Hey Chiropractors: Knock it off.

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Dares Dareson said:
Any examples? I'm sincerely curious.
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It's the fact that you can't run randomized control trials on everything. some things just make sense so people do them. most of the things we do aren't "evidence-based" but that doesn't mean that if someone publishes something in some journal that makes it the word of god
 
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gman33 said:
But I'd also say that a very large percentage of modern medicine is pseudo-science.
A lot of our interventions have no proven benefit and have a very real downside.
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No, a lot of medicine is not pseudoscience.

You are right that a lot of medicine hasn't been proven to be effective at the 95% confidence interval by a double blinded, randomized prospective trial. A lot of medicine is based on nothing more than our best understanding of physiology. Over time, as we do more trials, and learn more about how the body works, I am sure that much of what we are currently doing will be proven to be useless, or actively harmful.

And then we will stop doing those things.

That's not pseudoscience. That's science. In progress.

What make all of these professions we're discussing pseudoscience is the fact that they are not adjusting to the evidence. There is no amount of evidence that will ever, every convince an antivaxxer to give a vaccine, or a chiropractor to stop cracking backs, or an acupuncturist to stop poking people. They aren't unproven, they are opposed to the concept of proof. These theories aren't based on the best science available. They already operate in opposition to everything we understand about physiology (chiropractic, natropathy), physics (reiki, acupuncture), and object permanence (homeopathy).

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

Thinking you can fix disease with it like a lot of chiros do is nonsense though. It's more of an alternative to aspirin or other means to alleviate minor aches and pains then it is some kind of magical cure-all.
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Well, you might want to consider that A.T. Still had a lot of claims about being able to cure systemic disease with manipulation also at the beginning -- and, at least at TCOM, we were told to perform a "celiac ganglion release" by placing our fingers on the anterior abdomen to palpate all the way through to the anterior side of the spinal column for the celiac ganglion --- so before we start bashing chiropractors as quacks, we need to make sure our own osteopathic skirts are nice, clean and of appropriate length.... Do not get me started on cranial
 
JustPlainBill said:
Well, you might want to consider that A.T. Still had a lot of claims about being able to cure systemic disease with manipulation also at the beginning -- and, at least at TCOM, we were told to perform a "celiac ganglion release" by placing our fingers on the anterior abdomen to palpate all the way through to the anterior side of the spinal column for the celiac ganglion --- so before we start bashing chiropractors as quacks, we need to make sure our own osteopathic skirts are nice, clean and of appropriate length.... Do not get me started on cranial
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I don't disagree.
 
Perrotfish said:
No, a lot of medicine is not pseudoscience.

You are right that a lot of medicine hasn't been proven to be effective at the 95% confidence interval by a double blinded, randomized prospective trial. A lot of medicine is based on nothing more than our best understanding of physiology. Over time, as we do more trials, and learn more about how the body works, I am sure that much of what we are currently doing will be proven to be useless, or actively harmful.

And then we will stop doing those things.

That's not pseudoscience. That's science. In progress.

What make all of these professions we're discussing pseudoscience is the fact that they are not adjusting to the evidence. There is no amount of evidence that will ever, every convince an antivaxxer to give a vaccine, or a chiropractor to stop cracking backs, or an acupuncturist to stop poking people. They aren't unproven, they are opposed to the concept of proof. These theories aren't based on the best science available. They already operate in opposition to everything we understand about physiology (chiropractic, natropathy), physics (reiki, acupuncture), and object permanence (homeopathy).

These fact that medicine is not perfect does not make quackery equivalent to medicine.
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We do a better job at adapting then the fields that are not based on science.
That being said, medicine still does a terrible job at adapting.
Too high a percentage of what we do has already been proven "useless, or actively harmful", yet it is it still done everyday.
There are a lot of reasons that this happens.
 
Perrotfish said:
No, a lot of medicine is not pseudoscience.

You are right that a lot of medicine hasn't been proven to be effective at the 95% confidence interval by a double blinded, randomized prospective trial. A lot of medicine is based on nothing more than our best understanding of physiology. Over time, as we do more trials, and learn more about how the body works, I am sure that much of what we are currently doing will be proven to be useless, or actively harmful.

And then we will stop doing those things.

That's not pseudoscience. That's science. In progress.

What make all of these professions we're discussing pseudoscience is the fact that they are not adjusting to the evidence. There is no amount of evidence that will ever, every convince an antivaxxer to give a vaccine, or a chiropractor to stop cracking backs, or an acupuncturist to stop poking people. They aren't unproven, they are opposed to the concept of proof. These theories aren't based on the best science available. They already operate in opposition to everything we understand about physiology (chiropractic, natropathy), physics (reiki, acupuncture), and object permanence (homeopathy).

These fact that medicine is not perfect does not make quackery equivalent to medicine.
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Really good post.
 
DocJL said:
I could fathom how this might happen from a higher force adjustment, just wondering how you know they were caused by such.

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

The mechanism is stretching of the vertebral arteries during 'cracking' (or, officially, 'HVLA') treatments. This can cause dissection of the intima and media with resulting strokes.

It's the reason why, despite being a DO, I've never cracked a neck in my life. The rest of the manipulative treatments are merely useless whereas this one is both useless and dangerous.
 
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DOFOSHO said:
dude, i had the radio on today and was listening to some BS that a chiropractor was talking about. A guy with "barre syndrome" called in, "what should i do about my barre syndrome, doctor?" "Cut all carbohydrates out of your diet. no pasta, no bread,....,the viruses feed on the carbohydrates from your diet. Get cortisol supplements to boost your immune system." no joke..this guy was giving out medical advice that he was pulling straight out of his rectal sphincter.
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Wow. Just. Wow.
 
Along the lines of the radio-show chiropractor:

I seem to be encountering a string of people interested in asking me what my recommendation is for a good "detox product". Now, I'm not clear on what that means, and I'm relatively certain that they themselves have no idea what the hell they're talking about.

There's no physiologic principle that I can think of that corresponds to the concept of using one substance to otherwise rid an organ system of another (unwanted) moeity other than... hydration and avoidance of the offending agent(s). If you get into "poison/antidote" situations, you've gone too far and too specific. Yet... this concept of the pursuit of ethereal purity seems to be more and more common.

This... drives me nuts.
 
RustedFox said:
Along the lines of the radio-show chiropractor:

I seem to be encountering a string of people interested in asking me what my recommendation is for a good "detox product". Now, I'm not clear on what that means, and I'm relatively certain that they themselves have no idea what the hell they're talking about.

There's no physiologic principle that I can think of that corresponds to the concept of using one substance to otherwise rid an organ system of another (unwanted) moeity other than... hydration and avoidance of the offending agent(s). If you get into "poison/antidote" situations, you've gone too far and too specific. Yet... this concept of the pursuit of ethereal purity seems to be more and more common.

This... drives me nuts.
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Maybe it's about time you manufacture Dr. Fox's Detox Elixir and sell it for $250 a pop. After all, it's the only natural detox solution proven to help you profit.
 
jw3600 said:
Well said. I wonder when (?if) DO schools will start realizing (?admitting) this.
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When the money dries up? It's no different than selling snake oil. There's actually a tremendous amount of brainwashing at DO schools. No joke.

My favorite moment in my education thus far was the rampant criticism of one of our GI docs through surveys. All the guy did was recommend plant based diet and lifestyle medicine in adjunct to surgery and medical management. No one says anything about OMM.

So yea, while most students will never use OMM in practice, none will step up against it. If you think about it, it's existence is the reason many are able to become physicians. No ones gonna bite that hand full of altruistic opportunity.
 
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DOFOSHO said:
dude, i had the radio on today and was listening to some BS that a chiropractor was talking about. A guy with "barre syndrome" called in, "what should i do about my barre syndrome, doctor?" "Cut all carbohydrates out of your diet. no pasta, no bread,....,the viruses feed on the carbohydrates from your diet. Get cortisol supplements to boost your immune system." no joke..this guy was giving out medical advice that he was pulling straight out of his rectal sphincter.
Click to expand...

A couple of years ago I saw a promo for a local news story about taking your infant to the chiropractor. I don't know why I was so naive to think it might be about why it's a total crock of steaming ****, but I tuned in. It was a 5 minute piece on all of the good a chiropractor can do for your infant. Baby's got colic? I'll just go ahead and crack his soft little spine! Nothing stops fussiness like a carotid dissection! It was horrifying. The worst part was when another local channel ran pretty much the same story.
 
KinesiologyNerd said:
A couple of years ago I saw a promo for a local news story about taking your infant to the chiropractor. I don't know why I was so naive to think it might be about why it's a total crock of steaming ****, but I tuned in. It was a 5 minute piece on all of the good a chiropractor can do for your infant. Baby's got colic? I'll just go ahead and crack his soft little spine! Nothing stops fussiness like a carotid dissection! It was horrifying. The worst part was when another local channel ran pretty much the same story.
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This is where the government exposes their true colors, regarding so-called "cost savings," "pay for performance," and "evidence based care." The government demands this of us, yet gladly pays chiropractors and gladly funds chiropractic care through Medicare coverage determinations. This pseudoscience should get, not reimbursment cuts, but zero taxpayer dollars for anything and patients required to pay out of pocket. Yet, they twist the ---- of MDs monthly, yearly and paint us as the source of the problem in the court of public opinion. The guys sewing arteries back together, putting ankles back in place, sewing faces back together, and making dying people breathe are the bad guys. Yet these guys are the darlings of your Federal government and the Medicare reimbursement decision makers, frequently getting reimbursement hikes while doctors take the blade, in recent years.

Chiropractors get reimbursement hike

"Chiropractors are big winners in Medicare reimbursement..."

http://www.bizjournals.com/pittsbur.../12/chiropractors-get-reimbursement-hike.html
 
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Birdstrike said:
This is where the government exposes their true colors, regarding so-called "cost savings," "pay for performance," and "evidence based care." The government demands this of us, yet gladly pays chiropractors and gladly funds chiropractic care through Medicare coverage determinations. This pseudoscience should get, not reimbursment cuts, but zero taxpayer dollars for anything and patients required to pay out of pocket. Yet, they twist the ---- of MDs monthly, yearly and paint us as the source of the problem in the court of public opinion. The guys sewing arteries back together, putting ankles back in place, sewing faces back together, and making dying people breathe are the bad guys. Yet these guys are the darlings of your Federal government and the Medicare reimbursement decision makers, frequently getting reimbursement hikes while doctors take the blade, in recent years.

Chiropractors get reimbursement hike

"Chiropractors are big winners in Medicare reimbursement..."

http://www.bizjournals.com/pittsbur.../12/chiropractors-get-reimbursement-hike.html
Click to expand...

And why is this? Is there some sort of powerful Chiro lobby pulling some strings somewhere? Seeing things like this make me lose faith in people.
 
filhodeinferno said:
And why is this? Is there some sort of powerful Chiro lobby pulling some strings somewhere? Seeing things like this make me lose faith in people.
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You'd think MDs with their millions would be able to afford some sort of political representation.

:shrug:
 
filhodeinferno said:
And why is this? Is there some sort of powerful Chiro lobby pulling some strings somewhere? Seeing things like this make me lose faith in people.
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There's no powerful Chiro lobby that I know of. I suspect it has more to do with the present administration's tactics and ideology that doctors are the "bad guy" and choosing to demonize them as greedy-rich that don't care about people, cut their reimbursement/pay and by default, reward others seen as the "little guy." I think it fits very well into their strategy to pit rich vs. poor to win votes and their political ideology that wealth should be redistributed and not "concentrated at the top." It tends to sell very well, and harnesses for political gain, a very negative aspect of human nature: envy.

You know, surgeons just go and cut legs off to make $50,000:



And they just cut tonsils out to make lots of money when it's really just allergies:

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

DarkHorse22 said:
DO students take note. HVLA stands for high velocity low amplitude. Chiropractors do not do HVLA. They do HVHA. High velocity high amplitude. The risks are far greater with larger amplitude. And the above posts are correct, high amplitude allows for more spinal segments to be "treated" at once. Unsafe.
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Which Chiropractic school taught you this?
 
Birdstrike said:
There's no powerful Chiro lobby that I know of. I suspect it has more to do with the present administration's tactics and ideology that doctors are the "bad guy" and choosing to demonize them as greedy-rich that don't care about people, cut their reimbursement/pay and by default, reward others seen as the "little guy." I think it fits very well into their strategy to pit rich vs. poor to win votes and their political ideology that wealth should be redistributed and not "concentrated at the top." It tends to sell very well, and harnesses for political gain, a very negative aspect of human nature: envy.

You know, surgeons just go and cut legs off to make $50,000:



And they just cut tonsils out to make lots of money when it's really just allergies:

Click to expand...


Ugh. If you want to redistribute wealth, go find the millionaire CEO who's taking huge bonuses while the company is taking govt stimulus money because the corporation has been run into the ground by poor management. Don't go after the person that spent the best years of his life in the hospital learning how to save yours.

Anyway, I digress. I guess these politicians consider chiros to be primary care physicians and someone who is going to prevent a person from having to undergo a costly surgery. It's a shame that they don't understand science, because that would be really helpful in these situations.
 
Birdstrike said:
I think it fits very well into their strategy to pit rich vs. poor to win votes and their political ideology that wealth should be redistributed and not "concentrated at the top."
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🙄


giphy.gif



:hijacked:
 
Back 5 said:
This is absolutely false.
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Slight flexion of the neck versus extension makes a huge difference, as does the crazy amount of force many chiros use. Here's a paper from their own journal that covers the anatomy of dissections, common mechanisms, etc:

"The proposed mechanism of arterial strain during neck rotation involves the ipsilateral C1-2 joint being fixed while the contralateral side of C1 is propelled forward, which compresses and stretches the artery. The ICA is most susceptible to strain in the upper cervical region when the head and neck are in combined rotation or lateral flexion and simultaneous hyperextension."

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2647091/

Here's a typical chiro technique. This isn't one of the crazy multi-segment twists, but I'll dig up video for one of those in a few. It's much more forceful and pushes barriers much further than anything I've ever seen demonstrated in DO school:


Here's a typical osteopathic HVLA:


Personally I'm just not a fan of HVLA in general, but I've never seen a chiropractor do it in a way that doesn't translate enough force to move the patient's shoulders with the thrust, which just seems insanely excessive to me.
 
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The article is talking about a mechanism for artery dissection, it's not a manual for how to deliver a thrust. This isn't a DC vs DO debate. I don't think upper cervical HVLA is appropriate but we aren't going to make any inroads by making false statements.
 
filhodeinferno said:
I guess these politicians consider chiros to be primary care physicians and someone who is going to prevent a person from having to undergo a costly surgery. It's a shame that they don't understand science, because that would be really helpful in these situations.
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Our country suffers from an epidemic of willful denialism.

But then, when our politicians (our leaders) pick and choose their positions based on arbitrary ideas spewed forth from a random number generator, what can we expect of the population?
 
Spinach Dip said:
Our country suffers from an epidemic of willful denialism.

But then, when our politicians (our leaders) pick and choose their positions based on arbitrary ideas spewed forth from a random number generator, what can we expect of the population?
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Incorrect. They get their positions from lobbyists and their corporate masters. The Republicans are hopelessly captured by special interests. The Democrats are guilty of this as well, but there is a burgeoning progressive wing that could break free of money-driven politics. Unfortunately, conservatives vote zealously, while progressives/liberals/moderates/anyone leaning left of Rush Limbaugh says "they're all corrupt, it's pointless, forget voting, let's go watch TV." Or they show up to vote but are told they've been wrongly disenfranchised to "protect against voter fraud."

Very frustrating. :bang:
 
Dares Dareson said:
Incorrect. They get their positions from lobbyists and their corporate masters. The Republicans are hopelessly captured by special interests. The Democrats are guilty of this as well, but there is a burgeoning progressive wing that could break free of money-driven politics. Unfortunately, conservatives vote zealously, while progressives/liberals/moderates/anyone leaning left of Rush Limbaugh says "they're all corrupt, it's pointless, forget voting, let's go watch TV." Or they show up to vote but are told they've been wrongly disenfranchised to "protect against voter fraud."

Very frustrating. :bang:
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I was sorta referring to lobbyists/corporate masters/political viewpoints adopted in the '50s/etc as the 'random number generator'.

And the cognitive dissonance considered 'normal' by BOTH parties is pretty scary at times.
 
I'll be the first to admit that much of OMM is sheer quackery, but for patients with chronic musculoskeletal pain, I wholeheartedly support people trying it and will direct my patients in the direction of folks that do it. Absent cervical HVLA, the number needed to harm approaches infinity, and whether there's a placebo effect or a real effect for some people that gets lost in the way we do clinical trials, if it's helping to keep my patients from taking opiates, keeps orthopedists from cutting on their back, and prevents/slows them from getting on disability and turning into slugs I'm all for it. I tell people that I suggest it to that it will not be a panacea, and anyone who is telling them that is a flat-out liar, but they should give it a try because there's a chance we might get a small win in what is one of the most frustrating things to deal with as a patient or a provider. We can talk about the financial aspects of it another day, but there are much, MUCH bigger fish to fry.
 
TheBlueBlazer said:
I'll be the first to admit that much of OMM is sheer quackery, but for patients with chronic musculoskeletal pain, I wholeheartedly support people trying it and will direct my patients in the direction of folks that do it. Absent cervical HVLA, the number needed to harm approaches infinity, and whether there's a placebo effect or a real effect for some people that gets lost in the way we do clinical trials, if it's helping to keep my patients from taking opiates, keeps orthopedists from cutting on their back, and prevents/slows them from getting on disability and turning into slugs I'm all for it..
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So it is acceptable to give what you believe to be a placebo when its OMM, but not when its a cheaper, less time consuming, and more definitively risk free placebo pill? Blue chalk in a capsule would have the same effects with far fewer downsides.
 
Perrotfish said:
So it is acceptable to give what you believe to be a placebo when its OMM, but not when its a cheaper, less time consuming, and more definitively risk free placebo pill? Blue chalk in a capsule would have the same effects with far fewer downsides.
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The NNT can't be infinity. Just show a NNT of "infinity minus one" and you're good. The sugar pill therefore remains the most sad, lonely and culturally under-appreciated of the placebos. Redesign your study next year with just a few tweeks and you just might get that sugar pill FDA approved.
 
Perrotfish said:
So it is acceptable to give what you believe to be a placebo when its OMM, but not when its a cheaper, less time consuming, and more definitively risk free placebo pill? Blue chalk in a capsule would have the same effects with far fewer downsides.
Click to expand...

That's the thing about placebos, its like fight club.

Rule #1: don't ever call it a placebo.

Now if you called it an "all natural hawaiian cane sugar pill with amazing immune boosting and pain relieving effects" people would eat it up and pay hundreds of dollars for a single pill just like they do for OMM.

Reminds me of this duke anesthesiologist who goes around selling "hangover cures" to hungover people in Las Vegas for $200 + $300 to travel to your hotel room. Its basically just IV fluids, vitamins/antioxidants, and some anti nausea/headache meds.

Now there's nothing wrong with selling those products to people with a massive hangover, and I'm sure they work just fine, its just that you can get the same effect from a $2 bottle of orange juice plus some dramamine and ibuprofen.

http://www.hangoverheaven.com

and

http://www.nola.com/drink/index.ssf/2013/12/trend_in_iv_treatment_for_hang.html
 
Perrotfish said:
So it is acceptable to give what you believe to be a placebo when its OMM, but not when its a cheaper, less time consuming, and more definitively risk free placebo pill? Blue chalk in a capsule would have the same effects with far fewer downsides.
Click to expand...

I didn't say it was equivalent to a placebo, just that there is undoubtably some placebo effect there like many things we do. It's the same as when you tell patients that you're giving them "a strong pain medicine" the ones that aren't pros have more of a pain response than the ones that aren't. There are surely patients that receive benefit from OMM, the same way there are kids with bronchiolitis who get help from albuterol. When you aggregate things the way they are in studies, it says it doesn't help on the average, but that doesn't mean that there aren't individual kids who benefit. When you have a low-risk intervention like that, it's worth giving it a try.
 
TheBlueBlazer said:
I didn't say it was equivalent to a placebo, just that there is undoubtably some placebo effect there like many things we do. It's the same as when you tell patients that you're giving them "a strong pain medicine" the ones that aren't pros have more of a pain response than the ones that aren't. There are surely patients that receive benefit from OMM, the same way there are kids with bronchiolitis who get help from albuterol. When you aggregate things the way they are in studies, it says it doesn't help on the average, but that doesn't mean that there aren't individual kids who benefit. When you have a low-risk intervention like that, it's worth giving it a try.
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I feel like I have this conversation with OMM supporters a lot

Me 'there's no way OMM works, it would defy physiology and physics'
OS 'yeah but its worth it for the placebo effect'
Me 'But isn't it unethical to give placebos?'
OS 'well it probably actually works too'
Me 'but there's no way OMM works, it would defy physiology and physics'
OS 'yeah but its worth it for the placebo effect'

And around it goes. My re-response:

1) No it doesn't work
2) You don't think it works. If you thought it worked you wouldn't bring up the placebo effect to justify it during the first sentence
3) If you don't think it works, don't try it.
 
Perrotfish said:
I feel like I have this conversation with OMM supporters a lot

Me 'there's no way OMM works, it would defy physiology and physics'
OS 'yeah but its worth it for the placebo effect'
Me 'But isn't it unethical to give placebos?'
OS 'well it probably actually works too'
Me 'but there's no way OMM works, it would defy physiology and physics'
OS 'yeah but its worth it for the placebo effect'

And around it goes. My re-response:

1) No it doesn't work
2) You don't think it works. If you thought it worked you wouldn't bring up the placebo effect to justify it during the first sentence
3) If you don't think it works, don't try it.
Click to expand...

I have good DO friends. They admit that osteopathic training was a means to an end, an opportunity to become a physician. They put up with the OMM stuff to get the grades they needed, but now that they are done they fully admit that it was all just BS, and it has absolutely no role in modern medicine. There's no quicker way a DO can hurt his/her credibility than to start propping up that stuff.
 
In regards to the original post: We should remember "people who live in glass houses shouldn't throw stones". Have I made the comment "I can't believe Dr. XYZ missed this!" Absolutely, I do it all the time, I'm human. However, it is a statement I alway regret. I know deep down it could have just as easily been me that missed the diagnosis. Also as ER docs we are trained with a completely different mentality than any other specialty, to the point, that our own medical colleagues and especially our patients don't understand our focus. My 1st priority and main objective of your ER visit is not to figure out why you are having back pain. It is to make sure you aren't having something that is going to kill you... Once I have accomplished this then I'll try to figure out cause, but this is by no means a priority for me. Most other docs approach pt's with "what is the most likely cause" attitude. Also we have the luxury of having 24hr CT, MRI, Lab at our disposal. BTW RustedFox good pick up. I think chronic pain patients are a challenging population and easy to glance over.

In regards to the OMT bashing: Maybe it's the little man syndrome in me, but, I feel compelled to throw at least one punch in the other direction. I find it disturbing when people bash something they don't know anything about!😕 I also don't think it is fair to say it has no use in modern medicine and that it's all placebo. There is a lot of cross over between OMT techniques and those used in PT/PM&R/Sports Medicine. HVLA is only a small portion of techniques used. And for what it is worth, I don't practice OMT. Although my MD colleagues often ask me to fix their back pain...😀
 
barnacle said:
In regards to the original post: We should remember "people who live in glass houses shouldn't throw stones". Have I made the comment "I can't believe Dr. XYZ missed this!" Absolutely, I do it all the time, I'm human. However, it is a statement I alway regret. I know deep down it could have just as easily been me that missed the diagnosis. Also as ER docs we are trained with a completely different mentality than any other specialty, to the point, that our own medical colleagues and especially our patients don't understand our focus. My 1st priority and main objective of your ER visit is not to figure out why you are having back pain. It is to make sure you aren't having something that is going to kill you... Once I have accomplished this then I'll try to figure out cause, but this is by no means a priority for me. Most other docs approach pt's with "what is the most likely cause" attitude. Also we have the luxury of having 24hr CT, MRI, Lab at our disposal. BTW RustedFox good pick up. I think chronic pain patients are a challenging population and easy to glance over.

In regards to the OMT bashing: Maybe it's the little man syndrome in me, but, I feel compelled to throw at least one punch in the other direction. I find it disturbing when people bash something they don't know anything about!😕 I also don't think it is fair to say it has no use in modern medicine and that it's all placebo. There is a lot of cross over between OMT techniques and those used in PT/PM&R/Sports Medicine. HVLA is only a small portion of techniques used. And for what it is worth, I don't practice OMT. Although my MD colleagues often ask me to fix their back pain...😀
Click to expand...

Its not so much that they "missed" the diagnosis. Its that they failed to even consider it, and instead insist on pathology that doesn't even exist. A subluxed rib ? Come on, man.
 
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