Chiropractic medicine.

[Blue Wode]

From today’s CBS news, ‘Risk of chiropractic treatment’:

Britt Harwe hasn't eaten a meal in 15 years. She survives on nutritional drinks poured directly into her stomach through a feeding tube.

"If I try to swallow, it goes into my lungs, I aspirate," said Britt.

She says it's the result of suffering a stroke during a visit to her chiropractor.

"I slumped over to the left and he helped me straighten out and I couldn't really focus. I couldn't talk," said Britt. The chiropractor had just finished adjusting her neck.

More…
http://cbs3.com:80/health/Risk.of.Chiropractic.2.661491.html

(Don’t forget to watch the accompanying 2-minute video)

Note that at the end of the article the following study is cited in support of there being “no link between chiropractic treatment and stroke”:

Risk of Vertebrobasilar Stroke and Chiropractic Care: Results of a Population-Based Case-Control and Case-Crossover Study
http://spinejournal.com/pt/re/spine...ovft&results=1&count=10&searchid=1&nav=search

However, according to this letter from Sharon Mathiason, a mother whose daughter died following chiropractic neck manipulation, it appears that the study’s lead author, David Cassidy (DC), was discredited as a researcher some time ago:

This new "study" itself is a review of billing records. No patient charts or tests were examined. There was no new scientific data. The authors took 819 strokes and then used billing records to see who had seen a doctor in the past year and who had seen a chiropractor. Considering that billing payments were very limited for chiropractors in Ontario and now thank God have been completely eliminated, this is a very poor record of the actual number of visits to a chiropractor. Did the scientists not realize this simple statistical fact?

Of course, the strokes caused by the chiropractors happened in their offices while none happened in the office of the doctors. Where did they tell us that? According to the logic of this study, if my daughter Laurie or anyone else saw your medical doctor in January and then had a stroke in December after having a neck manipulation, it did not count against the chiropractor. Almost everyone has seen their doctor within a year. You would get the same result if she had stopped at McDonald’s to buy a hamburger and then went to the chiropractor.

The Globe and Mail [a newspaper in which the study was recently featured] is also negligent in not identifying the principal author, David Cassidy, as a chiropractor, one who has been sued in Saskatchewan, in 1999, by his research assistant for falsifying data, and one whose work is stated in the New England Journal of Medicine as "all of the study’s authors conclusions are completely invalidated by their methods".

David Cassidy, before he was dismissed from the University of Saskatchewan,was called as an "expert" witness by the Chiropractic Association of Saskatchewan (CAS) at my daughter’s inquest.

In the Globe and Mail article co-author David Cassidy is quoted "Has it ever happened that a chiropractor has caused a stroke? I can’t say it’s never happened. But if it’s happening, it’s not happening at a greater risk than when it is at a GP office". Well guess what, chiropractor David Cassidy admitted on the stand into the death of my daughter they he had manipulated the neck of a woman and caused a stroke, a very severe one called Wallenberg’s syndrome. Did he say it never happened because this poor woman also saw her doctor in the past year? I doubt if he has ever seen a patient coming out of a doctor's office having a stroke after a neck manipulation.

More…
http://www.chirowatch.com/Chiro-strokes/gm080120stroke.html

(Scroll down the link a little to locate the letter)

For those interested, a new critical evaluation of chiropractic by Professor Edzard Ernst has just been published in the Journal of Pain and Symptom Management. Here’s part of the abstract:

Chiropractic is rooted in mystical concepts. This led to an internal conflict within the chiropractic profession, which continues today.

-snip-

With the possible exception of back pain, chiropractic spinal manipulation has not been shown to be effective for any medical condition.

Manipulation is associated with frequent mild adverse effects and with serious complications of unknown incidence.

Its cost-effectiveness has not been demonstrated beyond reasonable doubt.

The concepts of chiropractic are not based on solid science and its therapeutic value has not been demonstrated beyond reasonable doubt.

More…
http://www.ncbi.nlm.nih.gov/pubmed/...ez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum

 

[arthwollipot]

One more for the "What's the harm" site?

 

[Blue Wode]

One more for the "What's the harm" site?

Good idea. I'll let them know about this thread, not least because the Victims of Chiropractic Abuse (VOCA) campaign seems to be growing:

This "Chiropractors Accused" Fox News segment (approx. 10 minutes) http://www.myfoxdc.com/myfox/MyFox/pages/sidebar_video.jsp?contentId=5888684&version=1&locale=EN-US
is related to VOCA's latest press release below.

The three television reports follow a recent opinion column in the Hartford Courant (February 15, 2008, No Sense Resisting Database) that called for the chiropractic industry to drop its defensive posture and support legislative proposals by Victims of Chiropractic Abuse (VOCA) to help patients learn more about the risks of chiropractic treatment through Informed Consent laws.

The Fox 25 story can be viewed online by going to:
http://www.myfoxboston.com/myfox/pa...n=1&locale=EN-US&layoutCode=VSTY&pageId=1.1.1

The CBS 3 story can be viewed online by going to:
http://cbs3.com/health/Risk.of.Chiropractic.2.661491.html

The WBZ News story can be viewed online by going to: http://wbztv.com/specialreports/chiropractor.and.strokes.2.659998.html


More…
http://www.prweb.com/releases/2008/2/prweb722453.htm

Just to underscore VOCA's concerns, here’s a recent study which looked at chiropractic consent procedures…

Consent: its practices and implications in United Kingdom and United States chiropractic practice

OBJECTIVE: This study explores the implementation of consent procedures in a sample of chiropractors in the United Kingdom (UK) and the United States (US) and how well they satisfy the core ethical principles of autonomy, veracity, justice, nonmaleficence, and beneficence.

Journal of manipulative and physiological therapeutics, 2007 Jul-Aug;30(6):419-31.
http://www.ncbi.nlm.nih.gov/sites/e...ez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum

…and here's its conclusions:

Results from this survey suggest a patient's autonomy and right to self-determination may be compromised when seeking chiropractic care. Difficulties and omissions in the implementation of valid consent processes appear common, particularly in relation to risk. Practitioners felt that a serious adverse event occurred so infrequently that this, coupled with a lack of convincing evidence regarding the risk associated with certain treatment, rendered the routine discussion of major risk unnecessary.

Go VOCA.

 

[kev]

When it comes to chiropractic, I have mixed feelings. In no way do I believe any claim about chiropractic being useful for "curing" illness or disease. When they talk about "energy" or "pathways", the warning bells chime. And, I don't contest the fact that scientific study does not adequately support chiropractic.

However, I also have personexperience that leads me to believe that there is at least limited value to chiropractic. Once, or perhaps twice per year, I will be lifting something that I should have known better than attempting. Usually I lift something heavy, try to turn while I am doing it, and essentially feel as though someone shoved an icepick into my lower back and hip area.

LITERALLY, I am completely laid out on the floor. It has been so bad that I have been immobile - only able to lie flat on my back, needing to crawl or roll to the bathroom. When this occurs, my wife puts me in the back seat of the car and drives me to the chiropractor. He cracks/twists my lower spine and I LITERALLY walk out the door. Generally I am still sore for a few days, and may need to go one or two more times. But, in a matter of minutes, I am transformed from agony to relatively normal.

I have tried doctors etc. in these instances, and have always been give some sort of heavy dose of ibuprofin or equivalent and told to, essentially, rest until it gets better.

I know it is only anectdotal, and my personal experience, but for acute back problems due to twisting/lifting/exertion - chiropractic has given me instant improvement, and traditional medicine has not. These are not situations where I feel "kinda bad" and then feel "a little better." This is "I can't move" to "I am almost fine."

Are there any studies that suggest any relevance to using spinal adjustment in these situations of acute injury vs. the more chronic/ keep coming back forever/keep the 'energy" flowing chiropractic that seems very flawed?

 

[JJM]

{snip} Are there any studies that suggest any relevance to using spinal adjustment in these situations of acute injury vs. the more chronic/ keep coming back forever/keep the 'energy" flowing chiropractic that seems very flawed?

Kev, you can poke around http://www.chirobase.org/ a bit. It is a subsidiary of www.quackwatch.org which is the best single source of info about quackery on the Net. I believe there is an article on "What a rational chiro can do for you."

In short, what you describe sounds reasonable; however, real health-care professionals (PTs, osteopaths, physiatrists) can do it, too. You can rest assured that there is nothing chiros know (that is true) that health professionals do not know.

What separates chiros from masseurs is that chiros spend a lot of time learning about nonexistent subluxations (and a life-force they call innate intelligence).

If your curiosity is not satisfied by chirobase, you can contact the author(s) there; or try, here, again. Good luck.

 

[zeusbheld]

i'm not worried about a proper diagnosis for my upper back problems, as i've been to MDs and chiros of all stripes and the x-rays are pretty obvious and they all seem to agree. second opinion? i've gotten about six, and that's just the MDs.

i was born with a twisted spine which leads to muscle spasms between my shoulders and neck problems. i've been to some damn good physios and good and bad chiros--really though i've found that "popping" the spine into place is a good short-term solution for a spine-induced muscle spasm, and have had poor results from all physios (including some of new york's reputed best).

that said, suxluxation theory is all fecal matter dropped from male bovines as far as i can tell.

my chiro here in bangkok is essentially a physiotherapist, he does all the local jocks and doesn't spout BS theory about colds and stuff. he works on getting my spine back to mobility, and has a team of phsyios doing deep-tissue massage (you can do that cheaply here in bangers) and pops my spine where it's out of whack and that's all, in as few visits as possible. usually 2 or 3. 6 to 12 months between incidents, probably far fewer if i got off my lazy buttocks and exercised. never once has he mentioned all that suxluxation crap. i've never asked though as my heart might break once he started talking that.

the moral of the story is: even if they're wrong, sometimes they can be useful.

 

[JJM]

{snip} the moral of the story is: even if they're wrong, sometimes they can be useful.

I appreciate you reinforcing my point. As I said, I think there is an article at chirobase that explains what a rational chiro can do for you. Samuel Homola, DC, runs that site; I know he has such a chapter in his book Inside Chiropractic. I should also point out that approximately 5% of chiros recognize the fictional aspects of their education, and eschew them.

 

[Blue Wode]

Here are Samuel Homola’s guides to good chiropractic practice:

What a Rational Chiropractor Can Do for You
http://www.chirobase.org/07Strategy/goodchiro.html

Finding A Good Chiropractor
http://archfami.ama-assn.org/cgi/content/full/7/1/20

This also from Samuel Homola:

As I warned in Bonesetting, Chiropractic and Cultism, if chiropractic fails to specialize in an appropriate manner, there may be no justification for the existence of chiropractic when there an adequate number of physical therapists providing manipulative therapy. Many physical therapists are now using manipulation/mobilization techniques. Of the 209 physical therapy programs in the US, 111 now offer Doctor of Physical Therapy degrees (DPT). Some of these programs have been opened to qualified chiropractors. According to the American Physical Therapy Association,

“…Physical therapy, by 2020, will be provided by physical therapists who are doctors of physical therapy and who may be board-certified specialists. Consumers will have direct access to physical therapists in all environments for patient/client management, prevention, and wellness services. Physical therapists will be practitioners of choice in patients’/clients’ health networks and will hold all privileges of autonomous practice…”​

More…
http://jmmtonline.com/documents/HomolaV14N2E.pdf

This is good too (although it's not by Samuel Homola):

Appropriate chiropractic practice

Choosing a chiropractor can be difficult because, according to several large surveys many chiropractors are involved in unscientific practices . If you decide to consult one, start with a telephone interview in which you explore the chiropractor's attitudes and practice methods.

Good signs

• Practice limited to conservative treatment of back pain and other musculoskeletal problems.
• Recommendation from your medical doctor.
• Membership in the National Association for Chiropractic Medicine or the Canadian Academy of Manipulative Therapists (CAMT); however, the number of chiropractors who belong to these groups is small. CAMT's "orthopractic guidelines" describe a science-based approach to manipulative therapy.
• In addition to manual manipulation or stretching of tight muscles or joints, science-based chiropractors commonly use heat or ice packs, ultrasound treatment (not diagnosis), and other modalities similar to those of physical therapists. They may also recommend a home exercise program.
• For most conditions that chiropractic care can help, significant improvement should occur within a few visits.

Avoid Chiropractors

• advertising about "danger signals indicating the need for chiropractic care
• making claims about curing diseases
• trying to get patients to sign contracts for lengthy treatment, promote regular "preventive" adjustments
• using scare tactics
• disparaging scientific medical treatment or preventive measures such as immunization or fluoridation
• who claim to diagnose or treat "subluxations," or who have literature promoting "nerve interference" as an underlying cause of disease
• who suggest that chiropractic might help nearly every type of health problem
• routinely performing or ordering x-ray examinations of all patients, particularly full spine X rays.
• Avoid chiropractors who "prescribe" dietary supplements, homeopathic products, or herbal products for the treatment of disease or who sell any of these products in their offices. For dietary advice, the best sources are physicians and registered dietitians.
• who offer any of the listed "Useless (for the patient) gadgets and tests". In addition other dubious tests and/ or procedures include:

o body fat analysis
o computerized "nutrient deficiency" testing
o computerized range-of-motion analysis
o cytotoxic testing, electrodermal testing
o Functional Intracellular Analysis (FIA)
o herbal crystallization analysis
o blood cell analysis (also called nutritional blood analysis or Hemaview)
o testing with a Nervo-Scope
o Nutrabalance, NUTRI-SPEC
o pendulum divination
o reflexology
o saliva testing

This list is by no means inclusive. The viewer is directed to quackwatch for a comprehensive review of dubious chiropractic (and medical) devices and procedures.

More…
http://your-doctor.com/patient_info/alternative_remedies/various_therapy/chiropractic.html#11

It’s worth remembering that currently around 90% of chiropractors in the USA think that spinal manipulation should not be limited to musculoskeletal conditions and all four chiropractic organisations in the UK - and their regulators - continue to believe in chiropractic ‘subluxations’.

 

[arthwollipot]

However, I also have personexperience that leads me to believe that there is at least limited value to chiropractic.

I agree. I have also found that chiropractic is useful in a limited domain of neck and back problems that I have had.

 

[humber]

...
LITERALLY, I am completely laid out on the floor. It has been so bad that I have been immobile - only able to lie flat on my back, needing to crawl or roll to the bathroom. When this occurs, my wife puts me in the back seat of the car and drives me to the chiropractor. He cracks/twists my lower spine and I LITERALLY walk out the door. Generally I am still sore for a few days, and may need to go one or two more times. But, in a matter of minutes, I am transformed from agony to relatively normal.

I have tried doctors etc. in these instances, and have always been give some sort of heavy dose of ibuprofin or equivalent and told to, essentially, rest until it gets better.

It is always difficult to deny personal experience such as this. Perhaps the manipulation has an analgesic effect, reducing the pain.
A friend of mine has a similar problem, and uses a chiropractor. He is never cured, but returns at regular intervals, giving each visit a glowing report.

I too had a lower back spasm, did the recommended exercises to strengthen the muscles so the damage could be healed before I "pulled" it a gain. It has long gone.

 

[zeusbheld]

It is always difficult to deny personal experience such as this. Perhaps the manipulation has an analgesic effect, reducing the pain.

i think its' simpler than that, in many cases. when i have upper back or neck pain, my spine actually is out of whack (one can feel it to the touch). the spasming muscles are working to hold the ship together, but when the spine goes back home they relax within a day. in my case i don't think it's a nerve thing at all, but rather, musculoskeletal.

I too had a lower back spasm, did the recommended exercises to strengthen the muscles so the damage could be healed before I "pulled" it a gain. It has long gone.

that is a very important point. doing relevant stretching and strengthening exercises is FAR more important in the long run. chiro is a short-term solution, and most good ones i've been to (same as most physios) advise you to get relevant exercise.

 

[JoeEllison]

It is always difficult to deny personal experience such as this. Perhaps the manipulation has an analgesic effect, reducing the pain.
A friend of mine has a similar problem, and uses a chiropractor. He is never cured, but returns at regular intervals, giving each visit a glowing report.

I too had a lower back spasm, did the recommended exercises to strengthen the muscles so the damage could be healed before I "pulled" it a gain. It has long gone.

That's the thing, isn't it? Reality-based treatment will include a recommendation to stretch and strengthen the muscles in your back, unless there is an underlying injury that requires more serious treatment. Chiropractic nonsense will insist on "treating" the problem with woo-tainted back rubs that require repeat visits.

 

[Blue Wode]

Reality-based treatment will include a recommendation to stretch and strengthen the muscles in your back, unless there is an underlying injury that requires more serious treatment. Chiropractic nonsense will insist on "treating" the problem with woo-tainted back rubs that require repeat visits.

Exactly.

Those endless repeat visits which are recommended by many chiropractors usually amount to little more than the financial exploitation of their patients.

If chiropractors didn’t (deliberately) create patient dependency, their ability to earn a good living would rapidly diminish. That’s why the vast majority of them treat infants and young children despite there seldom being any medical reason for them to do so, and despite the non-existence of chiropractic paediatric safety data. This exploitation also extends to their pushing of bogus concepts like “family wellness care” where whole (usually asymptomatic) families are encouraged to adopt the ‘chiropractic lifestyle’.

For those who’d like to learn more, John Jackson of UK Skeptics captured the all the problems with chiropractic in this excellent article:

http://www.skeptics.org.uk/article.php?dir=articles&article=chiropractic.php

This is its conclusion:

Chiropractic is a pseudoscientific approach to health care. The thinking behind it has no basis in fact, and even after more than a century, its core belief, the subluxation, cannot be shown to exist; even though it is a scientifically testable theory.

Some of the beliefs, such as the anti-vaccination stance, actually go against scientific evidence, medical opinion and government policy. Opposing germ theory exposes the 19th century thinking that Chiropractic is based upon.

Chiropractic is not one technique that can treat one class of illness or disease. It is promoted as a panacea and an all-encompassing preventative measure to be used from the moment we are born onwards.

A healing system that is based on a mystical life-force that gets blocked by imaginary subluxations, and that relies on anecdotal evidence; special pleading; the placebo effect; and subjective diagnoses is clearly an irrational concept: no matter how much credence is given to it with qualifications and self-regulation.

 

[JJM]

I agree. I have also found that chiropractic is useful in a limited domain of neck and back problems that I have had.

If you let a chiro work on your neck, there is the possibility of complications that will leave you seriously dead. There is nothing they can do there that cannot be done more safely. The information is at chirobase, the problem is a stroke caused by snapping your neck.

 

[JJM]

i think its' simpler than that, in many cases. when i have upper back or neck pain, my spine actually is out of whack (one can feel it to the touch). the spasming muscles are working to hold the ship together, but when the spine goes back home they relax within a day. in my case i don't think it's a nerve thing at all, but rather, musculoskeletal. {snip}

A chiro cannot actually change the configuration of your spine. The experiments showing that were done by an anatomy professor named Crelin- the paper is available at chirobase.

 

[zeusbheld]

A chiro cannot actually change the configuration of your spine. The experiments showing that were done by an anatomy professor named Crelin- the paper is available at chirobase.

not what i'm saying. let me clarify: what i am saying is that i have a bit of a twist in my spine. the diagnosis by (good) chiropractors i've been to and (good) physicians i've been to has been IDENTICAL, at least in terms of how they explained it to me. chiro doesn't "fix" this problem, nor can an MD. it's just there. i'm stuck with it.

however, i have found that producing a certain kind of "pop" (movement, not sound. the sound is cool but easier had by cracking knuckles) between my shoulder blades a) relaxes the muscle very quickly (a day or two to normal) and b) i can feel by running my hand on the little bumps in my back (my spine) that that particular vertebra isn't in an odd position, the little lump is no longer off to the side.

i am not saying my spine configuration is "changed" AT ALL perhaps i wasn't clear on that. just that when things are out of whack, the adjustment performed by a chiropractor has been 100 percent effective every time in giving me relief from back pain and muscle spasms. i haven't gone that often, but the problem has existed for over 15 years and was initially diagnosed by an MD.

if i were to speculate as to what the exact mechanism is for that particular adjustment, i would say the pressure applied to the muscle on either side allows the vertebra to return to its slightly less torqued position, and once there, it stays, and the muscle stops trying to hold it in place and the spasm ends. but that's speculation on my part.

i have also said consistently from my first post that problems like that need to be addressed long-term through sensible exercise, and that such an 'adjustment' is a short term solution.

 

[zeusbheld]

That's the thing, isn't it? Reality-based treatment will include a recommendation to stretch and strengthen the muscles in your back, unless there is an underlying injury that requires more serious treatment.

EXACTLY.

Chiropractic nonsense will insist on "treating" the problem with woo-tainted back rubs that require repeat visits.

*if* no claims other than the obvious musculoskeletal ones any physio might make are made, then i fail to see how a back rub is tactitly "woo-tainted" solely by virtue of taking place in a chiropractor's office. in fact, having been to MDs, physios and chiros for the same problem, i can say with some conviction (still just opinion, obviously) that a good back rub is a good back rub, regardless of whether you get it in an MD's office or a chiro's office. (and yeah for my problem that's on average what MDs do, too. usually they have a massage person or physio or two on staff.)

and in my experience, one needs short-term relief before embarking on an exercise program. (if you've ever tried to exercise with a back spasm, you know what i'm talking about. even NBA ballers sit out when they get 'em.)

however, back rubs are not the problem with chiro, are they? the problem is that suxluxations are allegedly responsible for everything from allergies to myopia to discolored voodoo auras.

not insignificantly, when going to an MD for back problems, one also needs to choose the practitioner VERY carefully. not only are there plenty of mediocre doctors and physios, but many of THEM are interested in nothing quite so much as you using their services until your insurance runs out and your bank account is dry. also MDs in my experience tend to over-prescribe medications, especially pain killers. (i find that muscle relaxers help significantly, but pain killers dont' make my back stop hurting any faster, just make it easier on me while i wait for the spasms to subside).

my personal bottom line is i'm not interested in any chiro selling anything but a finite program of short-term relief, and anywhere i'd go had better be physio-oriented and not make any voodoo-claims. voodoo claims are pretty easy to spot. once that hurdle is cleared, i look for a place where professional and high-level amateur athletes go. yeah, they get sucked in by voodoo too (who can forget Patrick Ewing with friggin' magnets on his knees) but in my experience once the voodoo hurdle's cleared athletes tend to flock to the best physios.

 

[zeusbheld]

[endorsement]chirobase is great btw. everyone with back problems should read it.

my favorite article i've read there so far is "Placebos, Nocebos, and Chiropractic Adjustment." [/endorsement]

 

[Blue Wode]

That's the thing, isn't it? Reality-based treatment will include a recommendation to stretch and strengthen the muscles in your back, unless there is an underlying injury that requires more serious treatment. Chiropractic nonsense will insist on "treating" the problem with woo-tainted back rubs that require repeat visits.

[My bold]

*if* no claims other than the obvious musculoskeletal ones any physio might make are made, then i fail to see how a back rub is tactitly "woo-tainted" solely by virtue of taking place in a chiropractor's office.

-snip-

...back rubs are not the problem with chiro, are they? the problem is that suxluxations are allegedly responsible for everything from allergies to myopia to discolored voodoo auras.

By his use of the word ‘nonsense’, I assumed that Joe Ellison was inferring that excessive back manipulations/mobilisations could be deemed to be woo-related (i.e. not evidence based).

not insignificantly, when going to an MD for back problems, one also needs to choose the practitioner VERY carefully. not only are there plenty of mediocre doctors and physios, but many of THEM are interested in nothing quite so much as you using their services until your insurance runs out and your bank account is dry.

Not universally so. Here in the UK most GPs and physios work for the NHS and are on fixed salaries. On the other hand, nearly all chiropractors in the UK work in private practice.

also MDs in my experience tend to over-prescribe medications, especially pain killers. (i find that muscle relaxers help significantly, but pain killers dont' make my back stop hurting any faster, just make it easier on me while i wait for the spasms to subside).

Perhaps clinical experience has shown GPs that painkillers are the best treatment. Indeed, the results of this recent scientific study indicates that advising patients to remain active and prescribing them paracetamol is the best course of action:

Australian researchers found that neither spinal manipulation or the
drug diclofenac hastened recovery of acute low-back pain patients who
had been properly counseled by their primary physician and prescribed
paracetamol for pain relief. The study involved 240 patients who
received either (a) diclofenac plus spinal manipulation, (b)
diclofenac and sham spinal manipulation, (c) spinal manipulation and
a placebo pill, or (d) sham manipulation plus a placebo pill. About
half recovered within two weeks and nearly all recovered within three
months.

[Hancock MJ and others. Assessment of diclofenac or spinal
manipulative therapy, or both, in addition to recommended first-line
treatment for acute low back pain: a randomized controlled trial.
Lancet 370:1638-1643, 2007]
http://www.ncbi.nlm.nih.gov/sites/e...med.Pubmed_ResultsPanel.Pubmed_RVAbstractPlus

Diclofenac is a nonsteroidal antiinflammatory drug (NSAID).

Paracetamol is a pain-reliever marketed in the United States as
acetominophen or Tylenol. An accompanying editorial noted:

**Systematic reviews had concluded that NSAIDS and spinal
manipulation were more effective than placebos. However, the patients
in the reviewed studies did not have optimum first-line care, and the
apparent benefit was not large.

**Advice to remain active and prescription of paracetamol will be
sufficient for most patients with acute low back pain.

[Koes BW.
Evidence-based management of acute low back pain. Lancet
370:1595-1596, 2007]


http://www.ncahf.net/digest07/07-47.html

More from the full text of the Hancock study:

The spinal manipulative therapy given in this trial included a range of low-velocity mobilisation and high-velocity manipulation techniques done by physiotherapists with postgraduate training in manipulative therapy. A systematic review of spinal manipulation concluded that there is no evidence that high-velocity spinal mobilisation is more effective than low-velocity spinal manipulation, or that the profession of the manipulator affects the effectiveness of treatment.

http://www.acatoday.org/pdf/Lancet_Acute_Back_Pain_Nov.07.pdf

my personal bottom line is i'm not interested in any chiro selling anything but a finite program of short-term relief, and anywhere i'd go had better be physio-oriented and not make any voodoo-claims. voodoo claims are pretty easy to spot.

Easy to spot for whom?

once that hurdle is cleared,

Can you suggest a source that members of the general public could use to help them clear that hurdle (and, if you can, would most of them know it exists)?

i look for a place where professional and high-level amateur athletes go. yeah, they get sucked in by voodoo too (who can forget Patrick Ewing with friggin' magnets on his knees),

although “voodoo claims are pretty easy to spot”?

but in my experience once the voodoo hurdle's cleared athletes tend to flock to the best physios.

But what about your Average Joe? How does he go about sorting the wheat from the chaff?

 

[zeusbheld]

By his use of the word ‘nonsense’, I assumed that Joe Ellison was inferring that excessive back manipulations/mobilisations could be deemed to be woo-related (i.e. not evidence based).

agree and at no point have disagreed.

Not universally so. Here in the UK most GPs and physios work for the NHS and are on fixed salaries. On the other hand, nearly all chiropractors in the UK work in private practice.

there is no NHS in the US or Thailand, and it is common in both countries. i suspect if chiros had to work in NHS on fixed salaries it'd stop being such a glamorous cash cow. definitely looks like one can't go too far wrong by avoiding ALL chiros in the UK. and most elsewhere.

Perhaps clinical experience has shown GPs that painkillers are the best treatment. Indeed, the results of this recent scientific study indicates that advising patients to remain active and prescribing them paracetamol is the best course of action:

fair enough, but just following the link and reading the abstract, i was talking about chronic upper back pain and muscle spasms whereas the study was talking about acute lower back pain, so it's not apples-to-apples.

as far as a general trend toward over-prescribing goes, antibiotics are the best thing to look at. not to digress too much but most MDs would agree that over-prescribing antibiotics is a bad idea in principle. yet (short version) it happens quite often, at least in the US or Thailand. however, if you want to discuss over-prescribing start a thread 'n' let me know, as it's not what this thread's about.

Easy to spot for whom?

look at the list you quoted above. anyone making those claims listed under "avoid" is likely to be making more than one of those claims. also, pretty much anyone who uses the word "subluxation," in my opinion.

'chirobase,' which you also cited, also has good advice.

i think anyone who reads the sources you cited then talks to the chiro before hiring them should be able to tell the difference. these people are NOT subtle.

Can you suggest a source that members of the general public could use to help them clear that hurdle (and, if you can, would most of them know it exists)?

you already did suggest a resource, and no, most of them would not know it exists. is supect most are aware of the existence of google, i'd imagine. however, most of them probably don't put any thought or care into researching their MDs either.

although “voodoo claims are pretty easy to spot”?

*if* you do your homework. if you don't do your homework, you might end up with a bad MD too.

But what about your Average Joe? How does he go about sorting the wheat from the chaff?

if the "average Joe" can't get off his average hindquarters and do some basic homework before choosing ANY healthcare practitioner, then average Joe has no one but himself to blame. google is readily available in public libraries in most countries.

well you tried hard to lead me to whatever conclusion you were trying to lead me to, sorry if i never arrived. your line of argument seems a bit odd. what are you really arguing here? i don't think that we're in disagreement that some chiros are good but most are bad. if i'm wrong, it seems odd you'd cite chirobase, for starters. are you arguing that chiro should be outlawed? (disagree) or regulated? (agree) if not why should it matter if Joe sixpack, who can access google same as i do, does his homework?