are triggering nerves in the bones, it is the muscles that need corrected so they "lay off" so to speak.

And now you're backing off. Initially muscle strain was the cause of most LBP, and now LBP is associated with muscle tension. Words have definitions for a reason, and muscle strain, in the medical realm, is defined in fashion similar to what I proposed. Perhaps you mean that most LBP is myogenic. I would still strongly disagree with you, but I think that term is more likely what you are looking for.

this paper supports that hypothesis
http://www.ncbi.nlm.nih.gov/pubmed?t...%20Back%20Pain


its treatment for CLBP is heat compresses. I really fail to see a mechanism by which a little heat works more towards bone than it does muscle

I would agree that it certainly isn't effecting the bone, and I would also say that it isn't all that likely to be effecting the muscles, either. The primary tissues effected would likely be the skin and the cutaneous nerves that lie within it. So, I don't it lends very strong support for your argument that most LBP is myogenic, but it does seem to hint (although quite indirectly) that short term reductions in LBP do not have to be a result of forces directed at joints, al la spinal manipulation.

Just saw your other edit:

Jesspt, are u a current pt student?

Nope.

 

[SpecterGT260]

im not backing off. i admitted that I may have used a wrong term. Then clarified what I intended. yes, myogenic is close enough, however I am not excluding pain sensation actually felt within the bone.

do you realize you are taking a series of arguments made to undermine chiropractic belief in subluxation and applying them to something completely different? and then asking me to justify why the statements dont seem appropriate or incorrect? what you and I have going here is a tangent originating because I was a little broad and careless with my terminology concerning the exact source of the pain - even though the source that was excluded (bone acting on nerve) was explicit.

so even the debate you and I are having now (both sides of it) is supporting my original intended points....

 

[macgyver22]

I think s/he is referring to the hygiene theory where it might be best to allow a child to develop in an unsterile environment and in fact promote exposure to pathogens so the child develops immunities to such organisms.

On a side note, can anyone chime in whether it is better to develop immunity the traditional way vs. vaccines? Is it better to "work out" our immune system responses to pathogens that are rarely life threatening and keep it at an optimal level vs. direct vaccination? Or is there no difference to have an "exercised immune system" when it comes to a response to a new threat (pathogen)?

What was said above is correct to a point, but the immunity you get form vaccines is not always identical to what you get from an actual infection ( although it is always much safer). Vaccines come in a number of varieties but for the purpose of this discussion lets just talk about killed and live attenuated virus vaccines.

Killed virus vaccines are produced by culturing the virus and then "killing" it by various chemical methods that disassemble the virus so it is no longer capable of reproduction when injected into the body. The final product often times only includes some components of the original virus. Usually the idea is to preserve the epitope we feel is most likely to stimulate the production of protective antibodies. While this method is very effective it does not always produce the exact same immune response that you would get if you had an infection with the live wild virus. Sometimes that is because there may be more than one epitope that is important and more than one antibody is produced. This suite of antibodies that are produced with a live virus infection may give better or longer lasting protection in some cases. The flu vaccine is a good example of this. That does not mean 'natural immunity' is better. Allowing people to contract the actual virus will always result in far greater morbidity and mortality and is a poor excuse for forgoing vaccination.

Live virus vaccines can overcome some of these limitations because the intact virus is injected (MMR, Varicella vaccine) or swallowed ( oral polio) or nasally ( FluMist nasal flu vaccine) but there is some risk of illness in immune compromised individuals or in cases where the virus spontaneously mutates to a more virulent form. Even live viruses may not produce the identical immunity you get from an infection because the virus is less virulent and may not trigger as robust an immune response in some cases.

Its a bit more complicated than this and things such as the way in which the epitope is presented to the immune system can effect the veracity of the immune response but the bottom line is that any defense of natural immunity is always flawed by the plain fact that more people will be injured and die if you take that approach. Most vaccine offer very good immunity and all protect against illnesses that may not seem serious today but would be devastating if allowed to run wild in the population again. Virtually every illness that we vaccinate for results in some deaths and significant morbidity when it occurs in the wild. Pertussis, measles, mumps, rubella, chicken pox, polio etc all had very significant and tragic effects on the health of people prior to the introduction of vaccines

 

[Raryn]

As a Neurosurg resident, I have seen more than my fair share of carotid and vertebral artery dissections following c-spine manipulations, but I've also had very good chiropractors refer patients to us who did have surgical problems...recently one picked up a kid with a jumped facet after a football injury who was referred to him by the kid's PCP. He promptly got x-rays and shipped him to us after the cause for his arm pain and weakness was found.

When I rotated on CT surg we had a pt who had a completely paralyzed left hemidiaphragm that could have only resulted if one of his phrenic nerves was severed somewhere. Coincidentally, his symptoms (SOB mostly) started pretty much right after he had his neck adjusted by a chiropracter for stiffness.

 

[SpecterGT260]

Even live viruses may not produce the identical immunity you get from an infection because the virus is less virulent and may not trigger as robust an immune response in some cases.

when you say identical, do you mean in magnitude or scope? im not aware of any molecular differences between any normally acquired pathogen and a vaccine. The only difference I am aware of comes from the dose given which can result in partial immunity which i only took to mean a smaller relative number of memory lymphocytes - potentially small enough that a sufficient exopsure would overwhelm requiring a full adaptive response inspite of previous exposure

is this correct?

 

[facetguy]

but these are not the things that chiropractors usually treat, nor do they strictly describe a subluxation. you're right though, i was being too general. My focus was on disarticulated spinal joints, misalignment of synovial joints like the hip, and the claim that the bone arrangement is the source of the pain. (anecdote warning...) my mother was told by a chiropractor that she had a cervical vertebra which had turned sideways.

even with a massive spinal deformity like severe scoliosis, often back pain is a result of the muscles which are trying to compensate for a bad structure, and treatment of these muscles will give some relief - which is why chiro is akin to a massage. what I was addressing was the flaw in the underlying assumptions of chiropractic. the deformities you are talking about are intrinsic to the structure of these bones. but for the most part, our bones are at the mercy of our muscles. if we "treat the bones" like chiropractics (and some aspects of OMM... ) the muscles will just pull the bones right back where they were because THEY were the problem.

Why is it that chiropractors "treat the bones"? Hint: it's not because a bone has jumped out of place.

And pay attention to what JessPT is telling you, because you're off the mark in your understanding of this issue.

 

[Fiveoboy11]

im not backing off. i admitted that I may have used a wrong term. Then clarified what I intended. yes, myogenic is close enough, however I am not excluding pain sensation actually felt within the bone.

do you realize you are taking a series of arguments made to undermine chiropractic belief in subluxation and applying them to something completely different? and then asking me to justify why the statements dont seem appropriate or incorrect? what you and I have going here is a tangent originating because I was a little broad and careless with my terminology concerning the exact source of the pain - even though the source that was excluded (bone acting on nerve) was explicit.

so even the debate you and I are having now (both sides of it) is supporting my original intended points....

You may want to take some of the commentary offered by jesspt as educational and stop arguing..

 

[thomprya]

And, exactly how does one diagnose a hypertonic and shortened psoas and bilaeterally hypertonic hamstrings? And how are you so "confident" that this was the "cause"? Perhaps the psoas spasm (if it truly existed at all) was a response to your back pain, not the cause of it. Not trying to start a fire here, but your idea that anyone can accurately diagnose one pain generator in most cases of LBP isn't consistent with the literature.

Also, you could have received the same treatment from a PT. All PT programs now are required to include HVLA into their curriculum in order to receive accreditation. However, they are (thankfully) not instructed in the psuedoscientific woo that is the pursuit of the mythical subluxation.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2775050/

Good point, I assume an accurate dx since I had one of our docs look at it. I could barely achieve >50 degree straight leg raise bilaterally. When pressing on the psoas muscle on the back the pain radiated down to my calf and exacerbated the original symptoms. Additionally after being treated (lots of stretching and soft tissue work) the pain is gone. Realistically my post was to bring up the point that HVLA is nice for a quick alignment but if you are not treating the misalignment cause then I'm confident the issue will come back. I didn't know PT schools now teach HVLA. That's pretty cool. Also, I look at the chiropractic profession similarly to acupuncture, there is something going on but as it gets put to scientific scrutiny then we will see if it is a truly useful modality or purely pseudoscience.

 

[SpecterGT260]

Why is it that chiropractors "treat the bones"? Hint: it's not because a bone has jumped out of place.

And pay attention to what JessPT is telling you, because you're off the mark in your understanding of this issue.

this has gotten off topic.

the argument between me and jesspt was a tangent over terminology that isnt core to my training and i consider it splitting hairs. from what I see, jesspt and i are somewhat in violent agreement on the main topic.

everything i have said (anecdotal, opinion, and referenced fact) has been to say that I think the core principles of chiropractic leave an unreasonable allowance for overstepping of ones education. The statement that spine/nerve interaction is the source of ailment in the body is faulty, and the specific examples i gave were not to dive into the minutia of these proposed ailments but just to show the logical flaw in chiropractic. Ive admitted, i misspoke. you cant exactly say I am off the mark in understanding when the opposing view is "we dont understand". had i known i was about to be called out for a technicality i would have been a little more selective with my words but honestly.... that isnt the discussion i was having. my focus was on chiropractic and why the explanations of treatment given by chiropractors do not hold up inspite of the fact that there is some evidence for benefit from treatment. if we wanna talk about specific sources of backpain that deserves a different thread and Id be happy to continue that part of the discussion there

 

[IlDestriero]

They don't treat disease, but here's a link from their page where they link all their "research" on chiro and pediatric disease.
shameful charlatans. Preying on desperate parents.
http://icpa4kids.org/Chiropractic-Research/

 

[jesspt]

this has gotten off topic.

the argument between me and jesspt was a tangent over terminology that isnt core to my training and i consider it splitting hairs. from what I see, jesspt and i are somewhat in violent agreement on the main topic.

everything i have said (anecdotal, opinion, and referenced fact) has been to say that I think the core principles of chiropractic leave an unreasonable allowance for overstepping of ones education. The statement that spine/nerve interaction is the source of ailment in the body is faulty, and the specific examples i gave were not to dive into the minutia of these proposed ailments but just to show the logical flaw in chiropractic. Ive admitted, i misspoke. you cant exactly say I am off the mark in understanding when the opposing view is "we dont understand". had i known i was about to be called out for a technicality i would have been a little more selective with my words but honestly.... that isnt the discussion i was having. my focus was on chiropractic and why the explanations of treatment given by chiropractors do not hold up inspite of the fact that there is some evidence for benefit from treatment. if we wanna talk about specific sources of backpain that deserves a different thread and Id be happy to continue that part of the discussion there

I didn't think we were having an argument. You made two points, one I am 100% in agreement with and another that I couldn't disagree with more strongly.

I understand that pain science and musculoskeletal examination and treatment is likely not within your core training as of yet (I'm making the assumption that you're in medical school based upon the info below your user name on the left and not in a residency as of yet). But I think this is part of a larger problem that gets magnified once MDs are out in the clinic after med school and residency. From my experience, a significant portion of primary care physicians over simplify spinal pain, which leads them to trivialize its treatment and to statements such as "all back pain is caused by muscle strain." A statement such as this (and believe me, I don't think you are the only med student or physician who believes this) doesn't even have face validity. If the cuase of the majority of LBP was simply muscular in nature, then treatments such as simple stretching and strengthening should have already shown far better outcomes than they have, and we wouldn't have such a HUGE chronic pain problem here in the US. We would be batting nearly a thousand with LBP patients. And, I'm sure I don't need to tell you, we are not.

I would encourage you to not become that type of practitioner, particularly if you end up in a primary care role. Depending on what reference you read, upward of 25% of primary care visits are now for musculoskeletal pain. Your future patients will need you to have a better, more comprehensive understanding of musculoskeletal pain, and maybe your generation of MDs, along with contientious, evidenced based rehabilitation providers, can start to turn the tide of this LBP mess we have gotten ourselves into.

OK. *climbs off of soap box*

I'd be happy to participate in a thread about potential causes of LBP.

Also, if you're curious, Melzak's theory of the Pain Neuromatrix makes for excellent and interesting reading and is an elegant explanation of pain, leading us away from solely blaming structures for pain.

 

[CaptainSSO]

I had been taken to a few chiropractors when I was a kid, but the last one I went to a couple years ago told me that my Centrum multi-vitamin was poisoning me and proceeded to offer me like a 200 dollar bottle of "natural" vitamins... My leg did feel a bit better afterwards, though.

After reading about all these basilar/carotid/vertebral artery dissections I definitely would never have my neck cracked, but I wouldn't be opposed to going for my back or legs.

 

[SpecterGT260]

I didn't think we were having an argument. You made two points, one I am 100% in agreement with and another that I couldn't disagree with more strongly.

I understand that pain science and musculoskeletal examination and treatment is likely not within your core training as of yet (I'm making the assumption that you're in medical school based upon the info below your user name on the left and not in a residency as of yet). But I think this is part of a larger problem that gets magnified once MDs are out in the clinic after med school and residency. From my experience, a significant portion of primary care physicians over simplify spinal pain, which leads them to trivialize its treatment and to statements such as "all back pain is caused by muscle strain." A statement such as this (and believe me, I don't think you are the only med student or physician who believes this) doesn't even have face validity. If the cuase of the majority of LBP was simply muscular in nature, then treatments such as simple stretching and strengthening should have already shown far better outcomes than they have, and we wouldn't have such a HUGE chronic pain problem here in the US. We would be batting nearly a thousand with LBP patients. And, I'm sure I don't need to tell you, we are not.

I would encourage you to not become that type of practitioner, particularly if you end up in a primary care role. Depending on what reference you read, upward of 25% of primary care visits are now for musculoskeletal pain. Your future patients will need you to have a better, more comprehensive understanding of musculoskeletal pain, and maybe your generation of MDs, along with contientious, evidenced based rehabilitation providers, can start to turn the tide of this LBP mess we have gotten ourselves into.

OK. *climbs off of soap box*

I'd be happy to participate in a thread about potential causes of LBP.

Also, if you're curious, Melzak's theory of the Pain Neuromatrix makes for excellent and interesting reading and is an elegant explanation of pain, leading us away from solely blaming structures for pain.

I didnt think we were having an "argument" either, but apparently a few others did with their "Listen herrrr young blood...." comments. I'm typically going to be one of the first ones around here who is up for a good debate on something and there are people that have what seems to be a pathological aversion to confrontation or conflict


I do understand what you are saying, however. And when you challenged me on it - you're right - i was being way too simplistic with it. When i said "splitting hairs" I wasnt trying to be facetious or pick a fight - I figured an oversimplification would be alright because the main point i was getting to was that when it comes to chiropractors: the primary mechanism that they explain to their patients, if true and accurate and whatever else, would result in paralysis if not death.

Although in doing so I treaded pretty far into PT territory so I accept the correction. But I am trying pretty hard to keep the discussion centered on the basic philosophy of chiro without getting lost in other details. if PT's are picking up HVLA (which i didnt know) this is actually a step forward. I dont believe that the therapies used by chiropractors are completely worthless, I just think in the hands of a pseudo-scientist that any value to such practices will be lost. PTs are trained according to modern evidence based principles and all of the PTs I know will reject a theory that conflicts with their understanding of basic sciences just as any physician would. So again, no conflict.

 

[facetguy]

I do understand what you are saying, however. And when you challenged me on it - you're right - i was being way too simplistic with it. When i said "splitting hairs" I wasnt trying to be facetious or pick a fight - I figured an oversimplification would be alright because the main point i was getting to was that when it comes to chiropractors: the primary mechanism that they explain to their patients, if true and accurate and whatever else, would result in paralysis if not death.

Although in doing so I treaded pretty far into PT territory so I accept the correction. But I am trying pretty hard to keep the discussion centered on the basic philosophy of chiro without getting lost in other details. if PT's are picking up HVLA (which i didnt know) this is actually a step forward. I dont believe that the therapies used by chiropractors are completely worthless, I just think in the hands of a pseudo-scientist that any value to such practices will be lost. PTs are trained according to modern evidence based principles and all of the PTs I know will reject a theory that conflicts with their understanding of basic sciences just as any physician would. So again, no conflict.

What is that mechanism? I believe you said chiropractors "treat the bones"; what does that mean?

 

[SpecterGT260]

That subluxation of spinal joints causes an interruption of information flow between the CNS and body which ultimately impairs the body's ability to heal itself thereby creating disease.

 

[SpecterGT260]

http://www.palmer.edu/WhatIsChiropractic/


Watch the video on that page. Palmer is the premier chiro school. The broad conclusion (body's ability to heal) with the narrow cause (subluxation) is what I perceive as dangerous with chiropractic as it allows practitioners to attempt to treat non musculoskeletal disease based on philosophy. Essentially they are saying that subluxation is interfering w the spine. Therefore they realign the bones to clear the interference with spinal signaling will allow the body to heal itself.
My issues (some assumption involved):
1. Subluxation to the degree that it interferes with spinal nerves (as described by Palmer) would result in severe symptoms - paralysis, debilitating pain. Also this will not affect other diseases as some chiros claim...
2. Adjustment of bone via chiropractic adjustment or HVLA will not result in altered skeletal arrangement. Any perceived misalignments will be due to long persisting factors like posture or muscle tone and if attributed to muscle tone the muscle will pull the bone right back to where it was.
3. If the concepts of subluxation and adjustment are false then there may be a physiological component to the relief that will remain hidden under the BS while chiropractors corner that market (this is less of a concern as it seems PTs are looking into HVLA. But I'd still like to see a coherent mechanism at some point.).

Basically the application of chiropractic principles is no different than the thought processes that had us bleeding people. Fact: components of illness are contained in the blood. Assumption: the bad components will be rejected by the body. Conclusion: bleeding will remove illness from the body. Fact: the CNS is the control center for the body. Assumption: subluxations impede the CNS in its ability to convey healing messages. Conclusion: "imma crack yo back and heal yo herpes!"

 

[Shnurek]

Basically the application of chiropractic principles is no different than the thought processes that had us bleeding people. Fact: components of illness are contained in the blood. Assumption: the bad components will be rejected by the body. Conclusion: bleeding will remove illness from the body. Fact: the CNS is the control center for the body. Assumption: subluxations impede the CNS in its ability to convey healing messages. Conclusion: "imma crack yo back and heal yo herpes!"

Haha except the funny part is that blood letting did help people that had systemic bacterial infections by reducing the amount of iron in the blood. This iron is necessary for some bacterial replication and if there are reduced levels they pay a higher metabolic price to obtain it and therefore reproduce slower. See: Hemochromatosis and bacterial infections. They may not have known the detailed biological processes behind this but they saw it worked.

http://iospress.metapress.com/content/d2kl255346g9r2q1/


Bacterial protection

In response to a systemic bacterial infection, the immune system initiates a process known as iron withholding. In iron withholding, the free iron in the plasma binds to transferrin, making it harder for bacteria to obtain it. The body cells, however, can easily get iron from transferrin.[1] If bacteria are to survive, then they must obtain iron from their environment. Disease-causing bacteria do this in many ways, including releasing iron-binding molecules called siderophores and then reabsorbing them to recover iron, or scavenging iron from hemoglobin and transferrin. The harder they have to work to get iron, the greater a metabolic price they must pay. That means that iron-deprived bacteria reproduce more slowly. So our control of iron levels appears to be an important defense against bacterial infection. People with increased amounts of iron, like people with hemochromatosis, are more susceptible to bacterial infection. [3]

It also helped people with hypertension. Now I'm not defending chiros here. I'm just showing you that not everyone knows everything. That's what specialization is for. To be a master of one trade.

 

[SpecterGT260]

Haha except the funny part is that blood letting did help people that had systemic bacterial infections by reducing the amount of iron in the blood. This iron is necessary for some bacterial replication and if there are reduced levels they pay a higher metabolic price to obtain it and therefore reproduce slower. See: Hemochromatosis and bacterial infections. They may not have known the detailed biological processes behind this but they saw it worked.

http://iospress.metapress.com/content/d2kl255346g9r2q1/


Bacterial protection

In response to a systemic bacterial infection, the immune system initiates a process known as iron withholding. In iron withholding, the free iron in the plasma binds to transferrin, making it harder for bacteria to obtain it. The body cells, however, can easily get iron from transferrin.[1] If bacteria are to survive, then they must obtain iron from their environment. Disease-causing bacteria do this in many ways, including releasing iron-binding molecules called siderophores and then reabsorbing them to recover iron, or scavenging iron from hemoglobin and transferrin. The harder they have to work to get iron, the greater a metabolic price they must pay. That means that iron-deprived bacteria reproduce more slowly. So our control of iron levels appears to be an important defense against bacterial infection. People with increased amounts of iron, like people with hemochromatosis, are more susceptible to bacterial infection. [3]

It also helped people with hypertension. Now I'm not defending chiros here. I'm just showing you that not everyone knows everything. That's what specialization is for. To be a master of one trade.

I already mentioned blood letting as a currently accepted treatment for hemochromatosis. My point at the time was just because it works for one thing it wont work for everything and chiropractors use their practice as a medical swiss army knife. You're just reiterating my point

I am REALLY skeptical of your article though... i havent heard of blood letting for these other conditions and they dont even mention hepatic involvement in the issues with excess iron (and your liver will kill you well before anything else with iron overload). blood letting for infection is a terrible idea. whatever benefit bacteria may have with iron is completely overshadowed by the blood born components of the immune system. and the only way a bacteria will get the iron is hemolysis and I REALLY wouldnt feel comfortable draining a patient already in hemolytic anemia.... a more senior student or an attending can feel free to chime in here, but something sounds very wrong about this

 

[SpecterGT260]

this makes more sense to me

http://www.plospathogens.org/article/info:doi/10.1371/journal.ppat.1001322

the way this article reads: you can see increased instance of infection in patients with iron loading diseases. That doesnt mean that reducing iron is a good idea for the average person. you can bleed someone with increased iron to bring their levels down to avoid the decreased bacterial resistance but still, you shouldnt bleed an otherwise healthy person - they need iron too.

Although broad application like that is exactly what I feel the chiropractors do... so... Thanks for helping me make my point (i know that came out really snarky but i didnt have a better way to say it lol)

 

[SpecterGT260]

never said chiropractics was a faulty or worthless therapy. just said the rationale behind the therapy was faulty - look up treatments for hemochromatosis and tell me if this is a defense for bringing back bloodletting. 1 lucky shot doesnt justify all the potential and documented harm that false assumptions can cause

it was here

 

[Shnurek]

it was here

Woops that's what I get for not reading the whole thread lol

 

[SpecterGT260]

its a hell of a long read.....

 

[IMcda]

In response to the above post from the Optometry Student-

Iron deficiency anemia resulting from hemorrhage is Hematology 101. Anemia of chronic inflammation, and the associated sequestration of iron in the presence of chronic infection, are also quite basic so I find it entertaining that you would post background information as though we [MS2s and up] weren't privy to it. Posting the supplemental text is hematological equivalent to linking a wikipedia article on Addition to support your argument that 2+2=4.

I would hope that you recognize that bloodletting is contraindicated in sepsis (and HTN). Making an argument that phlebotomy is a therapy for septicemia and correlating that to chiropractic care only establishes that both interventions are archaic and not based on empirical evidence; that each is derived from a primitive and cursory understanding of how the human body functions.

Your final quote is interesting as well:

"Now I'm not defending chiros here. I'm just showing you that not everyone knows everything. That's what specialization is for. To be a master of one trade."

Here are you speaking towards OD vs MD? A common refrain from physicians towards non-physician providers with a more limited education ( be it an Optometrists or DNP) is simply, 'you don't know what you don't know.' Specialization subsequent to establishing an extensive foundation in general medicine makes one an Ophthalmologist, and specialization prior to obtaining this breadth of knowledge leaves you with a more limited understanding- Optometry. Both are specialized providers of care, but they are not equivalent. Physicians should be the absolute first ones to proclaim, 'you can't know everything,' but, to be blunt, that isn't an excuse to take a shorter route of training, claim equivalency, and then lobby for medical and surgical privileges.

I apologize if you take offense.
---

Haha except the funny part is that blood letting did help people that had systemic bacterial infections by reducing the amount of iron in the blood. This iron is necessary for some bacterial replication and if there are reduced levels they pay a higher metabolic price to obtain it and therefore reproduce slower. See: Hemochromatosis and bacterial infections. They may not have known the detailed biological processes behind this but they saw it worked.

http://iospress.metapress.com/content/d2kl255346g9r2q1/


Bacterial protection

In response to a systemic bacterial infection, the immune system initiates a process known as iron withholding. In iron withholding, the free iron in the plasma binds to transferrin, making it harder for bacteria to obtain it. The body cells, however, can easily get iron from transferrin.[1] If bacteria are to survive, then they must obtain iron from their environment. Disease-causing bacteria do this in many ways, including releasing iron-binding molecules called siderophores and then reabsorbing them to recover iron, or scavenging iron from hemoglobin and transferrin. The harder they have to work to get iron, the greater a metabolic price they must pay. That means that iron-deprived bacteria reproduce more slowly. So our control of iron levels appears to be an important defense against bacterial infection. People with increased amounts of iron, like people with hemochromatosis, are more susceptible to bacterial infection. [3]

It also helped people with hypertension. Now I'm not defending chiros here. I'm just showing you that not everyone knows everything. That's what specialization is for. To be a master of one trade.

 

[facetguy]

In response to the above post from the Optometry Student-

Iron deficiency anemia resulting from hemorrhage is Hematology 101...

The King has spoken.

 

[Shnurek]

I wasn't trying to start another OD vs. MD vs. DO thing. I was just trying to join into the conversation from a neutral third-party standpoint coming from in-between chiros and MDs.

But I disagree with your assertion that delayed specialization is better than immediate specialization following college as is found in OD education. Neuroscience 101: our fluid intelligence is greater at a younger age. If a person gets exposed to ocular pathology, ocular surgery, the physics of light and the myriad of systemic diseases that have ocular manifestations at a young age then that person will be at an advantage. In my opinion this makes for a more efficient educational system. However, this is the point of the debate and fortunately or unfortunately the lawmakers have the final say.

 

[SpecterGT260]

I wasn't trying to start another OD vs. MD vs. DO thing. I was just trying to join into the conversation from a neutral third-party standpoint coming from in-between chiros and MDs.

But I disagree with your assertion that delayed specialization is better than immediate specialization following college as is found in OD education. Neuroscience 101: our fluid intelligence is greater at a younger age. If a person gets exposed to ocular pathology, ocular surgery, the physics of light and the myriad of systemic diseases that have ocular manifestations at a young age then that person will be at an advantage. In my opinion this makes for a more efficient educational system. However, this is the point of the debate and fortunately or unfortunately the lawmakers have the final say.

it depends on how you define "proficiency". From the medical aspect, you are not a proficient provider unless you can adapt previous knowledge to new circumstances and operate fluently in novel situations. From many other points of view, a proficient operator is one who can perform the same tasks with high precision. Many of these people fall on their faces when asked to adapt their knowledge. That isnt to say that it is bad either way - it is just the way it is. My girlfriend is getting her PhD in immunology and she has difficulty asnwering our test questions on the subject. all the same - she kicks my ass in raw knowledge of the material. without a broad base with subsequent narrowing you are much more likely to confuse oddities with your bread-and-butter work. This is honestly why I have issues with primary care PA's (although that is likely another thread's worth of discussion).

also, the age thing is beside the point. we were discussing length of time. nobody said it had to be started at a young age (that is reserved for Jedi training....) but even if we allow that - the above logic still stands. exposure to a single set of concepts or skills at a young age has no impact on ability to adapt, problem solve, or think outside of the box - even within that skill set.


I will say that i dont know a whole bunch about OD curriculum, however. Diagnostic skill comes from the narrowing of scope IMO. and I am not sure how much you guys do this

 

[CaptainSSO]

^I understand your point, and in general I am inclined to agree with you, but in this specific case honestly how often do you think ophthalmologists use their base knowledge learned in medical school? I just can't think of too much that would be applicable. I mean I guess certain things, like a Horner's sign (just a random example) they'd more readily pick up on and understand the phsyiology and implications thereof, but I think almost anyone would realize something was not right if only one pupil was constricted. And besides, the ophthalmologist wouldn't be the one to treat that anyway. But like you said, I'm not familiar at all with OD curriculum, so I don't know how much they don't learn.

 

[USCTrojan11]

Stirring the pot. Dear OD student, do you believe optometrists should be allowed to perform surgeries? See OK and Kentucky new legislation.

 

[THH]

this same principle applies between MD and DO, which IMO accounts largely for the ~2/3 pass rate of USMLE1 for DO students vs ~90% for MD.

Am I missing something? The DO pass rate for the USMLE Step1 is 81%, not 66%, and by the time Step 3 rolls around it's equal to the MD pass rate of 95%. I ask not because I disagree with your assumption that it is due to lower quality students on average, but because you seem to be making the exact same type of posts on the Osteopathic med student board for no other reason than to stir things up.

 

[SpecterGT260]

People get stirred up - and that is a poor response to have on a forum. The point of this place is conversation and debate. If one side just gets butthurt when presented with certain points of view then both sides leave without learning anything. And if I'm gong to make such claims I SHOULD do it on both boards. If I do it only there I risk just starting a flame war. If I do it just here I risk invaluable responses from fanboys. I haven't even said DOs make poor physicians.... I just respond to the rationalizations that use scores and pass rates as a system of intrinsic value but then ignores it when inconvenient....

 

[SpecterGT260]

Am I missing something? The DO pass rate for the USMLE Step1 is 81%, not 66%, and by the time Step 3 rolls around it's equal to the MD pass rate of 95%. I ask not because I disagree with your assumption that it is due to lower quality students on average, but because you seem to be making the exact same type of posts on the Osteopathic med student board for no other reason than to stir things up.

http://www.usmle.org/performance-data/default.aspx#2010_step-1

You're right. My numbers are a few years old. DO pass rate has increased. 5 years ago it was about 70%. I'm not sure about this but I don't think a DO student can take step2 without passing step 1 (I.e. comlex1 cannot sub in for usmle1) so an increased step1 fail rate will result in a relative increase in step2 pass rate as anyone who cannot pass earlier stages s weeded out. This is true for MD too but since it is % dependent the effect is smaller. If you look there is actually a 100% pass rate for DO in step3 for some years. For all 20 of those who took it....

 

[SpecterGT260]

^I understand your point, and in general I am inclined to agree with you, but in this specific case honestly how often do you think ophthalmologists use their base knowledge learned in medical school? I just can't think of too much that would be applicable. I mean I guess certain things, like a Horner's sign (just a random example) they'd more readily pick up on and understand the phsyiology and implications thereof, but I think almost anyone would realize something was not right if only one pupil was constricted. And besides, the ophthalmologist wouldn't be the one to treat that anyway. But like you said, I'm not familiar at all with OD curriculum, so I don't know how much they don't learn.

Sorry for the multi posts. The mobile app doesn't have a multi quote that I have found. I would say that all practicing physicians use more of their base knowledge than they are aware of. But thatis just my opinion

 

[IMcda]

Logged in to point out the irony that there's a "Find a Chiropractor" banner ad on the bottom of the page for me right now.

https://www.google.com/search?hl=en&q=facepalm&gs_upl=&bav=on.2,or.r_gc.r_pw.,cf.osb&biw=1366&bih=643&ix=sea&ion=1&um=1&ie=UTF-8&tbm=isch&source=og&sa=N&tab=wi&ei=J5c1T9vMM8GYiAK2sbVp

Stepping off the OD debate that I unfortunately derailed the thread with, to the OP- I legitimately respect that you came into this forum seeking an objective opinion. I can't speak to the beliefs of others, but for Chiropractic, I believe:

1) it is only indicated as palliative / non-curative care for certain lower back conditions
2) The basic premise, that correction of subluxations of the spine is a form of healing, (and can be applied to other multi-system conditions) is very flawed
3) Cervical manipulations are dangerous
4) Chiropractors should never refer to themselves as physicians. My friend's Dad is a chiropractor and refers to himself (on his facebook page) as a 'Chiropractic Orthopaedist.' As a student interested in Ortho, the use of Orthopaedist is to me very misleading, and the term 'Chiropractic Physician,' nearly infuriates me.

 

[facetguy]

Logged in to point out the irony that there's a "Find a Chiropractor" banner ad on the bottom of the page for me right now.

https://www.google.com/search?hl=en...source=og&sa=N&tab=wi&ei=J5c1T9vMM8GYiAK2sbVp

It's not irony. It's the genius of Google Ads.

Stepping off the OD debate that I unfortunately derailed the thread with, to the OP- I legitimately respect that you came into this forum seeking an objective opinion. I can't speak to the beliefs of others, but for Chiropractic, I believe:

1) it is only indicated as palliative / non-curative care for certain lower back conditions...

...that has been shown time and again to be as effective as anything else out there.

2) The basic premise, that correction of subluxations of the spine is a form of healing, (and can be applied to other multi-system conditions) is very flawed

Yes, I'll grant you that the subluxation thing only adds confusion. But manipulation works, and there are contemporary models as to why that have nothing to do with 100+ year old concepts.

3) Cervical manipulations are dangerous

Gotta call Total Bull **** here.

4) Chiropractors should never refer to themselves as physicians. My friend's Dad is a chiropractor and refers to himself (on his facebook page) as a 'Chiropractic Orthopaedist.' As a student interested in Ortho, the use of Orthopaedist is to me very misleading, and the term 'Chiropractic Physician,' nearly infuriates me.

Noted. Thanks.

 

[Raryn]

Gotta call Total Bull **** here.

Read through the thread again. There's several people that have had to treat patients who had morbidity after cervical manipulation. Including myself, where I saw a gentleman who had a nonfunctional (likely severed) left phrenic nerve that had no other explanation. There are many reported cases of even things along the lines of strokes happening as a result of cervical manipulation via chiropractic.

 

[JacobMcCandles]

Gotta call Total Bull **** here.

Do a Google search regarding cervical manipulations and carotid/vertebral artery dissections. Cervical manipulations aren't 100% benign.

 

[IDBasco]

I'm not sure about this but I don't think a DO student can take step2 without passing step 1

I did that very thing and know of others that have done the same.