Chiropractic - the good, the bad and the ugly

[SphinxnihpS]

Originally posted by: DrPizza
How do you post this:

In their view, chiropractic treatment should be restricted to muscular-skeletal ailments, the only area in which <<it has been conclusively shown to have any net positive effect.

And then claim that *all* chiropractors are frauds? I'm happy that my chiropractor falls under this (treat muscular-skeletal) category. I went to the chiropractor due to constant headaches that originated in my neck. I had been in two car accidents in which I was rear ended. My doctor's treatment: tylenol, advil, or aspirin. Chiropractor: "hey, looks like your right hand must be tingling a lot too." - I didn't complain about that, or even mention it; instead ignored it. I thought of it as no different than my leg falling asleep when I sit wrong. Long story short, the headaches are gone, the tingling is gone.

whoa... 13 minute double post??!

Doesn't matter where he falls. Fuck people, get some education in physiology! Manipulating the air sacks in between your joints will not do anything to treat anything. Your skeletal-muscular system is NOT ADJUSTABLE. There is zero science behind chiropracty.

 

[eits]

Originally posted by: ja1484

Originally posted by: eits
"the way you stand/sit is putting lots of stress on your muscles" is way different than "thoracic spine erector myalgia associated with hypertonicity complicated by working". you can make a correlation (not a diagnosis) based on postural analysis and subjective findings.

The way you stand or sit puts a lot of stress on spinal erectors regardless of posture. They are, after all, some of the postural muscles supporting the spine. How have you ruled anything in or out? How do you know he doesn't have additional symptoms which may indicate a fracture? Supposedly his x-rays are normal, per his report? How do you know he doesn't have additional symptoms which may indicate radiculopathy or claudication? What if he posts a picture of textbook perfect posture in all positions?

You're still not getting it. You can guess at a correlation, at best.

And suppose you do give him an "educated correlation", and he decides to act upon it and hurts himself? Suppose he has some contraindication to your suggested modality or whatever you recommend he try for relief? Now he's worse off than before and tells the doc (or whomever he eventually seeks in-person care from) about he brief adventure with over-the-web photo-based chiropractic care.

the only problem is that i can't say that the way he stands or sits or whatever is causing stress because i don't have a picture... and i can't give a diagnosis because i haven't done any orthopedic tests or palpated or checked his motion segments or anything.

like i said, there's a big difference.

Maybe his sitting and standing don't affect his symptoms at all and are unrelated to his complaints. Suppose the "suggestion" you make doesn't help at all. Exactly where would you take this adventure at that point? Tell him to see someone in person who could do a proper examination and implement a plan of care? Exactly, which is what I'm saying he should do from square one, rather than wasting his time with a forum circus.

You honestly think this is a beneficial process?

How's that powerpoint presentation going?

no, it's not regardless of posture. the proper amount of stress on a spine during standing and sitting is normal. improper biomechanics or posture will cause more stress, which causes pain and could cause anatomical changes.

i haven't ruled anything in or out because I'M NOT DIAGNOSING!

i get the feeling that you're pretending to be stupid just to be annoying. just in case you're not, let me spell it out more clearly for you.

he complains of t4-5 pain. your body compensates for areas that are either unstable or fixated, in one way or another. if he has a hyperkyphotic posture or if he rounds his shoulders too anteriorly or if his shoulders are shrugged or anything else, it could have more to do with a muscle imbalance issue. the reason why his adjustments never stuck is PROBABLY because none of his chiropractors have given him exercises to do at home (bird-dogs, t4 mobilization, wall/floor angels, etc.). either way, his posture would be a big help in figuring out why his mid-thoracics are hurting. i could even ask him to do some active range of motions or active orthopedic exams and have him tell me whether something hurt or not, which would ALSO help in telling him what MIGHT be wrong.

i wouldn't be diagnosing, but i would be able to correlate based upon presentation and i'd be able to better direct him where to go and how to improve his adjustment outcomes.

as for contraindications, wtf are you talking about? what contraindications would he possibly have to doing bird-dogs or any other home exercise? i really think you're just trying to be stupid for the sake of being annoying.

 

[Joemonkey]

The only chrio i've been to was like a GP and PT rolled into one. He took a complete medical history, BP, temp, listened to my lungs, all that good stuff. I'd been to at least 4 other GPs and 2 PTs as well as weeks and weeks of PT @ 3 times a week, plus all kinds of NSAIDS and pain pills. You know what? None of the docs suggested an Xray, and none of the meds did much of anything.

This guy had an Xray machine in his office and immediately took an xray of my back to ensure it WASN'T skeletal. It proved there was nothing skeletal going on, so he treated me much like a PT would with a TENS type unit and a table that had a ball that rolled up and down my spine while I laid there.

He put me face down on the special table thingy, spent maybe 30 seconds "adjusting" me both times. After 2 visits my back issues were GONE, so far for 3 months, hopefully for good. I think the guy cured me, and all this talk about snake oil and quacks was what kept me going for some time. The issue is finding the RIGHT person for the job, just like ANY OTHER JOB.

 

[ja1484]

Originally posted by: eits

Originally posted by: ja1484

Originally posted by: eits
"the way you stand/sit is putting lots of stress on your muscles" is way different than "thoracic spine erector myalgia associated with hypertonicity complicated by working". you can make a correlation (not a diagnosis) based on postural analysis and subjective findings.

The way you stand or sit puts a lot of stress on spinal erectors regardless of posture. They are, after all, some of the postural muscles supporting the spine. How have you ruled anything in or out? How do you know he doesn't have additional symptoms which may indicate a fracture? Supposedly his x-rays are normal, per his report? How do you know he doesn't have additional symptoms which may indicate radiculopathy or claudication? What if he posts a picture of textbook perfect posture in all positions?

You're still not getting it. You can guess at a correlation, at best.

And suppose you do give him an "educated correlation", and he decides to act upon it and hurts himself? Suppose he has some contraindication to your suggested modality or whatever you recommend he try for relief? Now he's worse off than before and tells the doc (or whomever he eventually seeks in-person care from) about he brief adventure with over-the-web photo-based chiropractic care.

the only problem is that i can't say that the way he stands or sits or whatever is causing stress because i don't have a picture... and i can't give a diagnosis because i haven't done any orthopedic tests or palpated or checked his motion segments or anything.

like i said, there's a big difference.

Maybe his sitting and standing don't affect his symptoms at all and are unrelated to his complaints. Suppose the "suggestion" you make doesn't help at all. Exactly where would you take this adventure at that point? Tell him to see someone in person who could do a proper examination and implement a plan of care? Exactly, which is what I'm saying he should do from square one, rather than wasting his time with a forum circus.

You honestly think this is a beneficial process?

How's that powerpoint presentation going?

no, it's not regardless of posture. the proper amount of stress on a spine during standing and sitting is normal. improper biomechanics or posture will cause more stress, which causes pain and could cause anatomical changes.

You're reading it wrong. Again, it's elementary that changes in posture change the stresses. What I'm saying is that some level of stress is always there, and you can't determine stress levels by looking at a photograph of posture. Okay, so he's hyperkyphotic - now, is his pain due to muscle imbalance, tendonopathy, arthritic changes, radicular changes, facet joint dysfunction, disc derangement, segmental hypomobility, segmental hypermobility, or some other cause? And if you haven't determined the source, how do you plan to affect it?

i haven't ruled anything in or out because I'M NOT DIAGNOSING!

Then how do you intend to recommend anything of use to him?

he complains of t4-5 pain. your body compensates for areas that are either unstable or fixated, in one way or another. if he has a hyperkyphotic posture or if he rounds his shoulders too anteriorly or if his shoulders are shrugged or anything else, it could have more to do with a muscle imbalance issue. the reason why his adjustments never stuck is PROBABLY because none of his chiropractors have given him exercises to do at home (bird-dogs, t4 mobilization, wall/floor angels, etc.). either way, his posture would be a big help in figuring out why his mid-thoracics are hurting. i could even ask him to do some active range of motions or active orthopedic exams and have him tell me whether something hurt or not, which would ALSO help in telling him what MIGHT be wrong.

Good, you're finally starting to figure out that you don't have access to the information you need through this medium. You yourself are using "coulds", "woulds", and "maybes". Granted, orthopaedic treatment is always a game of probabilities, but in this case, your probabilities are very very poor due to lack of hands on evaluation and testing.

And you would have someone completely untrained self-examine (unsupervised mind you, meaning you have no way of knowing if the active range of motion is performed properly and without compensation) and report to you the results when they don't even know what to look for or how to interpret the findings? That's scary.

i wouldn't be diagnosing, but i would be able to correlate based upon presentation and i'd be able to better direct him where to go and how to improve his adjustment outcomes.

Yes, and correlation is not causation, again as anyone familiar with statistics knows. Correlation doesn't mean much if you're not addressing his complaint.

as for contraindications, wtf are you talking about? what contraindications would he possibly have to doing bird-dogs or any other home exercise? i really think you're just trying to be stupid for the sake of being annoying.

I don't know if he has any contraindications to treatment or not - and neither do you, which is why you're walking on thin ice.

I really hope you don't intend to practice this way.

 

[Pacemaker]

Originally posted by: SphinxnihpS

Originally posted by: DrPizza
How do you post this:

In their view, chiropractic treatment should be restricted to muscular-skeletal ailments, the only area in which <<<<it has been conclusively shown to have any net positive effect.

And then claim that *all* chiropractors are frauds? I'm happy that my chiropractor falls under this (treat muscular-skeletal) category. I went to the chiropractor due to constant headaches that originated in my neck. I had been in two car accidents in which I was rear ended. My doctor's treatment: tylenol, advil, or aspirin. Chiropractor: "hey, looks like your right hand must be tingling a lot too." - I didn't complain about that, or even mention it; instead ignored it. I thought of it as no different than my leg falling asleep when I sit wrong. Long story short, the headaches are gone, the tingling is gone.

whoa... 13 minute double post??!

Doesn't matter where he falls. Fuck people, get some education in physiology! Manipulating the air sacks in between your joints will not do anything to treat anything. Your skeletal-muscular system is NOT ADJUSTABLE. There is zero science behind chiropracty.

Even the OP who is anti-chiropractor said in regards to one type of chiropractors

in their view, chiropractic treatment should be restricted to muscular-skeletal ailments, the only area in which it has been conclusively shown to have any net positive effect.

So unless you have some form of evidence of what you said, I will treat it as something you made up.

 

[AMDZen]

I agree. Its a placebo for most people

 

[dman]

There are a lot of treatments for conditions that medical science doesn't understand, and they work. Skeptics might consider it placebo effect,but, because of the lack of controlled studies it's hard to say either way. If you think it's a joke, dont' go, but, wait until you have a condition that isn't treatable via traditional medicine and I bet most folks will give alterntive options a go.

 

[eits]

Originally posted by: SphinxnihpS

Originally posted by: DrPizza
How do you post this:

In their view, chiropractic treatment should be restricted to muscular-skeletal ailments, the only area in which <<<it has been conclusively shown to have any net positive effect.

And then claim that *all* chiropractors are frauds? I'm happy that my chiropractor falls under this (treat muscular-skeletal) category. I went to the chiropractor due to constant headaches that originated in my neck. I had been in two car accidents in which I was rear ended. My doctor's treatment: tylenol, advil, or aspirin. Chiropractor: "hey, looks like your right hand must be tingling a lot too." - I didn't complain about that, or even mention it; instead ignored it. I thought of it as no different than my leg falling asleep when I sit wrong. Long story short, the headaches are gone, the tingling is gone.

whoa... 13 minute double post??!

Doesn't matter where he falls. Fuck people, get some education in physiology! Manipulating the air sacks in between your joints will not do anything to treat anything. Your skeletal-muscular system is NOT ADJUSTABLE. There is zero science behind chiropracty.

absolutely true! adjusting a joint to relieve air pockets between synovial joints doesn't do much except relieve the tension on the spindle fibers and shut down the signals being sent to your brain that there needs to be relief at the area and the air needs to escape (i.e. cracking your knuckles). it doesn't really fix any problem other than relieving some pressure inside a joint.

it's just a good thing that chiropractic (not chiropracty... there's no such word) isn't about cracking the air out of synovial joints. if you think that's what chiropractors focus on doing, you're sorely mistaken.

you see, IF you got some education in physiology or chiropractic, you'd realize that when a chiropractor adjusts the spine, the "popping" is secondary to the goal of the adjustment. the goal is to get motion through a fixated or hypomobile joint segment or a vertebral disc. why? there are a few reasons:

- to remove the fixation, which causes hypermobility in another motion segment, which leads to degeneration
- to decrease pain by interrupting the neural signals to the brain
- putting motion through the disc in order for proper imbibition to occur to curb degenerative changes
- to release minute pressures on nerve roots which could be sending the improper signals or magnitude of a signal... the pressures cause an occlusion of the vessels supplying the nerves, which means that they don't get the proper nutrients necessary to conduct their impulses at 100% capacity
- to help move vertebrae into proper alignment to offset any kind of malformations due to wolfe's law or improper biomechanics, which could cause various pains and aches in the body and head

i could go on forever, but i wont... i think you get the idea...

 

[eits]

Originally posted by: Joemonkey
The only chrio i've been to was like a GP and PT rolled into one. He took a complete medical history, BP, temp, listened to my lungs, all that good stuff. I'd been to at least 4 other GPs and 2 PTs as well as weeks and weeks of PT @ 3 times a week, plus all kinds of NSAIDS and pain pills. You know what? None of the docs suggested an Xray, and none of the meds did much of anything.

This guy had an Xray machine in his office and immediately took an xray of my back to ensure it WASN'T skeletal. It proved there was nothing skeletal going on, so he treated me much like a PT would with a TENS type unit and a table that had a ball that rolled up and down my spine while I laid there.

He put me face down on the special table thingy, spent maybe 30 seconds "adjusting" me both times. After 2 visits my back issues were GONE, so far for 3 months, hopefully for good. I think the guy cured me, and all this talk about snake oil and quacks was what kept me going for some time. The issue is finding the RIGHT person for the job, just like ANY OTHER JOB.

exactly.

fyi, your chiro did what i do. is he relatively young?

 

[Joemonkey]

Originally posted by: eits

Originally posted by: Joemonkey
The only chrio i've been to was like a GP and PT rolled into one. He took a complete medical history, BP, temp, listened to my lungs, all that good stuff. I'd been to at least 4 other GPs and 2 PTs as well as weeks and weeks of PT @ 3 times a week, plus all kinds of NSAIDS and pain pills. You know what? None of the docs suggested an Xray, and none of the meds did much of anything.

This guy had an Xray machine in his office and immediately took an xray of my back to ensure it WASN'T skeletal. It proved there was nothing skeletal going on, so he treated me much like a PT would with a TENS type unit and a table that had a ball that rolled up and down my spine while I laid there.

He put me face down on the special table thingy, spent maybe 30 seconds "adjusting" me both times. After 2 visits my back issues were GONE, so far for 3 months, hopefully for good. I think the guy cured me, and all this talk about snake oil and quacks was what kept me going for some time. The issue is finding the RIGHT person for the job, just like ANY OTHER JOB.

exactly.

fyi, your chiro did what i do. is he relatively young?

He was 30ish i'd imagine, i didn't ask Only thing that kinda bothered me is that he looked like he weighed like 300lbs

 

[eits]

Originally posted by: ja1484

Originally posted by: eits

Originally posted by: ja1484

Originally posted by: eits
"the way you stand/sit is putting lots of stress on your muscles" is way different than "thoracic spine erector myalgia associated with hypertonicity complicated by working". you can make a correlation (not a diagnosis) based on postural analysis and subjective findings.

The way you stand or sit puts a lot of stress on spinal erectors regardless of posture. They are, after all, some of the postural muscles supporting the spine. How have you ruled anything in or out? How do you know he doesn't have additional symptoms which may indicate a fracture? Supposedly his x-rays are normal, per his report? How do you know he doesn't have additional symptoms which may indicate radiculopathy or claudication? What if he posts a picture of textbook perfect posture in all positions?

You're still not getting it. You can guess at a correlation, at best.

And suppose you do give him an "educated correlation", and he decides to act upon it and hurts himself? Suppose he has some contraindication to your suggested modality or whatever you recommend he try for relief? Now he's worse off than before and tells the doc (or whomever he eventually seeks in-person care from) about he brief adventure with over-the-web photo-based chiropractic care.

the only problem is that i can't say that the way he stands or sits or whatever is causing stress because i don't have a picture... and i can't give a diagnosis because i haven't done any orthopedic tests or palpated or checked his motion segments or anything.

like i said, there's a big difference.

Maybe his sitting and standing don't affect his symptoms at all and are unrelated to his complaints. Suppose the "suggestion" you make doesn't help at all. Exactly where would you take this adventure at that point? Tell him to see someone in person who could do a proper examination and implement a plan of care? Exactly, which is what I'm saying he should do from square one, rather than wasting his time with a forum circus.

You honestly think this is a beneficial process?

How's that powerpoint presentation going?

no, it's not regardless of posture. the proper amount of stress on a spine during standing and sitting is normal. improper biomechanics or posture will cause more stress, which causes pain and could cause anatomical changes.

You're reading it wrong. Again, it's elementary that changes in posture change the stresses. What I'm saying is that some level of stress is always there, and you can't determine stress levels by looking at a photograph of posture. Okay, so he's hyperkyphotic - now, is his pain due to muscle imbalance, tendonopathy, arthritic changes, radicular changes, facet joint dysfunction, disc derangement, segmental hypomobility, segmental hypermobility, or some other cause? And if you haven't determined the source, how do you plan to affect it?

i haven't ruled anything in or out because I'M NOT DIAGNOSING!

Then how do you intend to recommend anything of use to him?

he complains of t4-5 pain. your body compensates for areas that are either unstable or fixated, in one way or another. if he has a hyperkyphotic posture or if he rounds his shoulders too anteriorly or if his shoulders are shrugged or anything else, it could have more to do with a muscle imbalance issue. the reason why his adjustments never stuck is PROBABLY because none of his chiropractors have given him exercises to do at home (bird-dogs, t4 mobilization, wall/floor angels, etc.). either way, his posture would be a big help in figuring out why his mid-thoracics are hurting. i could even ask him to do some active range of motions or active orthopedic exams and have him tell me whether something hurt or not, which would ALSO help in telling him what MIGHT be wrong.

Good, you're finally starting to figure out that you don't have access to the information you need through this medium.

And you would have someone completely untrained self-examine (unsupervised mind you, meaning you have no way of knowing if the active range of motion is performed properly and without compensation) and report to you the results when they don't even know what to look for or how to interpret the findings? That's scary.

i wouldn't be diagnosing, but i would be able to correlate based upon presentation and i'd be able to better direct him where to go and how to improve his adjustment outcomes.

Yes, and correlation is not causation, again as anyone familiar with statistics knows. Correlation doesn't mean much if you're not addressing his complaint.

as for contraindications, wtf are you talking about? what contraindications would he possibly have to doing bird-dogs or any other home exercise? i really think you're just trying to be stupid for the sake of being annoying.

I don't know if he has any contraindications to treatment or not - and neither do you, which is why you're walking on thin ice.

I really hope you don't intend to practice this way.

what? i still need a picture in order to tell what his posture is like.

also, yeah, i'd have him do certain orthopedic exams by himself. why does he need to be supervised to do scheppelman's? what about t/s arom? sternal compression (press the spine of a book against your sternum)? slump test? etc. these are all things he can do on his own without supervision if you explain what to do and show pictures you can rip from google images.

jesus christ, you really aren't trying to act stupid, are you? you really are serious. that's scary.

as for your semantic issue about "correlation," it's a correlation that will be able to tell someone what might be the issue. if someone off the street tells me that he has generalized low back pain that wakes him up in the middle of the night and he's been a smoker for 30 years, then the correlation i make is that smoking is correlated with cancer and cancer is correlated with pain that causes patients to wake up in the middle of the night. am i going to diagnose that he has cancer? no. will i tell him that he might want to see his gp? absolutely.

that's how coming up with a differential works. you make correlations to lead you down the right path and then you follow through with trying to diagnose. i cannot diagnose anything on the guy, so i'll try to send him to someone who can and can treat him properly based on what i know hasn't worked in the past and what might work.

i'm not walking on thin ice telling the guy to try doing bird-dogs or breugger's for a week. that's the dumbest thing i've ever heard haha.

 

[eits]

Originally posted by: Joemonkey

Originally posted by: eits

Originally posted by: Joemonkey
The only chrio i've been to was like a GP and PT rolled into one. He took a complete medical history, BP, temp, listened to my lungs, all that good stuff. I'd been to at least 4 other GPs and 2 PTs as well as weeks and weeks of PT @ 3 times a week, plus all kinds of NSAIDS and pain pills. You know what? None of the docs suggested an Xray, and none of the meds did much of anything.

This guy had an Xray machine in his office and immediately took an xray of my back to ensure it WASN'T skeletal. It proved there was nothing skeletal going on, so he treated me much like a PT would with a TENS type unit and a table that had a ball that rolled up and down my spine while I laid there.

He put me face down on the special table thingy, spent maybe 30 seconds "adjusting" me both times. After 2 visits my back issues were GONE, so far for 3 months, hopefully for good. I think the guy cured me, and all this talk about snake oil and quacks was what kept me going for some time. The issue is finding the RIGHT person for the job, just like ANY OTHER JOB.

exactly.

fyi, your chiro did what i do. is he relatively young?

He was 30ish i'd imagine, i didn't ask Only thing that kinda bothered me is that he looked like he weighed like 300lbs

yeah, he's one of the newer wave of chiropractors, i'd imagine. the older chiropractors typically don't keep up with the times and regard medicine as the devil... it's pretty ridiculous and pisses me off because they give us a bad name. they make shit up like "forward head syndrome" or whatever in order to sound like they deserves their license...

and, yeah, it kinda irks me whenever i see extremely obese or smoker doctors... especially with chiropractic, you get a lot of fat people walking through your office and they have low back pain and it's all because they are carrying all this extra weight in front which causes muscle imbalances and skeletal changes in the spine... how is someone who's 300 lbs going to tell another person who's 300 lbs that he needs to lose weight with a straight face?

 

[ja1484]

Originally posted by: eits
what? i still need a picture in order to tell what his posture is like.

Much better to examine in person. People tend to pose for pictures, even unintentionally, which means you get inaccurate information.

also, yeah, i'd have him do certain orthopedic exams by himself. why does he need to be supervised to do scheppelman's? what about t/s arom? sternal compression (press the spine of a book against your sternum)? slump test? etc. these are all things he can do on his own without supervision if you explain what to do and show pictures you can rip from google images.

jesus christ, you really aren't trying to act stupid, are you? you really are serious. that's scary.

You think he'd do thoracic spine AROM without compensation from the lumbar and/or cervical regions? You think he'd be able to properly provoke the slump test being someone with no (for all we know) orthopaedic knowledge?

You do realize that having someone self-compress their sternum using the method you describe completely confounds your results because the scapular retractors come into play as a stabilizer as the person attempts to put pressure on their sternum, thus potentially aggravating a muscular issue during a test for a skeletal problem in the same general region?

You're suggesting an untrained individual perform orthopaedic tests on themselves, unsupervised, and I'm scary? Are you missing a brain lobe?

as for your semantic issue about "correlation," it's a correlation that will be able to tell someone what might be the issue. if someone off the street tells me that he has generalized low back pain that wakes him up in the middle of the night and he's been a smoker for 30 years, then the correlation i make is that smoking is correlated with cancer and cancer is correlated with pain that causes patients to wake up in the middle of the night. am i going to diagnose that he has cancer? no. will i tell him that he might want to see his gp? absolutely.

It COULD, MIGHT, WOULD, MAY be a lot of things. It could be fucking evil spirits. The point is, over the internet, you will never be able to properly address or assess it, and thinking you can is dangerous, ill-advised thinking. The far better solution is the one you eventually arrive at in the end - send him to his family doc.

that's how coming up with a differential works. you make correlations to lead you down the right path and then you follow through with trying to diagnose. i cannot diagnose anything on the guy, so i'll try to send him to someone who can and can treat him properly based on what i know hasn't worked in the past and what might work.

You're finally starting to talk sense. You admit you can't diagnose, what I've been trying to tell you all along. You admit you need to send him to someone for proper care in person, what I've been trying to tell you all along.

That's cute, how you try to play off those ideas like you thought of them yourself.

And you might want to be more complete with your answer regarding differential diagnoses. You *should* know as well as I do that a differential diagnosis cannot be made based on one test, observation, or piece of history by itself (for example, looking at a photo over the internet). You need multiple concomitant findings implicating the same problem - at that point, the odds begin to work in your favor rather than against you.

That's why there's so much of an emphasis in the research right now on likelihood ratios and clinical prediction rules.

i'm not walking on thin ice telling the guy to try doing bird-dogs or breugger's for a week. that's the dumbest thing i've ever heard haha.

Really? If you represent yourself as a chiropractor (or even worse, are one already) and provide treatment advice based on a couple tidbits over a web message forum, you've just prescribed treatment without evaluation. A reach? Cases have been lost with worse.

Granted, it's highly unlikely in this situation that anything will come of it. I'm just trying to help you realize how people outside the profession would view what you're doing so you can preserve your image as a practitioner.

But, by all means, if you don't want the help, if you want to "practice" in poor form by handing out advice based on incomplete information over the web, be my guest. Doesn't affect me - just you and the poor sap who might follow your advice.

 

[eits]

Originally posted by: ja1484

Originally posted by: eits
what? i still need a picture in order to tell what his posture is like.

Much better to examine in person. People tend to pose for pictures, even unintentionally, which means you get inaccurate information.

also, yeah, i'd have him do certain orthopedic exams by himself. why does he need to be supervised to do scheppelman's? what about t/s arom? sternal compression (press the spine of a book against your sternum)? slump test? etc. these are all things he can do on his own without supervision if you explain what to do and show pictures you can rip from google images.

jesus christ, you really aren't trying to act stupid, are you? you really are serious. that's scary.

You think he'd do thoracic spine AROM without compensation from the lumbar and/or cervical regions? You think he'd be able to properly provoke the slump test being someone with no (for all we know) orthopaedic knowledge?

You do realize that having someone self-compress their sternum using the method you describe completely confounds your results because the scapular retractors come into play as a stabilizer as the person attempts to put pressure on their sternum, thus potentially aggravating a muscular issue during a test for a skeletal problem in the same general region?

You're suggesting an untrained individual perform orthopaedic tests on themselves, unsupervised, and I'm scary? Are you missing a brain lobe?

as for your semantic issue about "correlation," it's a correlation that will be able to tell someone what might be the issue. if someone off the street tells me that he has generalized low back pain that wakes him up in the middle of the night and he's been a smoker for 30 years, then the correlation i make is that smoking is correlated with cancer and cancer is correlated with pain that causes patients to wake up in the middle of the night. am i going to diagnose that he has cancer? no. will i tell him that he might want to see his gp? absolutely.

It COULD, MIGHT, WOULD, MAY be a lot of things. It could be fucking evil spirits. The point is, over the internet, you will never be able to properly address or assess it, and thinking you can is dangerous, ill-advised thinking. The far better solution is the one you eventually arrive at in the end - send him to his family doc.

that's how coming up with a differential works. you make correlations to lead you down the right path and then you follow through with trying to diagnose. i cannot diagnose anything on the guy, so i'll try to send him to someone who can and can treat him properly based on what i know hasn't worked in the past and what might work.

You're finally starting to talk sense. You admit you can't diagnose, what I've been trying to tell you all along. You admit you need to send him to someone for proper care in person, what I've been trying to tell you all along.

That's cute, how you try to play off those ideas like you thought of them yourself.

And you might want to be more complete with your answer regarding differential diagnoses. You *should* know as well as I do that a differential diagnosis cannot be made based on one test, observation, or piece of history by itself (for example, looking at a photo over the internet). You need multiple concomitant findings implicating the same problem - at that point, the odds begin to work in your favor rather than against you.

That's why there's so much of an emphasis in the research right now on likelihood ratios and clinical prediction rules.

i'm not walking on thin ice telling the guy to try doing bird-dogs or breugger's for a week. that's the dumbest thing i've ever heard haha.

Really? If you represent yourself as a chiropractor (or even worse, are one already) and provide treatment advice based on a couple tidbits over a web message forum, you've just prescribed treatment without evaluation. A reach? Cases have been lost with worse.

Granted, it's highly unlikely in this situation that anything will come of it. I'm just trying to help you realize how people outside the profession would view what you're doing so you can preserve your image as a practitioner.

But, by all means, if you don't want the help, if you want to "practice" in poor form by handing out advice based on incomplete information over the web, be my guest. Doesn't affect me - just you and the poor sap who might follow your advice.

look douchebag, i've said from the get-go i'm not trying to diagnose anything. i'm trying to answer his goddamn question. i've been talking sense the entire time, you dumbass.

he doesn't have to be trained in order to look up at a 45 degree angle over his right or left shoulder (maximum foraminal compression). he doesn't have to be trained in order to cough, sneeze, or bear down. these are simple fucking things people can do on their own. it's not like i'm asking him to do kemp's or scapular approximation or shoulder depression or straight leg raise or anything... those are passive exams that someone trained should do.

also, sternal compression has nothing to do with scapular motion. any scapular or pectoral contractions wouldn't negate a fractured rib head. compressing on the sternum to find a rib fracture is not dependent on whether or not you're using upper body muscles.

don't nitpick about the postural analysis pic either... you can tell if someone is straightening up for the camera or not. if you see it, you ask and tell him to do it again, but to just stand as he normally would. 9 times out of 10, people will do that because they really want to know what's wrong with them and will stop lying to themselves about their posture enough for you to examine and give them an informed and educated answer.

differential diagnosis starts at the moment you hear the chief complaint... after that, you build and eliminate as you go along. it's not like i was just going to look at a picture and say, "here's where the problem is. the end."

i haven't prescribed treatment whatsoever. suggesting to him to try doing breugger's exercises or bird-dogs is like telling someone to drink a glass of water. it's something that's good to do, regardless. if it helps, great... he should tell the next chiropractor he sees. if not, great... he should still tell the next chiropractor he sees. regardless, it will help them with his diagnosis.

like i said countless times, i'm not trying to diagnose a damn thing in these (or any other) forums... i never have and never will. the closest i'll ever come is to say something along the lines of, "hmm... it kinda sounds like you have __________. you might wanna go see a _____________." various atot members can attest to that, whether it was a conversation through a thread or in pm.

you can think whatever you want about my validity as a practitioner. the fact of the matter is that if i can help someone figure out what's wrong with them over a forum, i will.

 

[ja1484]

Originally posted by: eits
he doesn't have to be trained in order to look up at a 45 degree angle over his right or left shoulder (maximum foraminal compression). he doesn't have to be trained in order to cough, sneeze, or bear down. these are simple fucking things people can do on their own. it's not like i'm asking him to do kemp's or scapular approximation or shoulder depression or straight leg raise or anything... those are passive exams that someone trained should do.

Again, not the issue. He may or may not perform them correctly, and you have no way of determining which he happens to do. That's the problem here.

also, sternal compression has nothing to do with scapular motion. any scapular or pectoral contractions wouldn't negate a fractured rib head. compressing on the sternum to find a rib fracture is not dependent on whether or not you're using upper body muscles.

A fractured rib head, no, but what about other dysfucntion? Suppose you reproduce his pain using this "self sternal compression" with a book. In order to press that book into his own sternum, he's going to have to pull it backwards with his arms. Lots of musculature is going to come into play, not the least of which being the scapular retractors.

So now you've reproduced his symptom, but is it because of a rib fracture, a costo-vertebral dysfunction, or a contractile tissue source? You don't know, because you've confounded the test by having the patient perform it on himself. That's why the test is described as being performed by the practitioner and not the patient. There's a reason for it.

Notwithstanding on top of all this that the clinical accuracy of special tests is horrible, but that's another thread.

don't nitpick about the postural analysis pic either... you can tell if someone is straightening up for the camera or not. if you see it, you ask and tell him to do it again, but to just stand as he normally would. 9 times out of 10, people will do that because they really want to know what's wrong with them and will stop lying to themselves about their posture enough for you to examine and give them an informed and educated answer.

Oh it can be a useful tool, but I'd still much rather walk my patient in from the waiting room and observe their posture, gait, etc. at those times, when they don't even know it's being evaluated.

differential diagnosis starts at the moment you hear the chief complaint... after that, you build and eliminate as you go along. it's not like i was just going to look at a picture and say, "here's where the problem is. the end."

I've asked it about 5 times already, but I'll ask it again: Exactly how were you going to gather further accurate information without getting hands on with the patient?

i haven't prescribed treatment whatsoever. suggesting to him to try doing breugger's exercises or bird-dogs is like telling someone to drink a glass of water. it's something that's good to do, regardless. if it helps, great... he should tell the next chiropractor he sees. if not, great... he should still tell the next chiropractor he sees. regardless, it will help them with his diagnosis.

So essentially you're going to throw some shit at the wall and see what sticks?

I ask again: Why waste the time? Send him to someone who can fully treat his complaint.

like i said countless times, i'm not trying to diagnose a damn thing in these (or any other) forums... i never have and never will. the closest i'll ever come is to say something along the lines of, "hmm... it kinda sounds like you have __________. you might wanna go see a _____________." various atot members can attest to that, whether it was a conversation through a thread or in pm.

You don't even need the first half of that exchange. You can just roll with "You might want to go see a _________." Everyone, including yourself, would likely be better off.

 

[TraumaRN]

Originally posted by: AMDZen
I agree. Its a placebo for most people

I disagree with you.

I'd had occasional chronic hip pain since I injured my hip when I was 16. I've tried a couple different chiros. The one I use right is not the quack type. He took an xray, told me my hip was out of alignment, about 3 minutes on the adjustment table and my pain goes away within a day. The pain doesn't return for 3-6 months. I'm pretty sure thats not placebo and every medical doctor I've seen just tells me to change my posture/take pills. The orthopedic docs I've seen tell me to see a chiropractor.

*shrug* YMMV

 

[eits]

Originally posted by: ja1484

Originally posted by: eits
he doesn't have to be trained in order to look up at a 45 degree angle over his right or left shoulder (maximum foraminal compression). he doesn't have to be trained in order to cough, sneeze, or bear down. these are simple fucking things people can do on their own. it's not like i'm asking him to do kemp's or scapular approximation or shoulder depression or straight leg raise or anything... those are passive exams that someone trained should do.

Again, not the issue. He may or may not perform them correctly, and you have no way of determining which he happens to do. That's the problem here.

also, sternal compression has nothing to do with scapular motion. any scapular or pectoral contractions wouldn't negate a fractured rib head. compressing on the sternum to find a rib fracture is not dependent on whether or not you're using upper body muscles.

A fractured rib head, no, but what about other dysfucntion? Suppose you reproduce his pain using this "self sternal compression" with a book. In order to press that book into his own sternum, he's going to have to pull it backwards with his arms. Lots of musculature is going to come into play, not the least of which being the scapular retractors.

So now you've reproduced his symptom, but is it because of a rib fracture, a costo-vertebral dysfunction, or a contractile tissue source? You don't know, because you've confounded the test by having the patient perform it on himself. That's why the test is described as being performed by the practitioner and not the patient. There's a reason for it.

Notwithstanding on top of all this that the clinical accuracy of special tests is horrible, but that's another thread.

don't nitpick about the postural analysis pic either... you can tell if someone is straightening up for the camera or not. if you see it, you ask and tell him to do it again, but to just stand as he normally would. 9 times out of 10, people will do that because they really want to know what's wrong with them and will stop lying to themselves about their posture enough for you to examine and give them an informed and educated answer.

Oh it can be a useful tool, but I'd still much rather walk my patient in from the waiting room and observe their posture, gait, etc. at those times, when they don't even know it's being evaluated.

differential diagnosis starts at the moment you hear the chief complaint... after that, you build and eliminate as you go along. it's not like i was just going to look at a picture and say, "here's where the problem is. the end."

I've asked it about 5 times already, but I'll ask it again: Exactly how were you going to gather further accurate information without getting hands on with the patient?

i haven't prescribed treatment whatsoever. suggesting to him to try doing breugger's exercises or bird-dogs is like telling someone to drink a glass of water. it's something that's good to do, regardless. if it helps, great... he should tell the next chiropractor he sees. if not, great... he should still tell the next chiropractor he sees. regardless, it will help them with his diagnosis.

So essentially you're going to throw some shit at the wall and see what sticks?

I ask again: Why waste the time? Send him to someone who can fully treat his complaint.

like i said countless times, i'm not trying to diagnose a damn thing in these (or any other) forums... i never have and never will. the closest i'll ever come is to say something along the lines of, "hmm... it kinda sounds like you have __________. you might wanna go see a _____________." various atot members can attest to that, whether it was a conversation through a thread or in pm.

You don't even need the first half of that exchange. You can just roll with "You might want to go see a _________." Everyone, including yourself, would likely be better off.

*sigh*

i'm not sure who's more dumb... you for not understanding that i'm not trying to diagnose or make the forums my own personal exam room or me for replying to your idiocy. how many times do i have to tell you that i'm not trying to diagnose?

i'm done with you.

 

[Aimster]

eits went to school and as far as I know he is a chiropractor. With that said.. why the f are you all arguing with him? You don't just sign up to go to chiropractor school you know. 99% of you wouldn't even qualify to get in.

you make it sound as if it is a joke. I guess they just make paper airplanes there all day.

 

[So]

Originally posted by: Aimster
eits went to school and as far as I know he is a chiropractor. With that said.. why the f are you all arguing with him? You don't just sign up to go to chiropractor school you know. 99% of you wouldn't even qualify to get in.

you make it sound as if it is a joke. I guess they just make paper airplanes there all day.

I take it, reading the OP was just plain too much work for you then? I mean, I know the cliffs were really long and all, so I totally understand you responding without having read more than the first sentence of one post.

 

[OutHouse]

Originally posted by: GodlessAstronomer

Originally posted by: DrPizza
How do you post this:

In their view, chiropractic treatment should be restricted to muscular-skeletal ailments, the only area in which <<<it has been conclusively shown to have any net positive effect.

And then claim that *all* chiropractors are frauds? I'm happy that my chiropractor falls under this (treat muscular-skeletal) category. I went to the chiropractor due to constant headaches that originated in my neck. I had been in two car accidents in which I was rear ended. My doctor's treatment: tylenol, advil, or aspirin. Chiropractor: "hey, looks like your right hand must be tingling a lot too." - I didn't complain about that, or even mention it; instead ignored it. I thought of it as no different than my leg falling asleep when I sit wrong. Long story short, the headaches are gone, the tingling is gone.

whoa... 13 minute double post??!

Well my point is that muscular-skeletal manipulation is not chiropractic and any physical therapist can administer it. The problem is that in general, the chiropractor has not been trained to the extent of a proper MD in both diagnosis and administration of treatment. DrPizza, I respect you more than almost anyone on this forum and I don't doubt what you're saying, but you know more than anyone that your anecdotal evidence doesn't carry a lot of weight.

there is a difference between a Chiro and a PT. a PT can not practice chrio because they are not licensed to do so and it would be out of their scope of practice. get your facts straight.

 

[Aimster]

Originally posted by: So

Originally posted by: Aimster
eits went to school and as far as I know he is a chiropractor. With that said.. why the f are you all arguing with him? You don't just sign up to go to chiropractor school you know. 99% of you wouldn't even qualify to get in.

you make it sound as if it is a joke. I guess they just make paper airplanes there all day.

I take it, reading the OP was just plain too much work for you then? I mean, I know the cliffs were really long and all, so I totally understand you responding without having read more than the first sentence of one post.

I read enough.

I read people telling a chiropractor how to do his job.

Those people are freaking idiots

 

[SunnyD]

I'd like to say that there is a observable basis for bloodletting...

By removing blood from the system you also remove blood-borne pathogens and toxins from the system. By letting you are at least hopefully trying to reduce the amount of pathogen/toxin in the system in order to bolster the immune response or filtering (less toxin/pathogen, the more effective right?). After all, the body is going to (eventually) replace the tainted blood that was let with fresh blood as it is produced right?

Unfortunately it never really works out that way, since not all ailments are blood-borne. That and by letting you actually lessen the immune response (since it itself is blood-borne mostly), or run the risk of exsanguination. Hence the procedure is pretty much more harmful than any net gain that could be made.

With that said, I believe in cheese. Behold the power of cheese! Aside from being lactose intolerant...

 

[DangerAardvark]

Originally posted by: CycloWizard

Originally posted by: DangerAardvark
You're right. Facts have a profound bias toward reality. What, specifically, do you take issue with in the OP? Or is this just a general whinge?

What "facts" have you or the OP presented? None. There are abundant references in the literature, many of them recent, discussing the efficacy of accupuncture in particular. Anyone who knows how to do a simple literature search can easily identify them and read the free abstracts online. As someone who does medical research, I take issue with the propagation of ignorance, the derision cast upon those who might be as or more knowledgeable simply for disagreeing, and the spread of misinformation.

As for osteopathy, let's start with this: "[I can] shake a child and stop scarlet fever, croup, diphtheria, and cure whooping cough in three days by a wring of its neck". Guess who said that? Andrew Taylor St- waaaait a minute... that's the guy you're reading about!

Obviously you're unaware of the state of medicine back in 1874. The other major events listed in my book surrounding the founding of osteopathy are:

1865: Claude Bernard's Introduction a l'Etude de la Medicine Experimental is instrumental in establishing medicine as a cience with observation, hypothesis, and experimentation.

1874: Andrew Still discovers that dislocations of the vertebrae are a source of disease, founding osteopathy.

1876: Robert Koch demonstrates that bacilli are the cause of anthrax, the first linkage of a disease with a specific microorganism.

It's a joke to say that Still was behind the times or some quack because he thought he could treat people by fixing perceived problems with their spinal columns in an era where scientific medicine was in its infancy. Indeed, it appears that he was rather forward thinking for his time, even if he was woefully wrong in the scope of efficacy of his proposed treatments. That one line is the only mention of him in this book, yet by its inclusion, it means the founding of osteopathy was one of about 100 events in the history of medicine that warranted inclusion in every reference used by Murray in preparing his list. Thus, while you might not feel that it's important, people who spend their lives studying this sort of thing obviously do.

You're still dancing around the question of what, specifically is factually incorrect about the OP. But never mind that. All we need to know about Chiropractic is that the theory that spinal subluxation is the predominant cause of disease- the idea that underpins Chiropractic treatment, IS FICTION.

And insofar as Chiropractic is effective, it is in the area of the field where it overlaps with the physiotherapy and orthopedics. Sort of like how Reflexology is also a foot massage. Or how Homeopathic medecine doubles as a medium in which to mix Kool-Aid. I don't know about you, but foot masssages make me feel better.

Just a quick Google of chiropractors in my area brings up practitioners advocating accupuncture, spinal treatment for ADD, bed wetting, carpal tunnel, allergies and even weight loss. Talk of vertebral subluxation is rampant. Many advocate holistic (that's Latin for bullshit) philosophies of health. I even found a dude who practices within a mile of me (I just picked him randomly) who graduated from a "straight" (a.k.a the assholes) college and practices the "Kiso" method... that's right, "Ki", as in "life energy". He even calls himself "doctor". Now what are the odds that if I call this "doctor" with a complaint of chest pain, or bowel distress, or some other kind of symptom that is clearly outside the proven purview of Chiropractic, that he would treat me? Oh wait, someone already did this. Seems like a fun experiment.

But hey, if you're one of the extreme minority of Chiropractors practicing 100% science-based medicine, more power to you. But let's not pretend that you represent the field as a whole.

 

[foghorn67]

Originally posted by: DangerAardvark

Originally posted by: CycloWizard

Originally posted by: DangerAardvark
You're right. Facts have a profound bias toward reality. What, specifically, do you take issue with in the OP? Or is this just a general whinge?

What "facts" have you or the OP presented? None. There are abundant references in the literature, many of them recent, discussing the efficacy of accupuncture in particular. Anyone who knows how to do a simple literature search can easily identify them and read the free abstracts online. As someone who does medical research, I take issue with the propagation of ignorance, the derision cast upon those who might be as or more knowledgeable simply for disagreeing, and the spread of misinformation.

As for osteopathy, let's start with this: "[I can] shake a child and stop scarlet fever, croup, diphtheria, and cure whooping cough in three days by a wring of its neck". Guess who said that? Andrew Taylor St- waaaait a minute... that's the guy you're reading about!

Obviously you're unaware of the state of medicine back in 1874. The other major events listed in my book surrounding the founding of osteopathy are:

1865: Claude Bernard's Introduction a l'Etude de la Medicine Experimental is instrumental in establishing medicine as a cience with observation, hypothesis, and experimentation.

1874: Andrew Still discovers that dislocations of the vertebrae are a source of disease, founding osteopathy.

1876: Robert Koch demonstrates that bacilli are the cause of anthrax, the first linkage of a disease with a specific microorganism.

It's a joke to say that Still was behind the times or some quack because he thought he could treat people by fixing perceived problems with their spinal columns in an era where scientific medicine was in its infancy. Indeed, it appears that he was rather forward thinking for his time, even if he was woefully wrong in the scope of efficacy of his proposed treatments. That one line is the only mention of him in this book, yet by its inclusion, it means the founding of osteopathy was one of about 100 events in the history of medicine that warranted inclusion in every reference used by Murray in preparing his list. Thus, while you might not feel that it's important, people who spend their lives studying this sort of thing obviously do.

You're still dancing around the question of what, specifically is factually incorrect about the OP. But never mind that. All we need to know about Chiropractic is that the theory that spinal subluxation is the predominant cause of disease- the idea that underpins Chiropractic treatment, IS FICTION.

And insofar as Chiropractic is effective, it is in the area of the field where it overlaps with the physiotherapy and orthopedics. Sort of like how Reflexology is also a foot massage. Or how Homeopathic medecine doubles as a medium in which to mix Kool-Aid. I don't know about you, but foot masssages make me feel better.

Just a quick Google of chiropractors in my area brings up practitioners advocating accupuncture, spinal treatment for ADD, bed wetting, carpal tunnel, allergies and even weight loss. Talk of vertebral subluxation is rampant. Many advocate holistic (that's Latin for bullshit) philosophies of health. I even found a dude who practices within a mile of me (I just picked him randomly) who graduated from a "straight" (a.k.a the assholes) college and practices the "Kiso" method... that's right, "Ki", as in "life energy". He even calls himself "doctor". Now what are the odds that if I call this "doctor" with a complaint of chest pain, or bowel distress, or some other kind of symptom that is clearly outside the proven purview of Chiropractic, that he would treat me? Oh wait, someone already did this. Seems like a fun experiment.

But hey, if you're one of the extreme minority of Chiropractors practicing 100% science-based medicine, more power to you. But let's not pretend that you represent the field as a whole.

Have you narrowed your search to Chiropracters that surround hospital campuses or medical plazas? I don't have a need for one, but I know many that swear by them that don't get accupuncture, spiritual crystal rubbings are what not. And those chirocrackers don't peddle those. They probably keep close to those areas because they get referrals from orthopedic surgeons, PT's, etc.
I find many of the snake oil guys are scattered throughout low rent strip malls.
This could be a regional thing.

 

[Turin39789]

meh, move the chiro education into med school, and licensing and review processes should be similar. Practices should be based on peer reviewed scientific studies. Across the board, for anyone wanting to practice chiro. Until then, then industry is not reformed.