Hey Chiropractors: Knock it off.

[RustedFox]

This is the fourth one this year:

Patient: "I have this chronic degenerative spine disease, and I see my chiropractor, who recommends regular adjustments (whatever that means) of the region, and I saw him recently, and I've got this terrible pain right there, and now it hurts when I breathe in."

Me: "Yeah. You have a pulmonary embolism. Right there, where you get these "adjustments"."


Hey chiropractors: knock it off.

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[TheBlueBlazer]

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[WilcoWorld]

This is the fourth one this year:

Patient: "I have this chronic degenerative spine disease, and I see my chiropractor, who recommends regular adjustments (whatever that means) of the region, and I saw him recently, and I've got this terrible pain right there, and now it hurts when I breathe in."

Me: "Yeah. You have a pulmonary embolism. Right there, where you get these "adjustments"."


Hey chiropractors: knock it off.

Not good, but not as bad as the strokes we regularly see at my shop (about 1/mo) from arterial dissections s/p cervical "adjustments".

 

[DocJL]

Not good, but not as bad as the strokes we regularly see at my shop (about 1/mo) from carotid dissections s/p cervical "adjustments".

Seriously?

I infrequently see a chiropractor for relief from the cervical pain caused by spending 32 hours a week with my neck twisted looking into someone's pie-hole.

Can you explain in more detail the mechanism of injury, and findings that a chiropractic adjustment was the primary cause of the pts CVA?


(my older neighbor had a stroke last month, and seeing his huge loss in abilities I am definitely not looking forward to this particular issue when I get older.......)

 

[Tiger26]

Seriously?

I infrequently see a chiropractor for relief from the cervical pain caused by spending 32 hours a week with my neck twisted looking into someone's pie-hole.

Can you explain in more detail the mechanism of injury, and findings that a chiropractic adjustment was the primary cause of the pts CVA?


(my older neighbor had a stroke last month, and seeing his huge loss in abilities I am definitely not looking forward to this particular issue when I get older.......)

Carotid or vertebral dissection

 

[DocJL]

I could fathom how this might happen from a higher force adjustment, just wondering how you know they were caused by such.

Did the pt(s) you have seen start experiencing symptoms of a stroke at the time of adjustment or right after? or was this a conclusion reached because they let you know they see a chiropractor "to get my neck cracked" on a regular basis? How often have you seen this? are you seeing this in otherwise healthy people? or is this in a pt population that is high risk for stroke? Severity of the strokes you are attributing to this?

 

[RustedFox]

Its simple: "I just got adjusted and I'm way worse."

 

[Janders]

vetebral dissection is well known as a potential complication of cervical manipulation. I've certainly seen people minutes/hours after adjustment with acute dissection symptoms (radiating pain) and stroke/tia symptoms in the distribution of said artery.

 

[Hair Police]

It ranks up there with PTX after acupuncture:

http://m.emj.bmj.com/content/21/3/398.full

And electrolyte disorders after chelation "therapy" for autism:

http://www.ncbi.nlm.nih.gov/m/pubmed/18949650/

 

[Spinach Dip]

Carotid or vertebral dissection

Wow. Someone's doing it wrong.

 

[Birdstrike]

I could fathom how this might happen from a higher force adjustment, just wondering how you know they were caused by such.

Did the pt(s) you have seen start experiencing symptoms of a stroke at the time of adjustment or right after? or was this a conclusion reached because they let you know they see a chiropractor "to get my neck cracked" on a regular basis? How often have you seen this? are you seeing this in otherwise healthy people? or is this in a pt population that is high risk for stroke? Severity of the strokes you are attributing to this?

It doesn't take a lot of force at all. The vertebral artery travels through some very tight bony channels. Check your anatomy. It can easily be sheared. Such catastrophes will not occur with "adjustments" in the back, but can easily occur in the neck.

 

[deleted547339]

Wow. Someone's doing it wrong.

Eh. It's fairly common. I've saw it in med school.

 

[GeneralVeers]

There is no reason to ever see a chiropractor. They things they claim to do, are actually physically impossible. Not sure why society, and some insurance companies still let these frauds parade around as if they are legitimate medical professionals.

 

[WilcoWorld]

Carotid or vertebral dissection

You're right. It's far more commonly seen in the vertebral a's. Pardon my carelessness. I'd say that I shouldn't post at 1am while drinking wine, but... that's exactly when I should be posting!

 

[styphon]

I could fathom how this might happen from a higher force adjustment, just wondering how you know they were caused by such.

Did the pt(s) you have seen start experiencing symptoms of a stroke at the time of adjustment or right after? or was this a conclusion reached because they let you know they see a chiropractor "to get my neck cracked" on a regular basis? How often have you seen this? are you seeing this in otherwise healthy people? or is this in a pt population that is high risk for stroke? Severity of the strokes you are attributing to this?

I have seen this in people head banging at a metal concert, plumbers, and DIY home improvement guys. It is not that uncommon, and does not require a high physical force/impact.

 

[Mad Jack]

Seriously?

I infrequently see a chiropractor for relief from the cervical pain caused by spending 32 hours a week with my neck twisted looking into someone's pie-hole.

Can you explain in more detail the mechanism of injury, and findings that a chiropractic adjustment was the primary cause of the pts CVA?


(my older neighbor had a stroke last month, and seeing his huge loss in abilities I am definitely not looking forward to this particular issue when I get older.......)

Chiropractors typically extend, rather than flex, the neck when doing HVLA adjustments. This allows them to treat multiple segments at once, but also stretches the vertebral artery in the process. If they twist a bit too much or too forcefully, it the patient has any defects in the wall of their vertebral artery, it can easily cause a dissection.

I'm a DO student, and we learn how to do HVLA, but we flex the head, rather than extending it, which is infinitely safer because you're creating slack in the vertebral artery and only treating one vertebra at a time. While I'll never use HVLA in practice, learning how it's done by DOs versus chiropractors has given me a lot of insight into how these untried occur and how horrifying chiropractors are. Like, I can't watch a chiro HVLA video on YouTube without squirming, their techniques are insanely dangerous more times than not.

 

[NurWollen]

Chiropractors typically extend, rather than flex, the neck when doing HVLA adjustments. This allows them to treat multiple segments at once, but also stretches the vertebral artery in the process. If they twist a bit too much or too forcefully, it the patient has any defects in the wall of their vertebral artery, it can easily cause a dissection.

I'm a DO student, and we learn how to do HVLA, but we flex the head, rather than extending it, which is infinitely safer because you're creating slack in the vertebral artery and only treating one vertebra at a time. While I'll never use HVLA in practice, learning how it's done by DOs versus chiropractors has given me a lot of insight into how these untried occur and how horrifying chiropractors are. Like, I can't watch a chiro HVLA video on YouTube without squirming, their techniques are insanely dangerous more times than not.

Everytime I am asked to do cervical HVLA on an OMM practical, or or worse, to receive it, I get the creeps. We too were taught not to extend the neck when doing it... but then I've had some OMM professors say you need a slight amount of extension to 'lock out' the other vertebrae that aren't being treated. I'm still uncomfortable with it.

Thoracic HVLA on the other hand is the bomb-dizzle. Still irrelevant clinically. But man, it feels good.

 

[Mad Jack]

Everytime I am asked to do cervical HVLA on an OMM practical, or or worse, to receive it, I get the creeps. We too were taught not to extend the neck when doing it... but then I've had some OMM professors say you need a slight amount of extension to 'lock out' the other vertebrae that aren't being treated. I'm still uncomfortable with it.

Thoracic HVLA on the other hand is the bomb-dizzle. Still irrelevant clinically. But man, it feels good.

I tooootally agree on both counts. Cervical horrifies me and I generally avoid it at all costs. I love thoracic HVLA though. Not going to save any lives, but it's great to use on friends and family.

 

[GeneralVeers]

Why not shake some rattles and do a dance while you're at it? Seriously all this spinal manipulation stuff has to go.

 

[Zebra Hunter]

I don't know if any yall have spine warlocks on Facebook, but holy c@$p are they whacko. Advising new mothers to not get their kids vaccinated, talking about doing "adjustments" on newborns, advising individuals to stop taking their meds, talking about how diet and exercise and adjustments cures all diseases, the body's innate ability to heal itself...as long as you get adjusted, and clearing up "interference" in your nervous system.

 

[NurWollen]

I don't know if any yall have spine warlocks on Facebook, but holy c@$p are they whacko. Advising new mothers to not get their kids vaccinated, talking about doing "adjustments" on newborns, advising individuals to stop taking their meds, talking about how diet and exercise and adjustments cures all diseases, the body's innate ability to heal itself...as long as you get adjusted, and clearing up "interference" in your nervous system.

Yikes. That is some scary stuff.

 

[deleted547339]

This is going to end well.....

 

[SoCuteMD]

I could fathom how this might happen from a higher force adjustment, just wondering how you know they were caused by such.

Did the pt(s) you have seen start experiencing symptoms of a stroke at the time of adjustment or right after? or was this a conclusion reached because they let you know they see a chiropractor "to get my neck cracked" on a regular basis? How often have you seen this? are you seeing this in otherwise healthy people? or is this in a pt population that is high risk for stroke? Severity of the strokes you are attributing to this?

Seen it in multiple totally healthy people who had onset of symptoms within 24 hours of HVLA adjustment by a chiropractor. One devastating stroke, one asymptomatic person who saw her ENT who ordered a MRI/MRA that showed it (that may have actually been carotid...I can't fully recall)

 

[Mad Jack]

Why not shake some rattles and do a dance while you're at it? Seriously all this spinal manipulation stuff has to go.

Eh, I can relive thoracic back pain in friends with a quick thrust, which is kind of cool. I mean, it isn't lifesaving, but have you ever needed to crack your back after sleeping wrong or whatever and couldn't pull it off? It's just a directed version of a solid bear hug or having someone walk on your back. I'd never base a practice on it or anything, but it's a nice thing to know how to do.

Thinking you can fix disease with it like a lot of chiros do is nonsense though. It's more of an alternative to aspirin or other means to alleviate minor aches and pains then it is some kind of magical cure-all.

 

[Thought Crime Spree]

Chiropractors typically extend, rather than flex, the neck when doing HVLA adjustments. This allows them to treat multiple segments at once, but also stretches the vertebral artery in the process. If they twist a bit too much or too forcefully, it the patient has any defects in the wall of their vertebral artery, it can easily cause a dissection.

I'm a DO student, and we learn how to do HVLA, but we flex the head, rather than extending it, which is infinitely safer because you're creating slack in the vertebral artery and only treating one vertebra at a time. While I'll never use HVLA in practice, learning how it's done by DOs versus chiropractors has given me a lot of insight into how these untried occur and how horrifying chiropractors are. Like, I can't watch a chiro HVLA video on YouTube without squirming, their techniques are insanely dangerous more times than not.

Dude, come on. Chiropractic and HVLA are both on the same branch of the quackery tree. Flexion versus extension is not going to matter, they are both have the same risk.

 

[NurWollen]

Dude, come on. Chiropractic and HVLA are both on the same branch of the quackery tree. Flexion versus extension is not going to matter, they are both have the same risk.

Yeah OMM is full of instances where they break from a certain way of doing things because some DO said it would be safer. No study, just someone with an 'aha' moment and enough influence to change OMM textbooks.

 

[Birdstrike]

There is no reason to ever see a chiropractor. They things they claim to do, are actually physically impossible. Not sure why society, and some insurance companies still let these frauds parade around as if they are legitimate medical professionals.

In 2014 when certain specialties faced a reimbursement blood bath (Path, Pain; plus cards & Neuro a yr or two before that) Chiro got a medicare reimbursement increase. Not only did they get a reimbursement from CMS, they got a huge one (10%, gargantuan by cms standards) and one much bigger, by far, than any physician specialty that year.

All you can do is

 

[Birdstrike]

That being said....the only thing, the o n l y positive I see about chiropractic is, if the placebo effect keeps at least a few people from turning to an opiate for pain relief. God, I don't understand it, but some otherwise rational people do swear by chiro's.

 

[Mad Jack]

Dude, come on. Chiropractic and HVLA are both on the same branch of the quackery tree. Flexion versus extension is not going to matter, they are both have the same risk.

Hey, like I said, I'm no fan of cervical HVLA. But there are definitely ways to do it where you maximize the chance of injury.

 

[Spinach Dip]

I don't know if any yall have spine warlocks on Facebook, but holy c@$p are they whacko. Advising new mothers to not get their kids vaccinated, talking about doing "adjustments" on newborns, advising individuals to stop taking their meds, talking about how diet and exercise and adjustments cures all diseases, the body's innate ability to heal itself...as long as you get adjusted, and clearing up "interference" in your nervous system.

I also heard that if I drink a strain of the common cold diluted 10^200 times, it will make me immune to ebola.

Wait. You mean people LIE about these things?

 

[touchpause13]

Everytime I am asked to do cervical HVLA on an OMM practical, or or worse, to receive it, I get the creeps. We too were taught not to extend the neck when doing it... but then I've had some OMM professors say you need a slight amount of extension to 'lock out' the other vertebrae that aren't being treated. I'm still uncomfortable with it.

Thoracic HVLA on the other hand is the bomb-dizzle. Still irrelevant clinically. But man, it feels good.

Yup same thing here, slight extension to lock it out on some. I freaking hated doing this with classmates because there were always some idiots who just put wayyy too much force into it. Like seriously man my chin is not supposed to touch my shoulder cut it out.

Thoracic tho....love it. Feels amazing

 

[touchpause13]

I also heard that if I drink a strain of the common cold diluted 10^200 times, it will make me immune to ebola.

Wait. You mean people LIE about these things?

I've always wondered if these guys take diluted payments. Like if I put a hundred dollar bill in a water bottle and let it still for a while then take it out can I pay them with the water bottle. I mean water has memory you know.

 

[ohboy]

I had a 19 year old patient who had cervical manipulation by a chiro and had a carotid dissection. It was horrible. She clotted off her entire carotid. Massive stroke with left neglect, paralysis, sensory loss. Got tPA with minimal improvement. I stopped even cracking my own neck after that.

 

[Sheldon]

In 2014 when certain specialties faced a reimbursement blood bath (Path, Pain; plus cards & Neuro a yr or two before that) Chiro got a medicare reimbursement increase. Not only did they get a reimbursement from CMS, they got a huge one (10%, gargantuan by cms standards) and one much bigger, by far, than any physician specialty that year.

All you can do is

Physical therapists continue to experience reimbursement cuts too. Healthcare is a mess; it's not what you know, it's who your lobbyist knows.

 

[DarkHorse22]

DO students take note. HVLA stands for high velocity low amplitude. Chiropractors do not do HVLA. They do HVHA. High velocity high amplitude. The risks are far greater with larger amplitude. And the above posts are correct, high amplitude allows for more spinal segments to be "treated" at once. Unsafe.

I agree with the risks of chiropractic treatment. I disagree with the vilification of OMM. While it has little practical use in EM (except perhaps in some treatments to the vagus nerve to break SVT), it has a pretty widely accepted use in chronic pain, MSK complaints etc. In fact, there are entire residency programs in it. Moral of the story, it is never a good idea to crank on someone's neck.

 

[NurWollen]

DO students take note. HVLA stands for high velocity low amplitude. Chiropractors do not do HVLA. They do HVHA. High velocity high amplitude. The risks are far greater with larger amplitude. And the above posts are correct, high amplitude allows for more spinal segments to be "treated" at once. Unsafe.

I agree with the risks of chiropractic treatment. I disagree with the vilification of OMM. While it has little practical use in EM (except perhaps in some treatments to the vagus nerve to break SVT), it has a pretty widely accepted use in chronic pain, MSK complaints etc. In fact, there are entire residency programs in it. Moral of the story, it is never a good idea to crank on someone's neck.

Google HVLA and this is the first thing that pops up:
http://www.spine-health.com/treatme...manipulation-high-velocity-low-amplitude-hvla

Sounds like HVLA is at the core of a chiropractor's repertoire.

 

[Promethean]

Not good, but not as bad as the strokes we regularly see at my shop (about 1/mo) from arterial dissections s/p cervical "adjustments".

I also used to see these, at about the same rate, on the inpatient acute care stroke unit I worked on for a couple years. It isn't just your local chiropractor doing this kind of damage.

 

[Cerberus]

I don't understand why people don't just go get a massage. It's not ****ing magic. Getting your muscles manipulated feels good and makes you feel better. Once you start thinking it's aligning your chakras (or whatever chiropractors or OMM quacktitioners call it)
so your body can channel it's inner psychic power to battle GMO cancer cells, you've had too much kool-aid and need to chill for a few.

 

[Mad Jack]

Google HVLA and this is the first thing that pops up:
http://www.spine-health.com/treatme...manipulation-high-velocity-low-amplitude-hvla

Sounds like HVLA is at the core of a chiropractor's repertoire.

They call it HVLA, but the amplitude us not low lol

 

[NurWollen]

They call it HVLA, but the amplitude us not low lol

Maybe so, haha. But don't you think it's funny how OMM professors sometimes try to slam chiropractic? We have some faculty who do this, emphasizing the differences between osteopathy and chiropractic, but always in vague, nonspecific terms? It sure seems like they like to downplay any similarities, but I'm pretty sure they exist.

 

[GeneralVeers]

HVLA or HVVA. It's all pseudo-scientific nonsense with a pronounced placebo effect. I have several DO colleagues who readily admit to me that the OMM stuff is complete crap, and that they did DO school for the proper medical training aspect.

 

[xBODOMx]

.

 

[gman33]

HVLA or HVVA. It's all pseudo-scientific nonsense with a pronounced placebo effect. I have several DO colleagues who readily admit to me that the OMM stuff is complete crap, and that they did DO school for the proper medical training aspect.

I'm no fan of MSK adjustments, no matter who is performing them.
But I'd also say that a very large percentage of modern medicine is pseudo-science.
A lot of our interventions have no proven benefit and have a very real downside.
If the patient has some level of informed consent and gets a perceived benefit, then they can get whatever they want.

I do have a problem with insurance paying for things that have no proven benefit.

 

[RustedFox]

I'm sure that's how 99.99% of most entering DO students are. Some just slip through the cracks and end up brainwashed into OMT or get cohersed by schools that offer tuition breaks for being an OMT instructor.

I frequently teach/interact with our local Osteopathic Medical Students. 99% see OMM as Jedi Magic. 1% are fanatical "true believers". Just my sample size.

 

[deleted547339]

I frequently teach/interact with our local Osteopathic Medical Students. 99% see OMM as Jedi Magic. 1% are fanatical "true believers". Just my sample size.

"The Force can have a strong influence on the weak-minded"

 

[NurWollen]

I frequently teach/interact with our local Osteopathic Medical Students. 99% see OMM as Jedi Magic. 1% are fanatical "true believers". Just my sample size.

If only OMM were that much fun, lol. I'd be it's biggest supporter.

 

[VentJockey]

One day I slept wrong in bed, and had this nasty pain in my upper back. I took some ibuprofen and come to work. An osteopathic colleague of mine said I had a subluxed rib, did a manipulation, and the pain went away right away and I was back to normal. I don't know this OMM/Chriopractic stuff, but I was sure happy to get that adjustment in my office. My plan is to always have a few osteopathic colleagues around.

 

[Dares Dareson]

I'm no fan of MSK adjustments, no matter who is performing them.
But I'd also say that a very large percentage of modern medicine is pseudo-science.
A lot of our interventions have no proven benefit and have a very real downside.
If the patient has some level of informed consent and gets a perceived benefit, then they can get whatever they want.

I do have a problem with insurance paying for things that have no proven benefit.

Any examples? I'm sincerely curious.

 

[RustedFox]

Any examples? I'm sincerely curious.

http://www.thennt.com/

 

[Old_Mil]

I don't understand why people don't just go get a massage.

Absolutely. The best way to practice OMM is to quit once you take your fonal.