North American Spine

[joshmir]

facetguy-

I think these types of discussions happen often between disciplines (acupuncturists, etc) and one of the challenges is we don't have exact definitions of what we believe to be common terminology.

I think what you are hearing on this forum is that many pain physicians may diagree with your points, but I can see by the way you articulate and conduct yourself that you would be a cool guy to hang with and probably have patients who like you a lot regardless of whether their pain improves or doesn't. I am a big fan of manipulations for myself.

These forums can be a bit like "Fight Club". We like to duke it out and don't pull punches, but there's really no hating, so don't take it personally.

I hope you stick around because I enjoy hearing the outside perspectives of intelligent members of other tribes.

Can I ask you to expound on the following statement:

"The lame notion of all DCs simply lying patients down and banging on their spines is completely ridiculous and suggests a degree of ignorance on your part."

My assessment of chiro care is that it may duplicate a lot of what PTs do, and the unique aspect it offers beyond that redundancy is manipulation...I understand I may be ignorant in this regard so please enlighten me.

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[Jeff05]

Hey Jeff, be honest. How much have you really examined chiropractic? My guess is you haven't done any due diligence prior to forming your opinion. Just a hunch.

i've examined it enough to know that my statements are true. i am a well trained physician scientist and can see through BS pretty quickly. i have personally reviewed most crucial chiro literature as a part of my PAIN fellowship - and there is nothing there worth of any actual value.

 

[facetguy]

Firstly no one cares what's written in a "chiro" magazine, I mean their version of a 'journal'.

I assume you are referring to JMPT. Here's the Editorial Board; I'm seeing a lot of PhDs and even a few MDs: http://www.journals.elsevierhealth.com/periodicals/ymmt/edboard

Secondly, if you went to medical school you would realize that a meta analysis is worth basically NOTHING. So referring to those types of studies doesnt save your cause.

I included these review studies to simplify my task. I'm not about to summarize dozens of studies one by one here.

Stuff published in random journals and in chiro journals have just as much utility as stuff that goes into 'nursing journals'. Most medical journals have physicians that peer review topics.

See above.

Again, using the term "pain physician" should be solely dedicated to people that went to MEDICAL SCHOOL. The term 'physician' is dedicated to someone that went to medical school. Any joe blow can do chiro school and do a few manipulations. When you call yourself a 'physician' you are essentially committing fraud as it misrepresents your degree to your patient.

Cant wait for that bill to pass that makes sure everyone's occupation is properly identified.

I can only guess that there are some DCs in your area calling themselves "pain physicians", given that you continue to harp on this. FWIW, I've never seen this. As to the term physician, that varies state to state, and there is usually a requirement that the DC identifies himself/herself as 'chiropractor', 'chiropractic physician', or 'DC' along with the term physician. So, no fraud.

 

[Jcm800]

First of all i dont think any one is treating Facetguy like a jerk, but most of us get on this forum to talk with our peers, about "medical" pain management issues, often interventional issues. Therefore a chiropractor really has no business being on this forum. Should they be banned, i would like it, but cant say its really required, as thats what the private forum is for... but that being said, just as the wierd random PCP, or patient, or med student that has little offer, i think the chiropractor on this forum is the same.

I do believe he called some of us "babies"...
so i cant say he took the high road...

I applaud him for trying to convince us that there is science to support what he does, but clearly its still "alternative medicine" which has its place, i guess, where i dont know... neither side will agree, but there is a better board for the chiro propaganda.

i have never met a chiro that didnt know how to get a patient to come to them for at least 15 sesions before saying "maybe this isnt helping"

could you imagine if we did that. Its enought that people look down on us if a patient get 2 or 3 injections, but 10-15 manipulations, that help "for the day, but then the pain came back the next day"

 

[SleepIsGood]

First of all i dont think any one is treating Facetguy like a jerk, but most of us get on this forum to talk with our peers, about "medical" pain management issues, often interventional issues. Therefore a chiropractor really has no business being on this forum. Should they be banned, i would like it, but cant say its really required, as thats what the private forum is for... but that being said, just as the wierd random PCP, or patient, or med student that has little offer, i think the chiropractor on this forum is the same.

I do believe he called some of us "babies"...
so i cant say he took the high road...

I applaud him for trying to convince us that there is science to support what he does, but clearly its still "alternative medicine" which has its place, i guess, where i dont know... neither side will agree, but there is a better board for the chiro propaganda.

i have never met a chiro that didnt know how to get a patient to come to them for at least 15 sesions before saying "maybe this isnt helping"

could you imagine if we did that. Its enought that people look down on us if a patient get 2 or 3 injections, but 10-15 manipulations, that help "for the day, but then the pain came back the next day"

I wonder what these guys are telling their patients. EVERYONE i knw that's ever had any manipulation always seems to state that it was for 1-2 days MAX. Some for just a few hours.

I dont think I"ve ever seen a medical intervention last for just a few hours. typically we get more gas mileage.

 

[facetguy]

Please show me literature that shows that, in fact, chiropractic care normalize motion of the spinal motion segments.

Neck Mobility:
http://www.ncbi.nlm.nih.gov/pubmed/19119394

http://www.ncbi.nlm.nih.gov/pubmed/...nkpos=2&log$=relatedarticles&logdbfrom=pubmed

http://www.ncbi.nlm.nih.gov/pubmed/18758348

Gapping lumbar facet joints:
http://www.ncbi.nlm.nih.gov/pubmed/...nkpos=1&log$=relatedarticles&logdbfrom=pubmed

Show me literature that shows that chiropractic care restores normal afferentation, particularly mechanoreceptive information.

See any study reporting pain reduction following manipulation (there are many)

Improved head repositioning:
http://www.ncbi.nlm.nih.gov/pubmed/16461168

Show me literature that shows that chiropractic care improves the neuromechanics, to dysfunctional motion segments.

The term neuromechanics was used to indicate that spinal manipulation has effects on both the motion/biomechanics of the spine as well as various neurophysiologic effects. There are lots of studies showing all kinds of neuro effects (changes in EMG, muscle tone, pain thresholds, supraspinal effects, sympathetic effects, etc.).

As I stated earlier, an early criticism of chiropractic was that we had this basic science info but lacked outcomes in terms of neck and back pain patients. Now, however, there are a number of positive outcomes studies.

Unless you have basic science to back up the axiomatic tenets of your field, and science can actually document that chiropractic care can do what it claims it can do, all you have is a bunch of well-packaged pseudoscientifc jargon.

That info is present in the literature.

 

[facetguy]

First of all i dont think any one is treating Facetguy like a jerk, but most of us get on this forum to talk with our peers, about "medical" pain management issues, often interventional issues. Therefore a chiropractor really has no business being on this forum. Should they be banned, i would like it, but cant say its really required, as thats what the private forum is for... but that being said, just as the wierd random PCP, or patient, or med student that has little offer, i think the chiropractor on this forum is the same.

I've already explained how I ended up in this forum and why I posted.

I do believe he called some of us "babies"...
so i cant say he took the high road...

You were sounding like a baby, and that hasn't changed.

I applaud him for trying to convince us that there is science to support what he does, but clearly its still "alternative medicine" which has its place, i guess, where i dont know... neither side will agree, but there is a better board for the chiro propaganda.

I disagree that chiropractic is still in the "alternative" realm. There is science to support what chiropractors do.

i have never met a chiro that didnt know how to get a patient to come to them for at least 15 sesions before saying "maybe this isnt helping"

could you imagine if we did that. Its enought that people look down on us if a patient get 2 or 3 injections, but 10-15 manipulations, that help "for the day, but then the pain came back the next day"

Just out of curiosity, would you ever send a patient for only 1 or 2 visits of physical therapy? That doesn't make sense. Why would you expect pain patients, particularly difficult cases, to improve with that many chiro visits? Chiropractic isn't magic, you know.

 

[facetguy]

I wonder what these guys are telling their patients. EVERYONE i knw that's ever had any manipulation always seems to state that it was for 1-2 days MAX. Some for just a few hours.

I dont think I"ve ever seen a medical intervention last for just a few hours. typically we get more gas mileage.

This is why manipulation should be combined with other patient management strategies, including things like active exercise, dietary advice to help reduce inflammation or to lose weight, or even stress management strategies.

And not to throw stones, particularly in this forum, but if I had a dime for every patient that got zero benefit from invasive pain management interventions... The difference between you and I is that I don't then assume that every patient will get zero benefits.

 

[facetguy]

facetguy-

I think these types of discussions happen often between disciplines (acupuncturists, etc) and one of the challenges is we don't have exact definitions of what we believe to be common terminology.

I think what you are hearing on this forum is that many pain physicians may diagree with your points, but I can see by the way you articulate and conduct yourself that you would be a cool guy to hang with and probably have patients who like you a lot regardless of whether their pain improves or doesn't. I am a big fan of manipulations for myself.

These forums can be a bit like "Fight Club". We like to duke it out and don't pull punches, but there's really no hating, so don't take it personally.

I hope you stick around because I enjoy hearing the outside perspectives of intelligent members of other tribes.

Can I ask you to expound on the following statement:

"The lame notion of all DCs simply lying patients down and banging on their spines is completely ridiculous and suggests a degree of ignorance on your part."

My assessment of chiro care is that it may duplicate a lot of what PTs do, and the unique aspect it offers beyond that redundancy is manipulation...I understand I may be ignorant in this regard so please enlighten me.

There is some degree of overlap between PT and chiro, if for no other reason than we both use conservative means to address MSK problems. I am not a PT hater and I refer to PTs (and treat a few as well). Chiros do rely more on various manipulation techniques in the treatment of many patients, but keep in mind that there are all kinds of manual techniques out there, not all of which involve high velocity manipulation. I think in general chiros tend to focus a bit more on the integrity of intersegmental motion and not just global ROMs, but that may just be my impression. Chiros get more training in radiographic issues and in nutritional issues. In that patients have direct access to chiros, we place a greater emphasis on diagnosis, whereas patients show up at the PT office having been pre-screened so to speak (perhaps this will change if PTs get greater direct access).

Overall, a chiropractic encounter can have many facets which can change at any time. PTs are a bit more limited or focused in how they go about interacting with patients (and I don't mean that to be in any way derogatory).

I hope that helps.

 

[Jeff05]

true, some of the things we do in interventional pain do not work. however, all that is changing through deliberate effort and research. good pain fellowships are relatively a new phenomenon. historically many pain management procedures have not worked due to poor patient selection (do the procedure on everyone) by unscrupulous practitioners or unskilled performance (like blind epidurals and facets, etc).

i think we're getting better, all the time.

i think it is ok to practice chiropractics, as long as it is disclosed to patients that you are NOT physicians, do NOT practice medicine, and ARE an alternative therapy.

 

[facetguy]

true, some of the things we do in interventional pain do not work. however, all that is changing through deliberate effort and research. good pain fellowships are relatively a new phenomenon. historically many pain management procedures have not worked due to poor patient selection (do the procedure on everyone) by unscrupulous practitioners or unskilled performance (like blind epidurals and facets, etc).

i think we're getting better, all the time.

i think it is ok to practice chiropractics, as long as it is disclosed to patients that you are NOT physicians, do NOT practice medicine, and ARE an alternative therapy.

Patients have a good idea what chiropractors do. And they don't much care whether we are physicians or not (I've had plenty of patients come to see me despite having no idea, and not caring, what education or training I've had). Studies on patient satisfaction are very favorable for chiro. There's good data on effectiveness, cost effectiveness, and safety. And one could argue that if chiropractic care is as effective for neck and back pain as anything else out there, it's hardly alternative.

Don't worry yourself so much...life's too short.

 

[lonelobo]

I have no problem when Chiros do "actual manipulation", unfortunately more often often than not they end up doing all this other bull****
http://www.chirobase.org/06DD/techniquelist.html Just go to your local mall and visit the "free Chiropractic kiosk"
My experience with chiropracters has been in South, Midwest and Southwest, so I dont think these things are anomalies in any region of country

 

[Jeff05]

Patients have a good idea what chiropractors do. And they don't much care whether we are physicians or not (I've had plenty of patients come to see me despite having no idea, and not caring, what education or training I've had). Studies on patient satisfaction are very favorable for chiro. There's good data on effectiveness, cost effectiveness, and safety. And one could argue that if chiropractic care is as effective for neck and back pain as anything else out there, it's hardly alternative.

Don't worry yourself so much...life's too short.

you said it, patients come to see you despite having no idea what education you've had (or haven't had). many do think you are a medical doctor (as the billboards clearly, but falsely advertise).

as far as patient satisfaction, ok - but that's just because someone is finally paying attention to them, results notwithstanding. as far as cost effectiveness: most expensive placebo/1 day effect, ever.

look, at the end of the day, i don't really care that much. there have always been and will always be snake oil salesmen and people who subscribe to their remedies. "natural is best!" (yea, natural like cancer or maternal death). all I can do is practice the best science based medicine i know (because even though we don't have all the answers we are the ONLY ones that have a chance of figuring them out) and try to keep my patients out of harm's way.

 

[ampaphb]

Neck Mobility:
http://www.ncbi.nlm.nih.gov/pubmed/19119394

http://www.ncbi.nlm.nih.gov/pubmed/...nkpos=2&log$=relatedarticles&logdbfrom=pubmed

http://www.ncbi.nlm.nih.gov/pubmed/18758348

Gapping lumbar facet joints:
http://www.ncbi.nlm.nih.gov/pubmed/...nkpos=1&log$=relatedarticles&logdbfrom=pubmed


See any study reporting pain reduction following manipulation (there are many)

Improved head repositioning:
http://www.ncbi.nlm.nih.gov/pubmed/16461168

"increases cervical rotation" (http://www.ncbi.nlm.nih.gov/pubmed/19119394) is not equivalent to "normalize motion of the spinal motion segments."

"increasing active cervical range of motion" (http://www.ncbi.nlm.nih.gov/pubmed/1...gdbfrom=pubmed) is not equivalent to "normalize motion of the spinal motion segments."

"increased AROM" (http://www.ncbi.nlm.nih.gov/pubmed/18758348) is not equivalent to "normalize motion of the spinal motion segments."

increased separation (gapping) of the Z joints in normal subjects (http://www.ncbi.nlm.nih.gov/pubmed/1...gdbfrom=pubmed) is notequivalent to "normalize motion of the spinal motion segments" in those with pathologic joints

"restoration of normal afferentation, particularly mechanoreceptive information".
The study you cited to regarding disturbed kinesthetic sensitivity (http://www.ncbi.nlm.nih.gov/pubmed/16461168) concludes chiropractic care can be effective in influencing the complex process of proprioceptive sensibility and pain of nontraumatic cervical origin. However, Rix and Bagust (Arch Phys Med Rehabil. 2001 Jul;82(7):911-9) concluded that nontraumatic neck pain patients show little evidence of impaired cervicocephalic kinesthetic sensibility. Teng et al (Man Ther. 2007 Feb;12(1):22-8) found no association between mild chronic neck pain and cervicocephalic kinesthetic sensibility. There appears to be no consensus in the literature whether, in fact, there is an association between disturbed kinesthetic sensibility and neck pain.

 

[SSdoc33]

facetguy, we appreciate what you have to say. there is a "physicians-only" forum where interventional techniques and such can get washed out. this is precisely the forum to discuss what we are discussing.

jeff05 and sleepisgood are relatively early in their training, and for some reason, have an overblown sense of physician-entitlement. i think that they are are in for quite a shock when they hit the "real world" of medicine.

IMHO, chiropractic does have its place in certain conditions. however, it is difficult to find good ones. and by "good" i am referring to one who patients report they had good experiences, had decreased pain, and ones who didnt see patients for too many visits. i do believe that there is such thing as "good" and "bad" chiropractors.

 

[SleepIsGood]

Who cares if we're 'young' ?

No offense, but if you look at for example Anesthesia it was the 'old' guys that practically sold our profession our out.

So not really buying that young argument. Us younger grads do want to protect our specialty and the practice of MEDICINE from quacks like chiros that distort who/what they are. There's nothing wrong with that.

I think all too often too many physicians are just too passive and will let other midlevels and allied health people run all over them. The 'young' argument is a wash. No matter what, resident, fellow, or attending...they're all considered PHYSICIANS. There's no way a chiro or any other allied health person has the equivalent MEDICAL knowledge of a 4th year medical student. I've known guys that have gone into chiropractory after failing multiple classes in college, not getting into medical school, and doing it as a last resort. Apparently these guys went to the 'best' chiro school...yah, whatever that means

Again, I'm a patient advocate. Patients are the consumer. Our consumer needs to have transparency when it comes to who their caretaker is. This 'skewing' the line business of who can be called a physician/doctor is ridiculous. I think if Chiropractors want to practice chiropractory that's totally fine. But dont call yourself a chiropractic "PHYSICIAN".

Would any of you guys be fine with nurses calling themselves, Doctorate of Nursing PHYSICIANS? No. It's misleading. Protect the profession.

 

[Jeff05]

i am early in my career, but i think i have an appropriate sense of what i am entitled to as a physician. perhaps, if more physicians had that sense we would not be getting sodomized by everyone from hospital administrators to the ancillary staff and not getting called out by chiros.

i do understand that in PP it's about the bottom line, so once there (but, not just yet) i'll be sure to play nice.

 

[Jeff05]

i am early in my career, but i think i have an appropriate sense of what i am entitled to as a physician. perhaps, if more physicians had that sense we would not be getting sodomized by everyone from hospital administrators to the ancillary staff and not getting called out by chiros.

i do understand that in PP it's about the bottom line, so once there (but, not just yet) i'll be sure to play nice.

 

[ampaphb]

Field is called chiropractic, not chiropractory

They call themselves doctor, not physicians (in general)

DPTs, Nursing PhDs, Optometrists, and Naturopaths also use the title "Doctor"

My favorite Chiropractic excesses are those who call themselves Chiropractic Orthopedists (http://www.ccodc.org/) (http://www.dcorthoacademy.com/) and Chiropractic Radiologists (http://www.accr.org/)

 

[lobelsteve]

I am waiting for the chiropractic gynecologist for cervical manipulation.

 

[SleepIsGood]

I am waiting for the chiropractic gynecologist for cervical manipulation.

CMT

Cervical Motion Tenderness.

Remember that from med school? Without looking it up remember what that was for?

Betcha it was a 'manipulative' technique developed by a chiropractor

 

[Jcm800]

Field is called chiropractic, not chiropractory

They call themselves doctor, not physicians (in general)

DPTs, Nursing PhDs, Optometrists, and Naturopaths also use the title "Doctor"

My favorite Chiropractic excesses are those who call themselves Chiropractic Orthopedists (http://www.ccodc.org/) (http://www.dcorthoacademy.com/) and Chiropractic Radiologists (http://www.accr.org/)

just read a report of complete nonesense from some who is Dr XYZ DABCR (diplomate of the american board of chiropractic radiologists)
hmmmm...misleading...

 

[facetguy]

Who cares if we're 'young' ?

No offense, but if you look at for example Anesthesia it was the 'old' guys that practically sold our profession our out.

So not really buying that young argument. Us younger grads do want to protect our specialty and the practice of MEDICINE from quacks like chiros that distort who/what they are. There's nothing wrong with that.

I think all too often too many physicians are just too passive and will let other midlevels and allied health people run all over them. The 'young' argument is a wash. No matter what, resident, fellow, or attending...they're all considered PHYSICIANS. There's no way a chiro or any other allied health person has the equivalent MEDICAL knowledge of a 4th year medical student. I've known guys that have gone into chiropractory after failing multiple classes in college, not getting into medical school, and doing it as a last resort. Apparently these guys went to the 'best' chiro school...yah, whatever that means

Again, I'm a patient advocate. Patients are the consumer. Our consumer needs to have transparency when it comes to who their caretaker is. This 'skewing' the line business of who can be called a physician/doctor is ridiculous. I think if Chiropractors want to practice chiropractory that's totally fine. But dont call yourself a chiropractic "PHYSICIAN".

Would any of you guys be fine with nurses calling themselves, Doctorate of Nursing PHYSICIANS? No. It's misleading. Protect the profession.

It's not as though chiropractors are suddenly beginning to call themselves chiropractic physicians and as such are presenting some new threat to you. That title has been around a long time, much longer than you've been around.

 

[facetguy]

i am early in my career, but i think i have an appropriate sense of what i am entitled to as a physician. perhaps, if more physicians had that sense we would not be getting sodomized by everyone from hospital administrators to the ancillary staff and not getting called out by chiros.

i do understand that in PP it's about the bottom line, so once there (but, not just yet) i'll be sure to play nice.

I have no particular interest in perpetuating this thread. But I think you are being a bit defensive here. Called out by chiropractors?? What does that mean?

 

[facetguy]

I have no problem when Chiros do "actual manipulation", unfortunately more often often than not they end up doing all this other bull****
http://www.chirobase.org/06DD/techniquelist.html

I see your point. There is some goofy stuff out there, and I've never even heard of a number of the techniques on that list. But, for good or for bad, the chiropractic profession is not a completely homogeneous one, at least when it comes to treatment techniques. This presents a challenge for the profession when presenting ourselves to the public (or to legislators); in some cases we seem to speak with disparate voices. But, for patients, that there are many ways to go about treating a condition could be an advantage.

Just go to your local mall and visit the "free Chiropractic kiosk"
My experience with chiropracters has been in South, Midwest and Southwest, so I dont think these things are anomalies in any region of country

Believe me. This hurts me more than it does you.

 

[facetguy]

"increases cervical rotation" (http://www.ncbi.nlm.nih.gov/pubmed/19119394) is not equivalent to "normalize motion of the spinal motion segments."

"increasing active cervical range of motion" (http://www.ncbi.nlm.nih.gov/pubmed/1...gdbfrom=pubmed) is not equivalent to "normalize motion of the spinal motion segments."

"increased AROM" (http://www.ncbi.nlm.nih.gov/pubmed/18758348) is not equivalent to "normalize motion of the spinal motion segments."

increased separation (gapping) of the Z joints in normal subjects (http://www.ncbi.nlm.nih.gov/pubmed/1...gdbfrom=pubmed) is notequivalent to "normalize motion of the spinal motion segments" in those with pathologic joints

OK, OK. I should have said "improves motion of the spinal motion segments". Point taken.

"restoration of normal afferentation, particularly mechanoreceptive information".
The study you cited to regarding disturbed kinesthetic sensitivity (http://www.ncbi.nlm.nih.gov/pubmed/16461168) concludes chiropractic care can be effective in influencing the complex process of proprioceptive sensibility and pain of nontraumatic cervical origin. However, Rix and Bagust (Arch Phys Med Rehabil. 2001 Jul;82(7):911-9) concluded that nontraumatic neck pain patients show little evidence of impaired cervicocephalic kinesthetic sensibility. Teng et al (Man Ther. 2007 Feb;12(1):22-8) found no association between mild chronic neck pain and cervicocephalic kinesthetic sensibility. There appears to be no consensus in the literature whether, in fact, there is an association between disturbed kinesthetic sensibility and neck pain.

Good points. I think the literature is more clear for trauma (e.g., 'whiplash' injury). In truth, I grabbed that reference quickly as an example (this thread is fun and all, but we're all busy).

 

[Jeff05]

I have no particular interest in perpetuating this thread. But I think you are being a bit defensive here. Called out by chiropractors?? What does that mean?

here's the bottom line. for better or for worse i have an order of magnitude of education and real medical/research experience than you, my age aside. so forgive me if i don't really care about your opinions regarding your profession, or mine.

as far as your response to sleepisgood: it doesn't matter that chiropractic "physicians" have been around for a longer than him. just because something has been perpetuated doesn't mean it's right. you can be sure that OUR generation of physicians won't let things slide as much as previous generations - we've been pushed way too far.

 

[SleepIsGood]

as far as your response to sleepisgood: it doesn't matter that chiropractic "physicians" have been around for a longer than him. just because something has been perpetuated doesn't mean it's right. you can be sure that OUR generation of physicians won't let things slide as much as previous generations - we've been pushed way too far.

Now we just need some of us to get political and become Senators and Congressmen to enforce these things from a legislative point of view.

We've seen the damage via this new Health Care Reform Bill of having lawyers (present congressmen) slate our health care. Docs need to be in the process, as they were in the original congress (something like 25%).

 

[facetguy]

here's the bottom line. for better or for worse i have an order of magnitude of education and real medical/research experience than you, my age aside. so forgive me if i don't really care about your opinions regarding your profession, or mine.

Jeff, your non-answer above notwithstanding, I'm inclined to believe that what you meant by "getting called out by chiropractors" is that you expected me to bow down at your feet, shrivel up and go away. How dare I, a lowly chiropractor, actually engage in a discussion with someone of your heft and grandeur. I guess that's all part of the entitlement mindset someone mentioned earlier.

 

[Jeff05]

Jeff, your non-answer above notwithstanding, I'm inclined to believe that what you meant by "getting called out by chiropractors" is that you expected me to bow down at your feet, shrivel up and go away. How dare I, a lowly chiropractor, actually engage in a discussion with someone of your heft and grandeur. I guess that's all part of the entitlement mindset someone mentioned earlier.

you don't have to bow. i just don't consider chiros as having requisite education and experience to actually be able to intelligently discuss medical research (as you have proven by posting the garbage research on this thread) on the level of physicians.

as many midlevel providers (which you are not technically, i don't consider chiros legitimate providers of medicine; and as much as i hate to say it neither does the AMA) you don't know what you don't know and constantly overstep your threshold of knowledge and ability. this is a dangerous (and really annoying) practice.

this conversation is over, however, (after you have the last word, of course) as it is a completely useless endeavor.

 

[nleeds24]

I am waiting for the chiropractic gynecologist for cervical manipulation.

F***ING beautiful

 

[facetguy]

you don't have to bow. i just don't consider chiros as having requisite education and experience to actually be able to intelligently discuss medical research (as you have proven by posting the garbage research on this thread) on the level of physicians.

as many midlevel providers (which you are not technically, i don't consider chiros legitimate providers of medicine; and as much as i hate to say it neither does the AMA) you don't know what you don't know and constantly overstep your threshold of knowledge and ability. this is a dangerous (and really annoying) practice.

this conversation is over, however, (after you have the last word, of course) as it is a completely useless endeavor.

A dangerous practice? Show me the bodies.

One final question: Can you at least admit that chiropractors do help many patients?

 

[ampaphb]

One final question: Can you at least admit that chiropractors do help many patients?

Actually, let's have you answer that - can you document anything other than short term efficacy, and if so, postulate any longterm structural alteration your care yields? Can you document any parameters/guidelines your colleagues actually might follow in the real world to accomplish such ends?

I will grant that you seem like a thoughtful, reasonable guy, who seems to genuinely care about what you do and why you do it. My experience is, however, that you are FAR from typical, and that the average chiropractic provider is a business man, who gets referrals most of his or her from attorneys or through direct advertising, who cares far more about the bottom line than anything else, and is far more concerned about making nice to the patient than actually making them better. Chiropractors create an atmosphere in their offices, a safe zone, a happy place. Patients love that. Patients like going there. It's why, on the whole, they are willing to keep going back indefinitely. That being said, the sense of community you as a profession engender does not fix patients, nor resolve their issues. All of this is still encompassed as part of your service, as "chiropractic care" remains largely undefined. What I do know is, it ought not to be considered medical care, and ought not to be funded with our limited resources.

 

[facetguy]

Actually, let's have you answer that - can you document anything other than short term efficacy, and if so, postulate any longterm structural alteration your care yields? Can you document any parameters/guidelines your colleagues actually might follow in the real world to accomplish such ends?

I don't feel chiro care does much for structural alteration, save for the muscular hypertrophy effects of spine-targeted exercises. There are some small studies that suggest changes in disc morphology, but I wouldn't hang my hat on that. Instead, chiro treatment is much more function oriented.

As to short vs. longterm efficacy:
http://www.ncbi.nlm.nih.gov/pubmed/20053720 (SMT better longterm pain reduction and functional improvement than back school or PT).

This randomized trial looked at general exercise, stabilization exercise, and manipulation for chronic LBP: http://www.ncbi.nlm.nih.gov/pubmed/17250965 In short, they found all 3 had similar effects at 6 and 12 months, although manipuation and stabilization exercises were a bit better than general exercise at 8 wks. With exercise therapy being a commonly accepted intervention among traditional medicine, isn't it reasonable to also say that manipulation should also be seen in the same way?

Longterm effectiveness of manipulation: http://www.ncbi.nlm.nih.gov/pubmed/15726029 ; this is actually a >1 year follow-up of a randomized trial that compared medication, acupuncture and manipulation for chronic neck and back pain. From the authors: " In patients with chronic spinal pain syndromes, spinal manipulation, if not contraindicated, may be the only treatment modality of the assessed regimens that provides broad and significant long-term benefit."

Another longterm outcome study, this one compared manipulation to exercise: http://www.ncbi.nlm.nih.gov/pubmed/12642755
From the authors: " Improvements were found in both intervention groups, but manual therapy showed significantly greater improvement than exercise therapy in patients with chronic low back pain. The effects were reflected on all outcome measures, both on short and long-term follow-up."

Of course, in real practice, manipulation is usually combined with various exercises.


Over the years, there have been a number of guidelines published, particularly for low back pain. Recently, the American Pain Society and the American College of Physicians (not chiro-centric groups) published their findings as to non-pharma treatments of acute and chronic LBP: http://www.ncbi.nlm.nih.gov/pubmed/17909210
As I think I mentioned earlier, spinal manipulation (an obvious component of chiropractic care) was the only treatment recommended for both acute and chronic LBP (well, heat was recommended for chronic LBP too).

And from this same group of investigators: "RECOMMENDATION 7: For patients who do not improve with self-care options, clinicians should consider the addition of nonpharmacologic therapy with proven benefits-for acute low back pain, spinal manipulation; for chronic or subacute low back pain, intensive interdisciplinary rehabilitation, exercise therapy, acupuncture, massage therapy, spinal manipulation, yoga, cognitive-behavioral therapy, or progressive relaxation (weak recommendation, moderate-quality evidence)."

I will grant that you seem like a thoughtful, reasonable guy, who seems to genuinely care about what you do and why you do it. My experience is, however, that you are FAR from typical, and that the average chiropractic provider is a business man, who gets referrals most of his or her from attorneys or through direct advertising, who cares far more about the bottom line than anything else, and is far more concerned about making nice to the patient than actually making them better. Chiropractors create an atmosphere in their offices, a safe zone, a happy place. Patients love that. Patients like going there. It's why, on the whole, they are willing to keep going back indefinitely. That being said, the sense of community you as a profession engender does not fix patients, nor resolve their issues. All of this is still encompassed as part of your service, as "chiropractic care" remains largely undefined. What I do know is, it ought not to be considered medical care, and ought not to be funded with our limited resources.

Others have stated in this thread that they are trying to constantly learn and improve the pain profession. Chiropractic is no different. Education improves each year, research improves, and efforts are made to get better and better. You've got to admit that the chiro profession has advanced by leaps and bounds over the last few decades. Are there DCs that don't quite seek the same goal of improvement? Of course. But, as we said at the outset of our discussion, there are good and bad in all professions.

 

[facetguy]

What I do know is, it ought not to be considered medical care, and ought not to be funded with our limited resources.

Sorry, I missed this last part. Whether you call chiropractic care 'medical care' or not doesn't much matter, either to chiropractors or the public. As to funding, I don't think yours is a viable statement any longer. 20 or 30 years ago, prior to the availability of studies? Yes, an argument could have been made against funding. But now? I don't think so. Spinal manipulation has been shown to be superior to, or at least as effective as, whatever it's been compared to. Even if you say it's no better than anything else, how can you justify funding for a particular treatment that is equal to manipulation, be it medication, or exercise, or formal PT, or whatever, while at the same time recommend not funding spinal manipulation? Example: http://www.ncbi.nlm.nih.gov/pubmed/16540862

What happened to evidence-based practice?

 

[SSdoc33]

if SIJ injections, MBBs, RFs, epidurals, etc are not covered, I'll be damned if chiro is. it is disheartening to think that the chiro lobby may have more money to fight for their cause than ours....

 

[SleepIsGood]

Actually, let's have you answer that - can you document anything other than short term efficacy, and if so, postulate any longterm structural alteration your care yields? Can you document any parameters/guidelines your colleagues actually might follow in the real world to accomplish such ends?

I will grant that you seem like a thoughtful, reasonable guy, who seems to genuinely care about what you do and why you do it. My experience is, however, that you are FAR from typical, and that the average chiropractic provider is a business man, who gets referrals most of his or her from attorneys or through direct advertising, who cares far more about the bottom line than anything else, and is far more concerned about making nice to the patient than actually making them better. Chiropractors create an atmosphere in their offices, a safe zone, a happy place. Patients love that. Patients like going there. It's why, on the whole, they are willing to keep going back indefinitely. That being said, the sense of community you as a profession engender does not fix patients, nor resolve their issues. All of this is still encompassed as part of your service, as "chiropractic care" remains largely undefined. What I do know is, it ought not to be considered medical care, and ought not to be funded with our limited resources.

Precisely!

These reasons that ampa highlighted are why patients go seek "alternative' medical personnel. I think Chiropractors cater to these vulnerable patients that want to avoid typical American medicine. These patients are taken advantage of by the chiropractors because unfortunately these patients are scared of 'myths'...myths such as "my aunt's mom was paralyzed after an epidural, so i'd prefer to take pills or go see a chiro'.

(seriously i've heard that one)

Facet guy, you come on here, so you better have thick skin my friend. But AMPA said it how it is. Essentially, you guys are good businessmen, not physicians.

 

[facetguy]

Precisely!

These reasons that ampa highlighted are why patients go seek "alternative' medical personnel. I think Chiropractors cater to these vulnerable patients that want to avoid typical American medicine. These patients are taken advantage of by the chiropractors because unfortunately these patients are scared of 'myths'...myths such as "my aunt's mom was paralyzed after an epidural, so i'd prefer to take pills or go see a chiro'.

(seriously i've heard that one)

Facet guy, you come on here, so you better have thick skin my friend. But AMPA said it how it is. Essentially, you guys are good businessmen, not physicians.

I have indeed developed a thick skin, but I do find discussions like this more fun than anything else.

To your points. You are deluding yourself if you believe that chiropractic patients are some creatures that come crawling out of the swamp, or as you say, avoid typical American medicine. My patients are all (ok, mostly) regular people, including business owners, local politicians and social leaders, teachers, etc. I've treated lots of healthcare personnel. Dentists. Psychologists. PTs. Even MD/DOs of various disciplines (whispering: I even treated a pain management anesthesiologist a few weeks ago!). Thinking about it now, I'm pretty sure that ALL of my patients at least have a PCP. And, since in many cases patients have already been to various physicians before getting to my office, a lot of my cases are VERY well entrenched in typical American medicine. And my practice is no different than the typical chiropractic practice. Go ahead and keep telling yourself that DCs treat only the fringes of society if it makes you feel better, but it ain't reality.

And why is it that chiropractors are always "taking advantage" of their patients?

You've used an unfortunately timely example of 'myths'. A young woman in my local area WAS paralyzed by a cervical epidural 2 months ago. Of course, these are very rare occurrences; it's just interesting that you used that example.

I will grant that you seem like a thoughtful, reasonable guy, who seems to genuinely care about what you do and why you do it. My experience is, however, that you are FAR from typical, and that the average chiropractic provider is a business man, who gets referrals most of his or her from attorneys or through direct advertising,

It's true that, in general, chiros do have to do more advertising than MDs. But that is largely because we don't have a built-in network that funnels us patients like you guys have. I'd guess that you work almost exclusively on referrals, making advertising unnecessary...lucky you. While I do get referrals, and I don't do a whole lot of advertising, I do run a small ad in my local newspaper. But so do 2 dermatologists, a new PCP, the hospital and it's affiliated practices, podiatrists (I'm literally flipping through the local paper as I type), 2 radiology centers, an orthodontist, an OB/GYN group, a radiation oncology practice, an orthopedic group, and 2 PT centers. Apparently, advertising isn't just a chiropractic thing (by the way, my ad is way smaller than all those other ads).

... who cares far more about the bottom line than anything else, and is far more concerned about making nice to the patient than actually making them better.

I certainly try to be cordial and all in the office. But my patients are there to get better, not to chat. Times are economically tough all over, and copays aren't getting any lower for patients; they aren't interested in throwing their money away.

Chiropractors create an atmosphere in their offices, a safe zone, a happy place. Patients love that. Patients like going there. It's why, on the whole, they are willing to keep going back indefinitely. That being said, the sense of community you as a profession engender does not fix patients, nor resolve their issues. All of this is still encompassed as part of your service, as "chiropractic care" remains largely undefined. What I do know is, it ought not to be considered medical care, and ought not to be funded with our limited resources.

Since I like you, I'll give you a little inside information. Nothing keeps 'em coming back like big posters of bunnies snuggling with baby chicks, posted all over the office. Talk about creating a "happy place"! Or maybe it's the pictures of fairies with rainbows shooting out of their butts; "patients love that". For the male "community", I keep extra copies of the Sports Illustrated Swimsuit Issue around the waiting room. Or maybe it's the soothing voice of Deepak Chopra on that DVD loop I have playing throughout the office all day that makes them "willing to come back indefinitely".

Or maybe they seek my care because they derive some actual benefit. Why is that so difficult for you to say?

 

[SleepIsGood]

I have indeed developed a thick skin, but I do find discussions like this more fun than anything else.

To your points. You are deluding yourself if you believe that chiropractic patients are some creatures that come crawling out of the swamp, or as you say, avoid typical American medicine. My patients are all (ok, mostly) regular people, including business owners, local politicians and social leaders, teachers, etc. I've treated lots of healthcare personnel. Dentists. Psychologists. PTs. Even MD/DOs of various disciplines (whispering: I even treated a pain management anesthesiologist a few weeks ago!). Thinking about it now, I'm pretty sure that ALL of my patients at least have a PCP. And, since in many cases patients have already been to various physicians before getting to my office, a lot of my cases are VERY well entrenched in typical American medicine. And my practice is no different than the typical chiropractic practice. Go ahead and keep telling yourself that DCs treat only the fringes of society if it makes you feel better, but it ain't reality.

And why is it that chiropractors are always "taking advantage" of their patients?

You've used an unfortunately timely example of 'myths'. A young woman in my local area WAS paralyzed by a cervical epidural 2 months ago. Of course, these are very rare occurrences; it's just interesting that you used that example.



It's true that, in general, chiros do have to do more advertising than MDs. But that is largely because we don't have a built-in network that funnels us patients like you guys have. I'd guess that you work almost exclusively on referrals, making advertising unnecessary...lucky you. While I do get referrals, and I don't do a whole lot of advertising, I do run a small ad in my local newspaper. But so do 2 dermatologists, a new PCP, the hospital and it's affiliated practices, podiatrists (I'm literally flipping through the local paper as I type), 2 radiology centers, an orthodontist, an OB/GYN group, a radiation oncology practice, an orthopedic group, and 2 PT centers. Apparently, advertising isn't just a chiropractic thing (by the way, my ad is way smaller than all those other ads).



I certainly try to be cordial and all in the office. But my patients are there to get better, not to chat. Times are economically tough all over, and copays aren't getting any lower for patients; they aren't interested in throwing their money away.



Since I like you, I'll give you a little inside information. Nothing keeps 'em coming back like big posters of bunnies snuggling with baby chicks, posted all over the office. Talk about creating a "happy place"! Or maybe it's the pictures of fairies with rainbows shooting out of their butts; "patients love that". For the male "community", I keep extra copies of the Sports Illustrated Swimsuit Issue around the waiting room. Or maybe it's the soothing voice of Deepak Chopra on that DVD loop I have playing throughout the office all day that makes them "willing to come back indefinitely".

Or maybe they seek my care because they derive some actual benefit. Why is that so difficult for you to say?

Firstly, I dont believe in what you call "fringes of society".

I think there are vulnerable patients that Chiropractors cater to regardless of their social or educational level. There are a lot of 'alternative' med clinics and ads all over there place that tell you the 'natural' or 'non surgical way' is better.

For example, if a pt has a 'real' problem like a herniated disc. You can manipulate all you want, you arent going to make the disc disappear. Simply massaging doesnt make the herniated disc 'unherniate'. Sometimes interventions need to be done, that are somewhat invasive but not to the extent as surgery to 'mechanically' remove the infringement.

The other day I walked into a GNC. The lady behind the counter was telling me how the world is full of pollution and there's all this bad stuff in the air and water,etc. She's telling me how there's arsenic or xyz chemical in the soil. In the same conversation she's telling me how 'natural' herbal pills are the best thing for your body. I then went on to ask her what planet those 'natural herbal' pills came from that are soo good and safe for you to consume....because I know that the FDA doesnt regulate them.

These are the sort of distortions that herbal practitioners and people in your trade have brain washed people into thinking. Unfortunate.

 

[axm397]

For example, if a pt has a 'real' problem like a herniated disc. You can manipulate all you want, you arent going to make the disc disappear. Simply massaging doesnt make the herniated disc 'unherniate'. Sometimes interventions need to be done, that are somewhat invasive but not to the extent as surgery to 'mechanically' remove the infringement.

I actually don't inject most of my patients. A lot of them get better with just McKenzie based spine PT and proper education. For some I give a medrol dose pak. I probably inject about 1 in 6-7 patients I see in clinic. The rest I can get better with PT, short-term meds (nonopioid), things like heel lift (if there's a leg length discrepancy), ergonomic education, and teaching them what to avoid (flexion with rotation, etc.)

I am board certified in pain and know how to do procedures - and I do end up doing bread and butter injections along with a few stims, v-plasty, RFA, etc. but I try the non-invasive stuff first. The patients really like that because they have friends who went to pain docs who just did a series of 3 followed by facets followed by RFA followed by SIJ followed by SI RFA followed by unsuccessful stim trial. Most of them were also placed on long term high dose opioids. Then they ended up needing spine surgery anyway. I send about 1 patient a month to the spine surgeon out of all the patients I see because most of them don't need it.

I think of injections like any other "passive" modality. The relief is usually temporary. The pain will come back in most people. I will use it if the patient is in too much pain to tolerate PT. The only way to change pain is to change the cause which is anatomical. The only way to change anatomy is either surgery or PT (actually builds muscle, changes posture, etc.). It's amazing the difference a good competent and ethical PT can make.

When I was a fellow rotating through the VA, no one got better. Mostly because of the chronicity of the pain and the psychosocial issues but also because their PT sucked.

 

[SleepIsGood]

I actually don't inject most of my patients. A lot of them get better with just McKenzie based spine PT and proper education. For some I give a medrol dose pak. I probably inject about 1 in 6-7 patients I see in clinic. The rest I can get better with PT, short-term meds (nonopioid), things like heel lift (if there's a leg length discrepancy), ergonomic education, and teaching them what to avoid (flexion with rotation, etc.)

I am board certified in pain and know how to do procedures - and I do end up doing bread and butter injections along with a few stims, v-plasty, RFA, etc. but I try the non-invasive stuff first. The patients really like that because they have friends who went to pain docs who just did a series of 3 followed by facets followed by RFA followed by SIJ followed by SI RFA followed by unsuccessful stim trial. Most of them were also placed on long term high dose opioids. Then they ended up needing spine surgery anyway. I send about 1 patient a month to the spine surgeon out of all the patients I see because most of them don't need it.

I think of injections like any other "passive" modality. The relief is usually temporary. The pain will come back in most people. I will use it if the patient is in too much pain to tolerate PT. The only way to change pain is to change the cause which is anatomical. The only way to change anatomy is either surgery or PT (actually builds muscle, changes posture, etc.). It's amazing the difference a good competent and ethical PT can make.

When I was a fellow rotating through the VA, no one got better. Mostly because of the chronicity of the pain and the psychosocial issues but also because their PT sucked.

No doubt. I'm not by any means stating non interventional techniques need to be exhausted first. But I believe these should be spear headed by a physician...that's the difference.

 

[axm397]

No doubt. I'm not by any means stating non interventional techniques need to be exhausted first. But I believe these should be spear headed by a physician...that's the difference.

yes - I do agree with that. I have diagnosed cancer, OPLL, syrinx, compression fractures, etc. in patients who looked like they just had a simple "disc herniation" or "back pain".

 

[facetguy]

Firstly, I dont believe in what you call "fringes of society".

I think there are vulnerable patients that Chiropractors cater to regardless of their social or educational level. There are a lot of 'alternative' med clinics and ads all over there place that tell you the 'natural' or 'non surgical way' is better.

For example, if a pt has a 'real' problem like a herniated disc. You can manipulate all you want, you arent going to make the disc disappear. Simply massaging doesnt make the herniated disc 'unherniate'. Sometimes interventions need to be done, that are somewhat invasive but not to the extent as surgery to 'mechanically' remove the infringement.

The other day I walked into a GNC. The lady behind the counter was telling me how the world is full of pollution and there's all this bad stuff in the air and water,etc. She's telling me how there's arsenic or xyz chemical in the soil. In the same conversation she's telling me how 'natural' herbal pills are the best thing for your body. I then went on to ask her what planet those 'natural herbal' pills came from that are soo good and safe for you to consume....because I know that the FDA doesnt regulate them.

These are the sort of distortions that herbal practitioners and people in your trade have brain washed people into thinking. Unfortunate.

I think you've got me wrong (again). I am not anti-medicine or anti-surgery. I refer patients for both. And it's a small and shrinking percentage of DCs that take an anti-medical attitude (they take that attitude until they need medical care themselves, that is). So all this stuff about herbs and 'natural' and 'non-surgical' is off base.

Regarding the 'unherniation' of discs, perhaps it's lack of experience on your part (someone said you were early on in your training), but that isn't the goal of conservative treatment. You (should) know that the morphological appearance of a disc on MRI doesn't necessarily correlate with the clinical presentation. We can usually take the same patient, both when they are symptomatic and after their symptoms abate, compare MRIs from each of those stages and not see a whole lot of difference. So early conservative treatment is more about reducing myospasm, pain, and mechanical dysfunction (and all the related chemical/inflammatory soup). This is true for primary medical care, chiro, PT, or anyone else in the conservative realm. Sure, sometimes surgery is necessary, and trying the least extensive surgical means possible when it is. Sometimes injections are necessary too, as I'm sure you'd agree.

We aren't trying to 'unherniate' discs, per se. And since when do epidurals make herniated discs "disappear"? Yet they are done all the time.

 

[SleepIsGood]

I think you've got me wrong (again). I am not anti-medicine or anti-surgery. I refer patients for both. And it's a small and shrinking percentage of DCs that take an anti-medical attitude (they take that attitude until they need medical care themselves, that is). So all this stuff about herbs and 'natural' and 'non-surgical' is off base.

Regarding the 'unherniation' of discs, perhaps it's lack of experience on your part (someone said you were early on in your training), but that isn't the goal of conservative treatment. You (should) know that the morphological appearance of a disc on MRI doesn't necessarily correlate with the clinical presentation. We can usually take the same patient, both when they are symptomatic and after their symptoms abate, compare MRIs from each of those stages and not see a whole lot of difference. So early conservative treatment is more about reducing myospasm, pain, and mechanical dysfunction (and all the related chemical/inflammatory soup). This is true for primary medical care, chiro, PT, or anyone else in the conservative realm. Sure, sometimes surgery is necessary, and trying the least extensive surgical means possible when it is. Sometimes injections are necessary too, as I'm sure you'd agree.

We aren't trying to 'unherniate' discs, per se. And since when do epidurals make herniated discs "disappear"? Yet they are done all the time.

Dont even try the 'young' guy training on me bud. No offense, but your knowledge of anatomy/physiology is likely an inkling compared to even an intern's from a US medical school. Not a pissing contest, just the facts.

Secondly, let's see..epidurals help with the inflammatory process associated with herniated discs. How again does your massaging or manipulaton do that again? You'll likely say something that give a massage say. "it increases blood flow and lymph flow and take the toxins away'.

And since your name is facet..what does your manipulation do for facet arthropathy? How are you blocking pain that originates there?

Yah, I'll light a candle and sing Kumbaya and wait for your responses.

 

[facetguy]

No doubt. I'm not by any means stating non interventional techniques need to be exhausted first. But I believe these should be spear headed by a physician...that's the difference.

I think it's clear what you are saying is 'anyone but a chiropractor, no matter what'.

 

[facetguy]

I actually don't inject most of my patients. A lot of them get better with just McKenzie based spine PT and proper education. For some I give a medrol dose pak. I probably inject about 1 in 6-7 patients I see in clinic. The rest I can get better with PT, short-term meds (nonopioid), things like heel lift (if there's a leg length discrepancy), ergonomic education, and teaching them what to avoid (flexion with rotation, etc.)

I am board certified in pain and know how to do procedures - and I do end up doing bread and butter injections along with a few stims, v-plasty, RFA, etc. but I try the non-invasive stuff first. The patients really like that because they have friends who went to pain docs who just did a series of 3 followed by facets followed by RFA followed by SIJ followed by SI RFA followed by unsuccessful stim trial. Most of them were also placed on long term high dose opioids. Then they ended up needing spine surgery anyway. I send about 1 patient a month to the spine surgeon out of all the patients I see because most of them don't need it.

I think of injections like any other "passive" modality. The relief is usually temporary. The pain will come back in most people. I will use it if the patient is in too much pain to tolerate PT. The only way to change pain is to change the cause which is anatomical. The only way to change anatomy is either surgery or PT (actually builds muscle, changes posture, etc.). It's amazing the difference a good competent and ethical PT can make.

When I was a fellow rotating through the VA, no one got better. Mostly because of the chronicity of the pain and the psychosocial issues but also because their PT sucked.

Good post. As a chiropractor, I agree with everything you've said, ie. chiros operate with the same mindset. The only difference I might have would be the only way to change pain part. I think many patients, those coming to see me anyway, are more in the 'functional problem' category, as opposed to just anatomical. I think if we can change someone's function, we can reduce their pain. I agree with you that muscle building is important, and that would be anatomical. But there's also the aspect of muscle firing patterns and enhancing stabilization that way, more in a neurophys way, along with looking for other biomechanical/functional faults. Postural improvements, body mechanics, etc are important components to functional enhancement. These are among the things I try to work with my patients on.

 

[TX PAIN DOC]

In Texas, chiros were stopped from performing EMGs and manipulation under anesthesia (MUA) since this was defined as being beyond their scope of practice.

http://txmed.net/Template.aspx?id=8211


The practice of medicine is a physicians realm earned by years of study and training. We do not want to question what you study and do except when there is a claim that what you do is equal to a physician. Chiropractors serve a function if patients get better, but it is not medicine. Yet the chiropractic board in Texas is fighting the ruling.

 

[Pain Applicant]

It's funny that some of the same arguments people are hurling at facetguy are similar to what some of the surgeons I work with say about us interventional pain guys.

Nothing wrong with having a good debate, but people shouldn't try to insult someone's livelihood.

 

[Ligament]

It's funny that some of the same arguments people are hurling at facetguy are similar to what some of the surgeons I work with say about us interventional pain guys.

Nothing wrong with having a good debate, but people shouldn't try to insult someone's livelihood.

Agreed. Guys keep it civil. Nobody has all the answers.

 

[facetguy]

Dont even try the 'young' guy training on me bud. No offense, but your knowledge of anatomy/physiology is likely an inkling compared to even an intern's from a US medical school. Not a pissing contest, just the facts.

Secondly, let's see..epidurals help with the inflammatory process associated with herniated discs. How again does your massaging or manipulaton do that again? You'll likely say something that give a massage say. "it increases blood flow and lymph flow and take the toxins away'.

And since your name is facet..what does your manipulation do for facet arthropathy? How are you blocking pain that originates there?

Yah, I'll light a candle and sing Kumbaya and wait for your responses.

You suggested that if manipulation can't 'unherniate' a disc then it is of no value to these patients. So I reminded you that epidural injections don't 'unherniate' discs either, not to put down the usefulness of epidurals but to point out that your comments aren't always well thought out. Beyond that, you implied that 'unherniating' discs is the goal of conservative treatment, and to me that sounded like something coming from someone who hasn't been around for very long. That's all I meant by the experience comment.