First experience with Chiro

[Pain Applicant1]

I didn't really have strong opinions on chiros in either direction before PP as I didn't have much experience with them. I'm sure there are good and bad ones like in every group but my first experience with one is not so good.

This guy has patients seeing him daily, that's every day, for the first few weeks, for adjustments and dry needling. He then tells patients that meds, including things like BP and statins, are dangerous to take. He's definitely overstepping his grounds. He then has the patients pay cash for some type of vitamin panel lab testing. I'm not personally a big believer in vitamin supplementation, including vitamin D, and to charge the patients hundreds for testing is ridiculous. Not to start a flame war but anyone else with experiences like this?

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[pmrmd]

All the time. I share a parking lot with one. He used to see like 80 people a day, no joke. I saw his notes once. The patient fills out their own history in the waiting room. The guy always got three regions of adjustments (C,T,L) though the neck and thoracic areas were not painful, only the lumbar. I asked the chiropractic board here if the field of chiropractic has sunk so low as to that being acceptable. They made him get with the program. You could do the same here.

 

[SSdoc33]

All the time. I share a parking lot with one. He used to see like 80 people a day, no joke. I saw his notes once. The patient fills out their own history in the waiting room. The guy always got three regions of adjustments (C,T,L) though the neck and thoracic areas were not painful, only the lumbar. I asked the chiropractic board here if the field of chiropractic has sunk so low as to that being acceptable. They made him get with the program. You could do the same here.

how do you expect to treat the dysfunction in the SI joint without also manipulating the CTL spine? duh.

if patients are dumb enough to get swindled by chiropractors, there's not all that much you can do. you can set them straight when they see you, but these greezball chiros are a dime a dozen. there are a few good eggs out there, but i hate to say that these are very rare.

 

[Missorleans]

how about chiropractors who tell their patients not to vaccinate their kids:
http://www.drkurtperkins.com/2012/05/my-crystal-clear-stance-on-vaccines.html
allegedly it's also against the law for chiropractors to call themselves doctors in colorado?

 

[geauxg8rs]

Local chiro advertising for ADHD treatment. I don't know why someone would go for this? I thought the whole goal of adult ADHD treatment was for the adderall?

Even worse is a husband and wife chiro team who have a monthly write up in our community throw away monthly newsletter. Their first ad was advocating that you should have them evaluate your NEWBORN baby to see if they need an adjustment since birth can be so traumatic? ??? Scary

 

[emd123]

Chiro's got a 12% increase this year from CMS and this administration.

 

[NJPAIN]

I know chiros who were butchers and carpenters immediately before attending chiro school - no joke. I was told by a reliable source that there are a significant number of chiro schools that do not require a 4 year college degree for admission.
Here in NJ they routinely refer to their education as "medical school" and call themselves "physicians". My wife spent 21 years working for chiros before we were married. The stories she tells are beyond belief including one in which they spent all night shredding documents and re-writing chart notes before the Feds were coming. Of course both former employers retired early because they are so filthy rich.

 

[Dr Manhattan]

ethics and patient care trump profit. good for them for being in a lucrative field, as long as they within their spectrum of practice (which is entirely encompassed by "snap, crackle and pop".

i send my patients to PT rather than chiro. i dont speak negatively of chiros in general when patients ask for my opinion... i do advise that they seek indirect treatments rather than high velocity manipulation (cracks).

 

[SSdoc33]

ethics and patient care trump profit. good for them for being in a lucrative field, as long as they within their spectrum of practice (which is entirely encompassed by "snap, crackle and pop".

i send my patients to PT rather than chiro. i dont speak negatively of chiros in general when patients ask for my opinion... i do advise that they seek indirect treatments rather than high velocity manipulation (cracks).

???

like ultrasound, stim, and vitamin supplements? because those work so well? anybody good with manual medicine (PT, DC, DO) for the right patients are reasonable. the problem is the good chiros are so hard to find and the field gets such a bad name because of the majority.

 

[Dr Manhattan]

???

like ultrasound, stim, and vitamin supplements? because those work so well? anybody good with manual medicine (PT, DC, DO) for the right patients are reasonable. the problem is the good chiros are so hard to find and the field gets such a bad name because of the majority.

you completely misconstrued what i said. indirect treatments are a different type of manipulation. they do NOT encompass in any way or form "ultrasound, stim, and vitamin supplements". my point is that HVLA (thrusting and cracking) should be avoided in a large number of our patients, who have comorbidities and arthritic bones and joints. there have been cases of vertebral artery dissection with cervical spine HVLA.

finding someone you can reliably refer your patients to for manual medicine is very important.

INDIRECT ACTION TECHNIQUES work at the balance point away from the barrier of motion or away from the restriction. These techniques include: Indirect Technique, Functional Method, Indirect Myofascial Release, Strain/Counterstrain, Facilitated Positional Release, Balanced Ligamentous Tension, Balanced Membranous Tension, Manual Percussion and Vibration, Articulatory Technique

DIRECT ACTION TECHNIQUES work up against, or through the barrier to motion or the restriction. These techniques include: Muscle Energy Technique, Recoil Technique, Joint Translation of Accessory Motion, Direct Myofascial Release, Manual Percussion and Vibration, Articulatory Technique, the High Velocity Low Amplitude thrusting techniques

from: http://stevepaulus.com/Office_Website/Osteopathic_Manipulation.html

 

[Pain Applicant1]

I had another pt today from another chiro. Visits consisted of 3x/week for a year plus told to grow own herbs or something like that. $35 copay with each visit. The pt is desperate and with chronic pain and the chiro kept telling her her pain will improve but it just takes time, also selling biofreeze in office. Is this what they teach in chiro school?

Wasn't there a chiro on this forum at one time? He seemed like a good guy and I'd like his input. Why would insurance pay for this excessive treatment?

 

[Dr Manhattan]

good PT + masseuse > chiro

 

[emd123]

When a patient comes to me and says, "Doc, I've been to Dr So An So Chiro before, and it really helped. Can I go back?"

Then I say, "Yes, if you've already been to him, and it helped, then I'm okay with it." I figure that's better than starting a lifetime of opiates or dose escalation, if they've been to a specific person before and are convinced it helps. I don't try to talk them out of that belief. Otherwise, I recommend traditional PT 99% of the time.

 

[SSdoc33]

I had another pt today from another chiro. Visits consisted of 3x/week for a year plus told to grow own herbs or something like that. $35 copay with each visit. The pt is desperate and with chronic pain and the chiro kept telling her her pain will improve but it just takes time, also selling biofreeze in office. Is this what they teach in chiro school?

Wasn't there a chiro on this forum at one time? He seemed like a good guy and I'd like his input. Why would insurance pay for this excessive treatment?

Facetguy

I think we scared him off

 

[clubdeac]

I know a smokin hot chiro here where I work. I tried to develop a "referral" relationship with her and maybe something more until I went to one of her weekend seminars and listened to all the crazy crap she was selling. On top of it she got engaged to her boss... I think that's when I really lost interest 😉

 

[bedrock]

I know a smokin hot chiro here where I work. I tried to develop a "referral" relationship with her and maybe something more until I went to one of her weekend seminars and listened to all the crazy crap she was selling. On top of it she got engaged to her boss... I think that's when I really lost interest 😉

Not worth it man. You can't be with a woman for long that you can't respect, for one reason or the other.

But maybe you weren't hoping to be with her for long.......

 

[croak]

The renowned anesthesiologist/pain doc, and textbook author and lecturer Zill Crapmonger was a chiropractor before he "saw the light," so to speak.

 

[specepic]

No need to bash the whole profession. I know many good chiros. Sadly, the admission standards are low so bad apples are also many, and there are pockets of chiro cult that is all about crazy high volume, sales, psuedoscience, and $$$.

Its not too hard to figure out who is good in your area, just send a pt you trust to a chiro and they will tell you whether or not it was a shady operation or a professional. W/in a few months I knew who to use and who not to use.

Lets be frank, there are pain docs who also run block shops that are no better than a skecthy chiro

 

[croak]

No need to bash the whole profession. I know many good chiros. Sadly, the admission standards are low so bad apples are also many, and there are pockets of chiro cult that is all about crazy high volume, sales, psuedoscience, and $$$.

Its not too hard to figure out who is good in your area, just send a pt you trust to a chiro and they will tell you whether or not it was a shady operation or a professional. W/in a few months I knew who to use and who not to use.

Lets be frank, there are pain docs who also run block shops that are no better than a skecthy chiro

An issue in some states is the manner in which the "chiropractic mafia" functions. The corralling of patients is the most salient concern because sometimes very sick folks get hornswoggled into the clutches of chiro-land. Many patients first encounter chiros via an official looking mailer—derived from lists of motor vehicle accidents purchased by chiros and lawyers—an 800 number on daytime TV, or some other marketing ploy suggesting: "quick cash for whiplash" (citation). This targeting of the uninsured, or underinsured, focuses on state mandated PIP (personal injury protection) coverage—which is usually exhausted—before referring out.

There are thousands of so-called: Auto Accident, Pain Centers, or Accident Clinics in one sun drenched state that often have a retired generalist (MD/DO signing off on in-house care: meds, testing (mobile MRIs, surface NCS, 'chiropractic neurology [?]), physical therapy, massage, acupuncture, and of course spinal manipulation 3 x week, under the businessman/chiropractor/physician's direction.

Many chiros "lay claim" to the patient—they "own" that patient—often discouraging them "outside" consultation until the PIP dollars run out. Too often over the last few decades we've seen patients with cardiovascular, renal, neoplastic disease, or other undiagnosed (or undocumented) condition in need of surgery or hospitalization present after a course of "chiro care" dangling a: "Letter of Protection" provided by the attorney in cahoots with a chiro-run center in the state.

Many chiropractors are terrific business men and women, and there are a few thoughtful, and very bright DCs, but they're difficult to find.

As far as pain docs who've wandered over to the shady side? There are plenty, and some do some serious damage. There's no excuse for greedy block jocks, spinal cord stimulator salesmen, rhizotomy racketeers, who—with snazzier offices—conduct themselves like chiro-scammers. These docs, often well credentialed, fellowship trained, board certified folks can go for years under the radar, but they ultimately do get nailed.

PM & R, Neurology, Anesthesiologists, who are held to a higher standard, sometimes make the sleaziest den of brigands look like saints.

Eh. Just some Sunday reflections.

 

[jonnylingo]

No need to bash the whole profession. I know many good chiros. Sadly, the admission standards are low so bad apples are also many, and there are pockets of chiro cult that is all about crazy high volume, sales, psuedoscience, and $$$.

Its not too hard to figure out who is good in your area, just send a pt you trust to a chiro and they will tell you whether or not it was a shady operation or a professional. W/in a few months I knew who to use and who not to use.

Lets be frank, there are pain docs who also run block shops that are no better than a skecthy chiro

Really, in what case, with limited time/means/copays, would you intentionally send a patient to chiro? I might only consider chiro for acute/subacute lumbar sprain/strain, but in almost all those cases I'd prefer PT>>>chiro. I guess if they have all the time and unlimited means in the world, sure, throw in some massage and chiro, but I find most pts have to pick and choose what they spend their time/$ on.

In cases of chronic pain, I wouldn't consider getting a patient on the chiro train. That ride never ends.

The same can be said for intervention, and I agree there are sketchy block shops who will repeatedly inject 20 yr chronic LBP, and titrate to Cushing's.

 

[croak]

Well stated.

 

[clubdeac]

I send to chiro when they were in a car accident and are looking for a settlement. Did mbbs on a lady and she about lost it. Hysterical and crying for 30min after the injection. Told her I had nothing left to offer and sent her to my chiro hottie down the street

 

[pastafan]

Just saw this today:

CBP or Chiropractic BioPhysics is the most advanced, result-oriented chiropractic technique. Patients who have gone through the CBP treatment have shown significant improvements in their asthma. By addressing the root cause of the problem, CBP chiropractors are able to eliminate the major source of asthma and help patients live a more normal life again.

The majority of patients under the care of a CBP chiropractor not only report an immediate end to their asthma symptoms, but more importantly feel vibrant, energized, and notice their overall health improving every day.

 

[SSdoc33]

My favorite are the 'chiropractic neurologists'

 

[lobelsteve]

My favorite are the 'chiropractic neurologists'

And DABCR.

Diplomat American Board Chiropractic Radiologists

 

[Taus]

New patient today who has bilateral L5 pars defects with 6mm of translation on the F/E films I ordered..... had been going to chiro for 6 weeks per her lawyers advice... said they took xrays at first visit that showed "multiple disc herniations" and "a curvature" that would require 3x/week treatments for at least 3 months (aka.... til the $$ dries up). Also had what sounds like TPI's by the PA hired by the DC, US and estim each visit, an EMG done by the DC w/ a device "that was rolled up and down her back and legs". Awesome. Then again, we have our fair share of pain docs who run pill/injection mills in a similar fashion...just substitute a series of 3 facet/si/esi, then disco, then stim, back braces, UDS and compounding creams w/ in house labs for the chiro bs.

However, for acute to subacute axial pain (or even acute on chronic) in a patient w/ no medical contraindications, I have no issues w/ a TRIAL of manipulation by a reputable chiropractor. I make it clear to patients that if it helps after a few sessions... or doesn't help at all after a few sessions.... either way there is no need to keep going back routinely. The good chiropractors will tell you the same thing and if you're lucky refer you some really good straightforward patients after a trial of manipulation has not been helpful or pain continues to recur.

 

[jettavr6]

My favorite are the 'chiropractic neurologists'

Patient I am treating for CRPS of the right lower extremity, did about 5 lumbar sympathetic blocks on her with good results. Her friend pointed her towards a chiropractic neurologist. This lady (chiro), ended up prescribing a treatment plan of neck manipulations...not three times a week... but THREE TIMES A DAY for a couple of weeks. The patient literally went in before work, during lunch, and after work to get her neck cracked. Weeks and thousands of dollars later, she's back on my schedule next week for another round of sympathetic blocks.

 

[jesspt]

New patient today who has bilateral L5 pars defects with 6mm of translation on the F/E films I ordered..... had been going to chiro for 6 weeks per her lawyers advice... said they took xrays at first visit that showed "multiple disc herniations" and "a curvature" that would require 3x/week treatments for at least 3 months (aka.... til the $$ dries up). Also had what sounds like TPI's by the PA hired by the DC, US and estim each visit, an EMG done by the DC w/ a device "that was rolled up and down her back and legs". Awesome. Then again, we have our fair share of pain docs who run pill/injection mills in a similar fashion...just substitute a series of 3 facet/si/esi, then disco, then stim, back braces, UDS and compounding creams w/ in house labs for the chiro bs.

However, for acute to subacute axial pain (or even acute on chronic) in a patient w/ no medical contraindications, I have no issues w/ a TRIAL of manipulation by a reputable chiropractor. I make it clear to patients that if it helps after a few sessions... or doesn't help at all after a few sessions.... either way there is no need to keep going back routinely. The good chiropractors will tell you the same thing and if you're lucky refer you some really good straightforward patients after a trial of manipulation has not been helpful or pain continues to recur.

There is usually less dogma attached to the PT profession compared to chiropractic, although we have our shysters just like any other profession. But manipulation or HVLA is within the practice act of physical therapists in almost every state in the US and I think you're less likely to send your patient off to a PT and have that patient get the recommendation of 5xwk for one month, 3xwk for one month, and then once a month for the rest of your life to maintain optimal spinal health garbage.

 

[Jcm800]

Patient I am treating for CRPS of the right lower extremity, did about 5 lumbar sympathetic blocks on her with good results. Her friend pointed her towards a chiropractic neurologist. This lady (chiro), ended up prescribing a treatment plan of neck manipulations...not three times a week... but THREE TIMES A DAY for a couple of weeks. The patient literally went in before work, during lunch, and after work to get her neck cracked. Weeks and thousands of dollars later, she's back on my schedule next week for another round of sympathetic blocks.

quit stealing from her with your wasteful western medicine ways...

problem was she needed to see a chiropractic internist
http://www.councildid.com/index2.html
http://www.dabci.org/

 

[jonnylingo]

quit stealing from her with your wasteful western medicine ways...

problem was she needed to see a chiropractic internist
http://www.councildid.com/index2.html
http://www.dabci.org/

This is unbelievable.

"Qualifications: A DABCI degree (Diplomate of the American Board of Chiropractic Internists) requires doctors to attend and complete a 300 hour post doctorate course, pass a national certification examination and requires 12 hours of continuing education in advanced coursework each year."

So... this equates to a 7 week "noctor" course and you're ready to:

"routinely employ methods such as blood laboratory studies, urinalyses, electrocardiograms, vascular doppler ultrasound, spirometry, DEXA bone density testing, salivary assay hormonal and neurotransmitter tests, IgG food allergy testing, diagnostic imaging to include x-ray, CT, MRI, comprehensive gastrointestinal stool analyses, and many other diagnostic tools. "

Dang, that whole 4 years of residency sure was a waste.

 

[Missorleans]

This is unbelievable.

"Qualifications: A DABCI degree (Diplomate of the American Board of Chiropractic Internists) requires doctors to attend and complete a 300 hour post doctorate course, pass a national certification examination and requires 12 hours of continuing education in advanced coursework each year."

So... this equates to a 7 week "noctor" course and you're ready to:

"routinely employ methods such as blood laboratory studies, urinalyses, electrocardiograms, vascular doppler ultrasound, spirometry, DEXA bone density testing, salivary assay hormonal and neurotransmitter tests, IgG food allergy testing, diagnostic imaging to include x-ray, CT, MRI, comprehensive gastrointestinal stool analyses, and many other diagnostic tools. "

Dang, that whole 4 years of residency sure was a waste.

Would a chiropractor even know how to draw blood? (I know there are nurses, but still...) Do they learn immunology? Physiology?

 

[ampaphb]

No need to bash the whole profession. I know many good chiros. Sadly, the admission standards are low so bad apples are also many, and there are pockets of chiro cult that is all about crazy high volume, sales, psuedoscience, and $$$.

Its not too hard to figure out who is good in your area, just send a pt you trust to a chiro and they will tell you whether or not it was a shady operation or a professional. W/in a few months I knew who to use and who not to use.

Lets be frank, there are pain docs who also run block shops that are no better than a skecthy chiro

But there is no science behind the entire field. A substantial amount of research is being devoted to determining the extent to which scientific evidence of the chiropractic’s benefit can be verified, if any such benefit exists. They treat this mysterious pathology they call a "subluxation", even though, if you ask them, each practitioner will give you an entirely different rationale regarding its pathophysiology. The inter-observer reliability of their radiology readings are laughable (take a look at the mysterious lines they draw on films sometime).

In 1966, a policy passed by the AMA House of Delegates stated, “It is the opinion of the medical profession that chiropractic is an unscientific cult whose practitioners lack the necessary training and background to diagnose and treat human disease. Chiropractic constitutes a hazard to rational health care in the United States because of its substandard and unscientific education of its practitioners and their rigid adherence to an irrational, unscientific approach to disease causation.”
Chiropractic's Contentious History as Alternative Care
Yale Journal of Medicine and Law
http://www.yalemedlaw.com/2011/08/chiropractic-medicine-“quackery’s”-struggle-for-fair-practice/

The best thing they do is lay hands on patients, and as such, benefit from a placebo effect. But IMHO, there is no such thing as a "good" chiro - some are ineffective, and some clearly cause harm.

 

[Paddington]

In many states, the chiropractors quietly do their thing and make money. They're never seen or heard.

In some states like California, the chiropractors are terrible to deal with. They give patients diagnoses based on palpation and X-rays that are wildly inappropriate and inaccurate in order to justify their services. They tell patients they need to ask their doctor for unnecessary MRI's. Many also seem to be aligned closely with various attorneys. A lot of the medico-legal reports seem to be written by them which is hilarious. The patients come in with these little hand written notes on pieces of paper from the chiropractor telling you how to do your job.

 

[Ligament]

But there is no science behind the entire field. A substantial amount of research is being devoted to determining the extent to which scientific evidence of the chiropractic’s benefit can be verified, if any such benefit exists. They treat this mysterious pathology they call a "subluxation", even though, if you ask them, each practitioner will give you an entirely different rationale regarding its pathophysiology. The inter-observer reliability of their radiology readings are laughable (take a look at the mysterious lines they draw on films sometime).

In 1966, a policy passed by the AMA House of Delegates stated, “It is the opinion of the medical profession that chiropractic is an unscientific cult whose practitioners lack the necessary training and background to diagnose and treat human disease. Chiropractic constitutes a hazard to rational health care in the United States because of its substandard and unscientific education of its practitioners and their rigid adherence to an irrational, unscientific approach to disease causation.”
Chiropractic's Contentious History as Alternative Care
Yale Journal of Medicine and Law
http://www.yalemedlaw.com/2011/08/chiropractic-medicine-“quackery’s”-struggle-for-fair-practice/

The best thing they do is lay hands on patients, and as such, benefit from a placebo effect. But IMHO, there is no such thing as a "good" chiro - some are ineffective, and some clearly cause harm.

I agree a lot with what you state, but quoting anything the AMA states undermines your opinion. The AMA sold us out with their CPT codes, and exist soley to write and sell CPT codes. Not to mention their pitiful role in fighting Obamanocare

 

[pjuer]

I wonder about the pelvic exam part

http://www.councildid.com/9915/index.html

 

[jonnylingo]

This morning I had the unfortunate opportunity to inform a 66 y/o patient who presented to our spine clinic last week that he has a large mass in, around, and through his sacrum, into central canal, and penetrating psoas muscle. THAT was the cause of his S1 radic, not a disc.

Oh yeah, and his 30lb unintentional weight loss, fevers, chills and night sweats weren't due to a subluxation. This is in the setting of a 75 pack year history, currently smoking 1ppd. Just some small details that his "primary care" Chiro who has been working on him for the last 3 months had overlooked.

 

[emd123]

Nice

 

[Louisville04]

I wonder if chiropractors have to care malpractice insurance?

 

[clubdeac]

Can a physician sue on behalf of the patient? 😉

 

[Missorleans]

I heard about an orthopedist being called in as an expert witness in a case in which a chiro fractured a dude's femur while doing some adjustment (pt had metastatic prostate cancer).

 

[NJPAIN]

This morning I had the unfortunate opportunity to inform a 66 y/o patient who presented to our spine clinic last week that he has a large mass in, around, and through his sacrum, into central canal, and penetrating psoas muscle. THAT was the cause of his S1 radic, not a disc.

Oh yeah, and his 30lb unintentional weight loss, fevers, chills and night sweats weren't due to a subluxation. This is in the setting of a 75 pack year history, currently smoking 1ppd. Just some small details that his "primary care" Chiro who has been working on him for the last 3 months had overlooked.

I had a 70+ year old with hip and back pain with significant spine pathology unresponsive to various injections and and surgery. Over 18 month lost 80 lbs with elevated Ast, alt, alk phos and ggt. Told by PCP that.all this was due to pain and that with better pain control this would resolve. I kept telling him "something is seriously wrong" and PCP kept writing off to pain, dehydration and excessive alcohol. Finally, PCP reluctantly ordered abdominal ultrasound that showed several large liver masses and ct shows lung lesions and L1 lyric lesion.

 

[drf]

I had a 70+ year old with hip and back pain with significant spine pathology unresponsive to various injections and and surgery. Over 18 month lost 80 lbs with elevated Ast, alt, alk phos and ggt. Told by PCP that.all this was due to pain and that with better pain control this would resolve. I kept telling him "something is seriously wrong" and PCP kept writing off to pain, dehydration and excessive alcohol. Finally, PCP reluctantly ordered abdominal ultrasound that showed several large liver masses and ct shows lung lesions and L1 lyric lesion.

If you have red flags and pain, why not just order the study? I've found many cancers and fractures.

 

[ampaphb]

I agree a lot with what you state, but quoting anything the AMA states undermines your opinion. The AMA sold us out with their CPT codes, and exist soley to write and sell CPT codes. Not to mention their pitiful role in fighting Obamanocare

Lig, you need to let it go. As a progressive, I discount most of what the wackos on the right have to say, but every once in a while, Rush or Fox News surprise me and get an issue right. What the AMA said jibes with my opinion of chiros. What they had to say re the ACA has no bearing on this topic.

 

[jonnylingo]

Just followed up with another unfortunate patient of mine...

18 y/o 6'4" football player, who had 8 month history of pain at the LS junction. No neuro signs. Worse with extension/Stork, better with flexion. History of repetitive extension playing as lineman. Pretty classic H&P for spondylolysis. MRI confirms pars defect. Now wearing custom TLSO for 3-6 months.

Patient's and parent's only regret... getting the ol' shake and bake Chiro treatments for the last 6 months instead of getting actual medical treatment. Seems those adjustments couldn't keep that pars defect in place!!

 

[jonnylingo]

Interesting brief history of Chiro. "The White Paper", prepared by lawyer and edited by MD for the Institute of Science in Medicine:

http://scienceinmedicine.org/policy/papers/Chiropractic.pdf

FYI, Stephen Barrett MD is co-founder of the National Council Against Health Fraud (NCAHF), and the webmaster of Quackwatch. Great podcasts.

 

[SSdoc33]

Just followed up with another unfortunate patient of mine...

18 y/o 6'4" football player, who had 8 month history of pain at the LS junction. No neuro signs. Worse with extension/Stork, better with flexion. History of repetitive extension playing as lineman. Pretty classic H&P for spondylolysis. MRI confirms pars defect. Now wearing custom TLSO for 3-6 months.

Patient's and parent's only regret... getting the ol' shake and bake Chiro treatments for the last 6 months instead of getting actual medical treatment. Seems those adjustments couldn't keep that pars defect in place!!

Old thread, But not sure what a TLSO will do if the fracture is 8 months old

 

[clubdeac]

Since we're talking about spondy's. I've been treating an 18 y/o kid with a spondy. Braced him for 3 mos. He was doing fine then his back pain came back. Parent's show me video of him writhing in pain. Almost opisthotonic like choreiform posturing. Really weird. Anyway, I decided to get a SPECT scan that was negative. That pretty much rules out the spondy as the cause of pain, no?

 

[lobelsteve]

Since we're talking about spondy's. I've been treating an 18 y/o kid with a spondy. Braced him for 3 mos. He was doing fine then his back pain came back. Parent's show me video of him writhing in pain. Almost opisthotonic like choreiform posturing. Really weird. Anyway, I decided to get a SPECT scan that was negative. That pretty much rules out the spondy as the cause of pain, no?

Send to university. 18 yo with weirdness. No drug or needle from me. Get second set of eyes on this.

 

[emd123]

Send to university. 18 yo with weirdness. No drug or needle from me. Get second set of eyes on this.

+1 on punting to nearest hero. Likely a large supra-tentorial component. Exhibit A, see below:

18 y/o kid ... was doing fine then.......Parent's show me video of him writhing in pain. Almost opisthotonic like choreiform posturing. Really weird... SPECT scan negative...

 

[Jcm800]

i send patients to a chiro in situations where i cannot legally bludgeon them, because i hate them so much...

its usually some patient i cant stand, that wont leave me alone, and says, "what about a chir" and i say "yea, great idea! follow up with them..." they deserve each other