Need some info on Chiropractor things????

Man, it seems like attacking chiropractors is your hobby. There are some "basic" facts you are taking WAY out of context.

First of all my personal experience was a case of the average person (my family) getting hysterical during a possible emergency. For you to suggest that I have "no" ability, education, skill to make a preliminary 'suggestion' for someone to go to an emergency room is ludicrous. Of course no MD/DC is needed...but when people are freaking out whoever has the most experience is duty bound to step UP (not overstep). To clarify, the E.R. doc had the same suspicions of stroke that I had...that is why he sent him to OKC. The final diagnosis (which is not an EXPLANATION) in OKC was IBS and Ulcer so as I said my education, training, skill...voodoo doll led me to the same concerns that the E.R. doc had. Am I as skilled as him...of course not but to suggest I have ZERO ability because I went to D.C. school is just ridiculous.

Your obviously a smart guy who posts a lot of messages on this board. Thanks for your contribution. However, the messages have an "air of condescension" which invites disagreement not discussion. Just take it easy on the "read it and weep" approach. Just my .02.

As for my school...Yes, it's accredited (Parker in Dallas). CCE/SACS...the whole nine yards. My teachers...D.C.'s/M.D.'s/Phd yada yada. I feel my education was very good in basic sciences and excellent in chiropractic, however, I am not a student of philosophy so I couldn't care less about "subluxation". The excellence in chirpractic courses taught is strictly from a technique standpoint, not philosophy. I am what I would describe as a biomechanist...under Texas statute my job is to improve biomechanics. That's where "I" see manipulation as beneficial. As for straight vs. mixer, I guess you would categorize me as a mixer. Again, I couldn't care less about the straight/mixer garbage either, frankly it's stupid. Sounds too much like a sexual orientation designation.

No, I'm not going to read all your references/articles about pediatric chiropractic (which I do not support and think it's practically useless) because you don't have to convince me that I don't know didly about pediatrics. I agree! Others may not but I'll concede the point for many reasons.

I'm a Doctor, not a physician, who practices chiropractic for NMS conditions...that's it. As far as who makes me a Doctor, that's another philosophical arguement I couldn't care less about. In my view, the State of Texas gave me a license and they are the elected representatives of the people, the school gave me a degree which met all accreditation standards so it's good, too. If you don't agree argue with them.

Overall, I don't disagree with you much on fact, your probably right on most stuff. Except, the reality in the field leaves much to be desired in medicine and chiropractic.

Getting back to the original point of this thread...no, don't become a chiropractor UNLESS you want this kind of reaction every time you turn around. Point Proven.

chirodoc said:

Man, it seems like attacking chiropractors is your hobby. There are some "basic" facts you are taking WAY out of context.

Click to expand...

Nope, advocating for my patients is (my hobby). I am just sick of taking care of people hurt by chiropractors, which is about a once per week occurence around here. Now granted, I am at a tertiary referal center, but I am only 1 EM resident. If I am seeing one case a week, then there are likely a huge number throughout the U.S.

chirodoc said:

First of all my personal experience was a case of the average person (my family) getting hysterical during a possible emergency. For you to suggest that I have "no" ability, education, skill to make a preliminary 'suggestion' for someone to go to an emergency room is ludicrous. Of course no MD/DC is needed...but when people are freaking out whoever has the most experience is duty bound to step UP (not overstep).

Click to expand...

You misunderstood what I meant, my apologies. What I meant to say is that it was not the result of your DC that you would, and should, have made the decision to seek medical care for a person demonstrating the symptoms you described, it was your common sense that led to that. Likewise, it would be the common sense in any MD, DO, Ph.D., Sc.D., etc. that would lead to the same. Without diagnostic tools, equipment etc., anyone, regardless of training, is reduced to a cub scout with a merit badge in first aid in those situations.

chirodoc said:

To clarify, the E.R. doc had the same suspicions of stroke that I had...that is why he sent him to OKC. The final diagnosis (which is not an EXPLANATION) in OKC was IBS and Ulcer so as I said my education, training, skill...voodoo doll led me to the same concerns that the E.R. doc had. Am I as skilled as him...of course not but to suggest I have ZERO ability because I went to D.C. school is just ridiculous.

Click to expand...

No, I am saying that I do not believe your DC schooling added at all to your concerns. And, in fact, there are some chiropractors who took home very different lessons from chiropractic schooling than you (straights) who have less ability to assess as they would believe the cause of the problem to be some fanticiful subluxation.

chirodoc said:

Your obviously a smart guy who posts a lot of messages on this board. Thanks for your contribution. However, the messages have an "air of condescension" which invites disagreement not discussion. Just take it easy on the "read it and weep" approach. Just my .02.

Click to expand...

I am sorry you read me that way. Scientific debate is part and parcel of medical training. In classes, on rounds, and in the clinical setting, I am used to having to "back up" what I say with scientific studies and demonstrated facts. I take that same approach here as this is a forum for student doctors. If see that as condescending, I am sorry. And in reading some of my more personal, less scientific, responses to you I can see what you are referring to. Again, my apologies. I am also getting tired of arguing these points and seem to have launched into you a bit. I am sorry.

chirodoc said:

As for my school...Yes, it's accredited (Parker in Dallas). CCE/SACS...the whole nine yards. My teachers...D.C.'s/M.D.'s/Phd yada yada.

Click to expand...

Well, you had stated "I guess some of your information has to come from someone or something very inaccurate because it sure as hell doesn't cover the education or institution I got my degree from." I got my information from the CCE. So I was trying to show that it did cover your institution.

While I am not always a big fan of Dr. Barrett, he is uncannily right some of the time. From http://www.chirobase.org/11Responses/response.html

chirodoc said:

I feel my education was very good in basic sciences and excellent in chiropractic, however, I am not a student of philosophy so I couldn't care less about "subluxation".

Click to expand...

So you disavow the very source of the "science" you hold a doctorate in? Then from what do you draw your practice? Your own intereptation of the basic sciences you were taught and the limited clinical experiences you had in chiropractic school? And you feel comfortable that you are not missing significant pathology?

chirodoc said:

The excellence in chirpractic courses taught is strictly from a technique standpoint, not philosophy. I am what I would describe as a biomechanist...under Texas statute my job is to improve biomechanics.

Click to expand...

Then why not get a degree in biomechanics?

chirodoc said:

That's where "I" see manipulation as beneficial.

Click to expand...

Admittedly based on your very own brand of chiropractic, which, to be fair, has not been independently tested, validated, nor assessed in terms of efficacy or safety for your patients.

chirodoc said:

As for straight vs. mixer, I guess you would categorize me as a mixer. Again, I couldn't care less about the straight/mixer garbage either, frankly it's stupid. Sounds too much like a sexual orientation designation.

Click to expand...

Of course you don't care. You just do your own thing! Wow, I wish medicine worked like that. "Standard of care, yeah, I don't feel like meeting that today. Too much work."

Can you see where this is difficult for a physician to understand? I have undergone a great deal more education and training to practice my art, yet, I am held to a much more rigid pattern of practice. Now, I am not complaining about that, I think it is necessary for patient safety. The apparent lack of practice standards in chiropractic concern me. While you personally might be a very good and careful practitioner, there is no mechanism to insure that the next chiropractor, also practicing their own brand of chiropractic, is.

chirodoc said:

No, I'm not going to read all your references/articles about pediatric chiropractic (which I do not support and think it's practically useless) because you don't have to convince me that I don't know didly about pediatrics. I agree! Others may not but I'll concede the point for many reasons.

Click to expand...

The point was not about pediatric chiropractic. Pediatrics is just the most expedient medium as there is a great deal published on it. The point was that chiropractors inadvertantly treating patients with unrecognized significant pathology is dangerous. And that it does happen. In my, albeit anecdotal, experience it happens often.

chirodoc said:

I'm a Doctor, not a physician, who practices chiropractic for NMS conditions...that's it.

Click to expand...

Fair enough. And, perhaps the right role for chiropractic. If all of your patients were first screened by an MD/DO for significant non-NMS pathology, we would be in complete argeement.

chirodoc said:

As far as who makes me a Doctor, that's another philosophical arguement I couldn't care less about. In my view, the State of Texas gave me a license and they are the elected representatives of the people, the school gave me a degree which met all accreditation standards so it's good, too. If you don't agree argue with them.

Click to expand...

While I wouldn't hold the Texas legislature up as the shining example for educational policies, I agree with you. And I think we had both already agreed that while the DC is a doctorate degree, it is not viewed as an "academic" degree outside of chiropractic institutions.

chirodoc said:

Overall, I don't disagree with you much on fact, your probably right on most stuff. Except, the reality in the field leaves much to be desired in medicine and chiropractic.

Getting back to the original point of this thread...no, don't become a chiropractor UNLESS you want this kind of reaction every time you turn around. Point Proven.

Click to expand...

Yep, we agree again. I think anyone going into chiropractic had best only do so with the knowledge that both the science and practice of the profession will likely remain constantly under fire for the length of their professional career. Even if (and this is a HUGE if) high quality studies were released today that "proved" the efficacy of chiropractic, it would likely be 25+ years before real change was complete with regard to chiropractic's role in health care and maintainence.

- H

FoughtFyr said:

If all of your patients were first screened by an MD/DO for significant non-NMS pathology, we would be in complete argeement.

Click to expand...

This is exactly the point I am trying to make! I think the VA allowing DCs to practice collaboratively with MDs/DOs and other healthcare professionals is a positive move for medicine in general, and chiropractic in particular. If more DCs were allowed to practice within hospital settings, there would likely be fewer "quacks" in private practice trying to sell the subluxation idea to their patients in order to generate a profit, and more of the NMS/mixer chiropractors working alongside hospital staff in providing manipulation, rehabiliation, nutrition, and other complementary modalities of treatment for NMS conditions. Whad'dya think?

PublicHealth said:

This is exactly the point I am trying to make! I think the VA allowing DCs to practice collaboratively with MDs/DOs and other healthcare professionals is a positive move for medicine in general, and chiropractic in particular. If more DCs were allowed to practice within hospital settings, there would likely be fewer "quacks" in private practice trying to sell the subluxation idea to their patients in order to generate a profit, and more of the NMS/mixer chiropractors working alongside hospital staff in providing manipulation, rehabiliation, nutrition, and other complementary modalities of treatment for NMS conditions. Whad'dya think?

Click to expand...

That is the model I have been proposing throughout his debate with one caveat - there needs to be PT services available to the patient to provide the same modalities on request. I still do not buy the science behind chiropractic, but my concerns relate not toward ineffectiveness but rather risk vs. benefit. If the risks, most significantly delays in proper care for serious pathology and mistreatment of serious pathology by use of chiropractic outside its scope, are controlled then I respect a patient's right to choose what I believe to be an ineffective modality to treat their NMS complaint. As long as it is a choice. As I have said before, the "best case" scenario that I could support for chiropractic is that they become to PT what DOs are to MDs and that neither DCs nor PTs have direct access. In that setting I believe the patients' right to choose the chropractic "philosophy" and practice is left intact while risks are minimized and "standard" medical care through PTs is also available in a levelled marketplace (no direct access).

- H

PH, you bring up some great ideas. As it is now this quack Terry A. Rondberg, DC, president of the World Chiropractic Alliance (WCA) has been invited to serve on the Department of Defense (DoD) Chiropractic Advisory Committee. His argument is that there should not be a gatekeeper for chiropractic services. He will argue that a DC is the only doctor trained to diagnose and treat vertebral subluxation. So if a MD/DO is the gatekeeper and has no training in vertebral subluxation detection, then how will they know that chiropractic care is necessary? That will be his argument. Personally, I don't agree with many things Rondberg says. I do agree with him for direct access but not for his reasons. There are far too many medical or osteopaths that hate chiropractors for one reason or another. I have plenty of them right hear in town. You can surely bet that chiropractic services will hardly be used if there is a MD/DO gatekeeper. I live near a base and there are chiropractors on base. I treat active duty patients who can go get chiropractic care for free on base. They come to me and pay out of pocket because it's just about impossible for them to get a referral from their primary care doctor on base. It is important for DC's to get direct access under the VA other it will be a waste just like it already is for active duty personnel.

FF you can argue all you want that DC's are incompetent. I'm sure that you see plenty of patients hurt by DC's just like you do from MD's or DO's prescribing the wrong medications and misdiagnosing patients. I would imagine you see injuries from PT's, nurses and other health practitioners as well. I had a patient the other day that had a bladder infection and her doctor told her it was the flu. She ended up in the ER. I could easily match every story you have about a chiropractor misdiagnosing or hurting a patient with one that happened at the hands of a medical doctor.

BackTalk said:

FF you can argue all you want that DC's are incompetent. I'm sure that you see plenty of patients hurt by DC's just like you do from MD's or DO's prescribing the wrong medications and misdiagnosing patients. I would imagine you see injuries from PT's, nurses and other health practitioners as well. I had a patient the other day that had a bladder infection and her doctor told her it was the flu. She ended up in the ER. I could easily match every story you have about a chiropractor misdiagnosing or hurting a patient with one that happened at the hands of a medical doctor.

Click to expand...

Yep, that is true, MDs and DOs and PTs and NPs, etc. etc. misdiagnose everyday. And I would have no problem with chiropractic if there was a proven benefit to match the risk. Again, show me one documented patient with a pathology that places them at risk for significant morbidity and/or mortality missed by an MD, diagnosed and treated to resolution by a DC. Heck, just give me a documented patient with a pathology that places them at risk for significant morbidity and/or mortality that was diagnosed and treated to resolution by a DC. I mean DD cured deafness right? Why aren't fewer cochlear implants being sold and more chiropractic audiologists in business? You would think at least one case would have occured since 1895...

It is not that chiropractors are all incompetent, it is that it is impossible to discern the ones who are. It is also a simple matter of risk versus benefit. Mild risk versus no benefit does not help the public good.

- H

BackTalk said:

There are far too many medical or osteopaths that hate chiropractors for one reason or another. I have plenty of them right hear in town. You can surely bet that chiropractic services will hardly be used if there is a MD/DO gatekeeper. I live near a base and there are chiropractors on base. I treat active duty patients who can go get chiropractic care for free on base. They come to me and pay out of pocket because it's just about impossible for them to get a referral from their primary care doctor on base.

Click to expand...

It might surprise you BT but I would be in favor, strong favor, of mandating that any patient referred to a PT be allowed to access chiropractic services instead - either active duty or VA. If direct access were removed in the lay population, I would agree with such a mandate there as well. I do believe that a patient has the right to direct their own care if they are reasonably educated as to the relative risks and benefits. If someone wishes to use chiropractic services to treat an NMS complaint, I have no problem with that. My problem is with the lack of direct oversight, ill-defined scope of practice, (in)ability to screen and diagnose non-NMS conditions, etc. I do not believe that MD/DOs should be allowed to trump patient preferences out of petty spite where there are no medical contra-indications to chiropractic care.

- H

BackTalk said:

PH, you bring up some great ideas. As it is now this quack Terry A. Rondberg, DC, president of the World Chiropractic Alliance (WCA) has been invited to serve on the Department of Defense (DoD) Chiropractic Advisory Committee..

Click to expand...

Terry Rondberg-----------The "Britney Spears" of Chiropractic. Like Britney, his biggest talent is self promotion. It just cracks me up when FF uses WCA/Rondberg for most of his "data". Rondberg is self appointed president for life of WCA which can only be estimated(he refuses to produce a memberlist) of approximately only 240 DCs!!


-----------------------------------------------------------------


..[/QUOTE]His argument is that there should not be a gatekeeper for chiropractic services. He will argue that a DC is the only doctor trained to diagnose and treat vertebral subluxation. So if a MD/DO is the gatekeeper and has no training in vertebral subluxation detection, then how will they know that chiropractic care is necessary? That will be his argument. Personally, I don't agree with many things Rondberg says. I do agree with him for direct access but not for his reasons. There are far too many medical or osteopaths that hate chiropractors for one reason or another. I have plenty of them right hear in town. You can surely bet that chiropractic services will hardly be used if there is a MD/DO gatekeeper. I live near a base and there are chiropractors on base. I treat active duty patients who can go get chiropractic care for free on base. They come to me and pay out of pocket because it's just about impossible for them to get a referral from their primary care doctor on base. It is important for DC's to get direct access under the VA other it will be a waste just like it already is for active duty personnel. ..[/QUOTE]

I agree on that, backtalk. The scare tactics of politico-meds is pretty transparent. IMO, as DCs continue in military/VA settings, and DC expertise in NMS conditions is demonstrated, reasonable, sensible policy makers will make it happen.


--------------------------------------------------------------------------

rooster said:

Terry Rondberg-----------The "Britney Spears" of Chiropractic. Like Britney, his biggest talent is self promotion. It just cracks me up when FF uses WCA/Rondberg for most of his "data".

Click to expand...

Love the mischaracterization Rooster. Spoken like a true chiro, just say that it is so and it will be! I have never relied on Rondberg or the WCA for "data". I cite peer-reviewed journals and texts. However, when I do that you and others here accuse me of "chiro-bashing". So I quote the WCA to provide "pro-chiropractic" reports of current and past events in chiropractic. Are you suggesting that Rondberg is "anti-chiropractic"? I know, it is all just part of the AMA's conspiracy against chiropractic. I am actually a "sleeper agent" for the AMA. I get paid $100 a post.

{sarcasm}

- H
"President for Life" - World Protienatic Alliance (WPA)

Below are your WCA cites---(I only went back to 5-1-05), that you use to support your position. In case you are unaware, WCA is not a peer reviewed journal. It represents a position of one ambitious self promotor, and a few(@240) DCs. I do not consider it a representation of the majority of DCs(duh) or a respected source of "pro-chiropractic" information. I think you already know this.
------------------------------------------------------------------------------


Here is a "pro-chiro" account of the trials and tribulations of chiropractic colleges becoming accredited: http://www.worldchiropracticallianc...un/jun1992d.htm

Philosophy aside?!? You have to be kidding! Other than the "chiropractic philosophy" what do chiropractors offer? Less education, lower admission standards, less clinical training time, and no residencies, but now we are to make them prescription providers? That aside, here is the rub - they don't want them (prescription rights)! Don't take my word for it, here is an (albiet old) interview witht the presidents of each of the U.S. chiropractic colleges. None of them is for prescription rights for chiropractors.

See: http://www.worldchiropracticallianc...ar/mar1994e.htm


"First, we must safeguard our unique identity as non-medical, subluxation-centered wellness providers. We can't merely be one of a slew of practitioners offering spinal manipulation for neuromusculoskeletal disorders. Subluxation correction is the one thing we do that no one else does, and this will be the key to bringing patients into our office and helping them lead healthier lives without drugs and surgery." {italics added, bold type original}

See: http://www.worldchiropracticallianc...eb/rondberg.htm
Why add prescription rights to a profession that doesn't want them and was founded on the principle of health maintainence without drugs or surgery?

If the "Master's Circle" lawsuit wins, chiropractic will suffer. To quote Terry Rondberg (see: http://www.worldchiropracticallianc...pr/rondberg.htm) "Keep in mind that this case isn't about improper clinical care ‑‑


WOW! That statement is so ridiculous as to be asinine. But I'll answer it anyway.

from: http://www.worldchiropracticallianc...ar/mar1994e.htm


Philosophy aside?!? You have to be kidding! Other than the "chiropractic philosophy" what do chiropractors offer? Less education, lower admission standards, less clinical training time, and no residencies, but now we are to make them prescription providers? That aside, here is the rub - they don't want them (prescription rights)! Don't take my word for it, here is an (albiet old) interview witht the presidents of each of the U.S. chiropractic colleges. None of them is for prescription rights for chiropractors.

See: http://www.worldchiropracticallianc...ar/mar1994e.htm

Since you have so much time on your hands, why don't you find each of the peer-reviewed research papers I have posted?

No, guess you don't want that many data in one place. O.k., I will do it. Have a good laugh at how "FF uses WCA/Rondberg for most of his 'data'."

By my count I have cited four WCA articles (albeit multiple times each) and 23 peer reviewed journals (also multiple times each). Good to see that "most" of my data is from the WCA!

BTW - I went back to 12-28-04; there were no additional WCA citations in that time frame although there were repeats of the ones you posted.

- H
_____

OP: http://forums.studentdoctor.net/showpost.php?p=2687469&postcount=49

"Archives of Pediatrics & Adolescent Medicine

----------------------------------------------
Volume 151(5) May 1997 pp 527-528"

OP: http://forums.studentdoctor.net/showpost.php?p=2687469&postcount=48

"For example, there is a study which I have posted many times that suggested that 17% of chiropractors who identified themselves as treating children would treat a case of neonatal fever without referral to an MD/DO or more appropriately to an ED. (see: http://www.ncbi.nlm.nih.gov/entrez/...d&dopt=Abstract&list_uids=10768681&query_hl=8 ) Neonatal fever is a defacto emergency. No attempt should be made to treat as an outpatient – yet 17% of chiropractors who treat children would try."

OP: http://forums.studentdoctor.net/showpost.php?p=2561300&postcount=1

"Even SCARIER..."

http://www.jcca-online.org/client/cca/JCCA.nsf/objects/V49-1-46/$file/jcca-v49-1-046.pdf" - A chiropractic journal no less!

OP: http://forums.studentdoctor.net/showpost.php?p=2573803&postcount=19

"Now chiropractic and stroke."

from:http://www.ncbi.nlm.nih.gov/entrez/...ve&db=pubmed&dopt=Abstract&list_uids=12743225

from:http://www.ncbi.nlm.nih.gov/entrez/...ve&db=pubmed&dopt=Abstract&list_uids=12692699

from:http://www.ncbi.nlm.nih.gov/entrez/...ve&db=pubmed&dopt=Abstract&list_uids=15513007

from:http://www.ncbi.nlm.nih.gov/entrez/...ve&db=pubmed&dopt=Abstract&list_uids=12466778 - Your favorite journal; JMPT (that fun lovin' group of chiro-bashers!)

"I thought there were "no side effects" to chiropractic? Yep it never happens, but the chiropractic journals describe when and how. I guess they are used to reporting on fictional things (like subluxations) anyway..."

from:http://www.ncbi.nlm.nih.gov/entrez/...ve&db=pubmed&dopt=Abstract&list_uids=14586598

"To be fair, there is an article describing why there is such a different opinion of the level of risk chiropractic manipulation represents."

from:http://www.ncbi.nlm.nih.gov/entrez/...ve&db=pubmed&dopt=Abstract&list_uids=14589464

OP: http://forums.studentdoctor.net/showpost.php?p=2605708&postcount=59

"Great, now we are paying for "unproven" methods to be available to all. You know, given the amount of the population that screams "I can't afford health care" this program seems to me to be a step backward. Especially when you consider the following:

Trends in Alternative Medicine Use in the United States, 1990-1997
Eisenberg GM, Davis RB, Ettner SL, etal
From: Journal of the American Medical Association
Volume/Edition: 280 (18)
Pages/Time: 1569-1575
Source/Year: November 1998"

OP: http://forums.studentdoctor.net/showpost.php?p=2318810&postcount=16

"In that study (see: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=9761802), the findings were 'In children with mild or moderate asthma, the addition of chiropractic spinal manipulation to usual medical care provided no benefit.'"

"From my favorite (Cochrane reviews) on 'Manual Therapy for Asthma':
'From 393 unique citations, 59 full text articles were retrieved and evaluated, which resulted in nine citations to five RCTs (290 patients) suitable for inclusion. Trials could not be pooled statistically because studies that addressed similar interventions used disparate patient groups or outcomes. The methodological quality of one of two trials examining chiropractic manipulation was good and neither trial found significant differences between chiropractic spinal manipulation and a sham manoeuvre on any of the outcomes measured. Quality of the remaining three trials was poor. One small trial compared massage therapy with a relaxation control group and found significant differences in many of the lung function measures obtained. However, this trial had poor reporting characteristics and the data have yet to be confirmed. One small trial compared chest physiotherapy to placebo and one small trial compared footzone therapy to a no treatment control. Neither trial found differences in lung function between groups.'"

OP: http://forums.studentdoctor.net/showpost.php?p=2268005&postcount=8

Here are links to the abstracts: http://www.ncbi.nlm.nih.gov/entrez/...ve&db=pubmed&dopt=Abstract&list_uids=12221360 and http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=7638657.

OP: http://forums.studentdoctor.net/showpost.php?p=2183403&postcount=46

"Chiropractors were included in two types of these studies, those of low back pain, and those looking at workingmans' compensation costs. see: http://www.annals.org/cgi/content-nw/full/127/1/52/T2 Their findings were hardly supportive of chiropractic."

"The study abstract is here: http://www.ncbi.nlm.nih.gov/entrez/...ve&db=pubmed&dopt=Abstract&list_uids=15477432. While the study is interesting for it's size, there are serious design problems. I quote from the journal editor's comments in the same issue.

OP: http://forums.studentdoctor.net/showpost.php?p=2183516&postcount=47

"The study is here: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=9801210 with a follow-up study here: http://www.ncbi.nlm.nih.gov/entrez/...ve&db=pubmed&dopt=Abstract&list_uids=11940622. Now there are two problems with this as far as your argument is concerned. First, this test was not given to first year out chiropractic graduates, so it doesn't say that chiropractors would do any better. Second, it was administered to interns, who still had an average of three to five years of training remaining. The test itself was validated by administration to eight senior orthopedic surgery residents, all of whom passed. So what have we proven? MD/DOs do a residency for a reason. It is an integral part of our training. Big deal. I'd have granted you that without a study."

OP: http://forums.studentdoctor.net/showpost.php?p=2135577&postcount=95

"Now as an (I assume) educated person, what is your opinion/reaction to these studies?"

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=7884327&dopt=Abstract

http://www.cmaj.ca/cgi/content/full/166/12/1531

http://www.cmaj.ca/cgi/content/full/166/12/1544

http://www.ncbi.nlm.nih.gov/entrez/...ve&db=pubmed&dopt=Abstract&list_uids=11340209

OP: http://forums.studentdoctor.net/showpost.php?p=2139393&postcount=120

"No, what I am referring to is summarized here: http://nccam.nih.gov/health/chiropractic/index.htm#app2

Three systematic reviews that concluded "Overall, the evidence was seen as weak and less than convincing for the effectiveness of chiropractic for back pain. Specifically, the 1996 systematic review reported that there were major quality problems in the studies analyzed; for example, statistics could not be effectively combined because of missing and poor-quality data. The review concludes that the data 'did not provide convincing evidence for the effectiveness of chiropractic.' The 2003 general review states that since the 1996 systematic review, emerging trial data 'have not tended to be encouraging…. The effectiveness of chiropractic spinal manipulation for back pain is thus at best uncertain.' The 2003 meta-analysis found spinal manipulation to be more effective than sham therapy but no more or no less effective than other treatments."

- H

Wow, do people have a lot of time on their hands

611 said:

Wow, do people have a lot of time on their hands

Click to expand...

FF must have been on-call.

PublicHealth said:

FF must have been on-call.

Click to expand...

Worse, on call and off service. Only one surgical case last night. Should've gone to bed but didn't want to jinx it. Closest thing to a shut out that has happened this year!



- H

FoughtFyr said:

Worse, on call and off service. Only one surgical case last night. Should've gone to bed but didn't want to jinx it. Closest thing to a shut out that has happened this year!



- H

Click to expand...

Everyone must be at their chiropractor's office! After all, they are available 24 hrs/day, 7 days a week for "emergencies."

Chiropractic Audiology...hmmm. Sounds like a seminar I can sell. Thanks FF.

chirodoc said:

Chiropractic Audiology...hmmm. Sounds like a seminar I can sell. Thanks FF.

Click to expand...

You laugh, but one of the most widely-read journals among chiropractors contains articles purportedly showing that chiropractic manipulation may be used to treat hearing loss:

http://www.ncbi.nlm.nih.gov/entrez/...d&dopt=Abstract&list_uids=10863256&query_hl=4

http://www.ncbi.nlm.nih.gov/entrez/...d&dopt=Abstract&list_uids=11898020&query_hl=4

An obscure German article suggesting the same:

http://www.ncbi.nlm.nih.gov/entrez/...ed&dopt=Abstract&list_uids=8002367&query_hl=4

Here's a report suggesting that cervical manipulation may cause sensorineural hearing loss:

http://www.ncbi.nlm.nih.gov/entrez/...ed&dopt=Abstract&list_uids=3753736&query_hl=4

Mixed results from the Germans (note that an orthopedic surgeon performed the chiropractic manipulations!):

http://www.ncbi.nlm.nih.gov/entrez/...d&dopt=Abstract&list_uids=11253527&query_hl=4

I'm not going there PH...but thanks for your sources and information.

Just trying to break the 'tension'.

chirodoc said:

I'm not going there PH...but thanks for your sources and information.

Just trying to break the 'tension'.

Click to expand...

I got nuthin' but love for you, doc!

chirodoc said:

Chiropractic Audiology...hmmm. Sounds like a seminar I can sell. Thanks FF.

Click to expand...

No problem! Mandate at least 14 visits. I get the profits from the 14th as a royalty!

- H

rooster said:

I do not consider it a representation of the majority of DCs(duh) or a respected source of "pro-chiropractic" information. I think you already know this.

Click to expand...

Well, there are two problems with that statement, first, Dr. Rondberg and the members of the WCA are chiropractors, so what makes your views any more or less valid than theirs? Second, the articles were carefully chosen for their content, see the descriptions below (my links actually work!).

BTW - I did not ever rely on the WCA for data. You claim to hold a scientific doctorate degree and yet you cannot differentiate between data and opinions.

From my post: Here is a "pro-chiro" account of the trials and tribulations of chiropractic colleges becoming accredited: http://www.worldchiropracticalliance.org/tcj/1992/jun/jun1992d.htm

Discussion: Where is the falsehood in this article? It is a historical account of how the CCE got Chiropractic Colleges accreditated by the (then) DHEW. Now I will grant you that the WCA is upset that the CCE required standardization of the DC to a degree that they felt took away from chiropractic by requiring professionals in basic science subjects to teach at chiropractic colleges instead of DCs. They were also upset that the Ph.C. was retracted as not sufficently academically rigorous enough to warrant a separate doctorate. The article certainly has an agenda - but it is one I disagree with. However, it is the only online accounting of this history I could find.

From my post: Don't take my word for it, here is an (albiet old) interview with the presidents of each of the U.S. chiropractic colleges. None of them is for prescription rights for chiropractors.

See: http://www.worldchiropracticalliance.org/tcj/1994/mar/mar1994e.htm

Discussion: Now I am sure that we can agree that the WCA publication is well known to each of the Presidents responding to the survey. Yet, future editions carry no retractions. Nor does a google search reveal any calls for retractions from any of the quoted individuals. So, we can somewhat safely assume the quotes are remotely accurate. In that case, what is the problem with this article? I will admit that the Presidents (at the time) of Western States and Texas Chiropractic College declined to respond, but that was well described in the article. So once again, where is the falsehood?

From my post: Why add prescription rights to a profession that doesn't want them and was founded on the principle of health maintainence without drugs or surgery?

See: http://www.worldchiropracticalliance.org/tcj/2005/feb/rondberg.htm

Discussion: Contained in this article (and central to my using it) is the quote

Are you suggesting that document doesn't exist? Are you suggesting that a majority of chiropractors are for prescription rights? If so then what exactly are you basing the profession on? (And I am not willing to accept that a majority of chiropractors want prescription rights without some data to support the statement.) Chiropractic was founded very specifically on the principles of no drugs or surgery. Now you want to change that. Based on what? And what does that make the profession?

From my post: If the "Master's Circle" lawsuit wins, chiropractic will suffer. To quote Terry Rondberg (see: http://www.worldchiropracticalliance.org/tcj/2005/apr/rondberg.htm) "Keep in mind that this case isn't about improper clinical care ‑‑"

Discussion: Once again, coverage of a news worthy event. You don't think Rondberg's concerns are valid? You don't believe that if the suit is lost, insurance companies might use the findings of fact from the judgement to challenge the laws requiring coverage of chiropractic care? Wow, you are one of the few health professionals of any description that I know that doesn't believe insurance companies will try anything and everything to deny claims. Heck, I see nasty implications for MD/DOs who suggest medical follow-up visits if the suit prevails. How do you not see it as a threat?

rooster said:

WOW! That statement is so ridiculous as to be asinine. But I'll answer it anyway.

from: http://www.worldchiropracticalliance.org/tcj/1994/mar/mar1994e.htm

Philosophy aside?!? You have to be kidding! Other than the "chiropractic philosophy" what do chiropractors offer? Less education, lower admission standards, less clinical training time, and no residencies, but now we are to make them prescription providers? That aside, here is the rub - they don't want them (prescription rights)! Don't take my word for it, here is an (albiet old) interview witht the presidents of each of the U.S. chiropractic colleges. None of them is for prescription rights for chiropractors.

See: http://www.worldchiropracticalliance.org/tcj/1994/mar/mar1994e.htm

Click to expand...

Yeah, pointing out that I have quoted the same article more than once doesn't really bolster your argument. I've quoted several of the peer-reviewed journals I have quoted more than once. Responding to the circular logic the defenders of chiropractic use requires the repitition.

- H

Yes PH, I'm on call again!

You guys really crack me up. Lets take a look at some of the facts shall we. You guys suggest that ot/pt is a better career in terms of reinbursement. Ok first, pt's are absolutely not considered physicians in any states. Secondly, in order to see a patient they must have them referred from a physician. Occupational therapy?? No insurance coverage by any carrier, certainly not considered physicians, can not diagnose any pathology.. musculoskeletal or otherwise. Can not order or interpret x-rays or mri's. Physical therapists are not even aloud to move a joint past its passive range of motion. Physicians assistants??? Again all of the same above, although they do tend to make more money on average than the above professions. However chiropractors on average still make more money than physicians assistants. And there are many chiropractors who make well over $200,000 dollars, physician assistants simply do not have that earning capacity.

ok... if DCs make so much more money than PAs and are better trained than PAs then why are PA schools across the country littered with DCs who found that chiropractic "wasnt enough for them."

also, PAs routinely order tests and interperet them. so not "all of the same above" like you stated. honestly, putting PAs in the same boat as OT/PT/DC is completely inaccurate. and i have no idea how or why you coupled them together other than that you just might not have known better. You kinda had me convinced until you pulled this crazy comparison out of a hat.

Sorry guy, insurance does pay for OT. At least mine does and is doing so currently.

It also pays for PT. Some policies pay without referral. The louder the DCs whine, the funnier they get. I just saw another patient who had a leg length discrepancy and was seeing a local DC for 2 years BIW. I put a lift in her shoe and she had no more pain. that was 5 weeks ago and counting. Why do the sensible DCs defend the quacks and con artists. Purge yourself and you will get some more respect.

I wasn't sure where to put this....but I thought you guys would find what I stumbled across in the morning paper interesting.....

http://www.omaha.com/index.php?u_pg=1638&u_sid=1440239

According to the article, Bruce Crabtree, D.C. is offering chiropractic care to house pets....I really like the part about 'cold laser therapy'...heh heh.

"Using a machine that resembles a blunt corkscrew, Crabtree puts pressure on the animal's spine to look for unwanted muscle reactions through the skin. Not only is the treatment painless, he said it releases endorphins and other natural pain relief chemicals in the animal that make them feel better almost immediately.

In addition, Crabtree also uses cold laser therapy, or light waves, to stimulate healing in the pets."

rooster said:

http://www.animalchiropractic.org/default2.htm

Click to expand...

So now let's take stock.

A DC, in three calendar years of education, gets (according to them):

1. The same amount of education that an MD or DO gets in four years
2. Clinical diagnostic ability equal to that of an MD/DO who has gone through at least three years of residency

AND

3. All of the principles and practices of chiropractic.

Quite a three year stint. Now, add another year and you get:

4. The diagnostic and therapuetic skills of a DVM.

- H

I don't know what all this talk about chiropractors treating animals is all about. As far as I know, a chiropractor's license (MD or DO for that matter too) is to treat HUMAN ailments. That would make it ILLEGAL for anyone other than a DVM to treat animals.

AVCA is a DC/DVM collaboration requiring post grad. Certified docs are about 50/50(DC/DVM). I worked with a AVCA certified DVM on my own dog(old dog with progressive hind leg lameness).........Very interesting and with excellent results.

truthseeker said:

It also pays for PT. Some policies pay without referral. The louder the DCs whine, the funnier they get. I just saw another patient who had a leg length discrepancy and was seeing a local DC for 2 years BIW. I put a lift in her shoe and she had no more pain. that was 5 weeks ago and counting. Why do the sensible DCs defend the quacks and con artists. Purge yourself and you will get some more respect.

Click to expand...

I just saw another patient who had a leg length discrepancy and was seeing a local DC for 2 years BIW.

BTW how did you recognize the discrepancy? In my years of practice I found the best way is with a standing AP Pelvis radiograph. Only large discrepancies can be determined visually or by measuring. At least that is what I have found in my experience.

I put a lift in her shoe and she had no more pain.

That’s great! At least you recognized the problem. Many DC’s also use lifts. Shame on the DC for not recognizing this. One chiropractic failure does not make the whole profession bad.

Why do the sensible DCs defend the quacks and con artists. Purge yourself and you will get some more respect

I don’t know why. I don’t defend them just like I don’t defend anyone who practices quackery.

BackTalk said:

I just saw another patient who had a leg length discrepancy and was seeing a local DC for 2 years BIW.

BTW how did you recognize the discrepancy? In my years of practice I found the best way is with a standing AP Pelvis radiograph. Only large discrepancies can be determined visually or by measuring. At least that is what I have found in my experience.

I put a lift in her shoe and she had no more pain.

That’s great! At least you recognized the problem. Many DC’s also use lifts. Shame on the DC for not recognizing this. One chiropractic failure does not make the whole profession bad.

Why do the sensible DCs defend the quacks and con artists. Purge yourself and you will get some more respect

I don’t know why. I don’t defend them just like I don’t defend anyone who practices quackery.

Click to expand...

BTW how did you recognize the discrepancy? In my years of practice I found the best way is with a standing AP Pelvis radiograph. Only large discrepancies can be determined visually or by measuring. At least that is what I have found in my experience.

• 
  I agree that the best way is to take an AP pelvis radiograph, and I tell people that can order them so, however, what they often don't do, is to be sure that both feet are in the same amount of pronation i.e. subtalar neutral. I just had a lengthy discussion with one of my buddies, who is a DC, after we we both failed at an all-in attempt in our weekly Texas Hold'm game. What I do is look at them clinically since I can't personally order Xrays. Granted, none of my tests are very reliable but when I use them all I feel that I get a pretty good, valid, indication of the appearance of a true leg length discrepancy. These are my tests:
• iliac crest height in stance with both knees fully extended
• which foot pronates more - that suggests a long leg
• observe shoe wear pattern, again, more pronation usually indicates the long leg
• chronic complaints on one side - usually the pain is on the long leg whether it is plantar fasciitis, patello-femoral pain, lumbar facet arthropathy, or SI pain
• towel test - place a towel under one foot, have the patient feel how out of balance they are and then switch the towel, which one feels better
• hip hike test - full knee extension in stance, the patient hikes their hip up as much as they can, the one that hikes the most is the short one
• ASIS position in supine, which is higher
• apparent leg length once the ASIS's are level
• measured ASIS to medial malleolus bilaterally (probably the least reliable test on this list)
• hooklying - feet side by side, which knee is higher (I use a level). that tibia is longer.
• hooklying - which tibial tubercle is more caudal - not very reliable either (I wear glasses for a reason)

If I get a lopsided score, I put a 1/4 inch Spenco in the short leg's shoe. I read a study that 1/4 inch seems to be the LLD where most people become more likely to have back pain.

That’s great! At least you recognized the problem. Many DC’s also use lifts. Shame on the DC for not recognizing this. One chiropractic failure does not make the whole profession bad.

I am not saying that the whole profession is bad, there is just one out of 5 in my town of 5000 who is everything that you don't want your profession to exemplify. He treats people only enough so that they come back. He is a shyster and I think people are starting to recognize it. He has a radio show in town (that he pays for like an ad) where he claims that he can cure any ill. People are starting to laugh at him. Its bad for the three that are sensible. It doesn't matter for the other one, he treats auras and such by light touch. sort of voodoo to me.

BTW at work I am truthseeker at home I am DPTATC, I couldn't remember my password and stuff.

DPTATC said:

BTW how did you recognize the discrepancy? In my years of practice I found the best way is with a standing AP Pelvis radiograph. Only large discrepancies can be determined visually or by measuring. At least that is what I have found in my experience.

• 
  I agree that the best way is to take an AP pelvis radiograph, and I tell people that can order them so, however, what they often don't do, is to be sure that both feet are in the same amount of pronation i.e. subtalar neutral. I just had a lengthy discussion with one of my buddies, who is a DC, after we we both failed at an all-in attempt in our weekly Texas Hold'm game. What I do is look at them clinically since I can't personally order Xrays. Granted, none of my tests are very reliable but when I use them all I feel that I get a pretty good, valid, indication of the appearance of a true leg length discrepancy. These are my tests:
• iliac crest height in stance with both knees fully extended
• which foot pronates more - that suggests a long leg
• observe shoe wear pattern, again, more pronation usually indicates the long leg
• chronic complaints on one side - usually the pain is on the long leg whether it is plantar fasciitis, patello-femoral pain, lumbar facet arthropathy, or SI pain
• towel test - place a towel under one foot, have the patient feel how out of balance they are and then switch the towel, which one feels better
• hip hike test - full knee extension in stance, the patient hikes their hip up as much as they can, the one that hikes the most is the short one
• ASIS position in supine, which is higher
• apparent leg length once the ASIS's are level
• measured ASIS to medial malleolus bilaterally (probably the least reliable test on this list)
• hooklying - feet side by side, which knee is higher (I use a level). that tibia is longer.
• hooklying - which tibial tubercle is more caudal - not very reliable either (I wear glasses for a reason)

If I get a lopsided score, I put a 1/4 inch Spenco in the short leg's shoe. I read a study that 1/4 inch seems to be the LLD where most people become more likely to have back pain.

That’s great! At least you recognized the problem. Many DC’s also use lifts. Shame on the DC for not recognizing this. One chiropractic failure does not make the whole profession bad.

I am not saying that the whole profession is bad, there is just one out of 5 in my town of 5000 who is everything that you don't want your profession to exemplify. He treats people only enough so that they come back. He is a shyster and I think people are starting to recognize it. He has a radio show in town (that he pays for like an ad) where he claims that he can cure any ill. People are starting to laugh at him. Its bad for the three that are sensible. It doesn't matter for the other one, he treats auras and such by light touch. sort of voodoo to me.

BTW at work I am truthseeker at home I am DPTATC, I couldn't remember my password and stuff.

Click to expand...

Typically I start by a standing weight-bearing examination. I position the patient in bare feet with their feet about 6-8 inches apart. Instruct them to stand in a normal, relaxed position, with knees extended. I visually examine the feet and ankles to determine any excessive unilateral pronation. I palpate under the arches of both left and right foot to determine any drop of the longitudinal arch or marked tenderness under the arch. I look at the back of the knees and determine if there is a valgus deformity. I also look for any unilateral medial rotation of the knee. I will place my hands across the top of the iliac crest and determine if there is unleveling of the pelvis. I typically look at the sacral dimples for unleveling. I also will inspect for a flank fold. (Just above the iliac crest there may be a fold or indentation of the flank on the long leg side). I inspect for any lumbar curvature, check lumbar range of motion and check for more lateral bending on one side or the other. On flexion, I will inspect the lumbar erectors and see if they are more pronounced on one side that the other. Also, I will inspect for a rib hump. Further I will inspect for an elevated scapula and also look at shoulder heights. From there I move to the cervical spine and inspect for deviation of the head or neck to one side. This is my inspection for a functional short leg.

If there is unleveling of the pelvis or sacral dimples I have the patient rock up on the lateral aspect of both feet thus taking a supinated stance. If the pelvis levels out or the sacral dimples level out in this position then I suspect I’m looking at a functional short leg and an orthotic is typically prescribed. If the pelvis remains unleveled in that position an anatomical short leg is suspected and a heel lift is needed. If the pelvis tends to level out, but not completely, then I suspect a combination of functional and anatomical short leg. This would be an indicator for both orthotic and heel lift.

This technique is typically how chiropractor’s analysis a functional or anatomical short leg. If we suspect an anatomical short leg, then x-rays are done. There is a whole system of analysis we use that is too detailed for me to sit here and explain. Yes, patient position is very important and is key when taking radiographs to make this determination.

As far as the chiropractors in your town, it’s fairly typical to have a few oddballs out there. The ones you describe probably wouldn’t have a clue as to how to determine a leg length inequality. On the same note there are physical therapists that also have no clue. Many times with heel lifts and orthotics it helps but the patient still exhibits symptoms from time to time and will need supportive care. As the body adapts orthotics will need modification. Just my two cents.

I didn't get a chance to read the following article, but it seems to suggest that chiropractic students are not as well trained in primary care as medical students. Oddly, the conclusions stated in the abstract are not consistent with their results. Since when is performing "almost as well" considered "noteworthy?" My wife sure doesn't think so!


J Manipulative Physiol Ther. 2005 Jun;28(5):336-44.

Assessment of knowledge of primary care activities in a sample of medical and chiropractic students.

Sandefur R, Febbo TA, Rupert RL.

Cleveland Chiropractic College, Kansas City, MO 64131, USA. [email protected]

OBJECTIVE: To examine the influence of chiropractic education on knowledge of primary care tasks. Scores received on a test of knowledge of primary care tasks were compared between 3 samples of chiropractic students and 1 small sample of medical students. DATA SOURCES: The taxonomy of primary care tasks that was previously published provided the basis for test items used in this study. A team of test writers prepared an evaluation instrument that was administered to final-term chiropractic students at 3 colleges and to a small sample of medical students as they were entering their residency programs. RESULTS: The chiropractic students scored below the medical students on the primary care examination in every area except musculoskeletal conditions. Chiropractic students scored higher than medical students on the musculoskeletal portion of the examination. CONCLUSIONS: In this sample, chiropractic students performed almost as well as medical students on a test that was designed to measure knowledge of primary care tasks. If the premise is accepted that medical school is the gold standard of primary care instruction, that chiropractic students fared almost as well as medical students is noteworthy.

PublicHealth said:

I didn't get a chance to read the following article, but it seems to suggest that chiropractic students are not as well trained in primary care as medical students. Oddly, the conclusions stated in the abstract are not consistent with their results. Since when is performing "almost as well" considered "noteworthy?" My wife sure doesn't think so!

Click to expand...

I agree with your wife!

Especially when you look at the numbers (BTW - PH, PM me, I'll send you the article)

So, what they did was give a test to on basic primary care to three groups of chiropractic students in their final terms in chiropractic college (groups 1, 2 and 3) and one group of recent medical school graduates who had yet to start residency. The test was created by "2 DCs who also hold bachelor's degrees, 1 DC with a diplomate in radiology, a DC enrolled in the final year of a radiology residency program, and 2 MDs". It was a 100 question test broken into two 50 question sections and some description of attempts to validate the instrument for use on chiropractic students is offered by the authors. So here is what they found...

Group 1: 21 students, raw scores 32.7, % scores 65.4, SD 4.6
Group 2: 22 students, raw scores 28, % scores 56, SD 5
Group 3: 79 students, raw scores 32.1, % scores 64.2, SD 4.4
Groups 1 to 3 (combined): 122 students, raw scores 31.4, % scores 62.8, SD 4.7
Group 4: 20 students, raw scores 36.7, % scores 73.4, SD 3.3

Now, while the medical student sample size is low, the performance of the chiropractic students is abyssmally low. 68% of all of the chiropractic students (who are very soon to enter practice) taking the test, a test designed and validated by DCs, scored between 58.1% and 67.5%?!? This is noteworthy? Yes, it is! It succinctly proves the point that DCs are very ill prepared to serve as primary care physicians. As for the medical students, 68% scored between 70.1% and 76.7%. While I would normally bristle at these data as the sample size is so small, it should be noted that the SD was the narrowest, by a considerable amount, in this group. This leads me to question the need to validate the instrument not only with chiropractic students (as was done) but also with medical students (not done in this study). These results seem to indicate a very tight "clumping" of scores in the medical student group, which may suggest that areas of the test represented material outside their scope of instruction.

Other results:
Percentage scores of all students on 5 major categories of primary care tasks
Primary care activities (% correct)
Information gathering Group 1 - 60.12, 2 - 57.04, 3 - 64.72, 4 - 76.64
Screening and prevention Group 1 - 35.72, 2 - 27.09, 3 - 38.93, 4 - 63.10
Other diagnostic procedures Group 1 - 66.94, 2 - 57.64, 3 - 65.83, 4 - 74.34
Counseling and education Group 1 - 69.05, 2 - 75.00, 3 - 87.74, 4 - 95.24
Management of acute/chronic conditions Group 1 - 65.71, 2 - 57.04, 3 - 64.69, 4 - 73.01

By these data, chiropractic does not perform information gathering or screening and prevention well at all.

I'm not going to post the data on all individual "subcategories of management of acute and chronic conditions". Suffice it to say that group four handily out performed all of the other groups in every area except one:
Musculoskeletal (% correct) Group 1 - 71.04, 2 - 56.95, 3 - 54.75, 4 - 48.02
(but group four did outperform the others in neuro!:
Neurological (% correct) Group 1 - 78.1, 2 - 61.67, 3 - 78.99, 4 - 82.86)

My most significant concern on their methodology is this - the test was given to medical students about to enter residency training and to final term chiropractic students about to enter practice (presumably). Now, the article acknowledges a gap, but that gap should only grow as the medical students have at least three years of training remaining. Also, no attempt was made to identify what area of medicine the MD students were entering. I would argue that given the latitude to self direct fourth year cirricula to a certain degree, students heading into primary care would likely outperform a random sample from all medical students on this examination as they would have more training in this area than the "average" medical student.

Lastly, the conclusions (as Public Health points out) do not match the data. It is not "noteworthy", in a positive sense, that chiropractic students about to enter the workforce score abyssmally low on a test of basic primary care skills. Comparing them to MD graduates with at least three years of training remaining is comparing apples and oranges. And even given the disparity in time remaining in training, the MD students quite significantly outperformed the chiropractors. This paper completely demonstrates what I have been saying since I started coming to this forum. Chiropractors are not equipped to act as primary care physicians.

- H

BackTalk said:

Typically I start by a standing weight-bearing examination. I position the patient in bare feet with their feet about 6-8 inches apart. Instruct them to stand in a normal, relaxed position, with knees extended. I visually examine the feet and ankles to determine any excessive unilateral pronation. I palpate under the arches of both left and right foot to determine any drop of the longitudinal arch or marked tenderness under the arch. I look at the back of the knees and determine if there is a valgus deformity. I also look for any unilateral medial rotation of the knee. I will place my hands across the top of the iliac crest and determine if there is unleveling of the pelvis. I typically look at the sacral dimples for unleveling. I also will inspect for a flank fold. (Just above the iliac crest there may be a fold or indentation of the flank on the long leg side). I inspect for any lumbar curvature, check lumbar range of motion and check for more lateral bending on one side or the other. On flexion, I will inspect the lumbar erectors and see if they are more pronounced on one side that the other. Also, I will inspect for a rib hump. Further I will inspect for an elevated scapula and also look at shoulder heights. From there I move to the cervical spine and inspect for deviation of the head or neck to one side. This is my inspection for a functional short leg.

If there is unleveling of the pelvis or sacral dimples I have the patient rock up on the lateral aspect of both feet thus taking a supinated stance. If the pelvis levels out or the sacral dimples level out in this position then I suspect I’m looking at a functional short leg and an orthotic is typically prescribed. If the pelvis remains unleveled in that position an anatomical short leg is suspected and a heel lift is needed. If the pelvis tends to level out, but not completely, then I suspect a combination of functional and anatomical short leg. This would be an indicator for both orthotic and heel lift.

This technique is typically how chiropractor’s analysis a functional or anatomical short leg. If we suspect an anatomical short leg, then x-rays are done. There is a whole system of analysis we use that is too detailed for me to sit here and explain. Yes, patient position is very important and is key when taking radiographs to make this determination.

As far as the chiropractors in your town, it’s fairly typical to have a few oddballs out there. The ones you describe probably wouldn’t have a clue as to how to determine a leg length inequality. On the same note there are physical therapists that also have no clue. Many times with heel lifts and orthotics it helps but the patient still exhibits symptoms from time to time and will need supportive care. As the body adapts orthotics will need modification. Just my two cents.

Click to expand...

Like you described, there are many other things that figure into my clinical eval. I look at how they walk, do they vault over one leg or another, do they have valgus deformity at the knee etc . . . I think we both would probably agree with each other clinically when we look for an LLD.

Before I recommend orthotics, I need to see an abnormal rearfoot and/or forefoot varus. If I see that ( in prone with a goniometer) then I make my recommendations to the orthotist for appropriate posting. I have found that if they have an actual structural problem, the orthotics don't need modifications unless they are a kid and their body changes. If I don't see foot posture abnormalities, then I work on trying to train their balance and proprioception to improve for example the position of the first ray. Often, if you correct a true length length discrepancy, the overpronating foot will stop doing so and the patient will have saved $300 and the hassle of moving the inserts from shoe to shoe.
BTW, I agree that there are idiots everywhere. Hopefully I am not one very often.

DPTATC-
Why not make arrangements with your DC friend to either take or order the needed films?
All the tests you describe are excellent indicators, but without the films it is still a guess, albeit an educated guess. Additionally, not all anatomical short legs are amenable to lifts, or to a full height lifts. This is essential info that can only be assessed via films. Talk to your DC friend, I'll bet you can make arrangements.

I had a patient a few years back that had broken his leg. It healed @ 1/4" short and was SO obvious. I could not believe his med doc didn't see it. After years of life on a short leg, he developed LBP, which is what brought him into my office. A lift solved most of his problems, but after so many years like that, there was, unfortunately related degenerative changes.

I am amending my own post-
regarding the patient cited: I had to incremently lift him over a period of time, as the soft tissues changes allowed.

group_theory said:

Don't forget, chiropractors can also

5. Make valid recommendation on vaccination usage based on their expertise in public health, epidemiology, immunology, infectious disease, and pediatrics

and

6. Are experts on the usage of natural supplements which they can "prescribe" to their patients (esp as a "alternative" to those deadly medicine prescribed by their MD/DO to make pharm companies richer)

Click to expand...

5. Make valid recommendation on vaccination usage based on their expertise in public health, epidemiology, immunology, infectious disease, and pediatrics

I know you are being sarcastic. You're right, our education in public health is not up to par to make these recommendations.

6. Are experts on the usage of natural supplements which they can "prescribe" to their patients (esp as a "alternative" to those deadly medicine prescribed by their MD/DO to make pharm companies richer)

Most chiropractors have a good understanding of herbs and supplements, its part of our education. I will have to say that most medical physicians have a poor understanding of vitamins and herbs and other supplements. I think over the years their knowledge has improved but still needs improvement. I never tell people to take this or that as opposed to taking their prescribed medication. When it comes to joint and bone health there are many alternatives to taking NSAIDS. Omega 3's are a good for helping with inflammation. I was very surprised when a patient of mine mentioned her MD told her to start taking flax seed oil or fish oils.

BackTalk said:

Most chiropractors have a good understanding of herbs and supplements, its part of our education. I will have to say that most medical physicians have a poor understanding of vitamins and herbs and other supplements. I think over the years their knowledge has improved but still needs improvement.

Click to expand...

So what's the purpose of having Doctors of Naturopathic Medicine (NDs)? I noticed that some chiropractic programs offer combined DC/ND degrees in chiropractic and naturopathic medicine (e.g., University of Bridgeport). Is there overlap in the curricula or clinical training of DCs and NDs?

Chiropractors now have the option of obtaining advanced training and Diplomates in a host of areas other than chiropractic neurology, chiropractic orthopedics, chiropractic radiology, etc: http://www.chiroeco.com/article/2005/issue8/Specialize.php

Table of Diplomates in chiropractic specialties:
http://www.chiroeco.com/article/2005/issue8/images/chiropracticSpec.pdf

I had 350 class hours in nutrition. What is the MD/DO class hours?

rooster said:

DPTATC-
Why not make arrangements with your DC friend to either take or order the needed films?
All the tests you describe are excellent indicators, but without the films it is still a guess, albeit an educated guess. Additionally, not all anatomical short legs are amenable to lifts, or to a full height lifts. This is essential info that can only be assessed via films. Talk to your DC friend, I'll bet you can make arrangements.

I had a patient a few years back that had broken his leg. It healed @ 1/4" short and was SO obvious. I could not believe his med doc didn't see it. After years of life on a short leg, he developed LBP, which is what brought him into my office. A lift solved most of his problems, but after so many years like that, there was, unfortunately related degenerative changes.

Click to expand...

I actually have tried to make those arrangements. I have discussed it with him/them and asked that when they take the films that they assure subtalar neutral or at least approximate the same amount of pronation, but unfortunately, they don't seem to see the logic in it.

rooster said:

I had 350 class hours in nutrition. What is the MD/DO class hours?

Click to expand...

Depends on your definition of "class hours". True courses, specific to nutrition only? Varies by institution. Instruction in nutrition? A fair portion of every in-patient clinical experience. I'm not sure that you truly comprehend what gooes into medical education, but to simplify this question you should know that no inpatient patient eats without a physician writing an order for them to be fed. So, in addition to learning all we need to know about parenteral nutrition and the alteration of nutritional needs in times of physiologic stress, we also must learn more basic dietary principles.

- H

Thanks for the non-answer.

Translation----"We don't need no stink'in nutrition classes!!"

"I'm a resident and I have nutritional INNATE INTELLIGENCE!!" ha ha ha

rooster said:

I had 350 class hours in nutrition. What is the MD/DO class hours?

Click to expand...

350 CLASS HOURS! LOL! I suspect the chiropractic idea of nutrition is a little bit different than the rest of the worlds.

I mean, with all the different doctorates that the "doctor" of chiropractic "medicine" encompasses (in three years mind you), why the need for any other type of education. It must have been exhausting defending so many dissertations coupled with a residency in radiology, orthopedics, family medicine, epidemiology, pediatrics, PM&R, so on and so on...................

Or wait a minute.......... Did you chiropractors actually do any of this? Oh! No you didn't. You're either that good or that ignorant! Which is it?

Let’s put your best evidence based practice to the text.

Please vote: Ignorant or Just that good

WOW! Another non-answer with obsfucation.

Looks to be a very touchy subject.

rooster said:

WOW! Another non-answer with obsfucation.

Looks to be a very touchy subject.

Click to expand...

You mean "obfuscation". I think thats how you spell it! I really can't spell anyway. If you're looking for an answer of the number of hours I've completed in nutrition courses, read on.

1. Basic nutrition - 3 credits approx. 48 class hours,
2. Nutrition for sport - 3 credits, approx 48 class hours
3. Biochemical basis of nutrition - approx 60 class hours

This obviously doesn't cover pre-reqs for biochemical basis of nutrition which include biochemistry and thus the pre-reqs for biochemistry.

Total "nutrition class hours" = 156

I'm not a physician or PA or nutritionist and couldn't begin to recommend anything medically about nutrition. I would need training in pharmaceudicals, drug reactions, disease/pathology, medical hemotology ect. I would only feel comforable talking to people about nutrition for general health and performance. L.

Without comment------Thank-you for a reel answer