For the students here, a little note about the practical outcomes of chiropractic referrals:
I find myself in a position nowadays where I refer to chiro at least 1-2x a week. Anyone who's read my posts knows that I consider them to be complete bunk, but there is some evidence that in acute low back strain they are marginally more effective than placebo (how's that for a ringing endorsement?).
So on occassions where this is the case, I do refer to chiro.
The problem is that when you refer to another "provider" (and I use that term very very loosely) you cannot limit their scope of practice. In an ideal world, I would have a consult that read, "Please do your fake manipulation thing and try to tell my patients lots of crazy stuff." Unfortunately I can't do that.
So let me tell you what ends up happening. Or at least what's happened to me in the last month.
- patient comes back to me, says that chiropractor took an xray and he has horrible spinal disease and congenital malformations. He thinks he needs surgery. Why? Pseudoarthrosis of L5-S1.
- patient comes back, says all his problems are due to a "tilted pelvis". How did the chiropractor know the pelvis was tilted? Because it wasn't level on the xray. I politely point out that it doesn't really work that way, and that perhaps his back pain is more the result of the car accident he was in the previous week.
- patient is told he has a leg-length discrepancy, and that's why his back hurts. I point out he went on a 10mi hike with a 80lbs pack. I also point out that you have to actually do a specific xray (scanogram) to determine limb length discrepancies. I also suggest that perhaps, even if he has one, that he doesn't need to see a podiatrist just to be a lift.
- Chiropractor refuses to see patient because he also sees Sports Medicine. "No point seeing two doctors for the same problem." Um, what? Didn't know the board certified, fellowship-trained Sports Medicine physician provided equivalent services to the "Doctor" of Chiropractics.
Remember, once you send them there, you can't control what they will do or say. So yes, there is mild-to-moderate benefit from chiropractic manipulation in acute low back pain. But that doesn't mean that's all they'll do to your patients.