Fun with a Chiropractor

[Blue Wode]

I don't understand what is wrong with chiropractors.

Perhaps it would be an idea for you to read this article…

"The reasons for use of manipulation/mobilization by an evidence-based manual therapist are not the same as the reason for use of adjustment/manipulation by most chiropractors."

Can Chiropractors and Evidence-Based Manual Therapists Work Together? An Opinion From a Veteran Chiropractor
Samuel Homola, DC, The Journal of Manual & Manipulative Therapy
Vol.14 No.2 (2006) E14-E18

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

…as well as this report, which has just been published:

We report three cases of serious neurological adverse events in patients treated with chiropractic manipulation. The first case is a 41 years old woman who developed a vertebro-basilar stroke 48 h after cervical manipulation. The second case represents a 68 years old woman who presented a neuropraxic injury of both radial nerves after three sessions of spinal manipulation. The last case is a 34 years old man who developed a cervical epidural haematoma after a chiropractic treatment for neck pain. In all three cases there were criteria to consider a causality relation between the neurological adverse events and the chiropractic manipulation. The described serious adverse events promptly recommend the implementation of a risk alert system.

Chiropractic manipulation: reasons for concern?
Clinical Neurology and Neurosurgery 2007 Dec;109(10):922-5

http://www.ncbi.nlm.nih.gov/sites/e...ez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum

They take their training with regular MD's and then split off to focus on another area of medicine.

They certainly don’t do that here in the UK:

There are three institutions in the UK offering chiropractic courses. They offer either a BSc honours degree or a Diploma. Two of the institutions describe themselves as a "college of chiropractic", and the other, the University of Glamorgan, has seen fit to offer a BSc [Hons] Chiropractic amongst its degrees (interestingly listed under "health science").

The worth of a degree in a subject that cannot prove its basic tenet, the subluxation, seems rather dubious. The fact that an established university is prepared to offer such a degree may be a reflection of the cash-starved situation universities are in; however, it can only diminish the university's standing and reputation to so do.

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

In fact, the McTimoney Chiropractic course in the UK instructs its students in the following…

By correctly training the hands as an instrument of innate intelligence, healing can be encouraged to take place by the detection and correction of bony subluxations (slight displacements).

http://www.mctimoney-chiropractic.org/mca_objectives.htm

…which you’ll see is utter nonsense if you read the following article by Professor Edzard Ernst which was published in Expert Review of Neurotherapeutics last month:

...the early chiropractic literature provides ample evidence for the fact that chiropractic was not originally meant as a treatment for musculoskeletal problems, but as a cure for any human condition [1].

To understand this seemingly bizarre claim a little better, one should glance at the concepts that underlie chiropractic. Palmer was convinced that he had discovered a law of nature. In his view, all human illness and disease were caused by the blockage of the 'innate intelligence’ through vertebral malalignments or subluxations. Therefore, all conditions could and should be treated with adjustments of these abnormalities, in other words, spinal manipulation. This would restore the flow of the innate intelligence and, in turn, would cure whatever condition the patient was suffering from [1].

It seems obvious to any critical evaluator that these concepts are little more than fantasy: there is no evidence for any innate intelligence, and there is no reason to assume that adjusting malalignments of vertebra (if they at all exist) are the cause of disease or illness.

-snip-

In conclusion, spinal manipulation is based on questionable pathological concepts and therefore lacks biological plausibility [1]. Its risks may be considerable [4] and its benefits have not been convincingly demonstrated in rigorous trials [2]. What follows is sobering: the benefits of spinal manipulation do not seem worth the potential risks.

http://www.future-drugs.com/doi/full/10.1586/14737175.7.11.1451

 

[mayday]

You are saying surgery and surgical procedures pose no risk or adverse effects?

Do I need to start a list?

 

[Blue Wode]

You are saying surgery and surgical procedures pose no risk or adverse effects?

No, I’m not saying that at all.

Surgery and surgical procedures are usually performed when the benefits outweigh the risks. However the emerging evidence shows that the risks of chiropractic spinal manipulation for neck pain and back pain are unacceptable due to the availability of safer and cheaper options such as keeping active/exercising and taking paracetamol:

Spinal manipulation for neck pain is a treatment with unknown benefits and unknown harm. Because of this and the fact that serious risks are on record, a responsible risk–benefit assessment cannot ignore the risks and cannot come out in favour of spinal manipulation. Remember the supreme law in medicine: first do no harm. Other therapies for neck pain exist, e.g. exercise, which are supported by at least as good evidence for benefit and which are at the same time free of significant risks.The inescapable recommendation based on the best evidence available today is to use exercise rather than spinal manipulation as a treatment for neck pain.

See second part of this article:
http://www.medicinescomplete.com/journals/fact/current/fact0902a06d01.htm

[My bold]

And, once again, from the study published in last month’s Lancet…

Doubt cast on value of spinal manipulation and NSAIDS for acute back pain.

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

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

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

[My bold]

…and from the article published in last month's Expert Review of Neurotherapeutics:

In conclusion, spinal manipulation is based on questionable pathological concepts and therefore lacks biological plausibility [1]. Its risks may be considerable [4] and its benefits have not been convincingly demonstrated in rigorous trials [2]. What follows is sobering: the benefits of spinal manipulation do not seem worth the potential risks.

Spinal manipulation: are the benefits worth the risks?
http://www.future-drugs.com/doi/full/10.1586/14737175.7.11.1451

 

[JJM]

You are saying surgery and surgical procedures pose no risk or adverse effects? [A dumb, "straw man" argument. JJM]

Do I need to start a list?

It would not support chiropracty. However, with respect to chiro, can you supply a risk/benefit analysis list for it? I can get you started:

Neck-snap: risk of stroke exists / benefit no better than gentle massage. Therefore risk/benefit = risk/0. This is an unacceptably large number (division by zero) regardless of the possibly small (undetermined) number for the risk. "The good news is you are free of your headache today, the bad news is you will never walk again for the rest of your life. ... I sure hope you don't get another headache."

 

[mayday]

It would not support chiropracty. However, with respect to chiro, can you supply a risk/benefit analysis list for it? I can get you started:

Neck-snap: risk of stroke exists / benefit no better than gentle massage. Therefore risk/benefit = risk/0. This is an unacceptably large number (division by zero) regardless of the possibly small (undetermined) number for the risk. "The good news is you are free of your headache today, the bad news is you will never walk again for the rest of your life. ... I sure hope you don't get another headache."

I feel absolutely constrained if I can't pop my neck, back, etc....what a wonderful feeling it is. I'm more limber and relaxed after doing this.

The adverse reactions you speak of are not common.

 

[Frozenwolf150]

Ok I look pitiful. I am wearing a neck brace.

The reason? I recently underwent surgery to repair severely damaged vertebra.

So I am leaving the bank and this guy runs up to me and says:

"You should not be wearing that thing, you should come to me instead.
I''ll give you an adjustment and your pain with go away".

I let him have it with as much vermin as I could muster in such a public venue, He stood there like a deer in the headlights for a least a minute--- I did toss a Fbomb but only as he was rushing off...
-snip-

I am sure I went way passed skeptic and into the world of a cynic . Would you have done the same? What if Sylvia Browne hobbled up to you and tried to get you go come in for a sitting because your aura looked funky?

Well, let's think about this. A grown man, whom you do not know, walks up to you on the street and offers to touch you and put his hands on you because he thinks it will make you feel better. He also offers to do the same to your kids... Yeah, I think I would have done the same.

What exactly did you say to him? That would be interesting to hear.

 

[SRW]

Well, let's think about this. A grown man, whom you do not know, walks up to you on the street and offers to touch you and put his hands on you because he thinks it will make you feel better. He also offers to do the same to your kids... Yeah, I think I would have done the same.

What exactly did you say to him? That would be interesting to hear.

Unfortunately I lost my temper, and I do not recall exactly what I said. I know I said something about how, I would not be in this condition, if I had gone to a real doctor instead of a chiropractor. I do not think I was very eloquent, however I felt good about expressing my feeling about his profession to his face (and to the back of his head).

Of course, what I wish I had said is better than what I did say.

 

[Minarvia]

I feel absolutely constrained if I can't pop my neck, back, etc....what a wonderful feeling it is. I'm more limber and relaxed after doing this.

The adverse reactions you speak of are not common.

Then I am a little concerned for you. I hope you are healthy, as I am, in general. I do not have to pop my neck or back or anything else. I can't recall the last time I would have had to do so. Stretching is one thing, popping quite another.

I think I get your point about the adverse effects not being common, but how would you feel if they happened to you or a loved one? For every one of those horrible cases are many hurt and grieving people affected. Knowing the cases are uncommon would not comfort me if one day my mother suffered a stroke or paralysis or worse (I still get nervous at the fact she still occassionally sees a chiro).

 

[arthwollipot]

I pop my neck on a regular basis. I wish I didn't. I'm reasonably certain that this is the cause of the mild inflammation that I've been experiencing recently. I also crack my knuckles, and I wish I didn't. My ankles and knees sometimes crack spontaneously, and I wish they didn't.

I would have to grit my teeth and agree with mayday that it makes me feel less constricted, but I suffer under no illusions that it is actually doing me good - or even that it is not doing me harm. In fact, it makes me feel better in a very similar way that having a cigarette makes me feel better. Which as readers of Alan Carr know is not at all.

 

[Blue Wode]

I pop my neck on a regular basis. I wish I didn't. I'm reasonably certain that this is the cause of the mild inflammation that I've been experiencing recently. I also crack my knuckles, and I wish I didn't. My ankles and knees sometimes crack spontaneously, and I wish they didn't.

I would have to grit my teeth and agree with mayday that it makes me feel less constricted, but I suffer under no illusions that it is actually doing me good - or even that it is not doing me harm. In fact, it makes me feel better in a very similar way that having a cigarette makes me feel better. Which as readers of Alan Carr know is not at all.

Sounds similar to this…

Chiropractic Parlor Trick​

You can simulate this simple law of physics for yourself by moistening your lips, pressing them together and then separating them quickly. The sudden vacuum created inside your mouth makes a little popping sound. (This same acoustic principle is why you can make a clicking sound on the roof of your mouth with your tongue.)

Does making a sound by popping your lips or clicking your tongue have anything to do with healing or physical therapy? Could it have any medical purpose whatsoever? Or for that matter, does cracking your knuckles re-align your fingers?

No, of course not.

Here's what Dr. Badanes had to say:

Vertebral joints are synovial-type joints that "pop" when you "stretch" them... There is no evidence that cracking knuckles OR spines makes them "function" any better -- at least as "dysfunction" and "function" are variably defined by chiropractors from office to office. [3]​

Chiropractic manipulation may feel good, but it's entirely unnecessary and has nothing to do with re-aligning your spine. In fact, it can be harmful (and potentially dangerous) especially for someone with osteoporosis.

More…
http://www.rebuildyourback.com/chiropractic/manipulation.php

...all of which seems to be confirmed by the most up-to-date scientific data on the subject:

Collectively these data do not demonstrate that spinal manipulation is an effective intervention for any condition. Given the possibility of adverse effects, this review does not suggest that spinal manipulation is a recommendable treatment.

E Ernst, P H Canter. A systematic review of systematic reviews of spinal manipulation, J R Soc Med 2006;99:192-196
http://www.jrsm.org/cgi/content/full/99/4/192

 

[robinson]

There is hard scientific data that some Chiropractic methods work, and not just for back pain.

That still doesn't justify some Chiropractor approaching someone with a neck brace.

 

[SRW]

There is hard scientific data that some Chiropractic methods work, and not just for back pain.

So how do you know if the chiropractor you goto does the "Some" methods that work?

That still doesn't justify some Chiropractor approaching someone with a neck brace.

The term Ambulance chaser come to mind when I think of this.

 

[Blue Wode]

There is hard scientific data that some Chiropractic methods work

But are they any more effective than safer and cheaper options?

Spinal manipulation for neck pain is a treatment with unknown benefits and unknown harm. Because of this and the fact that serious risks are on record, a responsible risk–benefit assessment cannot ignore the risks and cannot come out in favour of spinal manipulation. Remember the supreme law in medicine: first do no harm. Other therapies for neck pain exist, e.g. exercise, which are supported by at least as good evidence for benefit and which are at the same time free of significant risks.The inescapable recommendation based on the best evidence available today is to use exercise rather than spinal manipulation as a treatment for neck pain.

See second part of this article:
http://www.medicinescomplete.com/journals/fact/current/fact0902a06d01.htm

[My bold]

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

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.

Adverse effects of spinal manipulation: a systematic review
http://www.jrsm.org/cgi/content/full/100/7/330

 

[Sefarst]

I'd rather just pop my own back. Much cheaper and easier.

My biggest question regarding chiropractic after whether or not it even works is how on earth Chiropractors are able to target individual vertebrae with their hands. Every Chiropractic video I've seen involves the Chiropractor looking at someone's back, declaring that a particular vertebrae is out of line, then pressing down real hard and popping the person's back. But more than one vertebrae is popped. So how would this be different than just asking someone else to pop your back? The same with the neck. When you jerk someone's neck to the side, that whole region of the spine twists, not just one individual vertebrae that might be "out of line."

Maybe a good test for the MDC would be to have ten people with back pain receive x-rays on their spines before and after a chiropractic adjustment. Then mix the x-rays up and have the Chiropractor select which x-rays were the pre-adjustment ones and which were the post adjustment ones.

 

[JJM]

There is hard scientific data that some Chiropractic methods work, and not just for back pain.

Why don't you reveal it to us.

 

[JJM]

{snip} Maybe a good test for the MDC would be to have ten people with back pain receive x-rays on their spines before and after a chiropractic adjustment. Then mix the x-rays up and have the Chiropractor select which x-rays were the pre-adjustment ones and which were the post adjustment ones.

Chiros have already failed the test of the "before" x-ray ("The Health Robbers" by Barrett and Jarvis) http://www.amazon.com/Health-Robber...=sr_1_1?ie=UTF8&s=books&qid=1198009158&sr=1-1
The "after" x-ray is moot. Chiros refuse to participate in rational tests, such as the one you suggest (for good reason).

 

[Sefarst]

Chiros have already failed the test of the "before" x-ray ("The Health Robbers" by Barrett and Jarvis) http://www.amazon.com/Health-Robber...=sr_1_1?ie=UTF8&s=books&qid=1198009158&sr=1-1
The "after" x-ray is moot. Chiros refuse to participate in rational tests, such as the one you suggest (for good reason).

The reviews of that book are painful.

 

[arthwollipot]

Sounds similar to this…

Not at all. The sounds that come from my knuckles when I crack them are definitely not coming from my mouth.

 

[Blue Wode]

Sounds similar to this...

Not at all. The sounds that come from my knuckles when I crack them are definitely not coming from my mouth.

If you click on the link I gave and read through it…

….it might interest you to know that the sound you hear when a chiropractor adjusts your back is not the sound of bones being re-aligned at all. What it is is nothing more than the sound of a temporary vacuum that is created whenever any joint is suddenly separated.

To put it in a slightly different perspective, it’s the same sound you hear whenever someone cracks their knuckles.

And - just as with knuckle cracking - the two bones will immediately return to the exact same position they were in prior to this little popping event. (At least you better hope they do because, if they don’t, you’re going to be in excruciating pain with a dislocated joint.)

But don't just take my word for it. Here's what former chiropractor, Dr. John Badanes had to say on the subject:

I stated that the "popping" of a joint doesn't signal any change in the "position" of that joint any more than "cracking" a knuckle does. [3]​

Chiropractic Parlor Trick​

You can simulate this simple law of physics for yourself by moistening your lips, pressing them together and then separating them quickly. The sudden vacuum created inside your mouth makes a little popping sound. (This same acoustic principle is why you can make a clicking sound on the roof of your mouth with your tongue.)

Does making a sound by popping your lips or clicking your tongue have anything to do with healing or physical therapy? Could it have any medical purpose whatsoever? Or for that matter, does cracking your knuckles re-align your fingers?

No, of course not.

Read on…

http://www.rebuildyourback.com/chiropractic/manipulation.php

[My bold]

 

[arthwollipot]

I see. Fair enough.