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Interesting thread in PT section
- Thread starter cdmguy
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Meh. I really don't see the point of starting a thread about a crazy fringe of the chiropractic profession, no matter how much you don't like chiros. If anything, I think that sort of argument tends to unfairly promotes parity between legitimate medicine and CAM: it's easy for chiros to point out the many, many examples of doctors that were just as bat**** insane, and the fact that both professions are similarly awful on the fringes can make the two professions seem more similar than they really are.
It's when you compare the 'legitimate' chiropractors to average doctors that you can make a good argument that CAM is really just a more expensive version of faith healing.
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This is a fine distinction but given that they are closely allied with three chiropractic schools and the viewpoint constitutes 75% of chiropractors (subluxation, curing organic disease, minimizing strokes and no informed consent) they certainly aren't fringe practitioners. This is just a defensive ruse by the chiropractors to try to disarm their presence so don't accept the "bad apple" excuse from them. These guys are learning these viewpoints in accredited schools so they are accepted by the field and not deviants. No chiropractor has ever lost their license for quackery and ineffective biomechanical treatments because all chiropractors technically practice to cure subluxations which they define to be whatever they feel like.
I just want people to be aware of what they are doing.
Do you think most MDs are warning patients about them?
I just want people to be aware of what they are doing.
Do you think most MDs are warning patients about them?
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Has a subluxation has ever been shown on plain film x-ray?
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I have to get into a bit of biomechanics to address the problems with why plain film isn't sensitive for biomechanical dysfunction. So far the best theory of pathology was discovered by Manhomar Panjabi who stated that joints have a neutral position and that the pathology involves loss of the joint support structure components (disks, ligaments, muscles) so that the neutral position is altered. We know from Robin McKenzie that the pulposis at the center of the disk moves around like a ball bearing opposite the postural shift and can become entrapped and lock the joint down so that it can't return to normal.
Our first problem is that plain film projections are two dimensional representations of three dimensional structures. This leads to distortions and to interpret them accurately we must know the starting 3d posture in advance.
The second problem with plain films is that they are typically not done at the ends of motion so we don't have a good representation of how the joint moves through its entire range of motion. In the past few years a new technology called Digital Motion X-ray has come on to the scene which is similar to flouroscopy but with higher reliability. It is ideal for evaluating subtle ligament injuries so remember it. Here's an example of a CAD injury scan.
So returning to chiropractic, can they really do anything to help biomechanical problems? Well chiropractors being the CAM medicine despising practitioners that they are have restricted their scope in most states to exclude rx and surgery. Ligament laxity of the spine is a very common co-factor with postural problems. The only treatment that in theory could be available for them to stabilize these lax ligaments and stabilize a normal neutral position would be osteopathy's prolotherapy but they won't give themselves the power to inject so they can't accomplish their stated goal of restoring good posture and neutral position to patient's spines.
Either they have to expand their scope and give up all of their outdated quack practices or osteopathy/medicine needs to incorporate the innovative chiropractic traction devices and do some research to see if this could be incorporated into PT to improve biomechanical outcomes.
Here is what chiropractic traction looks like:
http://youtu.be/JEMz9hnEL60
Here is what a few months of traction and mirror image exercise can do if there is no ligament laxity:
From http://drmauricecormier.com/English/posturalcare.html
Before
After
Normal is at least a 20 degree sagital curve in the neck. Less than that and you get a drastic (70%) increase in the incidence of chronic mechanical pain and headaches.
Medicine currently ignores this problem and treats it completely symptomatically.
Note that this traction is very crude three point traction of the neck. For example, the after image shows a lack of inclination at C3-4 with most of the force having been at the apex C4-5. This is why these segments deviate from the green ideal curve. This is a good example of crude, nonspecific chiropractic traction. Chiropractors haven't customized their traction to cover different neck sizes and presentations aside from varying the angle of pull. Still, because the curve has been somewhat restored the patient felt enough improvement to complete the treatment.
Our first problem is that plain film projections are two dimensional representations of three dimensional structures. This leads to distortions and to interpret them accurately we must know the starting 3d posture in advance.
The second problem with plain films is that they are typically not done at the ends of motion so we don't have a good representation of how the joint moves through its entire range of motion. In the past few years a new technology called Digital Motion X-ray has come on to the scene which is similar to flouroscopy but with higher reliability. It is ideal for evaluating subtle ligament injuries so remember it. Here's an example of a CAD injury scan.
So returning to chiropractic, can they really do anything to help biomechanical problems? Well chiropractors being the CAM medicine despising practitioners that they are have restricted their scope in most states to exclude rx and surgery. Ligament laxity of the spine is a very common co-factor with postural problems. The only treatment that in theory could be available for them to stabilize these lax ligaments and stabilize a normal neutral position would be osteopathy's prolotherapy but they won't give themselves the power to inject so they can't accomplish their stated goal of restoring good posture and neutral position to patient's spines.
Either they have to expand their scope and give up all of their outdated quack practices or osteopathy/medicine needs to incorporate the innovative chiropractic traction devices and do some research to see if this could be incorporated into PT to improve biomechanical outcomes.
Here is what chiropractic traction looks like:
http://youtu.be/JEMz9hnEL60
Here is what a few months of traction and mirror image exercise can do if there is no ligament laxity:
From http://drmauricecormier.com/English/posturalcare.html
Before
After
Normal is at least a 20 degree sagital curve in the neck. Less than that and you get a drastic (70%) increase in the incidence of chronic mechanical pain and headaches.
Medicine currently ignores this problem and treats it completely symptomatically.
Note that this traction is very crude three point traction of the neck. For example, the after image shows a lack of inclination at C3-4 with most of the force having been at the apex C4-5. This is why these segments deviate from the green ideal curve. This is a good example of crude, nonspecific chiropractic traction. Chiropractors haven't customized their traction to cover different neck sizes and presentations aside from varying the angle of pull. Still, because the curve has been somewhat restored the patient felt enough improvement to complete the treatment.
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