Is there such a thing as a good chiropractor?

davefoc said:
Would anybody here like to comment on the phenomena of long term chiropractic care?
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There’s basically very little evidence to justify it. It’s usually a win-win situation for chiropractors that has its roots in practice building tactics rather than genuine patient care:

“Some chiropractors take advantage of a patient's fear of subluxations by recommending regular 'preventive maintenance' spinal adjustments, which contribute more to the chiropractor's pocketbook than to the patient's health. Patients of such chiropractors become psychologically addicted to treatment they do not need.”

http://www.chirobase.org/01General/placebo.html

More on chiropractic practice building here:
http://www.chirobase.org/09Links/pb.html

I know of a few examples in my own extended family. One of the participants I don't know very well, the other tends toward woo type beliefs. These people and others that I have listened to seem to develop a sense that the chiropractic visits are an important part of alleviating symptoms of back pain or other pains in their lives. What is the nature of this interaction between the chiropractor and these kind of patients.
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Again, in many cases, the chiropractor/patient encounter is centred around practice-building tactics/sales scripts:
http://www.chirobase.org/01General/sellspine.html

Is the chiropractor really delivering treatments that migtigate pain?
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There is some evidence that spinal manipulative therapy can provide some pain relief in the case of acute and chronic low back pain, but even then there is no evidence that it is superior to standard treatments such as medication for pain, exercises, or care given by a general practitioner:
http://www.update-software.com/abstracts/AB000447.htm

For all other conditions, there’s very little evidence that chiropractic is helpful:
http://www.nzma.org.nz/journal/116-1179/539/

Is the personal interaction of getting a massage from a trusted individual really the most important aspect of what is going on?
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It could well be. In a rapid response letter to the British Medical Journal regarding the conclusions of the 2004 UK BEAM trial which looked at the effectiveness of physical treatments for back pain in primary care (which involved treatment by chiropractors), Professor Edzard Ernst gave his personal view that the results were compatible with a non-specific effect caused by touch:
http://bmj.bmjjournals.com/cgi/eletters/bmj.38282.669225.AEv1

Would a visit to a similarly skilled physical therapist have a similar result?
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It would seem so. What’s more, the continuing evidence-based expansion of the physical therapy profession may eventually see the demise of the chiropractic profession:
http://jmmtonline.com/documents/HomolaV14N2E.pdf

Is the woo nature of the treatment (meaning making non-scientific jargon and conversation part of the chiropractor/patient interaction) part of the appeal for these people?
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More than likely. Lots of people just want to feel cared for and chiropractors are very skilled at exploiting that situation:
http://www.chirobase.org/20PB/brailescript.html

For anyone looking for evidence based answers to other chiropractic questions, this is a very good resource:
http://www.chirobase.org/17QA/index.html
 
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I don't know whether anyone would obtain long term benefit from chiropractic treatment, but in my eyes it seems to be a ridiculous notion.

From my perspective as a physical therapist/bodyworker, then I normally find that people have problems because muscles have become shortened and contracted. You have one muscle group that is contacted and painful and then the opposing muscle group that is weak in comparison. This can result from trauma and poor posture.

When I work with someone, I use different bodywork techniques for working with the myofascia to help lengthen the contracted tissue and I do stretching with people and also give them exercises to do in between appointments.

One of the main problems I see following trauma is that people get pain follwing healing due to adhesions. These adhesions can be broken down and smoothed out with the use of specific massage techniques however.

I do seem to have a good success rate within my practice. I do a lot of postural re-education, which for someone who slouches behind a computer all day can be very important and I also give people stretches and exercises to do in between treatments.

Perhaps I have better success than most chiropractors, but I don't know - I have not done the research yet!!
 
I like the article by Homola and it is interesting that Physical therapy schools in the States are accepting Chiropractors as students to re-train.
 
Short answer: no

When somebody tells me they're going to a chiropractor, first I ask why?, then I ask them how often will they need to go back and for how long? Then I ask them "if your doctor told you that in order to treat the same problem you'd have to come and see him two times a week for several years what would you think of your doctor?".

People who claim chiropracty worked for them, have no way of knowing what would have happened if they DIDN'T go to the chiropractor. For all they know, they would have recovered sooner, with less complications and definitely less money spent!

I firmly believe that chiropractors are popular for the same reason McDonald's is popular. It's not because it's good, or even good for you, it's because it's something that fills the void and most importantly can be found ANYWHERE and you never have to wait more than a few minutes to get it. When bed rest, and time are the best medicine people immediately look for a quick immediate "solution". Even if quick and immediate takes a lifetime of visits to the same flim flam man.

Spinal manipulation is a scam. Talk to an orthopedic surgeon and ask him if it's possible to move vertebrae independent of one another without causing irreparable damage. A car accident might misalign your spine...but it probably severed your spinal column too...

The physiotherapist I went to employed chiropractic "manipulation" techniques; so there's a chiropractor masquerading as a physiotherapist! All my X-ray's were fine, but I was in constant pain, and my feet were going numb. Turns out the CT scan showed that my disk was ruptured, and compressing my spinal cord...the chiropractor, if I'd gone more than once, could possibly have paralyzed me....

Going to a chiropractor for a medical problem is like going to a psychic for schizophrenia. You might feel better temporarily, but long term, you're just losing money.
 
robinson said:
http://www.findarticles.com/p/articles/mi_m0999/is_7178_318/ai_54029145
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Yes, it’s incredible how such a prominent chiropractic educator could be so unaware of the unsound nature of two of his four references:

Ref [2] The 1990 Meade study was subsequently shown to be flawed:
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=1833493

Ref [3] And the 1995 follow-up as well:
http://bmj.bmjjournals.com/cgi/content/full/311/7015/1302

Regards ref [4], just last year the Royal College of General Practitioners withdrew its guideline which had formerly recommended chiropractic spinal manipulation in the first 6 weeks of acute low back pain.

On top of that, this was the conclusion of a 2004 study that looked at sources of bias in reviews of spinal manipulation for back pain:
We conclude that the outcomes of reviews of this subject are strongly influenced by both scientific rigour and profession of authors. The effectiveness of spinal manipulation for back pain is less certain than many reviews suggest; most high quality reviews reach negative conclusions.

http://www.springer.at/periodicals/article_pdf/xxxxxxxxx140xxxxxx379109_1.pdf
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Things don’t seem to be looking too good for chiropractors.
 
I have e-mailed Dr. Herold to encourage either himself, or anyone else he knows to join us.

A copy of the letter I sent to him follows:
Subject: Damning statements about chiropractic made on JREF Forum!

Dear Todd Herold,

It has been just over a week since you visited the WPCUG general meeting. I was the one with the web site hand-outs and Skeptic's Dictionary definition.

I now wish to bring to your attention the substantial number of negative, damning statements that have been piling up, about chiropractic, on the JREF Internet forum.
The thread can be found here: http://www.internationalskeptics.com/forums/showthread.php?t=65430

I invite either you, or anyone else you know to join the forum, to defend chiropractic against these statements, if you wish to do so. (The forum operates free of charge, in case you wanted to know.)
I promise the conversation will be civilized, despite the low opinions of the practice communicated so far. Most participants are well informed, and skilled at communicating their knowledge. (Rude behavior is a rarity.)

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Here are a few excerpts from the thread, http://www.internationalskeptics.com/forums/showthread.php?t=65430 :

(Many of these excerpts were shortened from their original text. But, they can all be read in full on the forum.)

The user "tkingdoll" stated:
"A Chiropractor who does not practice/believe the woo side of it is called a Physical Therapist. In other words, if you are a Chiropractor, you practice Chiropractic, which is the theory of mystical energy flow being the root cause of all disease and illness."

In response to your statement that "The circuit breaker in your house is just like your spine", the user "Dark Jaguar" stated:
"The analogy is flawed because our spinal cord and nerve signals are not power lines. They are information lines. It is more akin to your ethernet cable being snipped…
…we don't run on electricity. We just use it, and chemical communication, as data transfer..."

"Blue Wode" stated:
"There are a small number of ethical chiropractors who practice evidence-based manual therapy limited to neuromusculoskeletal disorders, but finding one is like trying to find a needle in a haystack as you have to have quite an in-depth understanding of chiropractic in order to know what to look for."

"The “nerves get pinched by vertebrae” theory was debunked by the Crelin study in 1973:
http://www.chirobase.org/02Research/crelin.html "

"In a recent survey examining the longevity of chiropractors vs. general population vs. MDs the lifespans of chiropractors turned out to be the lowest of the three groups:
http://www.jcca-online.org/client/cca/JCCA.nsf/objects/V48-3-P217-224/$file/V48-3-P217-224.pdf "

"There’s basically very little evidence to justify it. It’s usually a win-win situation for chiropractors that has its roots in practice building tactics rather than genuine patient care"

Blue Wode also pointed out this site:
http://your-doctor.com/patient_info/alternative_remedies/various_therapy/chiropractic.html
Check out the section labeled "Appropriate chiropractic practice"

More sites cited on chiropractic practice building include:
http://www.chirobase.org/01General/placebo.html
http://www.chirobase.org/09Links/pb.html"

"tkingdoll" pointed out this brochure from the U.K. Skeptics:
http://www.ukskeptics.com/factsheets/Chiropractic.pdf

Numerous people pointed to the web site www.ChiroBase.org (a division of Quackwatch)

The user "macgyver" had this to say:
"I firmly believe that chiropractors are popular for the same reason McDonald's is popular. It's not because it's good, or even good for you, it's because it's something that fills the void and most importantly can be found ANYWHERE and you never have to wait more than a few minutes to get it.
…
Spinal manipulation is a scam. Talk to an orthopedic surgeon and ask him if it's possible to move vertebrae independent of one another without causing irreparable damage."

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In addition, I would like to know your opinion regarding spinal adjustments given to children and infants. I am inclined to think such actions are particularly dangerous and unethical. You can respond to that concern either through e-mail and/or on the forum linked to, above.


A copy of this letter will be posted to the forum as well. So, we will be expecting a representative from your practice to join in, soon.

Sincerely,
Mitchell Scott Lampert
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I would like to remind everyone to please be courteous to our chiropractic guests, if and when they join us. I wish for the discussion to be civilized, intelligent and informative.

Rude, pointless Jokes (like MRC Hans' "a dead one" comment) will not be tolerated. Thank you.
 
In my case, when I had to consider surgery, I read a book called The Back Doctor by an orthopedic surgeon named Hamilton Hall.

He mentioned that a healthy spinal column's vertebrae are so perfectly interlocked that even if you were to put pliers on the spinous process and attempt to twist the vertibrae in relation to each other it would be nearly impossible to do..even with two people. Certainly, not without damaging the spine in the process.

Subluxations are a myth.

There are rare cases due to degenerative disease or developmental problems, of course, but this certainly wouldn't apply to the vast majority of "patients" diagnosed with subluxations by chiropractors.

Fortunately my situation was well defined as definitely requiring surgery to correct, so the choice to have surgery was an easy one:

A much more serious complication of a ruptured disc is cauda equina syndrome, which occurs when disc material is pushed into the spinal canal and compresses the bundle of lumbar and sacral nerve roots. Permanent neurological damage may result if this syndrome is left untreated.
 
Is there such thing as a good sceptic?

Wowbagger said:
...I wish for the discussion to be civilized, intelligent and informative....
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For the record, I wish for the same thing. I'm skeptical of it happening, but I still wish for it. If I became upset over every uninformed opinionated person spewing crap about subjects they know little to nothing about, the Internet would be unbearable. It is easy to sit on a keyboard and type out stuff, even to make it up or parrot things others have said.

It is quite another to be a scientist and a sceptic, and do the work of searching, researching, testing and thinking. It is also harder to be civil and intelligent than it is to crack stupid jokes or be insulting and stupid.
 
robinson, I checked out your link. One of the key references in the letter was this study:
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&list_uids=2143092&dopt=Citation

Di you think the study results were in disagreement with any of the posts in this thread? I am under the impression that most chiropractic critics including the ones in this thread agree that chiropractic care can be beneficial. The criticism of chriopracty goes to the theoies underlying it and the chiropractic claims of efficacy beyond what would be available from routine medical physiotherapy.

What I couldn't figure out from readng the abstract of the study was whether the 7% reduction in points on the Oswestry pain scale was based on a comparison of chiropractic treatment and routine physiotherapy or whether it was based on a comparison of chiropractic care versus no physiotherapy at all.

Do you know how significant a 7% reduction in points on the Oswestry pain scale is? It seems like that result was based on averaging the results from all the patients so it seems like some patients might have been helped while others may not have. It would have been interesting to see a breakdown of that.

One thing I noticed was that the chiropractors were allowed to choose what techniques they thought best in the study. Not unreasonable, except that if that was done then it might be difficult to distingusih what chiropractic treatments were effective and which weren't.

And, perhaps it goes without saying, but clearly the study provided absolutely no evidence for the subluction theories or support for the use of chiropracty beyond a narrow range of problems associated with back pain. That chiropracty might have some benefit in this narrow range is entirely consistent with articles critical of chiropracty that I have read including those at quackwatch.
 
Because of the way chiros are miseducated, they often are misguided about vaccines as well. If you don't know how the immune system really works, then you are apt to believe what other chiros, like Tim Bolen & Ted Koren, say about vaccines. The worst part is that Tim & Ted love to call themselves "consumer advocates", and send around "news"letters to other chiros to give to their clients.

These newsletters are appalling in their misinformation. I worked for a printing company once, and a local chiro brought in some this junk in to be photocopied on color paper so that he could mail it out and give to everyone he came in contact with.

Vaccine Tidbits
From Dr. Ted Koren's newsletter
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Delight in lies and anecdotes about vaccines causing alzheimers and killing babies.

Keep in mind that you can refute every one of Koren's articles and reasoning quite easily: like this

Hugh Fudenberg, who claimed in a 2004 interview with Brian Deer to cure autistic children with his own bone marrow...
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It's quite interesting how the likes of Koren and Bolen always follow the word of the clearly deluded. It's not surprising though, they are the only kind who will side with their misguided views of the human body and how things work.

I blame the miseducation that chiros get. If they found out how the body really worked in their schools, then they wouldn't be so prone to fantasy.
 
I found a response by the authors of the editorial that the letter linked to by robinson was critical of:

http://bmj.bmjjournals.com/cgi/content/full/318/7178/261/a#resp5

From the response:
The main focus of our editorial was on chiropractic and not spinal manipulation in general. For each favourable study cited in favour of chiropractic in these letters, at least one recent less favourable one can be found
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I found this section interesting also:
The two most recent randomised controlled trials of chiropractic provide further support for our reserved attitude. Cherkin et al showed that for acute, uncomplicated back pain, both chiropractic and McKenzie physiotherapy lead to roughly the same results, which were not superior to those in controls who merely received an educational booklet, which previously had been shown to be ineffective.8 The design of Skargren et al's trial9 resembled that of Meade et al.2 Half of the patients had acute back pain. The authors concluded that the effectiveness and total costs of physiotherapy or chiropractic, to reach the same results immediately after treatment and six months later, were similar
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In other words for "acute, uncomplicated back pain" chiropractic and "McKenzie physiotherapy" were about equally effective and neither was more effective than giving patients a booklet which had previously been shown to not be effective. So at least in this study even the benefits of physiotherapy for "acute, uncomplicated back pain" were not proven.
 
Eos of the Eons said:
I blame the miseducation that chiros get. If they found out how the body really worked in their schools, then they wouldn't be so prone to fantasy.
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I agree, and it’s very unfortunate that, for some chiropractors, the realities of their career choice don’t start to surface until it’s too late:
http://stopchiroschools.blogspot.com/

In fact, James Randi highlighted the problem in one of his recent commentaries:
http://www.randi.org/jr/2006-01/010620monkey.html#i5

Davefoc, you may be interested to know that in March of this year ‘A systematic review of systematic reviews of spinal manipulation’ was published in the Journal of the Royal Society of Medicine. It reached the following conclusion:
Spinal manipulation has been associated with frequent, mild adverse effects26 and with serious (probably) rare complications.27 Therefore the risk-benefit balance does not favour SM over other treatment options such as physiotherapeutic exercise. This statement is not in agreement with several national guidelines, for instance, for the treatment of back pain.28-30 We suggest that these guidelines be reconsidered in the light of the best available data.

In conclusion, we have found no convincing evidence from systematic reviews to suggest that SM is a recommendable treatment option for any medical condition. In several areas, where there is a paucity of primary data, more rigorous clinical trials could advance our knowledge.
http://www.jrsm.org/cgi/content/full/99/4/192
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As you can imagine, chiropractors and osteopaths were not at all happy about the review. You can read their comments, and the authors’ reply, here: http://www.osteopathy.org.uk/uploads/Letters_on_Ernst_and_Canters.pdf
 
robinson said:
For the record, I wish for the same thing. I'm skeptical of it happening, but I still wish for it. If I became upset over every uninformed opinionated person spewing crap about subjects they know little to nothing about, the Internet would be unbearable. It is easy to sit on a keyboard and type out stuff, even to make it up or parrot things others have said.
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Fortunately, on this thread at least, there has been little evidence of this happening.
 
Blue Wode, I appreciate your links, but you may think I have an opinion that I don't.

I believe that most of the claims for chiropracty are baseless and are the hangers on from a form of medical care that didn't change with the rise of science based treatments.

Based on reading on quackwatch, etc. I hold out the possibility that chiropractors may offer some legitimate medical treatments in very limited areas. I don't know that they do and I am uncertain of the benefit of physiotherapy in general. Although I realize that physiotherapy of some sort is part of the standard medical care for some maladies and I supect, as a result, it probably has some benefit.
 
davefoc said:
Blue Wode, I appreciate your links, but you may think I have an opinion that I don't.
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I think I understood you. I just liked reading your comments and thought you might be interested in some additional information. :)
 
It's now been two weeks since I posted this thread, and still no sign of the chiropractors I invited to defend themselves.
I guess it is now reasonably safe to call them all a bunch of cowards.

And, I shall deem them cowards, until they start defending their practice.
 
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