D.P.T. versus Chiropractor

[clo]

Not sure that I really agree with any of this. Very little data suggests a strong correlation between posture and spinal pain, particularly low back pain.

How do you tell if someone's LBP is related to a "weak" core. How do you assess "core" muscles function. What data do you have to suggest that "core" weakness correlates with LBP?

Also, why is that patient not a candidate for PT?

I asked my question "what do you think personal trainers do" because it sounds like you don't think we know what we do, or how we are trained.

we too have classes we can take for working with: special populations, perinatal fitness, mechanics of injury prevention to name a few. Were you aware of this? Or are you under the assumption that personal trainers get there certification and just go out there and train people?

Back to your first statement. So you are telling me that if an individual spends 3-4 hours daily in their chair at work without getting that poor posture CAN NOT lead muscular pain? You said Spinal pain. Define spinal pain. when I think spinal pain i think disc issues, etc......

Second statement. Assessing low back pain/weakness. First of all some will not complain of this during an general assessment. However while doing abdominal exercises on a stability ball they may indicate some low back pain shortly after starting the exercise. In my many years of experience this CAN and HAS indicated weak core/back. And to correct quadraped exercises which work the multifidus and side bridges which isolate the QL muscle and modified stomach exercises will fix and has fixed the issue.

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[MinnDasota]

Jess, Actually if you look into Vladimir Janda's (MD) work or Grey Gook's (PT) Functional Movement Screens, you will the theories of upper and lower-crossed syndromes. We were taught some of this in PT school.

Clo, I work in a large sports complex and gym and work closely with a lot of trainers. There are good ones and there are bad ones. The best ones are those that communicate well with me or with the client's physician when something is not right. I commend you with the way you look at the body and how to train your clients. However, not all trainers have the same training as you. I have treated countless numbers of patients who have injuries that were exacerbated by their trainers.

In the end, not every patient needs skilled PT. "Skilled" is the key word here. This is when I refer to a strength and conditioning specialist or trainer for post rehab.

Not all neck pain is due to posture but fixing the postures definitely helps (and is usually a part of the patient's rehab program). On the PT's end, we usually will incorporate some type of manual therapy such as cervical or thoracic mobilization/manipulation and support the manual therapy with postural strengthening. This is what I mean by "skilled". If certain segments of the spine are hypomobile, we mobilize them (when appropriate). Strengthening and postural exercises are usually only part of the equation.

Oh, many PTs have undergrad degrees in exercise science and have had the fitness and wellness training as part of the curriculum. So, although it is not standard in the PT curriculum per se (although it is usually an elective), many PTs do have the background in fitness and wellness.

Finally, sorry for hijacking this thread. I think we've diverged.

 

[clo]

Not all neck pain is due to posture but fixing the postures definitely helps (and is usually a part of the patient's rehab program). Strengthening and postural exercises are usually only part of the equation.

Oh, many PTs have undergrad degrees in exercise science and have had the fitness and wellness training as part of the curriculum. So, although it is not standard in the PT curriculum per se (although it is usually an elective), many PTs do have the background in fitness and wellness.

Finally, sorry for hijacking this thread. I think we've diverged.

Thanks for the compliments Minndasota. I do understand that all neck pain is due to posture. I also understand that some form of rehab may potentially be required first to fix muscular issues BEFORE any strength training can happen. (my example of my client who was in the car accident)

My degree is a BA in health fitness management which was the track required (minus some of the sciences) to get earn your MPT (which is what it was when I was in school). While there are courses that provide the backround in fitness and wellness there were no courses offered on personal training. IMO this should be required for PT's. Not that they are going to go into that profession; but I think it would make a PT a more well rounded health care professional.

And YES! I agree we've hijacked this thread. I'd be happy to continue this in a new thread.

Or if we think all has been said that needs to be said then we can stop posting here.

 

[jesspt]

I said nothing about spinal pain. I'm curious, just what exactly is it that you think personal trainers do? do you think we are unable to identify when certain muscles are weak or tight? do you think all we do is count reps?

Poor posture, shoulders slumped forward and neck protruded will cause tight over active traps no? and won't the chest/shoulder muscles be tight as a result of inactivity? Because if this is not the case then I'll let you talk to the countless people I've helped corrective this issue by showing proper exercises to help correct this issue. Serratus push to activate the serratus muscles, showing proper engagement of the shoulder blades when doing back exercises...

I certainly think that the vast majority of trainers can determine when a muscle is short, or produces less than ideal torque, although i have come across those whom I think are challenged by even counting repititions, as I'm sure you've met some less than brilliant PTs.

I just don't buy into the fact that that many musculoskeletal conditions correlate directly with short or weak muscles. We know quite well how long it takes to see muscle hypertrophy and to lengthen tight musculature, yet patients are routinely experiencing improvements in those conditions prior to those time frames.

I don't agree with your premise regarding the trapezius muscles in your previous post. Many of those patients who are routinely diagnosed with trapezius tightness, or the garbage can diagnosis of trapezius strain, are demonstrating tapezius muscles with increased resting tone, something that is modulated by their nervous system, and can be changed readily and rapidly changed by techniques (some of which could be exercise which could be perscribed by a trainer, PT, MD, DC, etc.) directed at modulating the nervous system.

Back to your first statement. So you are telling me that if an individual spends 3-4 hours daily in their chair at work without getting that poor posture CAN NOT lead muscular pain? You said Spinal pain. Define spinal pain. when I think spinal pain i think disc issues, etc......

I didn't say it can't cause musclular pain, but I would say that sitting at a desk for 3-4 hours at a time without moving is more likley to cause them pain than the dreaded label of "poor posture". Esentially, any sustained posture, be it what our textbooks tell is ideal or if it is forward head posture, will be potentially painful.

Definition of spinal pain: Pain originating from the spine.

Second statement. Assessing low back pain/weakness. First of all some will not complain of this during an general assessment. However while doing abdominal exercises on a stability ball they may indicate some low back pain shortly after starting the exercise. In my many years of experience this CAN and HAS indicated weak core/back. And to correct quadraped exercises which work the multifidus and side bridges which isolate the QL muscle and modified stomach exercises will fix and has fixed the issue.

Just citing experience is somewhat of a weak argument. And, your logic is faulty. Your assuming that just be cause you see them with some pain with a particular exercise, and then initiate strengthening exercises, that the cause of the pain was weakness.

Jess, Actually if you look into Vladimir Janda's (MD) work or Grey Gook's (PT) Functional Movement Screens, you will the theories of upper and lower-crossed syndromes. We were taught some of this in PT school.

Yup, I've looked into it. And the key word you used was "theory." Also, they get quite a bit into increased or decreased resting tone, and overactivity, which is a product of the nervous system, and does not originate at the muscluar level (at least from what I can recall of Janda's work).

Clo, overall, you sound like a good personal trainer. And I think a good personal trainer is quite qualified to see the average, deconditioned Joe off of the street who may be having a few minor aches and pains. But, in general I see way to many trainers who subscruibed to the philosophy that "Core" strengthening will cure whatever ails their clients, and they come to me becuase their back pain persists (after having spent significant amounts of dollars of trianing sessions and having been assured if they just get their core stronger their pain will vanish). It typically persists becuase the patient doesn't fit into the treatment category of stabilization, rather they fit more closely into specific exercise or manipulation category. And, I think few trainers are qualified to make that determination.

 

[clo]

First of all I tried to multiquote but I failed miserably so I had to edit. hope you can follow my reply to your last post.

Yes, and it's sad to say I work with a few like described. It's quite frustrating.



Then what do these muscular conditions correlate to?



Thinking about this more I can see your point. Most of the time when trying to teach someone how to do a particular exercise (push up, lat pulldown, chest press from the seated position) we will see them engage their traps (shoulder(s)) up to the ears. If taught proper form and how/which muscles to engage and when this will go away. However some lack that "body awareness" to be able to recognize when they are doing this and more importantly how to correct it.


You would not label someone who sits at their desk for 3-4 hours at a time repeatedly day after day as having "poor posture"?? then what? How is their neck/shoulder pain caused then? So let me ask you this: when a desk jockey complains of tight hamstrings and a sore back what would you determine the cause to be?

Yes, citing experience can be somewhat of a weak argument, but I sight personal experience based on the countless people I've helped who have complained of low back pain from nothing other than being a desk jockey who sits all day and doesn't get up and move around. Shown how to sit in their chair, proper stretches for the legs and upper/lower back and neck and putting them on a core strengthening plan has helped in the past.
If you are looking for tests done to look for low back weakness I use the sidebridge test. anything under 1 min. is at risk for low back injury. Exercises are modified until they are capable of doing so.
But if my 10 + years of personal experience is weak then we can start here: http://www.unm.edu/~lkravitz/Article%20folder/lowbackstability.html

and

http://www.unm.edu/~lkravitz/Article folder/lowback.html



Thank you for the compliment. But if all you know is bad trainers who can't even count than this statement does not hold up. A good well qualified trainer takes the time to take seminars from guys like the one I linked you above, take continuing ed and do our best to stay on top of these issues.

Unfortunately there are not enough of us around so like the bad chiro or pt that's out there the same goes for trainers.

 

[jles]

My bad about your screen name...is it clo as in CLO? or c|o? Anyway...

I'll just cut right to the wellness question due to others comments. Here is a great article that sums up a good deal about wellness. Who can say it better than the APTA?
http://www.apta.org/AM/Template.cfm?Section=Archives3&TEMPLATE=/CM/HTMLDisplay.cfm&CONTENTID=8632

Here is an excerpt:
"The APTA House of Delegates' position on "Health Promotion and Wellness by Physical Therapists and Physical Therapist Assistants" (HOD 06-93-25-50) states that the Association recognizes that "physical therapists are uniquely qualified to assume leadership positions in efforts to prevent injury and disability, and fully supports the positive roles that physical therapists and physical therapist assistants play in the promotion of healthy lifestyles, wellness, and injury prevention."

So here are some thoughts on the personal training or wellness coursework you (and other personal trainers) suggested that PT programs lack. I'm sure we would all agree that a dentist could do a decent job at being a dental hygenist right? Exercise principles are elementary in PT school. We covered all of that early on in our studies. Do you really think that PTs can safely exercise and appropriately progress complex patients in neurorehab (SCI, stroke, TBI, parkinsons...), cardiopulmonary rehab (COPD, pulmonary fibrosis, hypertension, diabetes, CABG (bypass surgery)..., pediatrics (CP, muscular distrophy...), geriatrics and all the comorbidities that entails, amputees, obesity, burns, orthopedic surgeries...requiring constant monitoring of O2 Sats, BP, and lab values such as in acute settings which determine appropriateness for exercise and intensity (hematocrit, WBCs, hemoglobin...), adhering to contraindications and precautions to treatment, etcetera, and NOT be able to train someone in general good health? Really? I've heard that said about PTs before, and as a former personal trainer, albeit not with your extensive experience or qualifications I'm sure, I frankly find it laughable. Maybe it's due to interactions with bad PTs which I have some experience with, but still those fundamentals are there.

Bottom line, I do not see a reason to have a separate class for "personal training" because we go far beyond that and besides, it's all covered anyway. Plain and simple. No disrespect intended, just my strong opinion based on my personal experiences in a DPT program.

Once again, killing night...Best of luck to you though. I believe I read you are thinking about applying? I must say that I love it, despite the ridiculous amount of work. I think it's like everything, you get what you put in and mediocre effort produces a mediocre PT. Based on what I have read, I highly doubt that would be you. Also, I don't discount experience as highly valuable and it will take you far, but I'm sure you know that.

 

[jesspt]

No time for a lengthy response, but I'll write more when I can...

You would not label someone who sits at their desk for 3-4 hours at a time repeatedly day after day as having "poor posture"?? then what? How is their neck/shoulder pain caused then? So let me ask you this: when a desk jockey complains of tight hamstrings and a sore back what would you determine the cause to be?

How do we operationally define "poor posture?" Is "good posture" what was described to us in Florence Kendall's text book? How did she determine this. Did she look at people who she deemed to have ideal posture and wether or not they had fewer instances od musculoskeletal pain? The answer to this is, of course, no.

If "poor posture" were this abomination, given the fact that an incredibly large percentage of the population in the US now sits at a desk for a great deal of their work day and have less than ideal posture, shouldn't we be seeing that almost everyone has back or neck pain, almost all of the time?

In regards to your tight hamstring and LBP question, I don't think that tight hamstrings are often a cause of LBP either. This is a muscle group that is tight in almost everyone in the general populace, but again, a relatively small number of those people are having LBP at any given time. Hamstring tightness may be a contributer to LBP, but in my opinion a minor one, and certainly not a primary cause.

 

[clo]

shouldn't we be seeing that almost everyone has back or neck pain, almost all of the time?

In regards to your tight hamstring and LBP question, I don't think that tight hamstrings are often a cause of LBP either. This is a muscle group that is tight in almost everyone in the general populace, but again, a relatively small number of those people are having LBP at any given time. Hamstring tightness may be a contributer to LBP, but in my opinion a minor one, and certainly not a primary cause.

Wouldn't you agree that a lot of people just learn to live with back or neck pain without seeking the help? I've often found that the case when I've done health evaluations on people.

And yes, I would agree. hamstring tightness may be a contributer to LBP. I should not have generalized.
Whether it's a minor and not primary cause should be determined on a case by case basis; especially if you consider the low back/glute/hamstring chain.

 

[clo]

Bottom line, I do not see a reason to have a separate class for "personal training" because we go far beyond that and besides, it's all covered anyway. Plain and simple. No disrespect intended, just my strong opinion based on my personal experiences in a DPT program.

Once again, killing night...Best of luck to you though. I believe I read you are thinking about applying? I must say that I love it, despite the ridiculous amount of work. I think it's like everything, you get what you put in and mediocre effort produces a mediocre PT. Based on what I have read, I highly doubt that would be you. Also, I don't discount experience as highly valuable and it will take you far, but I'm sure you know that.

Yes jles the fundamentals are there. No doubt the insane about of course work involved in obtaining your PT degree will cover ANYTHING a personal trainer would learn in their PT certification.

However as a former personal trainer you know how to train someone. And you also have a leg up on your fellow students around you when it comes to personal training. IMO a good trainer needs to have a sports back round which comes in handy when it comes to training individuals. All to often I've seen people come over from the IT profession with NO experience training or even experience in the gym and just want to train because they like helping people and think it'll be fun.

So even though the DPT program far exceeds a PT cert when it comes to the science aspect; unless you have a personal training cert, have a firm understanding of how and when you can push someone, work out your self, know how to operate machines properly and how to instruct/how to use properly and know correct ROM I would not hire one (a DPT). Does that make sense?

As for me and the DPT program. After much contemplation I've decided to go towards the PTA program. my reasons:

1. I have two young kids who are both in daycare. I can't do anything until after my 9 year old gets out of daycare (i pay the daycare bills)

2. I'm 39. I don't want to be in my early 40's fresh out and have to pay off the enormous bill I'm going to have. This is a time when we need to be saving for my kids college and our retirement.

I spoke with Allegheny College about their PTA program; they saw my transcripts from school and wanted a job description to see if they'd except my A&P courses which were done back in '98. My hope is with all that I've done over the years they will let it go. but if required I'll retake them.

 

[black]

Yes jles the fundamentals are there. No doubt the insane about of course work involved in obtaining your PT degree will cover ANYTHING a personal trainer would learn in their PT certification.

However as a former personal trainer you know how to train someone. And you also have a leg up on your fellow students around you when it comes to personal training. IMO a good trainer needs to have a sports back round which comes in handy when it comes to training individuals. All to often I've seen people come over from the IT profession with NO experience training or even experience in the gym and just want to train because they like helping people and think it'll be fun.

So even though the DPT program far exceeds a PT cert when it comes to the science aspect; unless you have a personal training cert, have a firm understanding of how and when you can push someone, work out your self, know how to operate machines properly and how to instruct/how to use properly and know correct ROM I would not hire one (a DPT). Does that make sense?

As for me and the DPT program. After much contemplation I've decided to go towards the PTA program. my reasons:

1. I have two young kids who are both in daycare. I can't do anything until after my 9 year old gets out of daycare (i pay the daycare bills)

2. I'm 39. I don't want to be in my early 40's fresh out and have to pay off the enormous bill I'm going to have. This is a time when we need to be saving for my kids college and our retirement.

I spoke with Allegheny College about their PTA program; they saw my transcripts from school and wanted a job description to see if they'd except my A&P courses which were done back in '98. My hope is with all that I've done over the years they will let it go. but if required I'll retake them.

Just wanted to point out that there are applicants (like me) with degrees in exercise science, kinesiology, athletic training, and by saying a DPT (7 years of schooling including classes on training in certain cases) isn't as good as a certified personal trainer (only requiring 2 years at most) is crazy. Personally I just don't want to be a personal trainer so I have no reason to become certified even though I know far more than many personal trainers will ever learn.

 

[AUGGIE]

Hello all,
I am currently getting ready to finish up chiro school. I'll be the first to tell you that half (at least) of our profession is backwards. There are still wayyyyy too many chiros that practice in a non-evidence based fashion. These chiros rely heavily on theories that were introduced in the late 1800's and never proven. I believe that if we are to be considered a part of mainstream healthcare, we need to be held to the same standards as the other healthcare fields. That standard being an Evidence based, research driven practice!!!

That being said, there is also a growing part of our profession that realizes this and is working very hard to turn our image in the right direction. I consider myself to be a part of this group and I am very excited about the profession I am entering. There is a huge need for back pain, neck pain, headache, and various other MSK condition specialists! I am hoping to work in an office (get this!) WITH a PT, MD, or DO. We as chiros are very well trained in manipulation and treating many disorders of the spine. A typical DPT gets limited training in back manipulation where chiros get over three years of daily practice in manip. Partner manipulation with Graston, ART, Mckenzie protocol, etc. and we are very well equipped to be non-surgical spinal specialists.

I believe we need to work together to fully encompass WHAT THE PATIENT NEEDS.

Thank you!

I am a DC and have been in practice for 5 years. When I first graduated I was much like Kyle. I was vehemently opposed to the subluxation model and the notion that an adjustment could do much more than help with certain types of neck and back pain but a funny thing happened between then and now. I had an uncountable number of patients have chronic health conditions not only improve but in many cases completely vanish secondary to the musculoskeletal treatment they were undergoing in my office, most times I was not even aware these chronic conditions existed until a patient would ask me if there is any possibility that the adjusment could have had an impact on said condition.

Some of these patients have had these conditions for decades and been through evey imaginable course of treatment that could be offered with little or no results, the only difference was the adjustment. When you look objectively and scientifically at the "why" this can occur the only logical conclusion is the effect the adjustment has on the nervous system and the nervous system's regulatory role in every living cell.

There is some very promising research being conducted on the effect of noxious interference on the sympathetic nervous system and the role this has not only in pain production but in visceral/somatic function. I can cite this tomorrow when back at the office.

I also couldnt agree more with the fact that DC vs. PT is a silly and unfortunate idea. Both professions have a tremendous value to the patient for different reasons which do not in any way invalidate the other.

 

[NWfuturePT]

"most times I was not even aware these chronic conditions existed until a patient would ask me if there is any possibility that the adjusment could have had an impact on said condition."

Good to know that you are taking a thorough history

 

[AUGGIE]

"most times I was not even aware these chronic conditions existed until a patient would ask me if there is any possibility that the adjusment could have had an impact on said condition."

Good to know that you are taking a thorough history

That's the funny thing about patients, they will tell you what they want to tell you. I don't find it odd or dishonest that Mrs. Smith wouldnt mention her irregular menstrual cycle she has had for 23 years to her chiropractor she is consulting for LBP.

Why would she, I mean chiropractic can't help with that right?

 

[NWfuturePT]

That's the funny thing about patients, they will tell you what they want to tell you. I don't find it odd or dishonest that Mrs. Smith wouldnt mention her irregular menstrual cycle she has had for 23 years to her chiropractor she is consulting for LBP.

Why would she, I mean chiropractic can't help with that right?

Well, in school we learn that a thorough history and exam leads to a differential diagnosis so that we can determine a treatment plan. But, you know, take away those and add treatments with no scientific backing and voila.... Magic happens

 

[AUGGIE]

Well, in school we learn that a thorough history and exam leads to a differential diagnosis so that we can determine a treatment plan. But, you know, take away those and add treatments with no scientific backing and voila.... Magic happens

So in the above referenced case the patient was consulting me for LBP and did not mention the 23 year chronic hx of irregular menstrual cycle, when you get into practice you will notice that patients will not always tell you all relevant history no matter how thorough you attempt to be.

If you think there is no scientific basis for manipulation in LBP you might want to question the education you received.

 

[NWfuturePT]

So in the above referenced case the patient was consulting me for LBP and did not mention the 23 year chronic hx of irregular menstrual cycle, when you get into practice you will notice that patients will not always tell you all relevant history no matter how thorough you attempt to be.

If you think there is no scientific basis for manipulation in LBP you might want to question the education you received.

1) I am well aware that patients don't tell you everything- that's why it's YOUR job to find out from them because, as you hopefully know, there are treatments that may be contraindicated or the LBP may be due to something other than a subluxation (imagine that!) So, for example, you may have a constipated patient who comes to you complaining of LBP, and have no reason to tell you that they are constipated, because hey, you're a DC, and what can you do about that. Turns out they are straining and that is the ultimate cause of their LBP, but you don't bother to find that out.

2) I am well aware of manipulation as ONE method of treating LBP. In our world there are others. In referring to treatments that are not scientifically based I was referrring to the fact that you are claiming your subluxation treatments are curing chronic conditions which you didn't even know exist. I find it alarming that you would post that as a defense for your profession.... Especially since I know there are DC's out there who are really trying to back up what they do with actual evidence- this anecdotal stuff earns you no credibility.

 

[AUGGIE]

can someone comment on Atlas Orthogonal Chiropractic

It is a very specific low velocity, low amplitude thrust into the atlas and sometimes even the occiput or axis. The x-ray and evaluation process is very exacting and time intensive with extremely expensive equimpment needs which is why you don't see a lot of DCs using the technique.

It is the technique that was used in the University of Chicago Med School study that showed this adjustment to be just as effective as dual-drug therapy in hypertension which is currently being planned for further study.

http://www.uchospitals.edu/news/2007/20070314-atlas.html

 

[AUGGIE]

1) I am well aware that patients don't tell you everything- that's why it's YOUR job to find out from them because, as you hopefully know, there are treatments that may be contraindicated or the LBP may be due to something other than a subluxation (imagine that!) So, for example, you may have a constipated patient who comes to you complaining of LBP, and have no reason to tell you that they are constipated, because hey, you're a DC, and what can you do about that. Turns out they are straining and that is the ultimate cause of their LBP, but you don't bother to find that out.

2) I am well aware of manipulation as ONE method of treating LBP. In our world there are others. In referring to treatments that are not scientifically based I was referrring to the fact that you are claiming your subluxation treatments are curing chronic conditions which you didn't even know exist. I find it alarming that you would post that as a defense for your profession.... Especially since I know there are DC's out there who are really trying to back up what they do with actual evidence- this anecdotal stuff earns you no credibility.

I don't need to defend my hx, it is a non-sequitur in this conversation anyways.

Couldnt agree more that anecdotal evidence = crap because it is but chiropractors and chiropractic patients have been making these kinds of claims for over a hundred years not simply without evidence but without any studies at all. There are now some studies being conducted which are promising ie the study cited here...

http://www.uchospitals.edu/news/2007/20070314-atlas.html

I mean chiropractic affecting hypertension that is "magic" right?

 

[facetguy]

Auggie,

I wish you luck in your conversations here. Unfortunately, however, you may want to keep your expectations of useful discussion low.

 

[AUGGIE]

Auggie,

I wish you luck in your conversations here. Unfortunately, however, you may want to keep your expectations of useful discussion low.

I guess that makes sense. I mean how neutral can a conversation truly be on a message board that doesnt even bother to include the profession being discussed?

 

[NWfuturePT]

I don't need to defend my hx, it is a non-sequitur in this conversation anyways.

Couldnt agree more that anecdotal evidence = crap because it is but chiropractors and chiropractic patients have been making these kinds of claims for over a hundred years not simply without evidence but without any studies at all. There are now some studies being conducted which are promising ie the study cited here...

http://www.uchospitals.edu/news/2007/20070314-atlas.html

I mean chiropractic affecting hypertension that is "magic" right?

Kay this is my last post on this.... and let me preface it by saying that I am open to learning what chiropractic method can do for patients.
That being said, I am opposed to chiros who don't follow good guidelines for treating and diagnosing their patients.
Your hx taking is of extreme consequence in this discussion- it's actually why I even bothered to reply. W/out a thorough history and exam, you are left treating the patients signs and symptoms (and LBP is a S&S of menstrual problems). So if you don't know where the problem lies then you don't have a justification for any treatment. And what is even worse for the patient, you miss referring them to a clinician who can treat the root cause of the problem, cause you were all too happy to hear LBP and do some nice manipulations.

 

[facetguy]

Kay this is my last post on this.... and let me preface it by saying that I am open to learning what chiropractic method can do for patients.
That being said, I am opposed to chiros who don't follow good guidelines for treating and diagnosing their patients.
Your hx taking is of extreme consequence in this discussion- it's actually why I even bothered to reply. W/out a thorough history and exam, you are left treating the patients signs and symptoms (and LBP is a S&S of menstrual problems). So if you don't know where the problem lies then you don't have a justification for any treatment. And what is even worse for the patient, you miss referring them to a clinician who can treat the root cause of the problem, cause you were all too happy to hear LBP and do some nice manipulations.

This seems to fit your pre-conceived notions about chiropractors, which has likely driven your comments thus far. But I'm glad to hear you are open to learning otherwise.

 

[AUGGIE]

Kay this is my last post on this.... and let me preface it by saying that I am open to learning what chiropractic method can do for patients.
That being said, I am opposed to chiros who don't follow good guidelines for treating and diagnosing their patients.
Your hx taking is of extreme consequence in this discussion- it's actually why I even bothered to reply. W/out a thorough history and exam, you are left treating the patients signs and symptoms (and LBP is a S&S of menstrual problems). So if you don't know where the problem lies then you don't have a justification for any treatment. And what is even worse for the patient, you miss referring them to a clinician who can treat the root cause of the problem, cause you were all too happy to hear LBP and do some nice manipulations.

Nice roll out of the jump to conclusions mat.

Again, my history, exam, and diagnoses have never been an issue and neither has making appropriate referrals when necessary. As a PT and or DC you will NEVER know about a patient's menstrual problems if they choose to not disclose that information, you can ask hundreds of times hundreds of different ways and if they choose to not disclose you will never know so as awesome a clinician as you are even YOU will have that limitation.

Again, this is all a nice non-sequitur you have chosen to discuss.

 

[clo]

Just wanted to point out that there are applicants (like me) with degrees in exercise science, kinesiology, athletic training, and by saying a DPT (7 years of schooling including classes on training in certain cases) isn't as good as a certified personal trainer (only requiring 2 years at most) is crazy. Personally I just don't want to be a personal trainer so I have no reason to become certified even though I know far more than many personal trainers will ever learn.

And with your athletic training backround i would could work as a trainer if you wanted and be great at it with your backround. Yes, you have 7 years of schooling which is WAY more than a trainer. And yes, some trainers prefer to be complacent in their education and there are alot of crappy trainers out there too. But last I looked the DPT program does not spend time in a weight room and without that experience you shouldn't be there; actually in your case black you could be. But others with no experience in a weight room shouldn't be there.

so if your goal is to be a physical therapist than obviously your studies will take you in that direction. Just because you are a physical therapist does not mean you will be a good personal trainer. Heck, I've met some who can look at a machine and not even know how to use it or what it's for.


Auggie, I'm sorry if this thread got way off track. I'm here because I'm interested in getting into the rehab field as a PTA. I've posted here because of my experience as a trainer for over 10 years. If you are following the posts from where I chimed in you'll see why it's gotten to this point.

 

[truthseeker]

http://www.sciencebasedmedicine.org/?p=3022

interesting read pertaining to the OP and the actual title of the thread.

How do you respond to this article Auggie and Facetguy?

 

[clo]

interesting read pertaining to the OP and the actual title of the thread.QUOTE]


sorry guys, I'd be happy to stop posting regarding the training. nothing I hate more than a thread hijacker

 

[AUGGIE]

http://www.sciencebasedmedicine.org/?p=3022

interesting read pertaining to the OP and the actual title of the thread.

How do you respond to this article Auggie and Facetguy?

It's an opinion piece masquerading as a scientific study. It thoroughly gets taken apart in the commentary section so there is no need for me to reiterate those points.

What do you think about this research truthseeker?

http://www.uchospitals.edu/news/2007/20070314-atlas.html

If a larger study comes out and reproduces the results that chiropractic manipulation of "fixation" (subluxation) of C1 can have the same effects as dual drug therapy what will be said of such research? Will it be chalked up to magic? placebo? will it matter?

 

[Husker DPT]

Facetguy, this is where you and Aussie differ. Aussie openly advocates for subluxation management to treat disease and consequently is true to the essential identity of chiropractic. For the purpose of this debate/thread I respect that honesty. The faction of chiropractic that desires to divorce this premise and "use physiotherapy and evidence based practice" to treat musculoskeletal disease is creating a profession that is on one hand redundant to PT and on the other hand making chiropractic a split personality that confuses prospective students and patients in addition to other things. Facetguy, Aussies posts here strengthen my overall stance regarding the nature of chiropractic.

Aussie, do you attempt to comanage patients then with the PCP? I find this interesting, will not attack your posts. This is something I am genuinely interested in.

 

[truthseeker]

It's an opinion piece masquerading as a scientific study. It thoroughly gets taken apart in the commentary section so there is no need for me to reiterate those points.

What do you think about this research truthseeker?

http://www.uchospitals.edu/news/2007/20070314-atlas.html

If a larger study comes out and reproduces the results that chiropractic manipulation of "fixation" (subluxation) of C1 can have the same effects as dual drug therapy what will be said of such research? Will it be chalked up to magic? placebo? will it matter?

If they actually can reproduce it, it will be the first time that non-musculoskeletal problems will have been supported by traditional scientific method and I will support it. Since your reference wasn't for the actual study I can't vouch for the quality of the study but from the way the article was worded and since the source seems credible without apparent secondary gain, it seems as though it is a believable study.

 

[Husker DPT]

When this study came out, it was a big thing. The testing methodology was analyzed on chirotalk, rehabedge, evidence in motion, all the therapy websites. This is not a top tier level of evidence study let me tell you. However, it is interesting. It seems to me, DO's and even PT's who are immersed in manipulation as a tx technique will state the most nonmusculoskeletal pathologies that perhaps may be influenced are HTN and asthma.

 

[truthseeker]

When this study came out, it was a big thing. The testing methodology was analyzed on chirotalk, rehabedge, evidence in motion, all the therapy websites. This is not a top tier level of evidence study let me tell you. However, it is interesting. It seems to me, DO's and even PT's who are immersed in manipulation as a tx technique will state the most nonmusculoskeletal pathologies that perhaps may be influenced are HTN and asthma.

I thought that I read a large well done study regarding manipulations vs asthma that showed fairly conclusively that there was no benefit. JAMA or NEJM maybe a 3-4 years ago?

 

[Husker DPT]

I believe it. I have read 2 books on therapy interventions, one written by a PT cert manip and another by a DO that listed HTN, asthma and I believe there was one more under "potential anecdotal benefits" of manipulation that they had seen. The originator of chirotalk ("the skeptical chiropractic forum") Allen Botnick himself stated his asthma was much benefited by chiropractic adjustments and this was the catalyst for him to enlist in the profession. All anecdotal, nothing substantiated by research, but I just find it interesting nonetheless.

 

[truthseeker]

I believe it. I have read 2 books on therapy interventions, one written by a PT cert manip and another by a DO that listed HTN, asthma and I believe there was one more under "potential anecdotal benefits" of manipulation that they had seen. The originator of chirotalk ("the skeptical chiropractic forum") Allen Botnick himself stated his asthma was much benefited by chiropractic adjustments and this was the catalyst for him to enlist in the profession. All anecdotal, nothing substantiated by research, but I just find it interesting nonetheless.

Given how Palmer came upon the wonders of chiropractic, you would think that there wouldn't be any deaf people by now.

 

[facetguy]

Facetguy, this is where you and Aussie differ. Aussie openly advocates for subluxation management to treat disease and consequently is true to the essential identity of chiropractic. For the purpose of this debate/thread I respect that honesty. The faction of chiropractic that desires to divorce this premise and "use physiotherapy and evidence based practice" to treat musculoskeletal disease is creating a profession that is on one hand redundant to PT and on the other hand making chiropractic a split personality that confuses prospective students and patients in addition to other things. Facetguy, Aussies posts here strengthen my overall stance regarding the nature of chiropractic.

Aussie, do you attempt to comanage patients then with the PCP? I find this interesting, will not attack your posts. This is something I am genuinely interested in.

Husk,

I wouldn't disagree with anything Auggie has said thus far. In fact, he said this in his first post, and it is absolutely true:

"There is some very promising research being conducted on the effect of noxious interference on the sympathetic nervous system and the role this has not only in pain production but in visceral/somatic function."

I have never said that chiropractic adjustments can't help with non-musculoskeletal problems. I've been practicing for over a decade and have seen many outcomes I cannot fully explain. I simply said that, the further away from MSK problems you get, the thinner the evidence gets, and in a lot of cases there is no evidence.

Again, I think you are somewhat hung up on the subluxation semantics. True, 'subluxation' is a confusing term and means different things to different people (even different chiropractors); we've established that already. I think you are stuck looking at subluxations as the old model of a bone out of place squeezing a nerve. 'Nerve interference' these days means something different and involves not only the local articular neurology (particular mechanoreceptors and nociceptors) but also autonomic system ramifications of abnormal afferentation. As Auggie said, we already know that there are effects in the sympathetic nervous system; basic science has already shown this. Where chiropractic needs more evidence is in these autonomic/non-MSK areas. The neurophysiologic model/pathway is there, just not many clinical trials.

In short, ask any chiropractor and they'll tell you they've helped patients with asthma, dysmenorrhea, or whatever. Where I have an issue is if a DC states that chiropractic adjustments will absolutely help these conditions every time. When I'm asked about these types of conditions by patients, I simply state that the research simply isn't there but there are countless anecdotes, so who knows. It is very rare (at least in my practice) for patients to present ONLY with a non-MSK problem. Instead, they present with, say, LBP and after some treatment they offer that other things seem to be improving as well. Just as Auggie offered with his patient's example.

And, to NWPT's jabs about history taking, patients withhold information sometimes. Period. Experience will show you this...someday.

 

[Husker DPT]

I have never said that chiropractic adjustments can't help with non-musculoskeletal problems. I've been practicing for over a decade and have seen many outcomes I cannot fully explain. I simply said that, the further away from MSK problems you get, the thinner the evidence gets, and in a lot of cases there is no evidence.

You may have thought this, but you did not post this. Never. Go back and look. Your mission statement on this particular thread has been, in an unwavering fashion, that subluxation based chiropractic that is admittedly used to treat nonm/s issues is virtually extinct. These are the vast minority, overshadowed by the mixer faction and also that the term mixer is a nonchiropractic term. Your argument changes to suit the discussion at hand. You didn't reply to Aussie with skepticism regarding his claims, and he himself wrote he was just like Kyle.... not you. Now look at Kyle's stance. That every employment opportunity out there involved selling subluxation based unethical lifetime packages. So, in the most basic terms, he is saying that he has seen so much benefit from treating subluxations for nonm/s pathology that he does so without the reservations Kyle does currently maintain. So that, once again, substantiates what I have been saying and it is in opposition to your stance on this issue. And once again, the use of referencing my name as Husk is deliberate and ad hominemistic although you refute that you do this as well.

 

[Husker DPT]

Given how Palmer came upon the wonders of chiropractic, you would think that there wouldn't be any deaf people by now.

Or diabetics, or cancer. There have been chiropractors jailed for telling diabetic pts to throw away there insulin and pediatric cancer patients that radiation and/or chemotherapy is unnecessary after they've "turned on the power" and released the innate!!

 

[facetguy]

You may have thought this, but you did not post this. Never. Go back and look. Your mission statement on this particular thread has been, in an unwavering fashion, that subluxation based chiropractic that is admittedly used to treat nonm/s issues is virtually extinct. These are the vast minority, overshadowed by the mixer faction and also that the term mixer is a nonchiropractic term. Your argument changes to suit the discussion at hand. You didn't reply to Aussie with skepticism regarding his claims, and he himself wrote he was just like Kyle.... not you. Now look at Kyle's stance. That every employment opportunity out there involved selling subluxation based unethical lifetime packages. So, in the most basic terms, he is saying that he has seen so much benefit from treating subluxations for nonm/s pathology that he does so without the reservations Kyle does currently maintain. So that, once again, substantiates what I have been saying and it is in opposition to your stance on this issue. And once again, the use of referencing my name as Husk is deliberate and ad hominemistic although you refute that you do this as well.

Well, I guess you'll see things the way you wish to see them. And calling you Husk was not meant to be a slight; generally names are shortened to nicknames as familiarity and comfort grow. (And I was too lazy to press the Shift key 4 times) Besides, if I cared enough, I'm pretty sure I could find a few instances where you called me 'Facet' in this thread.

PS Getting names right hasn't been your strong suit lately (Aussie??)

 

[Husker DPT]

Haha, true enough. I mean Auggie.

 

[PostLessOne]

UPDATE : My friend got accepted to the local chiropractor school. They took her without any delay or fuss. She has a GPA around 3.3, and they allowed her to use a PCAT score for admissions purposes rather than the GRE.

From my friends perspective, it seems like an obvious choice. She gets to start this summer, and being a chiropractor is better than being a personal trainer or a waitress. Were she to go for the DPT, she'd have to do hours of volunteering to meet that requirement, take a standardized test, and wait a year while spending thousands of dollars on application fees and travel. In addition, there's no guarantee that she would be accepted at all. (I'm unsure how hard it is to get into a DPT program with her stats)

So it looks like that settles it. Personally, I'd pick podiatry if I were her : possible to get accepted without too much fuss, and it's nearly all of the education and training a doctor receives and feet are a pretty good medical specialty, all things considered.

Still, this girl is extremely attractive and happens to be blonde. She has plenty of options that make the career downsides of being a chiropractor moot.

 

[MinnDasota]

I'm glad it's settled! whew. jk.

The points you just brought up are some of the reasons why the 2 careers differ...much stricter standards for admission. I'm sure she will enjoy being a chiro if it is her passion and she will be able to practice sooner which is nice.

As others have pointed out here and in other forums, there is a larger range of pay in the chiropractic field and not all chiros make 6 figures so hopefully she took that into account when deciding. Default rates are highest in the field so hopefully she can avoid that (as many chiros before her have been able to do). Good luck to your friend and happy holidays everyone!

 

[truthseeker]

easier to get into, choice between waitress and personal trainer, she's blonde so it doesn't matter . . . All examples, anecdotal for sure, why chiropractors will never be taken as seriously as other healthcare professionals.

 

[PostLessOne]

easier to get into, choice between waitress and personal trainer, she's blonde so it doesn't matter . . . All examples, anecdotal for sure, why chiropractors will never be taken as seriously as other healthcare professionals.

Prestige isn't everything. If I could do my life over again, I'd want to be a ski or surf bum with wealthy parents.

 

[Husker DPT]

Good luck to her. I am a proponent of the adage knowlege is power and if she has researched her options as you have assisted her with here and made an informed decision than she's good to go.

 

[cdmguy]

...Not Exactly Correct Regarding Asthma Treatment...

This is in response to Husker PTs statement that Allen Botnick observed favorable improvement with asthma in response to chiropractic adjustment. I am Allen Botnick DC. As a patient I was largely frustrated with the temporary muscle relaxation I received which never resolved my chronic asthma.

As a DC I was able to cure it using a new passive exercise device and physical therapy regimen which restores the biomechanics of the rib cage better than what manual treatments are able to accomplish. This led to the eventual complete resolution of my asthma at age 32. I am now 39 and am asthma free.

I believe that a signficant cohort of asthma patients are suffering from instability of the thoracic rib-vertebra complex.

I hope to one day market this device.

If anyone has any questions feel free to email me at [email protected] or post to Chirotalk.

Allen Botnick DC

I believe it. I have read 2 books on therapy interventions, one written by a PT cert manip and another by a DO that listed HTN, asthma and I believe there was one more under "potential anecdotal benefits" of manipulation that they had seen. The originator of chirotalk ("the skeptical chiropractic forum") Allen Botnick himself stated his asthma was much benefited by chiropractic adjustments and this was the catalyst for him to enlist in the profession. All anecdotal, nothing substantiated by research, but I just find it interesting nonetheless.

 

[ksiem]

I wonder if FacetGuy is also the great friend researching his buddies interests. He sounds more like a Chiro Admissions Counselor trying to recruit PT students. The problem with chiropractors (in my opinion), is that they change their modalities too often to catch them with their pants down. Many now use ultra sound, give x-rays, prescribe exercise, etc. I say, to truly get a great look at profession, look at it's roots. Look at the history of a profession to get an idea of the original philosophy. On a side note, you are aware that many chiropractic schools include business classes in their curriculum? You may ask "Why?!," I would (maybe you wouldn't)(the business classes are meant to market their service and help with salesmanship, plus accounting and etc). If their modalities work so great I wouldn't think business classes would be needed? Back to my original thought. I spoke to a new grad awhile back when I tried having an adjustment (didn't help, my experience is anecdotal though or maybe I just didn't believe hard enough-joke). He stated that he hasn't had a cold ever since he's received chiro treatment on a regular basis. Too wierd, and shocking considering he was a new grad fresh out of school practicing here in Northwest Arkansas. It seems to me that it's really hard to define the efficacy of chiropractic care because they do so many things now. I think that research should focus on manipulation. Manipulation is a chiros keystone in my opinion. That is their primary "marketable" service. Everything else they do, at least recently, seems to mimic PT. The fact of the matter is that chiros have always, conspiracy?, lacked research or proof behind the pudding. If they dominate so greatly, show it to me. Until then, I believe that anecdotal evidence and sugar pill mentality drives the profession.

Also, I may be confusing subluxation and manipulation

 

[ksiem]

With desire to be more straight foward: if you mix a bad treatment like manipulation with other treatments that are efficacious then the resulting mixed bag may be hard to condemn.

 

[truthseeker]

...Not Exactly Correct Regarding Asthma Treatment...

This is in response to Husker PTs statement that Allen Botnick observed favorable improvement with asthma in response to chiropractic adjustment. I am Allen Botnick DC. As a patient I was largely frustrated with the temporary muscle relaxation I received which never resolved my chronic asthma.

As a DC I was able to cure it using a new passive exercise device and physical therapy regimen which restores the biomechanics of the rib cage better than what manual treatments are able to accomplish. This led to the eventual complete resolution of my asthma at age 32. I am now 39 and am asthma free.

I believe that a signficant cohort of asthma patients are suffering from instability of the thoracic rib-vertebra complex.

I hope to one day market this device.

If anyone has any questions feel free to email me at [email protected] or post to Chirotalk.

Allen Botnick DC

Do you not recognize that what you just descried is the definition of anecdotal evidence and it is just as likely that your asthma abated simply because you aged or changed your living environment?

 

[cdmguy]

>Do you not recognize that what you just descried is the definition of anecdotal evidence and it is just as likely that your asthma abated simply because you aged or changed your living environment?

Sure and I want to test it in a group of asthmatics. However several things strongly support the theory. First, I had two chronic points of sensitivity, one at the right 3rd costochrondral joint and at the interspinous space of the same level. This could be quantified by algometry in a patient. Also, the tender costochondral joint had a palpable T3 right rib head indicating anterior translation of the rib-vertebra complex. There was also a Pottenger's Saucer at the T3 interspinous (indentation) indicating that this was the apex of the breakdown where the stress was most concentrated and breaking it down, translating it anterior with gravity. These chronic spots and rib head did not remit with manipulation but were reversible through mirror image type combined mobilization/exercise techniques. They needed to be treated for about three months to reach stability. Prior to this they would recur when the body was loaded in the direction of instability (anterior translation) with the asthma and joint tenderness recurring simultaneously. This symptomatology doesn't follow simple age changes and the living environment wasn't changed. The asthmatic wheezing eventually remitted with conversion to cough variant asthma with perhaps two or three recurrences in seven years that respond quickly to treatment.

Another supporting fact which I discussed with a pediatric allergist is that joint tenderness in these locations is very common in asthmatics.

My point is don't be so quick to jump to conclusions without collecting all the evidence.

I'm excited about this treatment because it cured my 32 year old asthma (it now has been seven years). It's just a way to stabilize the thoracic spine like you do with McKenzie Technique or using hyperextension stretching to fix kyphotic cervical spines. If proven perhaps it could also help explain and provide a nonsurgical treatment for costochondritis.

One tricky factor is that we may need to include prolotherapy to tighten up stretched posterior ligaments and provide passive stabilization that we can't get any other way. It may decrease recurrence. However this will require medical/osteopathic collaboration.

 

[facetguy]

I wonder if FacetGuy is also the great friend researching his buddies interests. He sounds more like a Chiro Admissions Counselor trying to recruit PT students. The problem with chiropractors (in my opinion), is that they change their modalities too often to catch them with their pants down. Many now use ultra sound, give x-rays, prescribe exercise, etc. I say, to truly get a great look at profession, look at it's roots. Look at the history of a profession to get an idea of the original philosophy. On a side note, you are aware that many chiropractic schools include business classes in their curriculum? You may ask "Why?!," I would (maybe you wouldn't)(the business classes are meant to market their service and help with salesmanship, plus accounting and etc). If their modalities work so great I wouldn't think business classes would be needed? Back to my original thought. I spoke to a new grad awhile back when I tried having an adjustment (didn't help, my experience is anecdotal though or maybe I just didn't believe hard enough-joke). He stated that he hasn't had a cold ever since he's received chiro treatment on a regular basis. Too wierd, and shocking considering he was a new grad fresh out of school practicing here in Northwest Arkansas. It seems to me that it's really hard to define the efficacy of chiropractic care because they do so many things now. I think that research should focus on manipulation. Manipulation is a chiros keystone in my opinion. That is their primary "marketable" service. Everything else they do, at least recently, seems to mimic PT. The fact of the matter is that chiros have always, conspiracy?, lacked research or proof behind the pudding. If they dominate so greatly, show it to me. Until then, I believe that anecdotal evidence and sugar pill mentality drives the profession.

Also, I may be confusing subluxation and manipulation

With desire to be more straight foward: if you mix a bad treatment like manipulation with other treatments that are efficacious then the resulting mixed bag may be hard to condemn.

Your comments are not worthy of response.

 

[cdmguy]

I'll respond to a few of ksem's comments-

>Everything else they do, at least recently, seems to mimic PT. The fact of the matter is that chiros have always, conspiracy?, lacked research or proof behind the pudding. If they dominate so greatly, show it to me. Until then, I believe that anecdotal evidence and sugar pill mentality drives the profession.

Correct. Chiropractic is an alternative non-evidence based profession. This means that it markets treatments without any proof and based solely on subgroups. If you get enough chiropractors to like something it becomes accepted.

Next, yes chiropractors constantly expand into other areas: PT, nutrition, neurology, pediatrics whatever. We want to have our cake and eat it too. We want the primary care scope of practice to treat anything while being able to not take responsibility when the treatments fail. Everybody does this, from the most conservative upper cervical chiropractor treating hypertension to the "wholistic" Applied Kinesiology quack giving you an arm test telling you need to buy liver pills for your weak liver.

>Also, I may be confusing subluxation and manipulation

There really isn't a difference since all of the popular techniques have fatal problems such as invalid biomechanics, failure to treat lower kinematic chain problems first and lack of scope to provide passive stabilization for good long term correction. To be a chiropractic adjustment it would have to be biomechanically accurate and solve the problems. No wonder patients never get better. So why does chiropractic continue to pretend it is an effective spinal treament when all it can do it give temporary palliative relief through nerve stimulation? Because it is an unethical profession. This lie is the core of all the bad will from former chiropractors and disgruntled patients alike. Come visit www.chirotalk.proboards.com if you'd like to learn more.