Can someone explain to me....

SDN Members don't see this ad. (About Ads)

On the ad hominem issue, I didn't bring up your stage of training to insult you. I was simply noting that until you have seen enough back pain cases, for example, you may have an idealised version of things in your mind. But on the flipside and in fairness, when you've seen enough of these cases as a chiropractor, you learn that meds have their place. Fair enough.

The "loyal base" comment I made earlier was in response to a post that was blatantly wrong regarding the influence of the chiro profession (on SDN?? No, can't be. ). Chiros don't have a "loyal base" because of mass media campaigns or legislative influence or any such thing. We've proven helpful to patients for many years.

For clarity, do you or do you not believe chiropractors (on the whole, since there are always the bad apples) help their patients?

Originally Posted by facetguy

On the ad hominem issue, I didn't bring up your stage of training to insult you. I was simply noting that until you have seen enough back pain cases, for example, you may have an idealised version of things in your mind. But on the flipside and in fairness, when you've seen enough of these cases as a chiropractor, you learn that meds have their place. Fair enough.

The "loyal base" comment I made earlier was in response to a post that was blatantly wrong regarding the influence of the chiro profession (on SDN?? No, can't be. ). Chiros don't have a "loyal base" because of mass media campaigns or legislative influence or any such thing. We've proven helpful to patients for many years.

For clarity, do you or do you not believe chiropractors (on the whole, since there are always the bad apples) help their patients?

I assumed you (like many here) wouldn't understand that. An ad hominem is not an insult. Being insulted has nothing to do with it. It is an argument that attempts to invalidate another's argument using an unrelated quality of the argument's maker. You did not address my argument but rather implied I couldn't make a valid argument because of my level of training. As defined, this is ad hominem.

This is a pet peeve of mine. This site is full of people who misuse the term. Believe you me, I don't feel insulted by anything you say


And I think chiropractors help some patients but are ill equipped to accurately or reliably select patients who will be benefitted. See the "man with hammer" example from earlier.

Originally Posted by SpecterGT260

in a proverbial sense, you are the guy who whacks his broken TV with a hammer and it works again. Some people have had success stories. Some have not. Many simply had nothing wrong with them and go in because it is either in style or their friend convinced them that it was a good thing to do. Your treatment modalities do not really vary with the individual condition and the "diagnostics" is almost entirely absent. The chiropractors who limit their practice to LBP I can deal with. But far too many of you guys treat chiropractics as a medical swiss army knife and act like you can treat everything by popping the same joints for 8 hours a day. I would also argue that chiropractic is no more curative for LBP than NSAIDs. It may feel good for a bit, but when this guy goes back home to slouch on his couch all day with his big mac, I wonder how long it takes before the pain returns. PT would be a much better option for this guy, but hell, that involves him actually working and heaven forbid you ask an american pain patient to put any effort into solving their condition

Originally Posted by SpecterGT260

I assumed you (like many here) wouldn't understand that. An ad hominem is not an insult. Being insulted has nothing to do with it. It is an argument that attempts to invalidate another's argument using an unrelated quality of the argument's maker. You did not address my argument but rather implied I couldn't make a valid argument because of my level of training. As defined, this is ad hominem.

This is a pet peeve of mine. This site is full of people who misuse the term. Believe you me, I don't feel insulted by anything you say


And I think chiropractors help some patients but are ill equipped to accurately or reliably select patients who will be benefitted. See the "man with hammer" example from earlier.

Ad hominem or not, I am convinced that your relative lack of experience/training/exposure causes you to think that medicine is a more exact science than it actually is, especially as it relates to the spine (but also in plenty of other areas as well). Medications are prescribed; sometimes they work, sometimes they don't, often they cause adverse effects. Sort of like whacking a TV with a hammer, as you'd say. Spines get operated on; sometimes things go well, sometimes they don't. And let's not forget pain management, who I respect and to whom I refer patients; I guess you've never seen a patient get an epidural, which doesn't work so they get left-sided facet joint injections, which doesn't work so they get right-sided facet joint injections, which doesn't work so they get trigger point injections, which doesn't work so they get SI joint injections. If that ain't whacking a TV with a hammer, I don't know what is. Sure, it's high-tech whacking, and yes it's very lucrative, but you see my point. You exist in an idealised world at the moment, which makes it easy to throw stones. Give it some time and (if your honest) you'll see what I'm talking about.

Stop making assumptions about me. You validate your opinions by assuming I fit your claims and you are simply wrong. Citing a number of specific conditions does nothing to change this. I don't think medicine is an exact science but this fact does not make it appropriate to be less exact and less evidence based.

Originally Posted by SpecterGT260

Stop making assumptions about me. You validate your opinions by assuming I fit your claims and you are simply wrong. Citing a number of specific conditions does nothing to change this. I don't think medicine is an exact science but this fact does not make it appropriate to be less exact and less evidence based.

Ha! That's a laugh. Have you noticed that that's your approach to me? You repeatedly assert that I do this and I believe that and I don't know the other thing, all simply because I have a DC behind my name?

Originally Posted by facetguy

Ha! That's a laugh. Have you noticed that that's your approach to me? You repeatedly assert that I do this and I believe that and I don't know the other thing, all simply because I have a DC behind my name?

No. I do not. I am speaking to my experience with chiropractors as a whole. Things I've seen advertised, things I've garnered from face to face conversations, things they have said to my friends and family. In fact, many times I have said that "just because you [facetguy] don't fit this mold doesnt mean that these things are not rampant in the DC world". To be blunt, I have often given you, the dude on the other end of the internetz, the benefit of the doubt, but have had issues with you trying to claim other DCs are not guilty of these things on the basis that you are not. This is an absurd logical progression.

Originally Posted by SpecterGT260

well then I really appreciate you having this viewpoint. if chiropractic as a whole was like that I would have nothing to complain about.

My issues are these guys (start at 1:42 for the setup, 2:20-4:20 for the bullsht) there was one good chiro providing counterpoint as well.
http://www.youtube.com/watch?v=k2Sw7...eature=related


p.s. im not trying to straight douche on you either here. I really do appreciate any time someone from the alternative or supporting healthcare roles comes forward and provides a level head and a voice of reason. At the very least it gives the rest of us some perspective when all we see are the crazies like the curly headed **** in that video

Heres one Try to keep in mind my problem with anyone on these boards is not who they are or what they do or what they choose to believe but in the validity of their arguments and the logic which supports them.

I've said many times that the chiro profession isn't perfect, and I don't try to defend those who do and say dumb things. Believe me, it aggravates me more than it does you. I just think it's unfair to the majority of the profession, who do act responsibly, when they get painted by the super-broad brush (which I might as well just call the SDN Brush). And when some of the arguments used in that painting turn out to apply to medicine as well, it's curious when there's a lack of ackowledgement to that fact.

fair enough

At the risk of being accused of "attacking" NSAIDs, I stumbled upon this today and thought I'd link:

http://www.outsideonline.com/fitness...paign=07052012


http://onlinelibrary.wiley.com/doi/1...2.01463.x/full

"While there is evidence for and against a beneficial role of NSAIDs in muscle repair after injury, it appears on balance that reports favoring NSAID treatment may be outweighed by evidence pointing to a long-term negative influence of NSAIDs on muscle recovery from injury and adaptation of muscle and connective tissue to exercise training."

This certainly isn't a new concept, as it's one I've seen over the years. But I'm not sure it's something that gets thought about very much by patients or physicians.

Originally Posted by facetguy

At the risk of being accused of "attacking" NSAIDs, I stumbled upon this today and thought I'd link:

http://www.outsideonline.com/fitness...paign=07052012


http://onlinelibrary.wiley.com/doi/1...2.01463.x/full

"While there is evidence for and against a beneficial role of NSAIDs in muscle repair after injury, it appears on balance that reports favoring NSAID treatment may be outweighed by evidence pointing to a long-term negative influence of NSAIDs on muscle recovery from injury and adaptation of muscle and connective tissue to exercise training."

This certainly isn't a new concept, as it's one I've seen over the years. But I'm not sure it's something that gets thought about very much by patients or physicians.

what is this I dont even.... 3 days ago? way to revive a thread from the dead

Personally I don't like NSAIDs for treatment of chronic conditions anyways. But I love them for pain relief in anything acute that doesnt warrant the hard stuff - minor fractures, some jaw/tooth pain, hangovers . This is where I use them, personally and they work great and I have seen no evidence that my occasional use (or occasional overuse) will ever cause any harm.

However - I really dislike 2nd or 3rd hand sources. They are unavoidably biased and routinely misinterpret the facts.

Originally Posted by SpecterGT260

However - I really dislike 2nd or 3rd hand sources. They are unavoidably biased and routinely misinterpret the facts.

Which is why I linked to the journal itself. But I saw the magazine article first, and they were kind enough to link to the journal. I hate when a 'media report' of a study fails to link to the study...I actually have to go aaaaalllllll the way to pubmed myself....sheeesh.

I am reading this as sarcasm.... but it actually happens quite frequently. Check anything with the word "natural" in the url and typically you will get a hit People can validate whatever sorts of nonsense they want online by simply tacking on the phrase "studies have shown" to anything they decide to make up At that point it is a fishing expedition if you want to go to pubmed yourself because you will have no idea which study they are referring to if any at all. A good many such sites also like to cite each other and in so doing they amplify whatever cockamamie idea was proposed in the first place.

I saw the original review itself (both in your post and in the news article). I am a little confused what the relevance is.... NSAIDs are not supposed to aid healing... As a rule they arrest certain cellular processes and impede healing (typically) and their purpose is pain relief which they do fairly well in certain situations. Any discussion beyond appropriate use for pain relief and negative outcomes is beside the point.

Originally Posted by SpecterGT260

I am reading this as sarcasm.... but it actually happens quite frequently. Check anything with the word "natural" in the url and typically you will get a hit People can validate whatever sorts of nonsense they want online by simply tacking on the phrase "studies have shown" to anything they decide to make up At that point it is a fishing expedition if you want to go to pubmed yourself because you will have no idea which study they are referring to if any at all. A good many such sites also like to cite each other and in so doing they amplify whatever cockamamie idea was proposed in the first place.
.

I was referring to the type of media article which says "A new study published today reports blah blah blah. Lead author GT Specter summarizes the findings as yada yada yada...", but then they never give the actual citation let alone provide a direct link, so you have to go to pubmed, put the author name in and see what comes up. Just seems like a link to the journal should be automatic.

OK, I'm being whiny today. Carry on....

Originally Posted by SpecterGT260

I saw the original review itself (both in your post and in the news article). I am a little confused what the relevance is.... NSAIDs are not supposed to aid healing... As a rule they arrest certain cellular processes and impede healing (typically) and their purpose is pain relief which they do fairly well in certain situations. Any discussion beyond appropriate use for pain relief and negative outcomes is beside the point.

Ask 100 people if they are aware that the NSAID they are taking for their muscle strain injury carries the side effect of negatively impacting the healing of that very injury. How many will be aware of that? Heck, ask 100 physicians the same thing. The whole idea was that NSAIDs are often treated as candy when in fact they carry some risk, as we discussed previously. NSAIDs aren't Satan in a pill, but they do have a potential downside.

wait... I think we are agreeing there.... I also dislike it when legitimate publications are not given. so... we good brah?

Originally Posted by SpecterGT260

wait... I think we are agreeing there.... I also dislike it when legitimate publications are not given. so... we good brah?

I don't know that we were ever not good.

Originally Posted by facetguy

Ask 100 people if they are aware that the NSAID they are taking for their muscle strain injury carries the side effect of negatively impacting the healing of that very injury. How many will be aware of that? Heck, ask 100 physicians the same thing. The whole idea was that NSAIDs are often treated as candy when in fact they carry some risk, as we discussed previously. NSAIDs aren't Satan in a pill, but they do have a potential downside.

I guarantee you that the majority of physicians are aware of the downside. In fact a good many attendings have chimed in in other threads where this topic has come up. Advising a patient to do something doesnt mean that the doctor is unaware of negative aspects. Negative aspects are not negative outcomes

Originally Posted by facetguy

I don't know that we were ever not good.

If I had significantly bad back pain my default action would be to go to a physical therapist first, is that a better option?

Originally Posted by ToldYouSo

If I had significantly bad back pain my default action would be to go to a physical therapist first, is that a better option?

PT is one viable option.

Originally Posted by facetguy

PT is one viable option.

How would you compare PT and chiropractic?

Originally Posted by SpecterGT260

How would you compare PT and chiropractic?

Gotta say a pretty heated and interesting convo... thoroughly entertaining at the least... this is why I come to SDN.

Anyways, I have a cousin who is currently in PT school and it seems like PTs use a lot of evidenced based medicine to back up their treatment modalities, in addition to them helping patients. I can't speak on behalf of Chiro's because I do not know any but I've seen some of the PT techniques and they are very similar to some of the techniques I've learned in my OMM labs but with different names. Of course, there are many differences but it was just interesting to see some similarities as well.

Originally Posted by facetguy

Off the top of my head, I do recall a similar study from years ago: http://www.ncbi.nlm.nih.gov/pubmed?t...and%20lauretti

"DATA SYNTHESIS:
Although there are a small number of well-performed trials of cervical manipulation for neck pain, we were unable to locate even a single randomized, controlled trial examining NSAID use specifically for neck pain. As for comparative safety, the best available evidence indicates that NSAID use poses a significantly greater risk of serious complications and death than the use of cervical manipulation for comparable conditions."

On the topic of NSAIDS, this interview from a few days ago is pretty good. It's only 10 minutes or so.
http://podcasts.bmj.com/bjsm/2012/08...icine+podcasts)

Toward the end, he says that he thinks steroids may actually be less problematic in some ways than NSAIDS.

It is important to keep in mind what clinically significant outcomes really are. "delayed bone healing" may be a perfectly acceptable "side effect" to avoid drug abuse issues all together assuming that the end point is the same (assuming pain management is the goal). I dont see anything to suggest that the delay is meaningful nor that the final result is of poorer quality.

Forgive me if I am speaking out of turn here (honestly not bringing my normal level of confrontationalness (is that a word?....) to the table now...) but you don't really seem to think like a clinician, Facetguy (and to be honest, I am only just learning how, so....)

But you (and from what I have seen from other DCs) seem to want a "no down side-medicine" but our current technology simply isnt there yet. Every clinical decision made comes with a risk - except for prevention which I am all for. But I believe the thing that gets lost is that the majority of patients, if they are already actually sick, stand to lose much much more if they do not receive treatment than compared to some potential side effects. The nit-picking over subtle side effects or poor outcomes with misuse is only appropriate if we have a suitable alternative that carries the same efficacy or at least the reduction in poor outcomes outweighs any loss of efficacy (one that has evidence rather than anecdote to support it.... sorry man )

p.s.

"at the present time I am personally somewhat more positive towards the corticosteroids but it is from a weak scientific basis I must say"

From the podcast. I cant always tell if you are intentionally neglecting key elements to the arguments that are made or if your predisposition makes you blind (or deaf) to them.... To be fair, a power rhetorical ploy (one lawyers use quite a bit, which is ironic given a few of your claims about me ) is not to outright attack a position but rather to subtlety imply while instilling just a little doubt. Your posts like the above seems to attempt precisely this while not necessarily giving the whole story

In the DC page I hyperlinked up in the text, there is so much unadultered and unsubstantiated rhetoric going on that it is really hard to find a defensible position for any of the claims. From the infant with the superhero immune system due to manipulations to the Wonka meme suggesting that it only works if you blindly adhere, the claims seem to set up a specific point of view and worldview that seems to color all further [pseudo]scientific discussion.

Originally Posted by SpecterGT260

It is important to keep in mind what clinically significant outcomes really are. "delayed bone healing" may be a perfectly acceptable "side effect" to avoid drug abuse issues all together assuming that the end point is the same (assuming pain management is the goal). I dont see anything to suggest that the delay is meaningful nor that the final result is of poorer quality.

Forgive me if I am speaking out of turn here (honestly not bringing my normal level of confrontationalness (is that a word?....) to the table now...) but you don't really seem to think like a clinician, Facetguy (and to be honest, I am only just learning how, so....)

But you (and from what I have seen from other DCs) seem to want a "no down side-medicine" but our current technology simply isnt there yet. Every clinical decision made comes with a risk - except for prevention which I am all for. But I believe the thing that gets lost is that the majority of patients, if they are already actually sick, stand to lose much much more if they do not receive treatment than compared to some potential side effects. The nit-picking over subtle side effects or poor outcomes with misuse is only appropriate if we have a suitable alternative that carries the same efficacy or at least the reduction in poor outcomes outweighs any loss of efficacy (one that has evidence rather than anecdote to support it.... sorry man )

You always think there's some diabolical meaning to my posts. Sometimes a link is just a link.

I don't have some pie-in-the-sky mindset that there should be a "no down-side-medicine"...of course there's risk/benefit. If anything, I think sometimes there's a tendency by those is medicine to downplay the risk side of things. NSAIDS, as we've discussed before, are a good example of this. Yes, they are useful and yes, patients benefit from them. But they do carry risks. The guy in the interview mentions some of these things. If this was all a no-brainer, why bother interviewing a researcher in this field in 2012? For that matter, why bother researching this at all? The answer is we don't know everything and are still learning.

Originally Posted by SpecterGT260

p.s.
From the podcast. I cant always tell if you are intentionally neglecting key elements to the arguments that are made or if your predisposition makes you blind (or deaf) to them.... To be fair, a power rhetorical ploy (one lawyers use quite a bit, which is ironic given a few of your claims about me ) is not to outright attack a position but rather to subtlety imply while instilling just a little doubt. Your posts like the above seems to attempt precisely this while not necessarily giving the whole story

In the DC page I hyperlinked up in the text, there is so much unadultered and unsubstantiated rhetoric going on that it is really hard to find a defensible position for any of the claims. From the infant with the superhero immune system due to manipulations to the Wonka meme suggesting that it only works if you blindly adhere, the claims seem to set up a specific point of view and worldview that seems to color all further [pseudo]scientific discussion.

Again, I wasn't trying to be slick or something, hoping you wouldn't hear him very clearly state that the evidence for the steroids statement was weak at this point. But this guy studies these things everyday, and what he said about steroids caught me by surprise a bit. There's nothing else to read into that. But as a clinician, perhaps these pearls should be stowed away somewhere in your brain (but not mine because a) I'm not a clinician apparently and b) everyone knows chiros don't have brains ).

And the facebook page you linked to...what can I say. It's a facebook page of one DC. Although I think you are overly critical on the Wonka thing. I didn't see anything about "blindly adhering" to anything. Would you go to the gym once, then proclaim working out has no benefits? Or closer to the issue, would you go to a PT once, or does everyone virtually automatically go for 12 or 24 or 36 visits without batting an eye? Or would you take one Naprosyn then state emphatically "these meds don't work at all!". Of course you wouldn't, but somehow you expect chiropractors to magically 'fix' a patient in one visit, otherwise they are ripping patients off. Why?

Its somewhere between diabolical and idealistic. Can't tell which . Not knowing everything is not a supporting argument to pursue things not based in science


the fb page was just an example to help you understand where I am coming from - the things I see that form my interpretation of your posts.

Originally Posted by SpecterGT260

facetduder, I dont have a problem with chiropractors. I have a problem with chiropractors who think they do anything more than massage.

This.

/end thread

Originally Posted by toxicwombat

This.

/end thread

ohh... you poor innocent little man... you do realize that you just /'ed the /thread, right?

Originally Posted by SpecterGT260

ohh... you poor innocent little man... you do realize that you just /'ed the /thread, right?

Originally Posted by facetguy

"/" is forum code (BBC code or something like that.... i dunno, not super up to date on computer lingo) to "end" something.

I was saying that he was potentially re-opening a can of worms by quoting that post.

Originally Posted by SpecterGT260

"/" is forum code (BBC code or something like that.... i dunno, not super up to date on computer lingo) to "end" something.

I was saying that he was potentially re-opening a can of worms by quoting that post.

Oh I realize that but, all things considered, you've got to stand up for science, even if that means wasting minutes of your life refuting garbage pseudoscientific anectdotes.

I'd be more willing (yet still admittedly irritated) to let these things slide if it wasn't for the fact that this nonsense is being spewed on a "scientific" forum by future healthcare workers. It makes me cringe.

Originally Posted by skinnyDO

Why is it that when someone gets a neck/back injury, the first thing they think is to go visit a chiropractor? I've noticed that the general consensus on sdn is that OMM >>> chiropractic, yet there's a chiro office on every block in south Florida, and I've never heard anyone say "I messed up my neck, I'm going to see my DO."

What gives?

Because it works. People get relief from their pain.

Since it came up in this thread, so does massage. I'll take a massage over anti-anxiety and anti-pain meds anyday.

bth

Originally Posted by bth7

Because it works. People get relief from their pain.

Since it came up in this thread, so does massage. I'll take a massage over anti-anxiety and anti-pain meds anyday.

bth

Originally Posted by bth7

Because it works. People get relief from their pain.

bth

Lobotomies work too...

Originally Posted by Acrowston

Lobotomies work too...

Not really

Originally Posted by bth7

Because it works. People get relief from their pain.

Are you ****ing kidding me? Simply touching patients can give them relief.

With the exception of possible adult low back pain relief, chiropractopic is a bunch of bull****. Ever care to notice the overall trend in the literature with increasingly well-performed, appropriately blinded, and larger studies producing progressively less and less significant results? Yeah, that's what happens when you're studying bull****.

On the other hand, chiropractic can -- and does -- have downsides: http://whatstheharm.net/chiropractic.html

For those of you interested in the great scam that is chiropratic, I recommend http://www.sciencebasedmedicine.org/.../chiropractic/ or anything by Mark Crislip.

Originally Posted by Acrowston

Lobotomies work too...

Lobotomies versus massage: A 12-week prospective trial for the reduction of anxiety.

This is EXACTLY the type of crap the evidence-based fundamentalists would study. Something so obvious, they can't see the forest through the trees.

bth

I feel think there are multiple factors going on: 1. Chiropractors are advertising machines. They have special courses for their graduates to learn how to market their business. 2. Chiropractors only do manipulation, whereas DOs practice medicine, which creates more of that "Chiropractors fix backs and necks" mentality. Even they fight against this because they believe they are primary care practitioners that can treat even things like autism and gastrointestinal problems. 3. Many DOs don't do manipulation and very few of them have done residency in it. 4. People are ignorant about their options, which is tied to all 3 previous reasons.

Originally Posted by TriagePreMed

I feel think there are multiple factors going on: 1. Chiropractors are advertising machines. They have special courses for their graduates to learn how to market their business. 2. Chiropractors only do manipulation, whereas DOs practice medicine, which creates more of that "Chiropractors fix backs and necks" mentality. Even they fight against this because they believe they are primary care practitioners that can treat even things like autism and gastrointestinal problems. 3. Many DOs don't do manipulation and very few of them have done residency in it. 4. People are ignorant about their options, which is tied to all 3 previous reasons.

Triage, please try to include a few more sweeping generalities in your comments next time. It makes your input all the more accurate.

The only generalization I see that isn't necessarily accurate (depending on how you cut the pie) is the one about believing they can treat things like autism ect... except that some do actually believe this. Some of the implications may be a little abrasive.... but not necessarily inaccurate.

Originally Posted by SpecterGT260

The only generalization I see that isn't necessarily accurate (depending on how you cut the pie) is the one about believing they can treat things like autism ect... except that some do actually believe this. Some of the implications may be a little abrasive.... but not necessarily inaccurate.

Originally Posted by TriagePreMed

I feel think there are multiple factors going on: 1. Chiropractors are advertising machines. They have special courses for their graduates to learn how to market their business. 2. Chiropractors only do manipulation, whereas DOs practice medicine, which creates more of that "Chiropractors fix backs and necks" mentality. Even they fight against this because they believe they are primary care practitioners that can treat even things like autism and gastrointestinal problems. 3. Many DOs don't do manipulation and very few of them have done residency in it. 4. People are ignorant about their options, which is tied to all 3 previous reasons.

Advertising machines: I don't know about where you live, but the newspapers around me are full of ads for hospitals, physician groups, all manner of surgical groups, etc. Who's on the billboards? Not chiros but hospitals and other medical groups. Who has the really nice shiny full color direct mail adverts? Around here it's the medical folks. Do chiros advertise? Of course. Did you exaggerate? Yes.

Only do manipulation: Manipulation is a major treatment method in chiropractic, obviously. But to say DCs "only do manipulation" strongly suggests lack of experience/insight on your part.

Treating autism and GI problems: some DCs get more involved with the diet/nutritional end of things. As such, it makes sense that some DCs help some GI patients. Autism is more of an unknown, but there's no doubt that some autistic kids benefit from dietary changes.

I'm not defending 100% of chiros because I know (believe me, I know) there are some that can be off-the-wall. But, as I said earlier, sweeping generalizations only suggest you don't have a good handle on what chiropractors do.

I guess I can concede those points. Manipulation only I took as treatment modalities. If we are including counseling and whatnot then sure. But I think it was pretty well understood what contexts triage was referring to.

Originally Posted by SpecterGT260

I guess I can concede those points. Manipulation only I took as treatment modalities. If we are including counseling and whatnot then sure. But I think it was pretty well understood what contexts triage was referring to.

Even re: treatment modalities. Chiros do all manner of manual therapies, including any number of manipulation techniques, joint and other tissue mobilization, myofascial treatments, along with rehab exercises, and the various passive modalities (ultrasound, various forms of electric stim, cold laser etc.).

No argument though that MD/DO encompasses a larger scope of practice.

lets.... lets just pretend that many of those other modalities arent really a thing, ok? Some of those heavily contribute to the reason why I push everyone I know towards PT>DC

Originally Posted by SpecterGT260

lets.... lets just pretend that many of those other modalities arent really a thing, ok? Some of those heavily contribute to the reason why I push everyone I know towards PT>DC

Which 'other modalities'? PTs use all of them.

Infrequently if at all. - cold laser is the one that tripped my trigger. And I took the electric stim to be neuroscoping.... There are some other dandies out there as well. Some little "gun" that pops you with a ball bearing, and a magic wand that removes excess electricity....

Originally Posted by SpecterGT260

Infrequently if at all. - cold laser is the one that tripped my trigger. And I took the electric stim to be neuroscoping.... There are some other dandies out there as well. Some little "gun" that pops you with a ball bearing, and a magic wand that removes excess electricity....

The data on cold laser is lacking at present, mostly because it's new. Some of the biological effects of laser are intriguing nonetheless. I don't personally use a cold laser, at least not yet.

Electric stim is one of those modalities that probably doesn't do a whole lot, particularly anything lasting. Some patients benefit from some stim with heat to get them prepped for some myofascial work, mobiliz, manip, etc. I don't use my e-stim machines much; entire days can go by without using them. I don't even own an ultrasound unit.

I'm not sure what the magic wand is. Toftness perhaps? If so, yes, that is really fringe. I know of exactly 1 guy who uses that (or used to use it; don't know current status).

On the issue of instrument-assisted manipulation, this is interesting. I can see why you'd be initially skeptical. But the main advantage these things provide is speed. They can deliver a force way quicker than any human, and this can come in handy for mechanoreceptor stimulation. The main guy that comes to mind is Chris Colloca, DC who has been doing research on these instruments for awhile (not surprisingly, he has also designed and sells one of these things). I would think that a quick Pubmed would bring up a few citations (I'll check this later). He's done some work with spine surgeons in which they've done various measurements on humans who have been opened up for a back surgery. It's been awhile since I've looked at any of this material, so I'm being a little vague here. Quite frankly, I wouldn't be surprised if we see PTs or other less-than-expert manipulators being drawn to these instruments some day because these instruments do remove much of the technical components of manipulation that need lots of practice to master.

I'm tired and babbling at this point.