The chiropractor and the Olympic athlete

[Pipirr]

Cools, a five-time world junior champion considered to be an Olympic medal hopeful, nearly didn't make it to the start line for yesterday's BMX cycling world championships in Taiyuan, China, because of a severe neck injury.

A chiropractor in Switzerland, where Cools trains, over-rotated her neck during a routine adjustment, tearing tendons and muscles, which then pushed up against the main artery in her neck and also the nerves.

Not only did the extremely painful injury limit her to just one bike ride in the last five weeks before departing for China – she only decided to go last Tuesday – it even affected her ability to eat.

"It was hard to chew because the muscles at the front of my neck were just so tight that I couldn't open my mouth all the way," said Cools yesterday in a telephone interview.

I don't have much to add to that. It sounds like a horrifying thing to do to a person in one's care, and a horrifying injury to sustain.

Samantha Cools has made it to the Olympics and at the time of writing, had qualified in her event. Yet bizarrely:

While it was a chiropractor who nearly put her out of action, it was also a chiropractor who enabled her to compete yesterday. Richard Robinson of Calgary, who has worked with Cools for three years, worked on her for 30 minutes between each of her races in China to loosen her muscles.

"I can credit all of my success for the day on him," she said.

That smiley of a head banging repeatedly against a wall would be apposite here, I think.

She should sue.

Story here.

 

[krelnik]

Her events at the Olympics started today, I see she qualified 13th out of 16. Wow, as if she doesn't have enough problems, the top ranked rider (from New Zealand) is being coached by her brother!

Should be interesting to see how she does and whether the neck injury figures in it.

ETA: I just checked and in the U.S. the semis and finals of her event are airing LIVE TONIGHT from 9pm to 11pm *EASTERN* on your NBC local broadcast station. I guess I'll have to watch.

ETA: 9PM EDT: It is raining quite steadily at the BMX event site, so all events have been postponed until tomorrow.

 

[Blue Wode]

It sounds like a horrifying thing to do to a person in one's care, and a horrifying injury to sustain.

In view of the fact that the adverse effects of chiropractic spinal manipulation are not subject to post-marketing surveillance, and that under-reporting has been put at close to 100%, I wonder if her injury will ever be recorded as a case report in the medical literature…

Spinal manipulation.....is the hallmark treatment of chiropractors.....For conditions other than back pain, there is no good evidence for the effectiveness of spinal manipulation.5

-snip-

The retrospective case series (Table 3) confirm that spinal manipulation is associated with risks such as vascular accidents and non-vascular complications. Such adverse effects are being reported from several countries and often have serious consequences. The therapists involved are mostly chiropractors; this predominance is probably due to the fact that these therapists use spinal manipulation more frequently than other practitioners. Most of the incidents reported in case series or surveys had not been previously reported, indicating that under-reporting may frequently be high.

-snip-

Consequently, the frequency of serious adverse effects is currently unknown. Estimates by chiropractors vary (e.g. 6.4 per 10 million manipulations of the upper spine and 1 per 100 million manipulations of the lower spine).53 These figures, however, may be over-optimistic. Retrospective investigations have repeatedly shown that under-reporting is close to 100%.13,52 This level of under-reporting would render such estimates nonsensical. At present, there is no sufficiently large and rigorous prospective study to generate reliable incidence figures; previous studies have failed to investigate those patients which were lost at follow-up. This could be the subgroup which has been harmed. It is therefore essential that future studies follow up close to 100% of the initial patient sample.

The effectiveness of spinal manipulation for most indications is less than convincing.5 A risk-benefit evaluation is therefore unlikely to generate positive results: with uncertain effectiveness and finite risks, the balance cannot be positive.

-snip-

The chiropractic profession tends to downplay the risks: ‘chiropractic services are safe’;60 ‘the healthy vertebral artery is not at risk from properly performed chiropractic manipulative procedures.’61 Others argue that ‘the occurrence of cerebrovascular accidents in the chiropractic population is 0.000008%’,62 that causality is not proven or even unlikely,61,63-66 that other interventions are more risky (see below),67 that the mechanical forces employed for spinal manipulation are too low to cause injury,68 or that there is a ploy from the medical establishment to sideline chiropractors.69-71 In the light of the evidence summarized above, such attitudes do not seem to be in the best interest of patients.

It is, of course, important to present any risk-benefit assessment fairly and in the context of similar evaluations of alternative therapeutic options. One such option is drug therapy. The drugs in question—non-steroidal anti-inflammatory drugs (NSAIDs)—cause considerable problems, for example gastrointestinal and cardiovascular complications.72,73 Thus spinal manipulation could be preferable to drug therapy. But there are problems with this line of argument: the efficacy of NSAIDs is undoubted but that of spinal manipulation is not, and moreover, the adverse effects of NSAIDs are subject to post-marketing surveillance while those of spinal manipulation are not. Thus we are certain about the risks and benefits of the former and uncertain about those of the latter. Finally, it should be mentioned that other therapeutic options (e.g. exercise therapy or massage) have not been associated with significant risks at all.

Ernst E. Adverse effects of spinal manipulation: a systematic review. J R Soc Med 2007;100:330-338
http://jrsm.rsmjournals.com/cgi/content/full/100/7/330

And here’s another injured chiropractic patient in the news:
http://www.chirobase.org/08Legal/nette.html

 

[robinson]

In view of the fact that the adverse effects of chiropractic spinal manipulation are not subject to post-marketing surveillance, and that under-reporting has been put at close to 100%, I wonder if her injury will ever be recorded as a case report in the medical literature…

Doubtful. If death and disabilities are not reported, injuries probably won't be either. The Medical field hardly ever admits a mistake.

Nearly half of doctors surveyed say they have failed to report an impaired or incompetent colleague or a serious medical error, and more than one-third say they would order an unneeded MRI scan for an insistent patient - though these actions conflict with what the physicians consider the heart of their professional obligations.

http://www.boston.com/news/nation/articles/2007/12/04/doctors_dont_report_colleagues_errors/

It's difficult to get an exact sense of how many people suffer from medical errors.

http://www.bizjournals.com/portland/stories/2003/09/15/story2.html

Admitting, or even reporting an error, is just against the code.

In the United States, reports estimate the number of people who die each year from medical errors is between 44,000 and 98,000. People who are hospitalized face the greatest risk.

Reporting errors has been complicated by a wave of rising medical malpractice insurance rates. Doctors in malpractice liability crisis states, Oregon included, face skyrocketing insurance premiums. As a result, some believe that doctors, and other medical personnel, are reluctant to admit mistakes.

http://www.bizjournals.com/portland/stories/2003/09/15/story2.html

If the number of deaths is hard to come by, the number of injuries is even harder.

 

[Blue Wode]

http://www.sciencebasedmedicine.org/?p=136

Robinson, you and I are probably still here thanks to modern medicine.

 

[robinson]

Of course, what does that have to do with the topic?

 

[Blue Wode]

It’s pretty obvious where you’re trying to go with this, Robinson.

However, to answer your question directly, judging by the links you provided and chiropractors’ apparent playing down of the risks associated with their manipulative treatments, I would agree that it is “doubtful” that the Olympic althlete’s case will make it into the medical literature.

 

[Pipirr]

Her events at the Olympics started today, I see she qualified 13th out of 16. Wow, as if she doesn't have enough problems, the top ranked rider (from New Zealand) is being coached by her brother!

Should be interesting to see how she does and whether the neck injury figures in it.

ETA: I just checked and in the U.S. the semis and finals of her event are airing LIVE TONIGHT from 9pm to 11pm *EASTERN* on your NBC local broadcast station. I guess I'll have to watch.

ETA: 9PM EDT: It is raining quite steadily at the BMX event site, so all events have been postponed until tomorrow.

How much do the helmets weigh? I think if one's sport involves wearing a bulky helmet and rapid acceleration, a neck injury would be, well, a pain in the neck. I hope it doesn't figure too much in her performance, but I can imagine it would.

 

[Pipirr]

In view of the fact that the adverse effects of chiropractic spinal manipulation are not subject to post-marketing surveillance, and that under-reporting has been put at close to 100%, I wonder if her injury will ever be recorded as a case report in the medical literature…

The injury was sustained in Switzerland. Isn't that one of those countries where chiropractic, like homeopathy, can do no wrong?

The under reporting / lack of surveillance has always struck me as a particularly shameful aspect of the chiropractic industry. It's as though they'd just rather not know.

 

[Pipirr]

Doubtful. If death and disabilities are not reported, injuries probably won't be either. The Medical field hardly ever admits a mistake.

Your concern for veracity and equivalency in the real sciences is noted.



edit: banned? But he was the very model of a skeptical concern troll!

 

[krelnik]

FYI: robinson got banned this morning (for reasons unrelated to this thread) so don't expect a reply.

 

[dogjones]

Doubtful. If death and disabilities are not reported, injuries probably won't be either. The Medical field hardly ever admits a mistake.


http://www.boston.com/news/nation/articles/2007/12/04/doctors_dont_report_colleagues_errors/


http://www.bizjournals.com/portland/stories/2003/09/15/story2.html

Admitting, or even reporting an error, is just against the code.


http://www.bizjournals.com/portland/stories/2003/09/15/story2.html

If the number of deaths is hard to come by, the number of injuries is even harder.

Depends on the hospital, but largely not true. I work closely with the risk management & patient safety depts of many, many US hospitals. The number of losses (ie complaints/summons/claims/lawsuits) that were previously reported as 'adverse events' usually FAR outweighs the losses that were completely unknown (ie, not previously reported).

Even if the statistic "half of doctors say they have failed to report..." is true, this does not translate into "half of adverse events go unreported". There are many systemic ways that hospitals can (and do) ensure adequate reporting. For starters, most have anonymous electronic reporting systems which any employee can access - nurses, orderlies, janitors, anyone. So if one doctor didn't report something/someone, the chances are someone else will. That's just the tip of the iceberg. There are a wealth of other methods.

 

[krelnik]

Well the rain-delayed BMX semifinal and final took place. Cools made it to the final, but crashed her bike a mere 10 seconds into the race.

CBC Sports: Canada's Cools crashes out of BMX final

Canada's Sam Cools saw her bid for a medal in the Olympic debut of BMX end in a heap when she crashed out of the women's final on Friday in Beijing.

Cools, from Airdrie, Alta., went down just seconds into the 350-metre Laoshan course after colliding in midair with Argentina's Gabriela Diaz. She was shaken up, but eventually got back on her bike and cross the finish line in the event, which can perhaps best be described as snowboard cross on dirt.

"I'm alive, I can walk, that's all the matters," said Cools, 22, who officially received a DNF. "It was frustrating when I was dusting myself off but really, I was there.

"I learned a lot and experienced so much for my first Olympics. I will take that onto the next one."

Cools came into the race as the top-ranked North American at No. 7 in the world, but barely scraped into Friday's final, claiming the fourth and final spot from her semifinal heat.

Calgary Herald: Cools crashes out in BMX final

Samantha Cools of Airdrie, Alta., waited her whole young life to compete at the Olympics, only to crash less than 10 seconds into the first-ever BMX final at the 2008 Summer Games.

Cools barreled down the eight-metre start ramp, and flew off the first jump but lost control on the landing, falling off her bike and onto her backside. Race over for her.

Cools, who picked herself and her bike up and watched the rest of the race from the crest of the berm she failed to negotiate, finished seventh in the eight-woman field in which world champion Shamaze Reade of Great Britain also crashed on the final turn of the course.

I don't see any of the news coverage referring back to her chiropractic issue, though. Would have been nice if someone asked her about whether that was still a problem.

 

[JoeTheJuggler]

Robinson's "tu quoque" observations don't hold up anyway. Just about everything has a risk associated with it (even if that risk is connected to incompetence). Comparing the risks of chiropractic to those of medicine ignores the benefit side of the risk/benefit analysis. As Pipirr pointed out, the benefits of medicine are very real and significant. The benefits of chiropractic (if any) are far less than what proponents claim, so the risks are absurdly high relative to the benefit.

On a slight tangent: I've gotten much more into running and the community of runners in recent months. I'm dismayed to see how many of these people subscribe to chiropractic, acupuncture, bogus supplements and so on. I hope it's not as prevalent as it seems, but that those people are simply very vocal.

 

[Pipirr]

I don't see any of the news coverage referring back to her chiropractic issue, though. Would have been nice if someone asked her about whether that was still a problem.

It was a TV news report that first gave me the clue that it was a chiropractic injury that she had sustained, even though the report didn't mention the word chiropractic at all. The description of the injury just sounded to me like yet another chiropractic neck snap. So I looked it up, and sure enough, thats what it was.

It would be great if reporters would just come right out and say that the chiropracter did it, instead of being so circumspect: this is, after all, a fairly high profile chiropractic neck snap story, and a good opportunity to educate the public of the dangers of chiropractic 'care'.

But I guess that most people think chiropractic is a legitimate practice, so reporters don't see a need to highlight it, or highlight it's lack of credibility, when it causes harm. Which is a shame.

 

[Mercutio]

If I am not merely imagining things, I saw one of the beach volleyball players call a medical time out so that she could have her neck "adjusted". I also think her side lost.

 

[Pipirr]

If I am not merely imagining things, I saw one of the beach volleyball players call a medical time out so that she could have her neck "adjusted". I also think her side lost.

You might not have imagined it. This chiro saw it too. Terribly exciting, seeing a fellow quack on the television.

And as an extra bonus, that black tape the beach and indoor volleyballers are wearing? Invented by a chiropractor. Also, has magic powers.

 

[dogjones]

Is it me, or is there way, way, WAY too much volleyball in this Olympics? I don't understand why each country gets to enter two teams for each volleyball event.

 

[JJM]

{snip} On a slight tangent: I've gotten much more into running and the community of runners in recent months. I'm dismayed to see how many of these people subscribe to chiropractic, acupuncture, bogus supplements and so on. I hope it's not as prevalent as it seems, but that those people are simply very vocal.

Athletes often win by slim margins, and they are prone to all sorts of superstitions. Michael Shermer, founder of the Skeptics Society and publisher of Skeptic describes his own experience in his book "Why People Believe Weird Things." When he was a professional athlete, he went so far as to wear a pyramid-hat. Tiger Woods wore (still does?) his lucky red shirt on the last day of every golf tournament. Several years ago I read "Don't Get Duped" by Larry Forness, MD; founder of the National Center for Sports Medicine. A female athlete asked if she should take "royal jelly" pills. (Royal jelly is a food that bees make and feed, exclusively, to the queen.) He replied that it would help if she wants to grow three time her normall size and ovulate a million times!

 

[dogjones]

I think there's a Roald Dahl story about that!