chiropracitic and K supplements

chirobase06 · Mar 25, 2006

Hey all. I'm kinda new to the studentdoctor.net forums. I'm a first year student in the Midwest. For the first time since starting medical school, I was totally pissed off by a chiropractor (well known to me) who thinks she/he knows as much as I do about medicine. She/he probably does at this point, but what about in a couple years? I immediately, of course, thought about that, and realized that I haven't seen anything about that on here in the allopathic forums in the past few months and was wondering what you all thought.

She/he started asking me 'why do MD's start all their patients on furosemide without potassium supplementation?' It felt like a total attack, and was wondering if all your thoughts were the same...Found some interesting websites though...

Chirobase06

Smurfette · Mar 26, 2006

Many patients I've had this year I do put on K-dur along with lasix, especially if they have a h/o MI or are s/p CABG. However, I don't if a pt has renal insufficiency, among other reasons.

sdn1977 · Mar 26, 2006

A complete drug history & past labwork is required to evaluate if potassium supplementation is required. Other medications, especially for htn (ie ACE inhibitors) will contribute to a reduced need for potassium supplementation even if a loop diuretic is used. If a loop diuretic is added to a thiazide or a combination thiazide/triamterene, supplementation is not required and can be dangerous without close lab monitoring.

sdn1977 · Mar 26, 2006

sorry - should have said....supplementation *may* not be required - there is no hard & fast rule

nabeya · Mar 27, 2006

You should've responded by saying "Because MD's earned that right to decide whether they need K+ supplementation or not by going to med school while Chiropracters didn't." If they don't like the way it's being handled, they should go to med school then.

chirobase06 said:
Hey all. I'm kinda new to the studentdoctor.net forums. I'm a first year student in the Midwest. For the first time since starting medical school, I was totally pissed off by a chiropractor (well known to me) who thinks she/he knows as much as I do about medicine. She/he probably does at this point, but what about in a couple years? I immediately, of course, thought about that, and realized that I haven't seen anything about that on here in the allopathic forums in the past few months and was wondering what you all thought.

She/he started asking me 'why do MD's start all their patients on furosemide without potassium supplementation?' It felt like a total attack, and was wondering if all your thoughts were the same...Found some interesting websites though...

Chirobase06

davematthews · Mar 28, 2006

nabeya said:
You should've responded by saying "Because MD's earned that right to decide whether they need K+ supplementation or not by going to med school while Chiropracters didn't." If they don't like the way it's being handled, they should go to med school then.

Chirpractors for sure, not arguable, know more about the anatomy of the entire humany body, at least right out of school anyway. Beyond that, the physician is the expert.
Interstingly, the depth with which they study this goes well beyond that taught in medical school. This is true of PTs as well. Chiros take many of the same courses taught in the first two years of medical school, except pharm. So they learn all about disease and the biochemistry, etc behind it.
Although the formal training is quite different, as a future physician, your knowledge will not be based on what your learned in medical school, but instead your ability to be a lifelong student. So, there may be some things that a chiropractor is very knowledgeable about because they constantly read, study, adn attend seminars- just as you will do. The best possible treatment for your patient will likely come from a collaborative effort among you, other docs, and other healthcare providers. If you run into a chiro or PT or whoever that rubs you the wrong way, simple take what they are saying into consideration as it may help you decide the best treatment for your patient. Doctors are managers, so ultimately it is your decision. But the key to being a manager is to not take on all tasks, but rather devide them up appropriately and bring eveyones strengths and input to the table.

OSUdoc08 · Mar 28, 2006

davematthews said:
Chirpractors for sure, not arguable, know more about the anatomy of the entire humany body. The depth with which they study this goes well beyond that taught in medical school. This is true of PTs as well. Chiros take all the same courses taught in the first two years of medical school, except pharm. So they learn all about disease and the biochemistry, etc behind it. Although the formal training is quite different, as a future physician, your knowledge will not be based on what your learned in medical school, but instead your ability to be a lifelong student. So, there may be some things that a chiropractor is very knowledgeable about because they constantly read, study, adn attend seminars- just as you will do. The best possible treatment for your patient will likely come from a collaborative effort among you, other docs, and other healthcare providers. If you run into a chiro or PT or whoever that rubs you the wrong way, simple take what they are saying into consideration as it may help you decide the best treatment for your patient. Doctors are managers, so ultimately it is your decision. But the key to being a manager is to not take on all tasks, but rather devide them up appropriately and bring eveyones strengths and input to the table.

Um, not more than physicians.

davematthews · Mar 28, 2006

OSUdoc08 said:
Um, not more than physicians.

Um, can you elaborate sir? You think a PGY1, for example, right fresh outta medical school knows more anatomy than a fresh outta chiro or PT school person? Or do you mean something else?

Ok, let me rephrase what I have said- I may have mispoken. CHIRO and PT graduates have a better understanding of anatomy than med graduates.
There, that's better. If you think about what a PT and CHIRO due in their daily roles, and keep in mind that eveything they learn and practice is dependent upon their understanding of the anatomy of the human body, then it is relatively easy to acknowledge that this makes sense.

funkless · Mar 28, 2006

davematthews said:
Um, can you elaborate sir? You think a PGY1, for example, right fresh outta medical school knows more anatomy than a fresh outta chiro or PT school person? Or do you mean something else?

Ok, let me rephrase what I have said- I may have mispoken. CHIRO and PT graduates have a better understanding of anatomy than med graduates.

Are you saying that a surgical intern at Johns Hopkins or MGH doesn't know human anatomy as well as a rookie D.C. from [insert name of illustrious chiropractic school here]??? :laugh:

davematthews · Mar 28, 2006

funkless said:
Are you saying that a surgical intern at Johns Hopkins or MGH doesn't know human anatomy as well as a rookie D.C. from [insert name of illustrious chiropractic school here]???

A rookie DC vs a rookie MD- yeah, sure.

synapse lapse · Mar 28, 2006

Yet another BS chiro thread. Haha davematthews knowledge is laughable :laugh:

chiros know more about anatomy than docs :laugh:

chiros are con artists, sorry to break it to you.

funkless · Mar 28, 2006

Alexander Pink said:
Yet another BS chiro thread. Haha davematthews knowledge is laughable chiros know more about anatomy than docs chiros are con artists, sorry to break it to you.

Oh come on, they must be experts in the field--after all, they have those ultra-professional-looking plastic skeletons dangling in the corner of their shopping mall kiosks!

funkless · Mar 28, 2006

davematthews said:
A rookie DC vs a rookie MD- yeah, sure.

Which textbooks did you study? How much time in a cadaver lab?

davematthews · Mar 28, 2006

funkless said:
Which textbooks did you study? How much time in a cadaver lab?

LOL- I am not a chiropractor or a PT. CHiro schools, for example NCC, spend a year and a half dissecting. Seems a bit crazy, most med school spend a few months tops. They spend longer because they have to know every detaill and know it extemely well. Actually, if you talk with your anatomy professor (if they are older) they will tell you that they had to know a lot more than med students now. It's really not that big of a deal- I would hope they know more, their job depends on it.

davematthews · Mar 28, 2006

Alexander Pink said:
Yet another BS chiro thread. Haha davematthews knowledge is laughable chiros know more about anatomy than docs chiros are con artists, sorry to break it to you.

Yes, your right, it is laughable. BUt, if you are right, you must be smarter and than quite a few physicians at Northwestern University and the Rehabilitation Institute of CHicago ("the #1 ranked rehad hospital" in the country for the last decade by USNEWS with prolly the most compettive residency programs for PMR in the country) who have chiros in their clinics whom they send off their patients to...

davematthews · Mar 28, 2006

Alexander Pink said:
sorry to break it to you.

Don't worry, it takes more than someone simply stating an opinion without any logical reasoning to "break it to me".
What do you think of acpuncture? (Although I think I know your an advocate I am curious)

OSUdoc08 · Mar 28, 2006

davematthews said:
Um, can you elaborate sir? You think a PGY1, for example, right fresh outta medical school knows more anatomy than a fresh outta chiro or PT school person? Or do you mean something else?

Ok, let me rephrase what I have said- I may have mispoken. CHIRO and PT graduates have a better understanding of anatomy than med graduates.
There, that's better. If you think about what a PT and CHIRO due in their daily roles, and keep in mind that eveything they learn and practice is dependent upon their understanding of the anatomy of the human body, then it is relatively easy to acknowledge that this makes sense.

A PGY-1 DO DOES.

PT's & DC's don't have any more understanding than a DO does.

Sorry to burst your bubble.

I should have been specific when I said physician with "DO" or "MD trained in OMM."

davematthews · Mar 28, 2006

OSUdoc08 said:
A PGY-1 D.O. DOES.

(I'm a D.O. student.)

LOL- touche.

Well, since you learn OMM you would probably agree that if forces you to learn and understand anatomy much more than simple dissection- yes?

OSUdoc08 · Mar 28, 2006

davematthews said:
LOL- touche.

Well, since you learn OMM you would probably agree that if forces you to learn and understand anatomy much more than simple dissection- yes?

Yes, I would agree.

However, you could not say that a chiropractor or physical therapist knows more anatomy than an osteopathic physician, now can you?

davematthews · Mar 28, 2006

OSUdoc08 said:
A PGY-1 DO DOES.

PT's & DC's don't have any more understanding than a DO does.

Sorry to burst your bubble.

I should have been specific when I said physician with "DO" or "MD trained in OMM."

There's no bubble- and no need to say that. I would NOT say a DC/PT understands more than a fresh DO, but I dont think a DO knows more than a DC/PT. You know, it may be more appropriate t to narrow this down further to say the muscleskeltal system-

OSUdoc08 · Mar 28, 2006

davematthews said:
There's no bubble- and no need to say that. I would NOT say a DC/PT understands more than a fresh DO, but I dont think a DO knows more than a DC/PT. You know, it may be more appropriate t to narrow this down further to say the muscleskeltal system-

Quick! Explain to me how a practicing chiropractor knows more about the musculoskeletal system than a practicing osteopathic physician who specializes in osteopathic manipulative medicine.

Ready?

1...2...3...GO !

davematthews · Mar 28, 2006

OSUdoc08 said:
Quick! Explain to me how a practicing chiropractor knows more about the musculoskeletal system than a practicing osteopathic physician who specializes in osteopathic manipulative medicine.

Ready?

1...2...3...GO !

I am talking about anatomy, not anatomy and physiology, maybe not quite the way you are thinking.
I hope you dont talk to people like there a piece of SH3t or your are better than them when you first meet (in person) like you are here. It is pointless and immature. I am not getting offended or upset because I am a chiro or PT or cause I want to be-cause I don't. But I don't disrespect people just because I dont like what they are saying. And maybe it is cause this is "online" and that is how a lot of these forums are. Maybe face to face you wouldn't say, "Quick! Explain to me..." If you did you would look like an a@@ Even online it doesn't make much sense to me and it makes people sound bitter, arrogant, and insecure. I have spent enough time on this thread, so I shall bid you adeau (sp?)

latinfridley · Mar 28, 2006

davematthews said:
Chirpractors for sure, not arguable, know more about the anatomy of the entire humany body, at least right out of school anyway. Beyond that, the physician is the expert.
Interstingly, the depth with which they study this goes well beyond that taught in medical school. This is true of PTs as well. Chiros take many of the same courses taught in the first two years of medical school, except pharm.

Can you elaborate on how exactly a PT or chiro grad goes into anatomy in more depth than a med student? I'm not seeing it. Also, as far as expectation of knowledge to be learned, give you give an example of a question that a PT/chiro grad should know that a med student wouldn't know?

OSUdoc08 · Mar 28, 2006

davematthews said:
I am talking about anatomy, not anatomy and physiology, maybe not quite the way you are thinking.
I hope you dont talk to people like there a piece of SH3t or your are better than them when you first meet (in person) like you are here. It is pointless and immature. I am not getting offended or upset because I am a chiro or PT or cause I want to be-cause I don't. But I don't disrespect people just because I dont like what they are saying. And maybe it is cause this is "online" and that is how a lot of these forums are. Maybe face to face you wouldn't say, "Quick! Explain to me..." If you did you would look like an a@@ Even online it doesn't make much sense to me and it makes people sound bitter, arrogant, and insecure. I have spent enough time on this thread, so I shall bid you adeau (sp?)

I guess that means you agree with me, then?

:laugh:

synapse lapse · Mar 28, 2006

davematthews said:
Don't worry, it takes more than someone simply stating an opinion without any logical reasoning to "break it to me".
What do you think of acpuncture? (Although I think I know your an advocate I am curious)

I have in other threads expanded on my reasoning that Chiros are con artist. As I asked in those other threads for any scientific studies that had concluded that chiro practices are 1)based on valid scientific data/understanding and not completely made up and 2) efficacious in treatment of any medical condition. As of yet noone has shown me such evidence. I would gladly entertain all scientific evidence and open the debate, but it is not up to me to find studies that conclude chiro is made up. I am claiming that due to complete lack of evidence the field is a crock. And simply because you spend longer in a class doesn't mean you learn more, you can learn something slower. You could also learn tons of useless crap. I assure you we learned the entire human body in our semester of Anatomy. What is a subluxation? Is there an anatomical basis? How about you research the history and modern practice of chiro before coming here with incorrect facts and idiotic assertions.As for acupuncture all studies I have seen have concluded that acupuncture may be efficacious at treating certain conditions (i.e. hypertension) but that the "chi map" on which the philosophy is based is incorrect and has no anatomical basis. I would not advocate a patient see an acupunturist unless I saw evidence that it would positively benefit them beyond placebo effect. Furthermore, as I stated in the other chiro thread, chiropracty is not only false, it is actually dangerous in certain circumstances (cervical manipulation tearing the vertebral artery).

OSUdoc08 · Mar 28, 2006

Alexander Pink said:
I have in other threads expanded on my reasoning that Chiros are con artist. As I asked in those other threads for any scientific studies that had concluded that chiro practices are 1)based on valid scientific data/understanding and not completely made up and 2) efficacious in treatment of any medical condition. As of yet noone has shown me such evidence. I would gladly entertain all scientific evidence and open the debate, but it is not up to me to find studies that conclude chiro is made up. I am claiming that due to complete lack of evidence the field is a crock. And simply because you spend longer in a class doesn't mean you learn more, you can learn something slower. You could also learn tons of useless crap. I assure you we learned the entire human body in our semester of Anatomy. What is a subluxation? Is there an anatomical basis? How about you research the history and modern practice of chiro before coming here with incorrect facts and idiotic assertions.As for acupuncture all studies I have seen have concluded that acupuncture may be efficacious at treating certain conditions (i.e. hypertension) but that the "chi map" on which the philosophy is based is incorrect and has no anatomical basis. I would not advocate a patient see an acupunturist unless I saw evidence that it would positively benefit them beyond placebo effect. Furthermore, as I stated in the other chiro thread, chiropracty is not only false, it is actually dangerous in certain circumstances (cervical manipulation tearing the vertebral artery).

How do you feel about physical therapists?

synapse lapse · Mar 28, 2006

OSUdoc08 said:
How do you feel about physical therapists?

Ok look I'm not gonna sit and explain my position on every single health care type provider. My general position is that if evidence supports a treatment beyond placebo effect and the treatment is not dangerous I am ok with it, and I may or may not refer patients to said treatment depending on the case. As I said in the other thread chiros can't do anything a massage therapist can't do, except that in addition 1)certain chiro treatments are dangerous and 2)chiros aren't doctors as they portray themselves as which is what the whole previous thread was on. Obviously physical therapists are an important part of recovery as someone needs to be willing to work one on one with the patient for long periods of time to regain motion, etc. Why would I feel any different?

OSUdoc08 · Mar 28, 2006

Alexander Pink said:
Ok look I'm not gonna sit and explain my position on every single health care type provider. My general position is that if evidence supports a treatment beyond placebo effect and the treatment is not dangerous I am ok with it, and I may or may not refer patients to said treatment depending on the case. As I said in the other thread chiros can't do anything a massage therapist can't do, except that in addition 1)certain chiro treatments are dangerous and 2)chiros aren't doctors as they portray themselves as which is what the whole previous thread was on. Obviously physical therapists are an important part of recovery as someone needs to be willing to work one on one with the patient for long periods of time to regain motion, etc. Why would I feel any different?

With the knowledge that the techniques employed by physical therapists closely resemble that done by osteopathic physicians, how do you feel about osteopathic physicians who practice osteopathic manipulative medicine?

davematthews · Mar 28, 2006

Alexander Pink said:
Ok look I'm not gonna sit and explain my position on every single health care type provider.

u act like a prick- you may not be, or you may not know you sound like it, but there you go. Many physiatrists and physicians working with chronic pain refer to chiro, and have them working in their clinics- this includes, if you saw my earlier post, "top notch" academic facilities like NOrthwestern and the Rehad Institute of Chicago. So your collegues at these institutions must be fools in your eyes, and so you alone are the know it all. I could "show" you more that supports chiro in the treatment of certain conditions, but you act like a prick and this blog is no longer fun or interesting it-

synapse lapse · Mar 28, 2006

davematthews said:
u act like a prick- you may not be, or you may not know you sound like it, but there you go. Many physiatrists and physicians working with chronic pain refer to chiro, and have them working in their clinics- this includes, if you saw my earlier post, "top notch" academic facilities like NOrthwestern and the Rehad Institute of Chicago. So your collegues at these institutions must be fools in your eyes, and so you alone are the know it all. I could "show" you more that supports chiro in the treatment of certain conditions, but you act like a prick and this blog is no longer fun or intersting because of a few people in it-

First of all your Argument ad Populum is not evidence of the efficacy of chiro. Second you like many others claim to be able to show me evidence of chiros efficacy, but you as well as them have failed to provide any evidence. If such evidence existed it surely could easily have been provided by now. The fact is that aside from anecdotal account, hearsay testimony, and case studies there is no evidence that I have seen that supports chiros. And OSUDoc I don't understand your question. I am not very knowledgable about what OMM is so I can't claim that it is or is not efficacious, but I obviously have no problem with either DO's or PT's. Perhaps you could rephrase the question, though I don't see how it matters what my opinion is on the matter.

davematthews · Mar 28, 2006

Alexander Pink said:
Second you like many others claim to be able to show me evidence of chiros efficacy, but you as well as them have failed to provide any evidence.

No, I never "claimed" I was going to provide evidence about anything- that was never the subject of the thread anyway...

ok... later

davematthews · Mar 28, 2006

chirobase06 said:
CHIROBASE

lol- thats pretty good.
www.chirobase.org

synapse lapse · Mar 28, 2006

davematthews said:
No, I never "claimed" I was going to provide evidence about anything- that was never the subject of the thread anyway...

ok... later

No, you said

I could "show" you more that supports chiro in the treatment of certain conditions

to which I replied that you as others claim that you have such evidence, yet none would provide it. In other words I am saying no, you could not show me such evidence as none exists, and that you should not come onto a thread saying DC's know more than physicians about anatomy and such nonsense when you are uninformed and ignorant of the facts.

MD Wiggy · Mar 29, 2006

Alexander Pink said:
I have in other threads expanded on my reasoning that Chiros are con artist. As I asked in those other threads for any scientific studies that had concluded that chiro practices are 1)based on valid scientific data/understanding and not completely made up and 2) efficacious in treatment of any medical condition. As of yet noone has shown me such evidence. I would gladly entertain all scientific evidence and open the debate, but it is not up to me to find studies that conclude chiro is made up. I am claiming that due to complete lack of evidence the field is a crock. And simply because you spend longer in a class doesn't mean you learn more, you can learn something slower. You could also learn tons of useless crap. I assure you we learned the entire human body in our semester of Anatomy. What is a subluxation? Is there an anatomical basis? How about you research the history and modern practice of chiro before coming here with incorrect facts and idiotic assertions.As for acupuncture all studies I have seen have concluded that acupuncture may be efficacious at treating certain conditions (i.e. hypertension) but that the "chi map" on which the philosophy is based is incorrect and has no anatomical basis. I would not advocate a patient see an acupunturist unless I saw evidence that it would positively benefit them beyond placebo effect. Furthermore, as I stated in the other chiro thread, chiropracty is not only false, it is actually dangerous in certain circumstances (cervical manipulation tearing the vertebral artery).

Read these:
http://www.jcca-online.org/client/cca/JCCA.nsf/objects/V48-1-P29/$file/V48-1-P29.pdf

http://www.joem.org/pt/re/joem/abstract.00043764-200006000-00018.htm;jsessionid=EqbB3OPdknKkDQnV6ctW5A6cL12dmiAznJXQ15XzN1ihXVndCthv!-420709791!-949856145!9001!-1

http://scholar.google.com/scholar?h...298-0032_changes.pdf+surface+EMG+chiropractic

I found these three articles in a matter of minutes with a simple search using Google Scholar. I think skepticism is beginning to fall off of the table and medicine is moving toward an integration with alternative therapies such as acupuncture and chiropractic. If you do not see this shift in the American culture then you need to take off your blinders.

latinfridley · Mar 29, 2006

WiggyUD said:
Read these:
http://www.jcca-online.org/client/cca/JCCA.nsf/objects/V48-1-P29/$file/V48-1-P29.pdf

http://www.joem.org/pt/re/joem/abstract.00043764-200006000-00018.htm;jsessionid=EqbB3OPdknKkDQnV6ctW5A6cL12dmiAznJXQ15XzN1ihXVndCthv!-420709791!-949856145!9001!-1

http://scholar.google.com/scholar?h...298-0032_changes.pdf+surface+EMG+chiropractic

I found these three articles in a matter of minutes with a simple search using Google Scholar. I think skepticism is beginning to fall off of the table and medicine is moving toward an integration with alternative therapies such as acupuncture and chiropractic. If you do not see this shift in the American culture then you need to take off your blinders.

Tip: Don't use Google to search for articles as references for anything. Also, instead of citing articles from obscure canadian journals, make sure its a reputable journal article. So, go to pubmed, type in alternative medicine, or physical therapy, or whatever, and look for some reputable journal entries. I remember reading some good articles in the Annals of Internal Medicine a while back on efficacy of different alternative medicine modalities. The summary consensus after reading many of these types of articles, is that compared to placebo, many of these modalities don't offer significant therapeutic benefit. The only alternative medicine therapy that i've read about having a statistically significant benefit is acupuncture; and this is for pain and or nausea relief ONLY. Many practitioners assert that you can heal just about anything with acupuncture; same with chiropractic. Good hunting.

davematthews · Mar 29, 2006

latinfridley said:
Tip: Don't use Google to search for articles as references for anything.

When I first began gad school everyone used pubmed- when I left we all used google, including a handful of professors. You have access to finding exactly the same research articles and links, but the google search engine is MUCH more user friendly. i.e. If you type in the first author and any part of the title of a research article, your article will amost always show up immediately. This sort of searching can be a nightmare on Pubmed, of which sometimes you can have almost the entire article's name in the search box and it will still not pull up your article. Google is ridiculously easy and useful as a search engine. Googlescholar is a powerhouse academic search engine and some good stuff!

latinfridley · Mar 29, 2006

davematthews said:
When I first began gad school everyone used pubmed- when I left we all used google, including a handful of professors. You have access to finding exactly the same research articles and links, but the google search engine is MUCH more user friendly. i.e. If you type in the first author and any part of the title of a research article, your article will amost always show up immediately. This sort of searching can be a nightmare on Pubmed, of which sometimes you can have almost the entire article's name in the search box and it will still not pull up your article. Google is rediculously easy and useful as a search engine. Googlescholar is a powerhouse academic search engine and some good stuff!

Kool. Maybe i'll mess around with it awhile, and check it out a bit more.

synapse lapse · Mar 29, 2006

WiggyUD said:
Read these:
http://www.jcca-online.org/client/cca/JCCA.nsf/objects/V48-1-P29/$file/V48-1-P29.pdf

http://www.joem.org/pt/re/joem/abstract.00043764-200006000-00018.htm;jsessionid=EqbB3OPdknKkDQnV6ctW5A6cL12dmiAznJXQ15XzN1ihXVndCthv!-420709791!-949856145!9001!-1

http://scholar.google.com/scholar?h...298-0032_changes.pdf+surface+EMG+chiropractic

I found these three articles in a matter of minutes with a simple search using Google Scholar. I think skepticism is beginning to fall off of the table and medicine is moving toward an integration with alternative therapies such as acupuncture and chiropractic. If you do not see this shift in the American culture then you need to take off your blinders.

Ok your first article is a test of 44 individuals broken into 2 groups of roughly equal size on which is measured the EMF before and after low force chiro adjustment. Aside from the small sample side the article fails to make any link between EMF meaasurements at the body surface and any disease. Instead it mentions some alleged correlations between general man made EMF and diseases, and it fails to support any evidence that a reduction in said body EMF was beneficial to the patient in any way, or linked to any particular disease, instead simply stating basic physiology. In addition the conclusion still rests that there is no understanding how said treatment works. The second abstract (not article) you provided simply states that "surface electromyography assessment of the paraspinal muscle activity may be a useful objective diagnostic tool in the comprehensive evaluation of CLBP." This is hardly chiro specific nor is it any new knowledge, of course paraspinal muscle activity can be detected by surface electromyography, it stands to reason with our knowledge of physiology. In any case it has nothing to support chiro. I don't have to to read the 3rd link right now but at cursery it didn't seem to support chiro treatment in any substantial way. I have yet to see evidence presented that supports that subluxations exhist or have any anatomical basis (the foundational philosophy of chiro is the subluxation!), that chiro is any more productive at treating chronic back pain that massage therapy or physical therapy, or drugs, etc. Nor is evidence available that the techniques they use have any scientific basis. In addition as stated cervical manipulation and other techniques are dangerous. You saw the chirobase website that had a lot of info, just read the wiki entry which even has a ton of criticism and it was written by a chiro in defense of practice (that's why its being debated NPV). http://en.wikipedia.org/wiki/Chiropracty

Flobber · Mar 29, 2006

Alexander Pink said:
Ok your first article is a test of 44 individuals broken into 2 groups of roughly equal size on which is measured the EMF before and after low force chiro adjustment. Aside from the small sample side the article fails to make any link between EMF meaasurements at the body surface and any disease. Instead it mentions some alleged correlations between general man made EMF and diseases, and it fails to support any evidence that a reduction in said body EMF was beneficial to the patient in any way, or linked to any particular disease, instead simply stating basic physiology. In addition the conclusion still rests that there is no understanding how said treatment works. The second abstract (not article) you provided simply states that "surface electromyography assessment of the paraspinal muscle activity may be a useful objective diagnostic tool in the comprehensive evaluation of CLBP." This is hardly chiro specific nor is it any new knowledge, of course paraspinal muscle activity can be detected by surface electromyography, it stands to reason with our knowledge of physiology. In any case it has nothing to support chiro. I don't have to to read the 3rd link right now but at cursery it didn't seem to support chiro treatment in any substantial way. I have yet to see evidence presented that supports that subluxations exhist or have any anatomical basis (the foundational philosophy of chiro is the subluxation!), that chiro is any more productive at treating chronic back pain that massage therapy or physical therapy, or drugs, etc. Nor is evidence available that the techniques they use have any scientific basis. In addition as stated cervical manipulation and other techniques are dangerous. You saw the chirobase website that had a lot of info, just read the wiki entry which even has a ton of criticism and it was written by a chiro in defense of practice (that's why its being debated NPV). http://en.wikipedia.org/wiki/Chiropracty

alright man, if you're going to be this dismissive of something at least take the time to spell everything right in your scathing post... it just makes you look silly not to.

alexander pink, MD. lol.

txfisher · Mar 30, 2006

PreMedAdAG · Mar 31, 2006

Oi! so much energy expended on trying to battle ignorance. This is insane. Coming from a family of chiropractors and me being in medical school, I can pretty much guarantee that for any musculoskeletal disorder I come up with, I will be heading straight to my trusted Chiropractor and NEVER to another MD. In addition, I can pretty much assume that my dad will always do a better job at the musculoskeletal portion of the physical exam than I ever will. We joke a lot and I tell him I'll give him some tips on listening to hearts and he gives me a hard time about overprescribing. It's great banter, and I love that he's set me up to have such an awesome relationship with alternative healthcare providers. I'm a big fan of "if the patient feels better and retains their quality of life and it's what they want out of the visit, then any form of medical treatmnet is valid". I do agree that there are fields that are probably better at assessing different things and so I respect that and I applaud providers who refer to others and know their limitations. For the ones who have the drive to basically piss on professions like chiropractic, osteopathic, physical therapy, acuptuncture, and chinese medicine, I'm sure karma will remind you in future years when you lose some of your patients to these field practioners. Have some tolerance my friends.

Blade28 · Mar 31, 2006

Someone a year out of chiro school knows more anatomy than an ortho intern finishing their PGY-1 year? Really?

liverotcod · Apr 2, 2006

When I urinate, the stream extends 13.79 meters from my body.

DR_G · Nov 3, 2006

I really don't understand the hostility towards chiropractic and physical therapy? I am a sports chiropractor and work with orthopaedic surgeons and physiatrists. I have also had ortho residents round with me, and have corrected them on their diagnoses and physical examinations.

MD, DC, DO, PT etc... are all great professions and generally attract good people who have a passion to serve others.

There is no need for immaturity or personal attacks based on unfounded claims or mere ignorance.

As DaveMatthews said, it is important to continue learning through CME seminars and consulting with various specialists.

DR_G · Nov 3, 2006

On side note; with respect to MSK educations, MDs are lacking (see short article below with sources):

-----

Musculoskeletal Education: MDs Still Fail the Test

In October 1998, the Journal of Bone and Joint Surgery featured a study that confirmed what most doctors of chiropractic have long suspected. The study, which examined the competency levels of nearly 90 recent medical school graduates, revealed that most medical and surgical residents "failed to demonstrate basic competency" in their knowledge of musculoskeletal medicine. The results prompted the authors of the study to conclude that the training provided in musculoskeletal medicine "is inadequate."
Now, more than six years later, a new study, again published in the Journal of Bone and Joint Surgery, shows that today's medical students and young physicians appear to be just as woeful in their understanding of musculoskeletal medicine as their cohorts were several years ago.

In the new study, 334 medical students, residents and staff physicians, specializing in various fields of medicine, were asked to take a basic cognitive examination consisting of 25 short-answer questions - the same type of test administered in the 1998 study. Each question was worth a maximum of one point, with partial credit given for some questions that required multiple answers. Test scores were then multiplied by a factor of four, for a maximum score of 100. A score of 73.1% was determined to be a passing grade.

While the questions used in the 2005 exam were different from the 1998 test, the results were surprisingly similar. In fact, the average score among medical doctors, students and residents who took the exam in 2005 was 2.7 points lower than those who took the exam in 1998.

Just over half of the staff physicians (52%) scored a passing grade or higher on the 2005 exam. Only 21% of the residents registered a passing grade, and only 5% of the medical students passed the exam (see chart above).

As with the 1998 exam, medical doctors and students with training or experience in orthopedics scored higher on the 2005 exam than subjects who lacked such experience. Among the 124 participants who reported taking a required or elective course in orthopedics, the average score was 69%. Among the 210 participants who had not taken an orthopedics course, the average score was 50%. Similarly, the 155 participants who stated they were comfortable with their ability to perform a musculoskeletal examination attained an average score of 66%. Subjects who felt uncomfortable in performing a musculoskeletal exam achieved an average score of just 49%.

In the original Journal of Bone and Joint Surgery article seven years ago, the authors stated that "all students must be instructed in musculoskeletal medicine," and that medical schools needed to revise their educational standards, either by adding more contact hours in specified training, or by providing additional training in musculoskeletal medicine during one's residency.

Those recommendations appear to have fallen on deaf ears, as the same sentiments continue to be echoed in the new study. As the authors note in their conclusion:

"This study strongly suggests that there is a lack of basic musculoskeletal education in medical school and during nonorthopaedic residency training. Improvements in education in musculoskeletal medicine should be pursued in all medical schools and residency training programs."

Given that musculoskeletal complaints are one of the leading reasons people seek the services of a doctor for care, one wonders why the medical profession is apparently unconcerned when it comes to educating the doctors of the future on the finer points of musculoskeletal medicine. Perhaps the moral to this story is one you already know: Patients would be best served by receiving care from a health care provider with more musculoskeletal training - a doctor of chiropractic.

-------------
References

Freedman KB, Bernstein J. The adequacy of medical school education in musculoskeletal medicine. Journal of Bone and Joint Surgery October 1998;80(10):1421-1427.

Matzkin E, Smith EL, Freccero D, Richardson AB. Adequacy of education in musculoskeletal medicine. Journal of Bone and Joint Surgery February 2005;87(2):310-314.

Droopy Snoopy · Nov 3, 2006

DR_G said:
I really don't understand the hostility towards chiropractic and physical therapy? I am a sports chiropractor and work with orthopaedic surgeons and physiatrists. I have also had ortho residents round with me, and have corrected them on their diagnoses and physical examinations.
MD, DC, DO, PT etc... are all great professions and generally attract good people who have a passion to serve others.
There is no need for immaturity or personal attacks based on unfounded claims or mere ignorance.
As DaveMatthews said, it is important to continue learning through CME seminars and consulting with various specialists.

So glad you could bring back a 7-months-dead flame war

DR_G · Nov 3, 2006

tic,

I'm new here and was surfing through the posts. Do you have anything of value to add to this discussion? If you note my tone on my previous posts was not of an adversarial nature, so I don't see it as opening a "7 month old flame war" as you put it.

Droopy Snoopy · Nov 4, 2006

DR_G said:
tic,
I'm new here and was surfing through the posts. Do you have anything of value to add to this discussion? If you note my tone on my previous posts was not of an adversarial nature, so I don't see it as opening a "7 month old flame war" as you put it.

I know you weren't adversarial, but did you read the rest of the thread? It's a can of worms, just don't know why you want to be a troublemaker and reopen it. Meh, guess it's better than that other 2-years-dead chiropractic post you reopened. I don't have anything of value to the conversation, except to say (in my best Dr. Cox), "Newbie, I don't know if they taught you this in the land of fairies and puppy-dog tails," but the list of things guaranteed to start a flame war are: 1) comparing MDs and DOs; 2) talking about chiropracty, homeopathic medicine, or anything else un-MD in the MD forum; 3) overweight people; 4) minorities; 5) anything that could come within a city block of religion; 6) pretty much any other thread if it goes on long enough. I didn't make the rules, please don't shoot the messenger. Welcome to SDN!

erichaj · Nov 4, 2006

nabeya said:
You should've responded by saying "Because MD's earned that right to decide whether they need K+ supplementation or not by going to med school while Chiropracters didn't." If they don't like the way it's being handled, they should go to med school then.

erichaj · Nov 4, 2006

DR_G said:
On side note; with respect to MSK educations, MDs are lacking (see short article below with sources):

-----

Musculoskeletal Education: MDs Still Fail the Test

In October 1998, the Journal of Bone and Joint Surgery featured a study that confirmed what most doctors of chiropractic have long suspected. The study, which examined the competency levels of nearly 90 recent medical school graduates, revealed that most medical and surgical residents "failed to demonstrate basic competency" in their knowledge of musculoskeletal medicine. The results prompted the authors of the study to conclude that the training provided in musculoskeletal medicine "is inadequate."
Now, more than six years later, a new study, again published in the Journal of Bone and Joint Surgery, shows that today's medical students and young physicians appear to be just as woeful in their understanding of musculoskeletal medicine as their cohorts were several years ago.

In the new study, 334 medical students, residents and staff physicians, specializing in various fields of medicine, were asked to take a basic cognitive examination consisting of 25 short-answer questions - the same type of test administered in the 1998 study. Each question was worth a maximum of one point, with partial credit given for some questions that required multiple answers. Test scores were then multiplied by a factor of four, for a maximum score of 100. A score of 73.1% was determined to be a passing grade.

While the questions used in the 2005 exam were different from the 1998 test, the results were surprisingly similar. In fact, the average score among medical doctors, students and residents who took the exam in 2005 was 2.7 points lower than those who took the exam in 1998.

Just over half of the staff physicians (52%) scored a passing grade or higher on the 2005 exam. Only 21% of the residents registered a passing grade, and only 5% of the medical students passed the exam (see chart above).

As with the 1998 exam, medical doctors and students with training or experience in orthopedics scored higher on the 2005 exam than subjects who lacked such experience. Among the 124 participants who reported taking a required or elective course in orthopedics, the average score was 69%. Among the 210 participants who had not taken an orthopedics course, the average score was 50%. Similarly, the 155 participants who stated they were comfortable with their ability to perform a musculoskeletal examination attained an average score of 66%. Subjects who felt uncomfortable in performing a musculoskeletal exam achieved an average score of just 49%.

In the original Journal of Bone and Joint Surgery article seven years ago, the authors stated that "all students must be instructed in musculoskeletal medicine," and that medical schools needed to revise their educational standards, either by adding more contact hours in specified training, or by providing additional training in musculoskeletal medicine during one's residency.

Those recommendations appear to have fallen on deaf ears, as the same sentiments continue to be echoed in the new study. As the authors note in their conclusion:

"This study strongly suggests that there is a lack of basic musculoskeletal education in medical school and during nonorthopaedic residency training. Improvements in education in musculoskeletal medicine should be pursued in all medical schools and residency training programs."

Given that musculoskeletal complaints are one of the leading reasons people seek the services of a doctor for care, one wonders why the medical profession is apparently unconcerned when it comes to educating the doctors of the future on the finer points of musculoskeletal medicine. Perhaps the moral to this story is one you already know: Patients would be best served by receiving care from a health care provider with more musculoskeletal training - a doctor of chiropractic.

-------------
References

Freedman KB, Bernstein J. The adequacy of medical school education in musculoskeletal medicine. Journal of Bone and Joint Surgery October 1998;80(10):1421-1427.

Matzkin E, Smith EL, Freccero D, Richardson AB. Adequacy of education in musculoskeletal medicine. Journal of Bone and Joint Surgery February 2005;87(2):310-314.

1. Chripractors don't study musclolskeletal medicine, They study the spine. You are not trained to diagnose disease of the foot, ankle, shoulder, knee, legs, soft tissue etc. And when it comes to the back you are limited to very basic diagnosis of back treatments. You don know your spine medicine well in theory. But you don't know how to mange many back problems. You use manipulation of the back for almost all its ailments. REMEMBER THE OLD SAYING "IF YOU HAVE A HAMMER EVERYTHING IS A NAIL".

Chiropractic manipulation has been shown to have short term effectiveness in many acute and chronic back problems. There is a place for it in treatment of back problems.

2. STOP CALLING YOURSELVES DOCTORS. People think you know what you are talking about when it comes to medicine because you call yourselves doctors. You don't. You don't know how do to diagnose and manage 95% of medical problems. So stop calling yourselves doctors. It confuses the patients.

There is a place for chiropractic in the medical field. They help many back patients in acute and some chronic settings. But you lose credibility when you misrepresent yourselves.

3. As far MDs not being well trained in musculoskeletal medicine when they come out of medical school, They don't need as that much training. We have PM&R specialist and orthopedics an FPs and FPS with sport medicine training that take this role one during residency. In fact since there is soooo much more medicine to be learned other than musculoskletal we choose to focous on the most important first.

4. By the way, since chiropractors are not trained in "musculoskeleta medicine" isnt this the pot calling the kettle black?

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