Current Views of Chiropractic; What Do You See?

[mmmcdowe]

I was wondering when you would show up

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



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



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.



Gotta call Total Bull **** here.



Noted. Thanks.

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[Shnurek]

But like you said, I'm not familiar at all with OD curriculum, so I don't know how much they don't learn.

That's really the problem. Most people are unaware of the OD curriculum and how privileged we are in our scope of practice (glaucoma tx 49 states, oral meds 47 states, narcotics rx 36 states). We spend 4 years learning about eyes so think about it as medical/optical school for the eyes. Hell, we learn everything from the simple picking out of glasses to laser/scalpel eye surgery (on bovine or human eyes depending on state).

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

Yes, but only with appropriate training and few ODs will actually do it.

Stirring the pot some more: http://www.theoptometricproceduresinstitute.com/ODCE.TV/About_US.html click on FreeODCETV. We are trying to follow the dental model when it comes to eyes and this is why ophthals hate us. Check out their forum and the #1 sticky there is about OD surgery. Its really a rural profession however as we basically become ophthals in areas ophthals don't want to practice. So they'll still be #1 for a long while. But if you want more info just do a search in the opto/ophthal forums as I don't want to de-rail this thread anymore lol even though I have.

 

[facetguy]

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

Is there anything 100% benign? And keep the risk in perspective...extraordinarily rare.

Very good article on the subject:
http://chiromt.com/content/18/1/22
Read it so you will at least be up to date.

 

[facetguy]

I was wondering when you would show up

Did you think I'd miss all the fun?

 

[SpecterGT260]

Is there anything 100% benign? And keep the risk in perspective...extraordinarily rare.

Very good article on the subject:
http://chiromt.com/content/18/1/22
Read it so you will at least be up to date.

Back massage is benign. Unless you get the happy ending in a shady parlor.... Is the clap considered an associated morbidity here? But still, with same outcomes as chiro with no stroke I'd rather of this wrote

 

[SpecterGT260]

I just did a quick breeze through of the article but it looks like the guy is just trying to poke holes in previous studies by citing others that show various mechanisms that wouldn't result in dissection. However this doesn't invalidate the link. There are obviously convoluting factors. We are even told to be gentle while palpating the carotids in older patients because mashing on them could potentially dislodge plaques. I doubt cervical manipulation will have a negative effect on a healthy set of arteries. But this is America and artery disease is kinda our thing.

 

[drfamilymed]

 

[SpecterGT260]

I looked closer at that "paper". He defends case control as the best approach but IMO it is the worst. He suggests you should compare stroke vs non stroke and then look for incidence of cervical manipulation. Awful and borderline *****ic approach..... Selection bias is outrageous and strokes are common enough that this is a totally inappropriate study design.

Cohort is much more appropriate. You look at exposure and then compare outcomes vs non exposure.

P.s. no calling you a ***** lol. The guy in this study really should know better.....

 

[tiedyeddog]

Is there anything 100% benign? And keep the risk in perspective...extraordinarily rare.

Very good article on the subject:
http://chiromt.com/content/18/1/22
Read it so you will at least be up to date.

What is the benefit you're trading the risk for?

 

[facetguy]

What is the benefit you're trading the risk for?

Reduced neck pain would be a good start, with improved functional parameters being another worthwhile target.
http://www.ncbi.nlm.nih.gov/pubmed/21979312

http://www.ncbi.nlm.nih.gov/pubmed/16949939

NSAIDs are an almost-automatic recommendation for a condition like nonspecific neck pain. Are they without risk? Of course not, yet you will recommend them in nearly every case. Are they super risky? No, but compare the incidence of adverse reactions (including death) from NSAID use with that of cervical spinal manipulation. You'll be surprised.

 

[SpecterGT260]

Risk alone is an inappropriate. Severity of outcome seems to be neglected here.....

 

[facetguy]

Risk alone is an inappropriate. Severity of outcome seems to be neglected here.....

I'd say death is pretty severe, and NSAIDs alone kill a lot of people each and every year, WAY more than cervical spinal manipulation ever will.

 

[ijn]

Good luck developing "natural" immunity to tetanospasmin before you're in opisthotonus. The reason we give toxoid vaccines like tetanus, diphtheria, anthrax etc. is because the toxin straight up kills or severely deforms you before an immunocompetent host has a chance to develop an immune response.

 

[tiedyeddog]

I'd say death is pretty severe, and NSAIDs alone kill a lot of people each and every year, WAY more than cervical spinal manipulation ever will.

I am not doubting NSAID's do kill many people each year (http://www.nature.com/ajg/journal/v100/n8/full/ajg2005305a.html) but aspirin also has the added quality of (arguably) being a prophylactic anti-thrombotic. People who have developed GI bleeds probably developed them on low-dose aspirin using it as a "blood thinner", not a neck pain reliever. Plus, it seems with new proton-pump inhibitors GI bleed rates are going down.

I'd say the risk of gastric bleed/grandma throwing a clot is a lot more acceptable than temporarily ending neck pain/VAD. I guess if VAD caused by chiro manipulation is as low as you say it is it's a non-issue.

The thing that bothers me is if Chiropractors actually warn people about possibly VAD before neck manipulation? Is there a consent form signed and is the patient actually briefed at all on the risk?

 

[SpecterGT260]

I'd say death is pretty severe, and NSAIDs alone kill a lot of people each and every year, WAY more than cervical spinal manipulation ever will.

 

[SpecterGT260]

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

It's somewhat odd to allow that but whatever. However, if step1 scores are a major component of residency matching and the only reason for a DO to take usmle is for allopathic residency then why would you take usmle step 2 without taking step 1? Just curious... I feel like I'm missing something


Edit: did some digging.

"You must pass Step 1 and Step 2 before you are eligible to take Step 3. In LCME-accredited medical schools, although Step 1 and Step 2 can be taken in any order, most students will take Step 1 at the end of their second year and Step 2 in their fourth year; Step 3 is usually taken during the first or second year of postgraduate training. Students and graduates of medical schools outside the United States and Canada should contact the ECFMG for information on ECFMG Certification and Step 1 and Step 2 eligibility. Most medical licensing authorities require completion of USMLE Steps 1, 2, and 3 within a seven-year period, which begins when you pass your first Step. Check the FSMB website for further information on such requirements."

So that answers that

 

[CaptainSSO]

The thing that bothers me is if Chiropractors actually warn people about possibly VAD before neck manipulation? Is there a consent form signed and is the patient actually briefed at all on the risk?

To be fair, physicians frequently give out some pretty powerful prescriptions with potentially nasty sides without adequate warning of the risk, if any warning at all.

Ex: SSRIs are given out like candy, and in general they're well tolerated, but they do have the potential to cause a bad withdrawal, and the list of possible side effects is insane. Tardive dyskinesia, memory loss, insomnia to name a few of the more (relatively, but all 3 of those would suck) benign ones. QT prolongation leading to Torsade de Pointes to name a not so benign one.

 

[cyclohexene]

I think the point that most miss is that Chiropractor's injure patients disproportionately less relative to other healthcare professionals, such as MD's. (Admittedly their are 3 times as many MDs than DCs) DCs can perform full spinal adjustments and manipulations of the limbs, joints, appendages etc. I have been an athlete all my life and if it weren't for my chiropractor.. Sure some chiro's make bogus claims, but other's are very honest and legit and do a better specialized service unlike PT does. Because a subluxation doesn't exist on film it can't be proven or disproven. Thus, the idea of aligning the spine and restoring health in patients is based purely on observational methods. For example, many chiros see patients that suffer from chronic headaches. After several cervical manipulations the headaches dissipate. There have been numerous scientific, scholarly, studies confirming, but they're observational in nature. The rhetoric of chiropractic as quackery is long gone.

 

[Rendar5]

to put an EM voice in here regarding complications of treatments of neck/back pain.

In the last 3 years, I have seen 3 or 4 vertebral artery dissections, one of which was related to chiropractic manipulations. That dissection did not lead to a stroke and was treated with aspirin, as is pretty standard. Actually I don't think any of those led to strokes, fortunately.

In the last 3 years I have seen dozens and dozens of upper GI bleeds, 30-40% of which are related to NSAIDS, the other half presumed PUD, with some variceal bleeds thrown in. Some of those have had ridiculous morbidity and mortalitiy and resource utilization.
I've even had someone taek pain meds that were too strong for them for back pain, to the point where he had a bad aspiration pna and developed ARDS and was lucky not to have died. I've seen an epidural abscess related to a bad back with conventional medical treatment, and I've seen a case of arachnoiditis related to L-spine injects. I've seen maybe 2 rneal failures that may have been related to NSAID use.

Vertebral a. dissections are a known complication of chiropractic manipulation and need to be cautioned against, but it doesn't make chiropractic care excessively dangerous. If so, you need to tell people not to drive (or crash their cars) or to do yoga as both of those activities are associated with these dissections.

I would say medical therapy for these things can be just as dangerous if not more so. It's just that we have more scientifically established benefit, in some cases. Medicine honestly isn't that great at treating these things. back and neck pain is the bane of my ER existence. I don't particularly recommend chiropracters, but I give patients who want chriopracters the warning about some scam artists out there and the existence of a few rare complications they need to be aware of so they can look at it intelligibly. But I'm not scared of chiropractors and I don't fear for my patients that choose to use them.

 

[facetguy]

to put an EM voice in here regarding complications of treatments of neck/back pain.

In the last 3 years, I have seen 3 or 4 vertebral artery dissections, one of which was related to chiropractic manipulations. That dissection did not lead to a stroke and was treated with aspirin, as is pretty standard. Actually I don't think any of those led to strokes, fortunately.

In the last 3 years I have seen dozens and dozens of upper GI bleeds, 30-40% of which are related to NSAIDS, the other half presumed PUD, with some variceal bleeds thrown in. Some of those have had ridiculous morbidity and mortalitiy and resource utilization.
I've even had someone taek pain meds that were too strong for them for back pain, to the point where he had a bad aspiration pna and developed ARDS and was lucky not to have died. I've seen an epidural abscess related to a bad back with conventional medical treatment, and I've seen a case of arachnoiditis related to L-spine injects. I've seen maybe 2 rneal failures that may have been related to NSAID use.

Vertebral a. dissections are a known complication of chiropractic manipulation and need to be cautioned against, but it doesn't make chiropractic care excessively dangerous. If so, you need to tell people not to drive (or crash their cars) or to do yoga as both of those activities are associated with these dissections.

I would say medical therapy for these things can be just as dangerous if not more so. It's just that we have more scientifically established benefit, in some cases. Medicine honestly isn't that great at treating these things. back and neck pain is the bane of my ER existence. I don't particularly recommend chiropracters, but I give patients who want chriopracters the warning about some scam artists out there and the existence of a few rare complications they need to be aware of so they can look at it intelligibly. But I'm not scared of chiropractors and I don't fear for my patients that choose to use them.

Mods, please make this post a sticky.

 

[Cuthbert]

My personal opinion is one shared by the majority of the preceptors I've worked with so far: Chiropracters have some place in adjusting backs for lower back pain. They may also have a small place for neck pain, though I'd never want one anywhere near my neck. Any chiropracter who claims to be able to do anything else other than help out MSK back or neck pain is a quack.

This. I think most of you guys are quacks. The reason being that I am a DO and have had 100's of hours of manipulatory training. I understand the limits to manipulation and they are many.

Furthermore, many of the chiropractors in my area are against immunizations and make my life a living hell during my well child visits. They spill filth and misinformation into the community. They are therefore quacks in my book. Sorry, but true.

 

[Baron Samedi]

 

[Nymphicus]

This. I think most of you guys are quacks. The reason being that I am a DO and have had 100's of hours of manipulatory training. I understand the limits to manipulation and they are many.

Furthermore, many of the chiropractors in my area are against immunizations and make my life a living hell during my well child visits. They spill filth and misinformation into the community. They are therefore quacks in my book. Sorry, but true.

Sounds about right.

 

[surftheiop]

to put an EM voice in here regarding complications of treatments of neck/back pain.

In the last 3 years, I have seen 3 or 4 vertebral artery dissections, one of which was related to chiropractic manipulations. That dissection did not lead to a stroke and was treated with aspirin, as is pretty standard. Actually I don't think any of those led to strokes, fortunately.

In the last 3 years I have seen dozens and dozens of upper GI bleeds, 30-40% of which are related to NSAIDS, the other half presumed PUD, with some variceal bleeds thrown in. Some of those have had ridiculous morbidity and mortalitiy and resource utilization.
I've even had someone taek pain meds that were too strong for them for back pain, to the point where he had a bad aspiration pna and developed ARDS and was lucky not to have died. I've seen an epidural abscess related to a bad back with conventional medical treatment, and I've seen a case of arachnoiditis related to L-spine injects. I've seen maybe 2 rneal failures that may have been related to NSAID use.

Vertebral a. dissections are a known complication of chiropractic manipulation and need to be cautioned against, but it doesn't make chiropractic care excessively dangerous. If so, you need to tell people not to drive (or crash their cars) or to do yoga as both of those activities are associated with these dissections.

I would say medical therapy for these things can be just as dangerous if not more so. It's just that we have more scientifically established benefit, in some cases. Medicine honestly isn't that great at treating these things. back and neck pain is the bane of my ER existence. I don't particularly recommend chiropracters, but I give patients who want chriopracters the warning about some scam artists out there and the existence of a few rare complications they need to be aware of so they can look at it intelligibly. But I'm not scared of chiropractors and I don't fear for my patients that choose to use them.

I never have (and probably never will) go to a chiropractor or advise a family member to, but I agree that MD's (and particularly medstudents) freak out way too much about chiros. Now if there happens to be a chiro in your town telling parents not to vaccinate, go wild telling people to avoid him like the plague. But this could just as easily be said about the intern year completed MD doing random cosmetic stuff.

 

[Jarrodmac10]

IMO PTs treat everything and more that a chiropractor would - except in a modern, evidence based fashion. I'm in favor of PTs achieving direct access status; why should you need a referral for evidence based treatment from a PT when any chiro can open up shop and crack away with impunity?

As a DPT student it is nice to hear this from a physician/ med student, regarding direct access.

 

[drizzt3117]

I think ppl should stop hating on DOs

 

[Galatasaray]

what's with the all the chiro hate ? my mom has had back pain for 8 years now, and chiropractic manipulation got rid of most of her pain for at least 2 days every time. she ended up having surgery to fix her lower back, but she couldn't have done it without the chiropractor.

 

[tiedyeddog]

what's with the all the chiro hate ? my mom has had back pain for 8 years now, and chiropractic manipulation got rid of most of her pain for at least 2 days every time. she ended up having surgery to fix her lower back, but she couldn't have done it without the chiropractor.

Did you even read a single post before yours?

 

[gail]

Ha! This so true.

 

[cdmguy]

The HVLA maneuver realigned my vertebrae and released the compression on sciatic nerve.

No it didn't. Manipulation is a totally random procedure and the mechanism of action isn't realignment but rather providing neural stimulation to proprioceptors to break a pain cycle. This is analgesic and relaxes the muscle. This often allows a previously guarded body part to now move and speeds recovery.

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.

Not necessarily because PTs often stink at msk treatment unless they are certified in orthopedics and learn to fit foot orthotics. So most PTs wouldn't have addressed it properly. Many times psoas shortening is due to an underlying biomechanical problem in the foot that needs correction and is limiting leg extension. So you'd need a PT/podiatrist/pedorthist who could fit an orthotic and do the rehab.

Either way the chiropractor gave you the standard of practice, he failed to diagnose and treat your underlying problem, pretended to know what he was doing and would have put you on a lifetime care plan for a problem instead of fixing it. Imagine if you had a neck problem and the care stroked you out.

I don't see this as support for chiropractors.

 

[SpecterGT260]

Your sig is interesting.... unless I am missing something it looks like the DOE is already keeping their hands clean of such things and the lending for pseudoscience practices is done privately. I would suspect this would be a self-limiting problem over time.

 

[eject]

Whatever else is going on with chiropractors, they have fantastic lobbyists--and you don't need much else, apparently. http://www.nytimes.com/2012/12/06/h...-margins-of-health-coverage.html?ref=us&_r=1&

 

[cdmguy]

Your sig is interesting.... unless I am missing something it looks like the DOE is already keeping their hands clean of such things and the lending for pseudoscience practices is done privately. I would suspect this would be a self-limiting problem over time.

Thanks. No, ED (acronym for US Dept of Education) aquiesced to lobbying and completely deregulated accreditation in the USA. This gives the current situation where quacks market themselves directly to students as legitimate accredited programs. Because the official student loan default cohort rate calculation was changed to only count the first two years of repayment in the original loan, most defaults were hidden so schools have no accountability for poor graduate outcomes. It's a mess and the best solution is to do what the Aussie's are proposing-to ban them from the federal aid programs as quackery.

The petition gathered a few signatures but didn't get enough momentum to do anything in the USA unfortunately. I don't think MDs want to put in the effort it would take to stop them.

Here are two more links:

http://www.forbes.com/sites/stevens...e-government-subsidize-chiropractic-colleges/

http://open.salon.com/blog/ipab/2012/06/07/why_congress_wants_you_to_default_on_your_student_loans_1

 

[facetguy]

No it didn't. Manipulation is a totally random procedure and the mechanism of action isn't realignment but rather providing neural stimulation to proprioceptors to break a pain cycle. This is analgesic and relaxes the muscle. This often allows a previously guarded body part to now move and speeds recovery.

Whoa!! Dude, I was starting to worry about you since I hadn't seen you around much lately. I guess you've been busy. (OK, that was a low blow. No more of that.)

When you say "random procedure", what does that mean? If a patient is a candidate for manipulation, and said manipulation is applied in a skilled fashion, how is that random? Is it random when an analgesic, NSAID, muscle relaxer etc is prescribed? To use one of your favorites, is it random when prolotherapy is utilized? Are you saying that because manipulation isn't a guaranteed cure-all that it is therefore flawed, or random as you say?

Explain.

Not necessarily because PTs often stink at msk treatment unless they are certified in orthopedics and learn to fit foot orthotics. So most PTs wouldn't have addressed it properly. Many times psoas shortening is due to an underlying biomechanical problem in the foot that needs correction and is limiting leg extension. So you'd need a PT/podiatrist/pedorthist who could fit an orthotic and do the rehab.

Either way the chiropractor gave you the standard of practice, he failed to diagnose and treat your underlying problem, pretended to know what he was doing and would have put you on a lifetime care plan for a problem instead of fixing it. Imagine if you had a neck problem and the care stroked you out.

I don't see this as support for chiropractors.

That's not the standard of practice and you know it. Frankly, I don't know a single chiro who would do what this guy says, i.e. "just lay down and let me crack your back without doing anything else first". That's ridiculous. The funny thing is that it seemed to have worked for a year!! In the back pain world, that's a win. And I like how you slipped in the stroke reference, which is your go-to scare tactic.

You're back, but nothing's changed.

 

[SpecterGT260]

When you say "skilled fashion" what do you mean exactly? What is your strategy? Do you have a case example you could walk us through?

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[facetguy]

When you say "skilled fashion" what do you mean exactly? What is your strategy? Do you have a case example you could walk us through?

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A skilled fashion, as in performed by someone who has studied the anatomy/pathoanatomy and biomechanics of the spine, has developed good palpatory skills through training and repeated exposure, and has trained extensively in the application of various manual techniques, including having an understanding of contraindications to those techniques.

Similar to surgery performed in a skilled fashion. I don't think you'd want, say, ex-chiro CDMguy doing your surgery, right? You'd want someone who has studied and trained in a surgical discipline and could perform the surgery in a skilled fashion.

 

[cdmguy]

Whoa!! Dude, I was starting to worry about you since I hadn't seen you around much lately. I guess you've been busy. (OK, that was a low blow. No more of that.)

Defensive egotistical overcompensating ad hominems and low blows are par for the course with you I'm afraid. Frankly I'm surprised you weren't banned years ago.

When you say "random procedure", what does that mean? If a patient is a candidate for manipulation, and said manipulation is applied in a skilled fashion, how is that random? Is it random when an analgesic, NSAID, muscle relaxer etc is prescribed? To use one of your favorites, is it random when prolotherapy is utilized? Are you saying that because manipulation isn't a guaranteed cure-all that it is therefore flawed, or random as you say?

In the context of what I wrote I was referring to the idea that manipulation to realign a vertebra (called the chiropractic adjustment) and relieve unpinched nerves is a debunked idea. Remember, this is the basis for the chiropractic claim of superiority and distinctness from everyone else who manipulates. Published research on HVLA low back manipulations using pins surgically inserted shows that the movement is in no way localized to the contact point where the DC is trying to move but actually occurs within three vertebra and even contralaterally. Research also shows that the analysis methods aren't reliable. And the final nail in the coffin is the fact that mainstream chiropractic techniques (Gonstead and Diversified technique) are based on false biomechanics which never include the full range of translation movements (except posterior translation).

The core concept of traditional chiropractic, vertebral subluxation, is not based on sound science. The biomechanical listing systems taught in chiropractic college technique offerings have been criticized as inaccurate, inadequate and invalid.
-Harrison, DE (Feb 1998). "Three-dimensional spinal coupling mechanics: Part I. A review of the literature.". J Manipulative Physiol Ther. 21 (2): 101–13. PMID 9502066[195]
http://en.wikipedia.org/wiki/Chiropractic#Controversy_and_criticism

So you have a triple whammy. This destroys the idea that the mechanism of action for manipulation is due to realigning vertebra. Besides, even if they were realigned what would hold them there if ligamentous support were lacking due to chronic misaligment? Nothing. So it's a game you can't win without introducing some additional sort of passive support into the mix. Unfortunately DCs aren't interested in being scientific so they shun increased scope to do things like that. We do see utilization by DCs of existing support braces (low back and sacroiliac joint belts) and stabilization exercises but nothing that would fix the problem and show that chiropractors are taking charge of this issue, starting to embrace science rather than use it as a marketing gimmick and validate their claims of being the go to guys for biomechanical and postural problems in the spine thus warranting keeping them around.

That's not the standard of practice and you know it. Frankly, I don't know a single chiro who would do what this guy says, i.e. "just lay down and let me crack your back without doing anything else first". That's ridiculous. The funny thing is that it seemed to have worked for a year!! In the back pain world, that's a win. And I like how you slipped in the stroke reference, which is your go-to scare tactic.

Yes it is. I won't ask you to reference that because you can't. I'm not sure if students here know the straight vs. mixer chiropractor history but both factions agree that repeat sessions of manipulation is needed to stop spinal degenerative joint disease based on the idea that manipulation improves neutral position and joint range of motion. Even the reformist groups (NACM and orthopractic) preserved this ineffective treatment as a scope of practice.

Your deception is that you are trying to pretend that chiropractors practicing this way are just relics and the new way to practice is as pseudo physical therapists. This is suspicious because you won't reveal your real name and office website so we could at least verify that you don't advertise the use of mainstream chiropractic quackery and don't have any questionable certifications. The relic claim is bunk of course because chiropractic college accreditors require and test on false biomechanics for licensing exams and colleges don't ban techniques because it would be an admission of fault and make practicing DCs look bad.

You're back, but nothing's changed.

Chiropractic's biggest change has been postural correction gimmicks to try to look legitimate while justifying repeat office visits for years and then lifetime maintenance visits (often weekly). They are futile because of the scope problem mentioned above. Students not trusting chiropractors because they are academic underachievers and quacks are correct. The field needs to die.

 

[SpecterGT260]

A skilled fashion, as in performed by someone who has studied the anatomy/pathoanatomy and biomechanics of the spine, has developed good palpatory skills through training and repeated exposure, and has trained extensively in the application of various manual techniques, including having an understanding of contraindications to those techniques.

Similar to surgery performed in a skilled fashion. I don't think you'd want, say, ex-chiro CDMguy doing your surgery, right? You'd want someone who has studied and trained in a surgical discipline and could perform the surgery in a skilled fashion.

I didn't need the dictionary definition of "skilled". I wanted more tangible examples. Different people can have the same definition of "skill" and still assign the term to very different actions.


So cdmguy is an ex chriro?

What are you up to now?

 

[SpecterGT260]

In the context of what I wrote I was referring to the idea that manipulation to realign a vertebra (called the chiropractic adjustment) and relieve unpinched nerves is a debunked idea. Remember, this is the basis for the chiropractic claim of superiority and distinctness from everyone else who manipulates.

This has actually been a focal point of mine in similar discussions (possibly this thread... it is an older one) with facetguy.

Although my experience with him has been that he denies such ideas in chiropractic as having meaningful prevalence... I guess I dont know what is actually taught in the classes, but I know most lay people believe so and the word "adjustment" has specific connotations and implications.

 

[facetguy]

Defensive egotistical overcompensating ad hominems and low blows are par for the course with you I'm afraid. Frankly I'm surprised you weren't banned years ago.

I decided months ago that I would lighten up my comments toward you. I'm a compassionate guy. If that sounds cryptic to everyone else, so be it.

In the context of what I wrote I was referring to the idea that manipulation to realign a vertebra (called the chiropractic adjustment) and relieve unpinched nerves is a debunked idea. Remember, this is the basis for the chiropractic claim of superiority and distinctness from everyone else who manipulates. Published research on HVLA low back manipulations using pins surgically inserted shows that the movement is in no way localized to the contact point where the DC is trying to move but actually occurs within three vertebra and even contralaterally. Research also shows that the analysis methods aren't reliable. And the final nail in the coffin is the fact that mainstream chiropractic techniques (Gonstead and Diversified technique) are based on false biomechanics which never include translation movements. So you have a triple whammy. This destroys the idea that the mechanism of action for manipulation is due to realigning vertebra. Besides, even if they were realigned what would hold them there if ligamentous support were lacking due to chronic misaligment? Nothing. So it's a game you can't win without introducing some additional sort of passive support into the mix. Unfortunately DCs aren't interested in being scientific so they shun increased scope to do things like that.

I've said before that I don't disagree with you on this bold/underlined part. That doesn't mean manipulation, or specifically chiros, have no beneficial impact on patients. It means the old original ideas/concepts have evolved over the last 100+ years, as they should.

Yes it is. I won't ask you to reference that because you can't. I'm not sure if students here know the straight vs. mixer chiropractor history but both factions agree that repeat sessions of manipulation is needed to stop spinal degenerative joint disease based on the idea that manipulation improves neutral position and joint range of motion. Even the reformist groups (NACM and orthopractic) preserved this ineffective treatment as a scope of practice.

A reference would be any chiro curriculum. They all teach diagnosis, assessment, etc. No school teaches students that all they need to do is lay patients down and recklessly bang on their spines. And if that's what you're trying to claim, that's ridiculous.

Your deception is that you are trying to pretend that chiropractors practicing this way are just relics and the new way to practice is as pseudo physical therapists. This is suspicious because you won't reveal your real name and office website so we could at least verify that you don't advertise the use of mainstream chiropractic quackery and don't have any questionable certifications. The relic claim is bunk of course because chiropractic college accreditors require and test on false biomechanics for licensing exams and colleges don't ban techniques because it would be an admission of fault and make practicing DCs look bad.

Again,, there may be a kernel of truth in what you say here. I think outdated ideas should be relegated to the historical bin. That doesn't mean all of your ideas are right, and it certainly doesn't validate your heavily biased views of chiropractic. And I don't have a website (which perhaps ironically does make me a relic).

Chiropractic's biggest change has been postural correction gimmicks to try to look legitimate while justifying repeat office visits for years and then lifetime maintenance visits (often weekly). They are futile because of the scope problem mentioned above. Students not trusting chiropractors because they are academic underachievers and quacks are correct. The field needs to die.

I don't even know what you mean by "postural correction gimmicks". CBP?

 

[cdmguy]

Facetguy is a practicing chiropractor and resident apologist. I'm a former chiropractor turned skeptic.

You can rest assured this is all current. All you have to do is verify that Diversified Technique and Gonstead Technique are still tested on by the chiropractic national board exams (they are) and that confirms the false biomechanics. Check my post above, I added a reference showing that chiropractors have been aware of the false biomechanics since 1998 yet did nothing to correct the problem.

Here's the verification for the board exams:

All "set-ups" in the review will have listings and full explanations as shown in Example 2 above. There are 65 "Set-Ups" described in the CNBA review that you would need to know for the Part IV examination. View sample videos below.
http://www.cnbareview.com/Technique.htm (see video)

Listings is an acronym for diversified and/or Gonstead biomechanical listings.

Here's an instructor in the most popular review course. Note the listing of diversified and Gonstead in his bio.

Dr. Donofrio is the core of our Radiology preparation for Part IV, both instructing the program himself and preparing all other instructors in his subjects. In addition to X-Ray, he teaches Part I, II and III classes as well.

As a Board Certified Chiropractic Neurologist, he maintains a practice in Reading, Pennsylvania and utilizes Coupled Reduction Neurological Techniques, Diversified, Gonstead, Activator, Applied Kinesiology, and Toggle.

Professional affiliations are: American Board of Chiropractic Specialties, American Chiropractic Association, Pennsylvania Chiropractic Association, American Academy of Pain Management, Physicians Committee for Responsible Medicine, and President of the American Chiropractic Neurology Board.

http://www.irenegoldassoc.com/instructors.html​

Just for kicks google Applied Kinesiology.

 

[facetguy]

This has actually been a focal point of mine in similar discussions (possibly this thread... it is an older one) with facetguy.

Although my experience with him has been that he denies such ideas in chiropractic as having meaningful prevalence... I guess I dont know what is actually taught in the classes, but I know most lay people believe so and the word "adjustment" has specific connotations and implications.

I'd be willing to bet, based on countless interactions here on SDN, that most medical students and even MDs believe in vertebrae jumping out of alignment and that manipulation puts them back in. Are you one of them?

 

[facetguy]

Facetguy is a practicing chiropractor. I'm a former one turned skeptic.

At the risk of breaking my own rule and sounding mean toward you, I think we'd need to examine which came first: the failure in practice or the skepticism? You frame it as though you became a chiro skeptic and therefore left practice; I'm not so sure that's actually what happened, but I'll accept your version whatever it may be.

 

[cdmguy]

Notice how he assumes I failed in practice rather than having to admit I quit because of the widespread corruption. You see that a lot, blaming the victim. Here is another one, Steven Piserchia DC in CT, doing it to a stroke victim. The chiropractic board tried to pretend the DC needed psychiatric help and make him the scapegoat. Meanwhile chiropractic associations use biased literature review and poor quality research to deny that manipulations cause stroke so they can keep people getting unnecessary manipulations when they don't have a condition that would justify the risk, that's the entire point of the listings-to treat a biomechanical problem rather than a real musculoskeletal condition that would meet medical necessity. It's more of the bad apple defense myth. But you see facetguy denying strokes here also, it's common.

"A chiropractic manipulation permanently paralyzed one of her vocal cords and left her unable to swallow food. She received $900,000 in a settlement. Later the chiropractor was given probation for harassing her by phone."

Brittmarie Harwe Age: 40 Wethersfield, Connecticut
Unable to swallow 1993

[YOUTUBE]http://www.youtube.com/watch?v=a48WqJr2psQ[/YOUTUBE]
http://whatstheharm.net/chiropractic.html
http://www.vocact.com/news_stories/051008.php

 

[IlDestriero]

It doesn't really matter which came first, the chicken or the egg, because it's still just a pile of steaming horse ...
And he was smart enough to get out.

 

[tiedyeddog]

I'd be willing to bet, based on countless interactions here on SDN, that most medical students and even MDs believe in vertebrae jumping out of alignment and that manipulation puts them back in. Are you one of them?

I would bet most of us don't believe that. I have never met a practicing M.D. who believed it, especially a practicing orthopod or neurosurgeon.

 

[SpecterGT260]

I'd be willing to bet, based on countless interactions here on SDN, that most medical students and even MDs believe in vertebrae jumping out of alignment and that manipulation puts them back in. Are you one of them?

no.

Not with the implications in the words you chose. Nor in any way that would result in a scheduled chiro visit. If a vertebra were to jump out of place - physical displacement - if the patient survives (depending on location) it would require more than hand manipulation to put it back in without risking further spinal injury. If a vertebra is being pulled on by tensed or spastic muscles, it will not be "out of place", and manipulation in this sense may impact the muscle tone and resolve pain. MAY. My major beef with the practice, as you know from the times we have discussed the topic, is the claim that chiropractic manipulation has anything at all to do with the skeleton and the extension that this has anything at all to do with the CNS. There are still those within the craft who believe (or pretend to) that there are magical healing messages that travel the spine and apparently they are too large to go through subluxations correctly even when sensation and motor control is intact. Until that notion is dead, decayed, and dumped into a mass grave with other party favors like homeopathy, naturopathy, and reflexology the entire profession is suspect Whether you personally buy it or not.

 

[tiedyeddog]

no.

Not with the implications in the words you chose. Nor in any way that would result in a scheduled chiro visit. If a vertebra were to jump out of place - physical displacement - if the patient survives (depending on location) it would require more than hand manipulation to put it back in without risking further spinal injury. If a vertebra is being pulled on by tensed or spastic muscles, it will not be "out of place", and manipulation in this sense may impact the muscle tone and resolve pain. MAY. My major beef with the practice, as you know from the times we have discussed the topic, is the claim that chiropractic manipulation has anything at all to do with the skeleton and the extension that this has anything at all to do with the CNS. There are still those within the craft who believe (or pretend to) that there are magical healing messages that travel the spine and apparently they are too large to go through subluxations correctly even when sensation and motor control is intact. Until that notion is dead, decayed, and dumped into a mass grave with other party favors like homeopathy, naturopathy, and reflexology the entire profession is suspect Whether you personally buy it or not.

Exactly, well said. The profession can not cling dearly to an unproven, totally unsubstantiated method of "curing" people and in the same breath cry for professional respect in the scientific community.

 

[IlDestriero]

I believe that cervical facets can jump out of alignment (dislocation) after a significant trauma. Then, usually, a neurosurgeon distracts the neck under anesthesia and correctly realigns the facets. I've seen and done that. This other "alignment" hogwash, no way homie. They teach dislocation in medical school, not the laying on of hands.

 

[SpecterGT260]

I believe that cervical facets can jump out of alignment (dislocation) after a significant trauma. Then, usually, a neurosurgeon distracts the neck under anesthesia and correctly realigns the facets. I've seen and done that. This other "alignment" hogwash, no way homie. They teach dislocation in medical school, not the laying on of hands.

This is what I was alluding to. Not exactly specifically, but the general notion that "jumping out of alignment" is decidedly more traumatic than it is portrayed, and that this fact becomes immediately obvious to anyone who understands the skeleton and how it is held together beyond the naked plastic one on hangers in HS bio labs. A significant part of my problem with the practice is the overall degree of misunderstanding of human anatomy and physiology that is required to hold such beliefs and what that would mean when extended over the entire scope of practice.