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[JaggerPlate]

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You are still posting a whole lot of nothing fine I show you multiple scientific articles showing the effectiveness of PT. Since you are repeatedly asking for it. So I guess OMM=PT to you...

http://www.best-seller-books.com/ki...tal-system-foundations-for-rehabilitation.pdf

http://ajpheart.physiology.org/content/early/2008/10/10/ajpheart.00902.2008.full.pdf

http://ukpmc.ac.uk/abstract/MED/5378020

http://www.ncbi.nlm.nih.gov/pubmed/19290675

http://www.ncbi.nlm.nih.gov/pubmed/21423253

http://www.ncbi.nlm.nih.gov/pubmed/21421266

http://www.ncbi.nlm.nih.gov/pubmed/21419358

So just to make sure I have this straight ... you're evidence that proves physical therapy is backed by solid science consists of some articles comparing running to cycling, talking about massage, and discussing lymphatic issues, and an article about the 'function of the knee' published in 1969? Did you even look at these articles before you hit enter and then copy/paste???

Boy, you sure showed me. Borderline nonsensical.

I guess a 3 second google search is too hard for you. Sure you believe that PT is supported by science which is why you asked for multiple articles...🙄

Man, you really just don't "get it" do you ...

1. Thanks for confirming that your sound, scientific proof consisted of a 3 second google search that you performed just now to prove anecdotes and personal beliefs

2. I've never doubted PT was scientifically proven, my point was that you had absolutely no basis to state this. It was simply an opinion that you'd forged and were trying to pass off as fact - the same reason you condemn OMM.

3. You actually provided me with absolutely nothing.

Get off your persecution complex you are not held to no different standard. And get it straight AMA said chiropractors where DANGEROUS and could lead to harm of multiple patients. They made numerous attacks on the profession.

http://www.chiro.org/Wilk/

Why do you keep tying in DOs with Chiropractors? I don't feel like I'm being persecuted at all. The whole reasons DCs were brought up was because you incorrectly stated that they 'paralyzed multiple people using cranial manipulation.' Again, I pointed out how this was 100% wrong and in character of the absolutely lack of any sound proof you put behind your bold opinions.

Nope I gave multiple studies that should that OMM had little effectiveness. I dismissing OMM based off of numerous empirical studies that have not shown that in is more effective than massage.

I didn't see these ... can you post them? Did you review these before you condemned OMM? Like I said before, all I saw was one study that dismissed inter-practitioner reliability with regard to cranial (a technique I've repeatedly dismissed in this argument) and some arguments with regard to the methods of the NEJM study that found OMM effective (from what I understand).

You are the one trying to throw red herrings out by posting things like "MDs do stuff that is not supported by science" and acting as if that justifies the use of OMM at all.

Again, I'm not doing this at all. You pulled up an 'n=1' example with Udlinger. I countered your 'n=1' example with Andrew Weil to demonstrate how easy it is to make these types of assumptions based off very small sample sizes and by transiently relating things. You've taken it as something else because you're very bad at arguing.

Furthermore, I've advocated NUMEROUS times in this thread for more sound, objective research in OMM.

And for the study I linked 3 cases of iatrogenesis occurred which means that the treatment caused it.

The study I saw that you linked was one where some DOs studied what they believe is a diagnostic cranial sign in people who had already had brain injuries. Did I read the wrong one here or something?

Ok dude show me evidence of cranial bone movement and cranial rhythm.

As I've said again, and again 'dude,' I don't think cranial (as it's currently theorized and taught) is a valid treatment or diagnostic method and I do not defend it or pretend to back it's scientific validity.

And show proof that harm is literally 1 in a million.

Consensus provided during one of those 'non-evidence based' OMM lectures:

'occurrence between 1:1.4 million and 1:3.8 million'

below are the professors sources ... enjoy:

Haldeman, S, Kohlbeck, F, McGregor, M. Unpredictability of
Cerebrovascular Ischemia Associated With Cervical Spine
Manipulation Therapy: A Review of Sixty-Four Cases After Cervical
Spine Manipulation. Spine. 27(1):49-55, January 1, 2002

• A Systematic Review of the Risk Factors for Cervical Artery
Dissection Sidney M. Rubinstein, MSc; Saskia M. Peerdeman,
MD, PhD; Maurits W. van Tulder, PhD; Ingrid Riphagen, MSc;
Scott Haldeman, MD, PhD. Stroke. 2005;36:1575-1580.

Dabbs V, Lauretti WJ.
“A risk assessment of cervical manipulation vs. NSAIDs for the
treatment of neck pain.”
J Manipulative Physiol Ther 1995 Oct;18(8):530-6

Haldeman S, Kohlbeck FJ, McGregor M. Unpredictability of
cerebrovascular ischemia associated with cervical spine manipulation
therapy. SPINE 27:49-55.

• Assendelft WJ, Bouter LM, Knipschild PG. Complications of spinal
manipulation. J of Family Practice (1996) 42:475-480.

• Vick DA, McKay C, Zangerle CR. The safety of manipulative treatment:
review of the literature from 1925 to 1993. JAOA (1996) 96:113-115

• Schmitt HP. Anatomical structure of the cervical spine with reference to
the pathology of manipulation complications. J of Manual Medicine
(1991) 6:93-101.

• Murphy: Current understanding of the relationship between cervical
manipulation and stroke: what does it mean for the chiropractic
profession?. Chiropractic & Osteopathy 2010 18:22

Easton JD, Sherman DG. Cervical manipulation and stroke. STROKE
(1977) 8:594-597.

• Daneshmend TK, Hewer RL, Bradshaw JR. Acute brain stem stroke
during neck manipulation. BMJ (1984) 288:189.

• Krueger BR, Okazaki H. Vertebral-basilar distribution infarction
following chiropractic cervical manipulation. Mayo Clinic Proceedings
(1980) 44:322-332

• Parkin PJ, Wallis WE, Wilson JL. Vertebral artery occlusion following
manipulation of the neck. NZ Med J (1978) 88:441-443.

• Mueller S, Sahs AL. Brain stem dysfunction related to cervical
manipulation. Neurology (1976) 26:547-550

• Magee, David J., Orthopedic Physical Assessment ED 5. Chapter 3.
Elsevier (2008).

• Malanga, G. A., Nadler, S. F., Musculoskeletal Physical Examination:
An Evidence-Based Approach. Chapter 3. Elsevier (2006).

Patjin J. Complications in manual medicine: a review of the literature.
J of Manual Medicine (1991) 6:89-92.

• Dvorak J. Inappropriate indications and contraindications for manual
therapy. J of Manual Medicine (1991) 6:85-88.

• Terrett AGJ. Vascular accidents from cervical spine manipulation:
Report on 107 cases. ACA J of Chiropractic, April 1988 pp 63-72.

• Laughlin TM. Complications of spinal manipulation a literature review
1975-1984. Osteopathic Annals 14:21-23.

• Fritz VU, Maloon A, Tuch P. Neck manipulation causing stroke. South
African Med J (1984) 66:844-846.

• Kerry R et al., Cervical arterial dysfunction and manual therapy: A
critical literature review to inform professional practice, Manual
Therapy (2008), doi:10.1016/j.math.2007.10.006

 

[JaggerPlate]

This one is going to be an interesting one when finally published (don't ask me what's taking so long to analyze the data) too:

http://www.om-pc.com/content/2/1/5

Additionally, it's interesting to read some of the opinions of the DOs and DO/PhDs researching at the UNT-Osteopathic Research Institute. Essentially, they echo many of the same concerns regarding a lack of sound OMM research, a lack of research funding and viable research coming out of DO schools, etc.

 

[Pansit]

Please do so and point out that a higher % of US MDs use alternative medicine.

And this is an argument about OMT and its effectiveness. And 5% of D.Os use OMT on about 50% of their patients which does not mean no other % of D.O uses it. The fact that so many D.Os disregard OMT shows that it has little evidence of being effective.

So what if Chinese MD's use alternative medicine that does not justify its use in of its self and does not justify OMM.

And cranial manipulation is dangerous which is part of the reason why there was such a big fallout against chiropractors there are cases where chiropractors who did cranial manipulation ended up paralyzing patients so yeah it is dangerous.

And Andrew Weil is following what is in his own deranged head. They didn't teach the curative powers of selling black salves at Harvard to cure cancer.

I dont know what you are trying to argue here? My whole point is that the backbone of osteopathic medicine is evidence based medicine, not OMT. Which is why few DO's use it in the first place, and which is why over half my class is going into non-primary care fields (surgery, radiology, anesthesiology), and which is why you are going to get the MAJORITY of DO's to agree with you that it lacks evidence based support. You are going to get MD's who subscribe to alternative treatments and you will have your share of DO's who subscribe to alternative treatments (like the OMT gurus), but the vast majority of us (MD's and DO's) subscribe to Evidence based standard of care. That is it. To argue the validity of OMT is moot because the majority of DO's agree with you. You are arguing with a small minority of physicians.

 

[Bacchus]

oh brother.

 

[motomed]

I know it works because my patients keep coming back and tell me. Should I disagree that they are feeling better and say that what I'm doing doesn't work?🙄

Again, your entire post is purely your opinion and perception.

Anyone see any hard evidence yet in motomed's comments to support his/her argument? Let me know when you find some.

seriously? you still don't understand the notion of burden of proof? I have no desire or reason to try to form a negative argument. the absense of a postive argument is more than enough.

"I know bloodletting works because my patients keep coming back and tell me. Should I disagree that they are feeling better and say that what I'm doing doesn't work?"

there are so many flaws in that justification, it's actually scary that you as a practicing physician would offer it up.... somebody post that correlation/causation cartoon for me....

"It isn't what we don't know that gives us trouble, it's what we know that ain't so." - Will Rogers

and people, the validity of all kinds of other treatments, or how they made their way into medical practice, has NOTHING to do with the validity of OMM.... if you're going to throw this crap out there agian, I want you to try to spell it out for me in a way that actually makes logical sense. (FYI, you won't be able to do it...) this is real simple, there's OMM treatments out there, there's an established notion of acceptable justification for treatments to be considered effective, and it's up to the proponents of those treatments to meet that burden of proof. absent that (especially after 100's of year!!) I'm fully justified in saying that OMM has not been shown to be an effective treatment, and as such I can't support its use.

 

[fozzy40]

seriously? you still don't understand the notion of burden of proof? I have no desire or reason to try to form a negative argument. the absense of a postive argument is more than enough.

"I know bloodletting works because my patients keep coming back and tell me. Should I disagree that they are feeling better and say that what I'm doing doesn't work?"

there are so many flaws in that justification, it's actually scary that you as a practicing physician would offer it up.... somebody post that correlation/causation cartoon for me....

"It isn't what we don't know that gives us trouble, it's what we know that ain't so." - Will Rogers

and people, the validity of all kinds of other treatments, or how they made their way into medical practice, has NOTHING to do with the validity of OMM.... if you're going to throw this crap out there agian, I want you to try to spell it out for me in a way that actually makes logical sense. (FYI, you won't be able to do it...) this is real simple, there's OMM treatments out there, there's an established notion of acceptable justification for treatments to be considered effective, and it's up to the proponents of those treatments to meet that burden of proof. absent that (especially after 100's of year!!) I'm fully justified in saying that OMM has not been shown to be an effective treatment, and as such I can't support its use.

I agree that the burden of proof is on the advocates. The research must continue because I don't like resting on the fact that we know it works in some patients but we can't definitively prove it.

My point is (again) is that patient selection and study design is difficult. I know everyone's going to say that if physical therapy can do it why can't we. Physical therapy is different from OMM whether or not you choose to believe me or not.

When you're an intern and you have a patient with an acute spinal cord injury, tell your attending that you don't want to give IV steroids to decrease inflammation and edema. The literature does not support the use of that as well.

 

[JaggerPlate]

This puppy is derailed ... here's my official vote to not pointlessly bicker any further in this thread (lol).

 

[facetguy]

4. She's probably one of the people who should have been tested for vertebral artery issues before cervical manipulation was attempted. We're trained how to do this (I was at least), but like I said, it's literally 1 in a million.

The safety of cervical spine manipulation is well established, as you note. As far as pre-manipulation screening maneuvers, however, they aren't as predictive as we'd like to think (citations available; too lazy right now).

(And if I didn't know better, Jaggs, I'd say you might finally be coming over to the dark side given your comments about DCs 😉 👍)

 

[motomed]

When you're an intern and you have a patient with an acute spinal cord injury, tell your attending that you don't want to give IV steroids to decrease inflammation and edema. The literature does not support the use of that as well.

I tell ya what, if 100 years from now this situation presents itself, I'll go ahead and suggest that maybe we not bother.... and it will still have nothing to do with OMM...

and I'm done.

 

[Brigade4Radiant]

I dont know what you are trying to argue here? My whole point is that the backbone of osteopathic medicine is evidence based medicine, not OMT. Which is why few DO's use it in the first place, and which is why over half my class is going into non-primary care fields (surgery, radiology, anesthesiology), and which is why you are going to get the MAJORITY of DO's to agree with you that it lacks evidence based support. You are going to get MD's who subscribe to alternative treatments and you will have your share of DO's who subscribe to alternative treatments (like the OMT gurus), but the vast majority of us (MD's and DO's) subscribe to Evidence based standard of care. That is it. To argue the validity of OMT is moot because the majority of DO's agree with you. You are arguing with a small minority of physicians.

Look at the topic the whole thing is not about osteopathic doctor not practicing being evidence based it is about OMM and its claims of being effective. I'm arguing about OMT because a poster thinks OMT is just as scientifically sound as Physical therapy. And other posters who claim that OMT is an effective treatment. I would do the same thing for black salve treatment but the topic is not about that. This isn't a criticism of D.O's you originally posted that my claim about OMT is moot because most D.Os don't practice it. My claims were just about OMT not about osteopaths not being good scientists or clinicians. This is about the use of OMT as an effective treatment so I don't now why people try to bring osteopaths into it especially since most of them agree with me which is why I was wondering why you responded to me calling my point "moot".

So just to make sure I have this straight ... you're evidence that proves physical therapy is backed by solid science consists of some articles comparing running to cycling, talking about massage, and discussing lymphatic issues, and an article about the 'function of the knee' published in 1969? Did you even look at these articles before you hit enter and then copy/paste???

Boy, you sure showed me. Borderline nonsensical.




Man, you really just don't "get it" do you ...

1. Thanks for confirming that your sound, scientific proof consisted of a 3 second google search that you performed just now to prove anecdotes and personal beliefs

2. I've never doubted PT was scientifically proven, my point was that you had absolutely no basis to state this. It was simply an opinion that you'd forged and were trying to pass off as fact - the same reason you condemn OMM.

3. You actually provided me with absolutely nothing.



Why do you keep tying in DOs with Chiropractors? I don't feel like I'm being persecuted at all. The whole reasons DCs were brought up was because you incorrectly stated that they 'paralyzed multiple people using cranial manipulation.' Again, I pointed out how this was 100% wrong and in character of the absolutely lack of any sound proof you put behind your bold opinions.



I didn't see these ... can you post them? Did you review these before you condemned OMM? Like I said before, all I saw was one study that dismissed inter-practitioner reliability with regard to cranial (a technique I've repeatedly dismissed in this argument) and some arguments with regard to the methods of the NEJM study that found OMM effective (from what I understand).



Again, I'm not doing this at all. You pulled up an 'n=1' example with Udlinger. I countered your 'n=1' example with Andrew Weil to demonstrate how easy it is to make these types of assumptions based off very small sample sizes and by transiently relating things. You've taken it as something else because you're very bad at arguing.

Furthermore, I've advocated NUMEROUS times in this thread for more sound, objective research in OMM.



The study I saw that you linked was one where some DOs studied what they believe is a diagnostic cranial sign in people who had already had brain injuries. Did I read the wrong one here or something?



As I've said again, and again 'dude,' I don't think cranial (as it's currently theorized and taught) is a valid treatment or diagnostic method and I do not defend it or pretend to back it's scientific validity.



Consensus provided during one of those 'non-evidence based' OMM lectures:

'occurrence between 1:1.4 million and 1:3.8 million'

below are the professors sources ... enjoy:

Oh boy....

The purpose of posting those studies is that PT uses science and there is a large depth of info out there and age of the article does not matter unless the results are controversial and its methods are unsound. But nice try but your reasoning was very poor. PT uses many sciences and must go under rigorous studies which is why D.Os and M.Ds and PTs have their patients do it. And which is ALSO why patients show consistent benefit. Most D.O's don't think OMT is effective and those that do think it is basically just limited to acute back pain.

Also the studies I posted do not prove anecdotes because it shows strong empirical evidence.

There are tons of sources for PT and its effectiveness. I used the 3 second google option to show you the vast amount of info one can find. And here is the important thing. Most of them show very significant results. Biomedical engineering and what not and use of prosthetic limbs. You might as well argue about Nutrition not being backed by science.

And now you are moving the goal post you are the one who arguing about MD doing stupid things and AMA not saying chiropractors are dangerous and they SAID that chiropractors given in care of adequate medical treatment could lead to outcomes such as paralysis. And now you are making things up saying I am comparing chiropractors to osteopaths. And guess what chiropractors when given to treat things like asthma and stuff ARE dangerous. No one would have a problem with these treatments if they are kept to lower back pain or whatnot but some seriously believe they can prevent stroke which leads patients not getting appropriate care.

Please stay on topic this is about OMT and its uses NOT clinicians. I brought up klingman because he is claiming the use of OMT i.e what this topic is about and its use as treatment for something other than back pain (autism). You just brought a redherring and claimed "But..But M.D's do this too!!!!" So what? this is about OMT and its use which posters like you claim works and is useful all I'm saying is show me the evidence.

At best all those studies say . Cerebrovascular accidents after manipulation appear to be unpredictable and should be considered an inherent, idiosyncratic, and rare complication of this treatment approach.

And for the study I posted they all had brain injury and the cases made it worse.


And about your studies

Show me the specific study where complications are 1:1.4 million and also most of these studies only had participants that ranged from 100-200 patients. In a lot of them it said complications were indeed low but it didn't give patients any long term benefit. Also some of your studies are about Physical therapy for cranial injuries and the study didn't use OMT for it. A lot of the other studies are spinal injury procedures and risks that are used in physical therapy not OMT cranial sacral therapy and techniques used to tune into the cranial sacral rhythm.

And none of these studies had any strong evidence of cranial rhythms existing. And looking at the first study it says cranial manipulation is unpredictable and none of these studies showed no real benefit.

http://chspr.ubc.ca/files/publications/1999/bco99-01J_cranio.pdf

Here is a study showing that there is little evidence that supports cranial scaral therapy.

 

[Bacchus]

This is how OMM usually works: You either use it on patients (and find results) or have it done (and get results). I don't need a study to let me know what is effective due to first hand experience. Not the most sound, but oh well.

 

[facetguy]

This is how OMM usually works: You either use it on patients (and find results) or have it done (and get results). I don't need a study to let me know what is effective due to first hand experience. Not the most sound, but oh well.

Well, to be fair, that argument wouldn't fly if we were talking chiros, so I think the goal for OMT-oriented DOs should be toward more research.

 

[facetguy]

Look at the topic the whole thing is not about osteopathic doctor not practicing being evidence based it is about OMM and its claims of being effective. I'm arguing about OMT because a poster thinks OMT is just as scientifically sound as Physical therapy. And other posters who claim that OMT is an effective treatment.

It can be said with evidence backing that the HVLA component of OMT is as effective, or more effective, than PT for LBP. As I said earlier, "OMT" is too nebulous a term to study easily, since it can be comprised of so many different treatments under the one common OMT umbrella; that's the art of practice. But the HVLA part is solid from an EBM standpoint.

 

[Bacchus]

Well, to be fair, that argument wouldn't fly if we were talking chiros, so I think the goal for OMT-oriented DOs should be toward more research.

True. But does it really bother chiros? There's a rather large client base and I always hear of people going to their chiros before their PCP (often don't have a PCP). It might make me lackadaisical, but I don't care that the research isn't there. Ya know? I'll use it if I deem necessary, but am not going to go out of my way to reincarnate Still.

 

[facetguy]

True. But does it really bother chiros? There's a rather large client base and I always hear of people going to their chiros before their PCP (often don't have a PCP). It might make me lackadaisical, but I don't care that the research isn't there. Ya know? I'll use it if I deem necessary, but am not going to go out of my way to reincarnate Still.

It boils down to two issues. The first is insurance reimbursement. Provided a DC or an OMT-oriented DO is accepting insurance for manual treatments, we will increasingly need "proof" that what we are billing for does indeed have proven effectiveness. If you're all cash, it doesn't matter in that regard. The second is professional pride, if you will. It's nice to be able to provide evidence that what you say works actually has some data behind it. Of course, many of the "experts" on SDN already know it all so it doesn't matter much around here anyway (not referring to you, by the way).

 

[JaggerPlate]

The safety of cervical spine manipulation is well established, as you note. As far as pre-manipulation screening maneuvers, however, they aren't as predictive as we'd like to think (citations available; too lazy right now).

Yeah, in the end, the professor essentially provided some contraindications for cervical manipulation and some 'signs' (which were pretty obvious IMO) to look for as a no no for cervical.

I'll admit that I was hesitant with cervical at first, but I feel totally fine with it now, have had multiple first year DO students perform it on my neck without any issues whatsoever, etc.

(And if I didn't know better, Jaggs, I'd say you might finally be coming over to the dark side given your comments about DCs 😉 👍)

Hahaha, I've always thought DCs had a place in spinal manipulation. My only real arguments have been with that Vanbamm guy who thinks DCs should be primary care physicians.

 

[JaggerPlate]

You've officially crossed over into incoherent. I can barely fathom your lack of comprehension. Thank God you went into medicine and not law.

Oh boy....

The purpose of posting those studies is that PT uses science and there is a large depth of info out there and age of the article does not matter unless the results are controversial and its methods are unsound. But nice try but your reasoning was very poor. PT uses many sciences and must go under rigorous studies which is why D.Os and M.Ds and PTs have their patients do it. And which is ALSO why patients show consistent benefit. Most D.O's don't think OMT is effective and those that do think it is basically just limited to acute back pain.

Also the studies I posted do not prove anecdotes because it shows strong empirical evidence.

There are tons of sources for PT and its effectiveness. I used the 3 second google option to show you the vast amount of info one can find. And here is the important thing. Most of them show very significant results. Biomedical engineering and what not and use of prosthetic limbs. You might as well argue about Nutrition not being backed by science.

And now you are moving the goal post you are the one who arguing about MD doing stupid things and AMA not saying chiropractors are dangerous and they SAID that chiropractors given in care of adequate medical treatment could lead to outcomes such as paralysis. And now you are making things up saying I am comparing chiropractors to osteopaths. And guess what chiropractors when given to treat things like asthma and stuff ARE dangerous. No one would have a problem with these treatments if they are kept to lower back pain or whatnot but some seriously believe they can prevent stroke which leads patients not getting appropriate care.

Please stay on topic this is about OMT and its uses NOT clinicians. I brought up klingman because he is claiming the use of OMT i.e what this topic is about and its use as treatment for something other than back pain (autism). You just brought a redherring and claimed "But..But M.D's do this too!!!!" So what? this is about OMT and its use which posters like you claim works and is useful all I'm saying is show me the evidence.

At best all those studies say . Cerebrovascular accidents after manipulation appear to be unpredictable and should be considered an inherent, idiosyncratic, and rare complication of this treatment approach.

And for the study I posted they all had brain injury and the cases made it worse.


And about your studies

Show me the specific study where complications are 1:1.4 million and also most of these studies only had participants that ranged from 100-200 patients. In a lot of them it said complications were indeed low but it didn't give patients any long term benefit. Also some of your studies are about Physical therapy for cranial injuries and the study didn't use OMT for it. A lot of the other studies are spinal injury procedures and risks that are used in physical therapy not OMT cranial sacral therapy and techniques used to tune into the cranial sacral rhythm.

And none of these studies had any strong evidence of cranial rhythms existing. And looking at the first study it says cranial manipulation is unpredictable and none of these studies showed no real benefit.

http://chspr.ubc.ca/files/publications/1999/bco99-01J_cranio.pdf

Here is a study showing that there is little evidence that supports cranial scaral therapy.

 

[Brigade4Radiant]

You've officially crossed over into incoherent. I can barely fathom your lack of comprehension. Thank God you went into medicine and not law.

So it seems you have reached the end of your weak arguments.

Thank God I did go into medicine, to challenge claims of quacks who talk about the benefits of OMM when it really doesn't do anything except for addressing acute lower back pain. Thank God that I will practice evidence based medicine on my patients and not try to make excuses of "other doctors doing something that is not supported by evidence" so it justifies me billing patients for placebo treatment.

And I'm still waiting for evidence that supports cranial rhythms to exist.

 

[JaggerPlate]

So it seems you have reached the end of your weak arguments.

Thank God I did go into medicine, to challenge claims of quacks who talk about the benefits of OMM when it really doesn't do anything except for addressing acute lower back pain. Thank God that I will practice evidence based medicine on my patients and not try to make excuses of "other doctors doing something that is not supported by evidence" so it justifies me billing patients for placebo treatment.

And I'm still waiting for evidence that supports cranial rhythms to exist.

Lol, yeah ... weak for sure. You couldn't counter a single one of my claims, follow any of my most basic arguments and/or points (you've either ignored them, not understood them, or simply not had the aptitude to counter them) and still insist on flying off the handle into a series of unrelated rants and cheap, ill-fitting sources to justify your 'arguments.'

To top this off, you made a 'plea' with me to 'get back on topic' because you've refuted nothing and grew tired of trying to do so. I'd have no problem continuing this discussion with you if you were capable of understanding and/or offering any sort of valid responses, but since you aren't and have, like I said, crossed into some self-delusional state of complete incoherence, it's nearly impossible.

Just to make a point based off your last (hilarious) bit of verbal diarrhea:

1. You've challenged no one. You forged an opinion based on some pre-conceived notion and then tried to back it up with logical fallacies and back peddling during this discussion (ie finding sources now and pretending like you've reviewed and comprehended them before forging your opinion).

2. It's great to hear you state that OMM treats acute lumber pain after you've repeatedly stated in the thread that its evidence as even an adjunct or complementary therapy doesn't exist. Doesn't this kind of go against your crusader for truth and light mantra?

3. Find me one instance where I've advocated the use of cranial therapy and then I'll argue your claims of palpating some sort of cranial pulse. How many times have I stated that I don't believe in the current model of cranial as a diagnostic or therapeutic treatment? Why would I offer 'proof' to you of something that has failed to convince me with proof?

How many times have I stated this? Do you seriously not read the posts? Or are you, again, falling back onto the fallacy that not supporting one technique somehow validates it all and negates the other 99% of OTM?

And, if you want to play tit-for-tat (which you misunderstood before with the Weil, MD example, so I wouldn't really expect you to grasp it this time), you still have provided any scientific sources that support the current modalities of PT. Instead, you've, again (let me know where you're going to practice so I can never send loved ones near there) misunderstood and taken the fact that PTs and PT entities conduct scientific research on various topics to conclude that the field itself is sound.

This is the same vein as if I tried to justify OTM by stating that an OTM professor at my school published a paper in 'clinical anatomy,' ergo, the principles of OTM are valid and directly related to anatomy because he published scientific research in a related field.

As you can tell, this is not the same thing as a paper that concludes 'OTM works,' just in the same vein that a paper conducted by a PT department that studies the difference in cycling and running doesn't conclude 'PT is valid.'

Furthermore, you've still misunderstood my point the ENTIRE time (I've never once doubted the validity of PT) that both your opinion that OTM and PT are valid was simply an unscientific conclusion you forged based on personal opinion, and because of this, you couldn't provide me ANY papers you've PREVIOUSLY studied about the subject of PT validity.

 

[Brigade4Radiant]

Lol, yeah ... weak for sure. You couldn't counter a single one of my claims, follow any of my most basic arguments and/or points (you've either ignored them, not understood them, or simply not had the aptitude to counter them) and still insist on flying off the handle into a series of unrelated rants and cheap, ill-fitting sources to justify your 'arguments.'

Oh, so my post is now comprehensible to you now is it? I addressed many of your "basic" bs arguments but you side-stepped them because you couldn't refute them. Let me refresh your weak memory with some of the arguments that I gave with evidence: 1)AMA saying chiropractors can't diagnose disease and if chiropractor care was given in favor of evidence based treatment patients could face bad outcomes such as being paralyzed(not that chiropractors paralyzed thousands of people but that didn't stop AMA from using lawsuits against chiropractors to their advantage). 2) My argument that just because an MD is doing a quack treatment doesn't justify the use of OMT as a quack treatment. 3) Burden of proof falls upon you if you are advocating OMT use especially since evidence shows that it isn't effective.

To top this off, you made a 'plea' with me to 'get back on topic' because you've refuted nothing and grew tired of trying to do so. I'd have no problem continuing this discussion with you if you were capable of understanding and/or offering any sort of valid responses, but since you aren't and have, like I said, crossed into some self-delusional state of complete incoherence, it's nearly impossible.

I never made a 'plea' with you to get back on topic. You're just being silly. I said get back on topic because you keep on adding irrelevant topics at hand. The discussion in this thread was about the use of OMT and its effectiveness. In fact you said that there was no point in debating the topic because it had be derailed. I suggested we get it back on topic and you take that as back peddling 🙄. No the self-delusional one is not me, sorry I gave multiple sources to back my claims and you still accuse me of being biased about OMT and not researching it. Even when I made multiple claims that the burden of proof falls on YOU.

Just to make a point based off your last (hilarious) bit of verbal diarrhea:

1. You've challenged no one. You forged an opinion based on some pre-conceived notion and then tried to back it up with logical fallacies and back peddling during this discussion (ie finding sources now and pretending like you've reviewed and comprehended them before forging your opinion).

Jeez you are really bad at this. No, my opinion was well formed by multiple empirical studies and skepticism. Your argument against me is that I have a "bias" about OMT and that I need to research it more to see its benefits...even though I stated that the evidence at best shows OMT to only be effective in some cases for acute lower back pain. And when I find more sources to support my initial claim you accuse me of backing it up with logical fallacies. Even though your support of OMT is based on logical fallacies

2. It's great to hear you state that OMM treats acute lumber pain after you've repeatedly stated in the thread that its evidence as even an adjunct or complementary therapy doesn't exist. Doesn't this kind of go against your crusader for truth and light mantra?

Massage and Icy hot also treats acute lumbar pain buddy. OMT claims that it does a lot of things and the evidence that it treats acute lumbar pain is only in comparison with placebo treatment. Not other well documented treatments for acute lower back pain. Again what about claims that "cranial osteopathy," "craniosacral therapy," "cranial therapy," and similar methods claim that the skull bones can be manipulated to relieve pain (especially of the jaw joint) and remedy many other ailments. That is also a part of OMT and there are other techniques such as muscle Energy technique soft tissue myofascial release, which are lacking on the evidence side.

3. Find me one instance where I've advocated the use of cranial therapy and then I'll argue your claims of palpating some sort of cranial pulse. How many times have I stated that I don't believe in the current model of cranial as a diagnostic or therapeutic treatment? Why would I offer 'proof' to you of something that has failed to convince me with proof?

You don't believe in cranial therapy and yet when I post that there is no evidence to support the claims of cranial therapy, you accuse me of being biased and not really "researching" cranial OMT. Numerous times I have stated that cranial therapy has little evidence and you have stated the below a couple of post back:

"I don't "believe" in cranial (in the sense that it's taught and propagated right now), but I find it ironic that most of the time, the argument that I hear is that it's a farce and doesn't work. I'm having a bit of trouble seeing how if it's something that's fake, literally putting your hands on someone's head, etc, why it's also dangerous?

It is dangerous in the sense that a patient gets treatment from OMT cranial therapy and uses it as a means of primary treatment. Cranial therapy claims that is able to diagnose and treat some symptoms. For this reason and also why homeopathic medicine and other forms of non evidence based medicine can be dangerous. This is a treatment that says that it can do something like diagnose and treat so if a practitioner performs it and somehow believes in the results and does not refer the patient or actually do something to address the problem then it is dangerous.

How many times have I stated this? Do you seriously not read the posts? Or are you, again, falling back onto the fallacy that not supporting one technique somehow validates it all and negates the other 99% of OTM?

You mean the techinque that is basically massage for the lower back or other claims that OMT can cure asthma and help women in pregnancy. Lets look at the AOA website. http://www.osteopathic.org/osteopat...ry/womens-health/Pages/omt-and-pregnancy.aspx Here is one excerpt:

"And, recent findings show that infants and toddlers who suffer from repeat ear infections can find relief from OMT. The treatment requires the physician to put their fingers on the bony prominence behind the ear and applying a gentle rocking motion. This enables fluid to flow more freely through the ear. "

"Dr. Tettambel, states that OMT can benefit women during pregnancy by helping their bodies adjust to a growing uterus and displaced organs. OMT also can be used to help pregnant women with their posture by adjusting the body mechanics to work more efficiently. "

But it can also help patients with a number of other health problems such as:

* asthma
* sinus disorders
* carpal tunnel syndrome
* migraines
* menstrual pain

When appropriate, OMT can complement, and even replace, drugs or surgery. In this way, OMT brings an important dimension to standard medical care.

http://www.osteopathic.org/osteopathic-health/treatment/Pages/default.aspx

All I'm saying that there is very little evidence to these claims, and you keep on arguing with me by claiming that 1) I make incoherent weak arguments at criticizing OMT 2) I'm biased and that my claims about PT AND OMT are unscientific. 3) You accuse me for criticizing cranial and following a logical fallacy that dismisses most of OMT. But look at all the claims OMT claims to diagnose and treat. I focused on cranial to be consistent. I also made the claim that it is your duty to defend cranial. Now defend the above claims and justify billing for them (see below link).

http://www.osteopathic.org/inside-a...e-management-notes/Pages/billing-for-omt.aspx

And, if you want to play tit-for-tat (which you misunderstood before with the Weil, MD example, so I wouldn't really expect you to grasp it this time), you still have provided any scientific sources that support the current modalities of PT. Instead, you've, again (let me know where you're going to practice so I can never send loved ones near there) misunderstood and taken the fact that PTs and PT entities conduct scientific research on various topics to conclude that the field itself is sound.

Of course you would never send your loved ones to me, you don't like evidence based medicine. You would prefer if they go to the chiropractor for heart disease or something . Again you go with the PT=OMM while some Physical therapists practice some dubious things, they are not taught about cranial rhythms and what not.

As for evidence of PT is sound and used:
http://www.ncbi.nlm.nih.gov/pubmed/10651597
http://www.aafp.org/afp/2007/1201/p1661.html
http://www.medicalnewstoday.com/articles/98345.php
http://physther.net/content/86/5/710.short
http://cre.sagepub.com/content/18/8/833.short
http://www.nejm.org/doi/pdf/10.1056/NEJM198803313181302

The early studies that I posted on PT show that it also draws from other sciences and that there is a wealth of info about it.

Go ahead and find scientific articles that find the conclusions made to be controversial.

This is the same vein as if I tried to justify OTM by stating that an OTM professor at my school published a paper in 'clinical anatomy,' ergo, the principles of OTM are valid and directly related to anatomy because he published scientific research in a related field.

As you can tell, this is not the same thing as a paper that concludes 'OTM works,' just in the same vein that a paper conducted by a PT department that studies the difference in cycling and running doesn't conclude 'PT is valid.'

First this is a thread about OMT and not PT, but it seems that you have to jump all over the place to argue about OMT. The point of that paper was that PT does a wide amount of studies it is a very large field that has had studies going on for years. It would take me days to post all the studies that show PT effectiveness.

Furthermore, you've still misunderstood my point the ENTIRE time (I've never once doubted the validity of PT) that both your opinion that OTM and PT are valid was simply an unscientific conclusion you forged based on personal opinion, and because of this, you couldn't provide me ANY papers you've PREVIOUSLY studied about the subject of PT validity.

So you never doubted the validity of PT yet, unless I post the many academic articles I read about PT I'm forming opinions of the field based on unscientific conclusions? You missed my point and keep on reaching PT relies on many sciences and the field of engineering and do other studies i.e cycling vs walking which shows that they are getting many results. Yet your argument is that I need to validate the the entire field based on scientific articles? Can you do that on nutrition or psychiatry?

I never said OMT was valid outside of acute lower back pain. And now you are making jumps that I based my "opinion" that PT is effective based on "unscientific" conclusions based on personal opinion. Based on what? Because I did a 3 second search on PT on google? Don't kid yourself there is a ton of evidence and multiple reviewed papers. I have friends who are in graduate programs for exercise science and I have looked at papers of their research.

And you are making a big logical fallacy in stating that I have not PREVIOUSLY studied about PT because I did a 3 second google search. As I said in my earlier responses, you might as well argue about the validity of nutrition being unscientific because a quick google search didn't satisfy you. And you are trying to link that because of that my "opinion" of OMT is wrong 🙄. And I'll say it again this is a topic about OMT and its effectiveness not PT.

If you don't like the vast amount of empirical evidence that shows that PT is helpful in some cases for rehabilitation then go on then...I have no desire to educate you on many fields of science on SDN, sorry.

Follow what you posted earlier about complaining about this thread being off-topic and get back on topic. Instead of jumping around and moving the goal post.

Now to follow is your response that I'm incoherent and can not argue a single one of your claims...Man you are like a debating genius🙄.

 

[JaggerPlate]

Note to the world ...

I have typed out not one, but two large replies to BR above and deleted both of them accidentally by hitting a singular button on my mobile device. Aside from it making me so angry I want to chuck this god damn thing across the room, it's made me view this as Devine intervention and a sign to stop the pointless bickering.

BR ...

While I think at this point you're arguing just to argue (and you're still making hilarious logical fallacies, not understanding things, trying to tie in inane points, extrapolating to prove a point, etc), I still will answer your questions as they relate to OMM. Keep in mind that i don't want to discuss cranial, but if you want to clearly state your arguments and questions ... I'll do my best to address them. However, I'm not going to bother trying to debate things like the chiropractor war or misinterpreting cranial "studies" with you any further. Keep in my that this doesn't mean your views on these issues or how youve tried to debate them aren't weak and indicative of someone clearly lacking in this skill, but state your related points and I'll address them.

 

[JaggerPlate]

Br,

Also, why do you keep editing and adding to your replies after you've posted them? It makes it even harder to follow.

 

[Brigade4Radiant]

Note to the world ...

I have typed out not one, but two large replies to BR above and deleted both of them accidentally by hitting a singular button on my mobile device. Aside from it making me so angry I want to chuck this god damn thing across the room, it's made me view this as Devine intervention and a sign to stop the pointless bickering.

BR ...

While I think at this point you're arguing just to argue (and you're still making hilarious logical fallacies, not understanding things, trying to tie in inane points, extrapolating to prove a point, etc), I still will answer your questions as they relate to OMM. Keep in mind that i don't want to discuss cranial, but if you want to clearly state your arguments and questions ... I'll do my best to address them. However, I'm not going to bother trying to debate things like the chiropractor war or misinterpreting cranial "studies" with you any further. Keep in my that this doesn't mean your views on these issues or how youve tried to debate them aren't weak and indicative of someone clearly lacking in this skill, but state your related points and I'll address them.

Here you go again with the weak "argument" excuse 🙄

Here is something I do not Understand:

Who Can Benefit From OMT?

OMT can help people of all ages and backgrounds. The treatment can be used to ease pain, promote healing and increase overall mobility. OMT is often used to treat muscle pain. But it can also help patients with a number of other health problems such as:

*asthma
*sinus disorders
*carpal tunnel syndrome
*migraines
*menstrual pain

When appropriate, OMT can complement, and even replace, drugs or surgery. In this way, OMT brings an important dimension to standard medical care.

http://www.osteopathic.org/osteopathic-health/treatment/Pages/default.aspx


Go ahead and explain as well as justifying billing patients for these procedures.


Also you are making claims that my arguments are weak and follow logical fallacies. Back it up then if they are so weak it should be easy to counter no?

And I guess I am misunderstanding cranial studies. Show me papers where OMT cranial therapy is effective.

And lets get something straight, YOU came into this thread to just argue. You argued with my post saying OMT has little supportive evidence and then you tried to get me to argue the effectiveness of PT (derailing topic). You also brought up clinicians doing non-evidenced based care in a means to justify OMT (which I showed is does not justify the claims OMT makes). You act as these points you made are strong arguments.

You then claimed that my understanding of PT and OMT was unscientific and biased (logical fallacy of yours when I posted non controversial papers of PT and the depth of research that PT does i.e walking vs cycling). I am asking for evidence why OMT is an effective treatment and if the claims it makes are justified.

Then instead of debating anything you resort to "Your arguments are weak" when I sourced my arguments and gave strong examples of why you arguments are faulty.

 

[JaggerPlate]

Br,

Keeping in mind that I'm still using the mobile device ...

You're clearly frustrated and this is inhibiting your ability to follow my simple requests. You continue harking on issues I stated are unrelated to the topic at hand and instead of asking logical points to address, you've pulled up one blurb from a cranial practitioners website (a topic I said I wouldn't address and a point - discussing individual clinicians - you said is unrelated) and continued trying to convince me that you aren't really bad at debate. I'd try to figure this out further, but a quick post history told me all I need to know about that 🙄 . At this point, it's pointless to discuss with you any further, but if you'd like to continue repeating yourself illogically ... Knock yourself out. However, I'm going to focus my attention replying to the adults.

 

[fozzy40]

Anybody brought this one up yet:

http://www.ajog.org/article/S0002-9378(09)00843-6/abstract

Great study! This is actually a pretty well designed study if anyone is interested. Thanks for the suggestion.

Here is another one I like:
Hollis H King et al., “Osteopathic manipulative treatment in prenatal care: a retrospective case control design study,” The Journal of the American Osteopathic Association 103, no. 12 (December 2003): 577-582.
d:

 

[Brigade4Radiant]

Br,

Keeping in mind that I'm still using the mobile device ...

You're clearly frustrated and this is inhibiting your ability to follow my simple requests. You continue harking on issues I stated are unrelated to the topic at hand and instead of asking logical points to address, you've pulled up one blurb from a cranial practitioners website (a topic I said I wouldn't address and a point - discussing individual clinicians - you said is unrelated) and continued trying to convince me that you aren't really bad at debate. I'd try to figure this out further, but a quick post history told me all I need to know about that 🙄 . At this point, it's pointless to discuss with you any further, but if you'd like to continue repeating yourself illogically ... Knock yourself out. However, I'm going to focus my attention replying to the adults.

and you claim that I'm bad at this. The blurb that you claim I posted is not from "some" cranial practitioners website it is the official AOA webpage.

http://www.osteopathic.org/osteopathic-health/treatment/Pages/default.aspx

I'm the one who said, "lets stay on topic". The other points where just to address arguments you had with mine about the topics you initially brought up. I posted them since you thought I was making a 'plea' with you to go back to OMT because I couldn't "debate" with you.

I'm debating your simply requests, you came in here claiming I was biased against OMT. And now you are not directly addressing my arguments (b/c you can't without massive sidetracking and back peddling) and you claim again and again that I'm making logical fallacies and give the excuse that you deleted your response to me (why are you replying with a mobile device? This thread requires no urgency what so ever) 🙄.

From the beginning the "debate" (I use this term very loosely) has been all over the place because you claimed that I was biased against OMT. Because of your desire to "win" the debate.

The only reason why I carried it this far with you is that I was hoping you could post some evidence about other things OMT claims it can do.

But if you don't want to respond to any of my claims and arguments from now on then go ahead and do so, it's no skin off my back.

 

[facetguy]

...3) Burden of proof falls upon you if you are advocating OMT use especially since evidence shows that it isn't effective.

...about OMT and that I need to research it more to see its benefits...even though I stated that the evidence at best shows OMT to only be effective in some cases for acute lower back pain.

Massage and Icy hot also treats acute lumbar pain buddy. OMT claims that it does a lot of things and the evidence that it treats acute lumbar pain is only in comparison with placebo treatment. Not other well documented treatments for acute lower back pain.

...I never said OMT was valid outside of acute lower back pain.

Just for clarification, when we say "OMT" are we referring to any specific component of OMT, all possible components together, only literature with "OMT" in the title or authored solely by DOs? I ask because, as I stated earlier, the spinal manipulation component (particularly HVLA) is very well researched for especially neck and low back pain applications, both acute and chronic. And spinal manipulation has been compared to other, as you say, well documented treatments for acute low back pain (as well as acute and chronic neck pain and chronic LBP).

So, when you assert that OMT is only effective for acute LBP and isn't as effective as other forms of treatment for LBP, you are incorrect if we are including the spinal manipulation component of OMT.

Can you clarify for me?

 

[cyclohexanol]

I'm just going to leave this here...


[YOUTUBE]http://www.youtube.com/watch?v=5hfYJsQAhl0[/YOUTUBE]

 

[fozzy40]

I am not trying to convince you one way or the other. My point is simply that the burden of proof for the efficacy of OMM is on the people who advocate that it is highly effective at treating the most simple of problems (musculoskeletal pain) to the claims that require even larger leaps of faith (the lymph pump).

I've already commented on the most reputable OMM study (the Andersson study in the NEJM) and had no problem in interpreting the designs and data. In fact, I pointed out major design flaws in the study (evaluation by a DO for ability to be treated - this study predates the methodology of the PT study you provided) as well as many other problems with it that are present in the responses. All that aside, Andersson's findings were modest.

The article you provided me with initially, I have no problem with at all. I understand the methodology. It also had nothing to do with OMM and was not carried out by osteopaths.

On a separate thread, I looked at the study for using the lymph pump for reducing hospital stays and noted that, with the exception of two outcomes, the p values were less than impressive. One p value was .94.

I haven't read your current article, but I will eventually. At any rate, I am perfectly capable of reading a peer reviewed article and thinking critically about it and analyzing the biostatistics.

I think you also misinterpret my thoughts on OMM. I am not rooting against it. If OMM (as opposed to narcotics) were highly successful for treating musculoskeletal pain and we could stop handing out narcotics like candy, I'd be it's biggest fan. I do think OMM has legitimate use and is helpful, I just think it's value is overstated. To date, I've seen little evidence outside of anecdotes that would argue against that.

What I often seen is a sort of "bunker mentality" when it comes to this issue. (i.e. "You don't understand the osteopathic philosophy" With all due respect, that is just bunk. All physicians treat the "whole body" and if you are suggesting that only people with the D.O. degree are capable of understanding or implementing OMM, then it becomes really ludicrous).

With respect to the last paragraph: that's also not a terribly persuasive arrangement. As I said before, as someone who strongly believes in this, you should be interested in trying to "sell it" and not simply dismiss anyone that has legitimate issues with the claims behind it's efficacy. The vast majority of physicians who aren't trained in OMM know little about it. If you are going to automatically marginalize their questions on the matter on that basis alone, OMM will continue to be something that is a rarity in medicine these days.

And I respect that. However, that is alone is not going to quash inquisitive minds on this matter.

Maybe I've not cited it on this particular thread, but this is the study I have looked at the most on this matter (mostly because it appears in the NEJM, which can be viewed as relatively unbiased on this matter).

http://www.nejm.org/doi/full/10.1056/NEJM199911043411903

The responses to the article do a better job of pointing out the flaws than I could:
http://www.nejm.org/doi/full/10.1056/NEJM200003163421112

The response sums up the basic debate on the matter:
http://www.nejm.org/doi/full/10.1056/NEJM199911043411910
(Though I admit there is some snarkyness in there that I don't personally agree with and felt served the article poorly).

I am not trying to be disrespectful to you and I have nothing but respect for any physician who is competent, regardless of degree source. I just have problems with the wide ranging claims about the efficacy of OMM when they haven't been well supported by clinical research. That is my only point.

Thanks again for pointing out this study to me.

As you said, the study design was actually pretty good for 1999. It's a great finding that the OMT group had decreased medication use when compared to usual treatment. It does show that it's a nice tool that can have effect on pain control. I posted another good study you should check out at the end of the this thread.

 

[Brigade4Radiant]

Just for clarification, when we say "OMT" are we referring to any specific component of OMT, all possible components together, only literature with "OMT" in the title or authored solely by DOs? I ask because, as I stated earlier, the spinal manipulation component (particularly HVLA) is very well researched for especially neck and low back pain applications, both acute and chronic. And spinal manipulation has been compared to other, as you say, well documented treatments for acute low back pain (as well as acute and chronic neck pain and chronic LBP).

So, when you assert that OMT is only effective for acute LBP and isn't as effective as other forms of treatment for LBP, you are incorrect if we are including the spinal manipulation component of OMT.

Can you clarify for me?

All possible components of OMT including those that claim it can treat asthma.

And for the neck pain and spinal manipulation it is still controversial.

http://onlinelibrary.wiley.com/doi/10.1111/j.1742-1241.2010.02352.x/abstract

Keep in mind that this is a systematic review and looks at all studies published that are relevant to the topic in question.

 

[JaggerPlate]

Just curious ...

-26 deaths out of an estimated number of how many treatments?

-Were these patients screened for vertebral artery dissection before the cervical manipulation was performed?

-Does this study only look at cervical manipulation from DCs or does it take into account DOs as well?

-Are there any studies that examine these rates based solely off osteopathic cervical manipulation (as I'm sure you're aware of the differences between the mechanisms performed by DCs and DOs) performed by DOs? If so, what did these say?

-Why are you extrapolating that thoracic and lumbar manipulation is 'unsafe' as well based upon a study that looked at deaths associated with cervical spine manipulation?

 

[JaggerPlate]

Just to play devil's advocate here with the c-spine manipulation:

http://www.ncbi.nlm.nih.gov/pubmed/17906581

METHODS: We studied treatment outcomes obtained from 19,722 patients. Manipulation was defined as the application of a high-velocity/low-amplitude or mechanically assisted thrust to the cervical spine. Serious adverse events, defined as "referred to hospital A&E and/or severe onset/worsening of symptoms immediately after treatment and/or resulted in persistent or significant disability/incapacity," and minor adverse events reported by patients as a worsening of presenting symptoms or onset of new symptoms, were recorded immediately, and up to 7 days, after treatment.

RESULTS: Data were obtained from 28,807 treatment consultations and 50,276 cervical spine manipulations. There were no reports of serious adverse events. This translates to an estimated risk of a serious adverse event of, at worse approximately 1 per 10,000 treatment consultations immediately after cervical spine manipulation, approximately 2 per 10,000 treatment consultations up to 7 days after treatment and approximately 6 per 100,000 cervical spine manipulations. Minor side effects with a possible neurologic involvement were more common. The highest risk immediately after treatment was fainting/dizziness/light-headedness in, at worse approximately 16 per 1000 treatment consultations. Up to 7 days after treatment, these risks were headache in, at worse approximately 4 per 100, numbness/tingling in upper limbs in, at worse approximately 15 per 1000 and fainting/dizziness/light-headedness in, at worse approximately 13 per 1000 treatment consultations.

CONCLUSION: Although minor side effects following cervical spine manipulation were relatively common, the risk of a serious adverse event, immediately or up to 7 days after treatment, was low to very low.

 

[facetguy]

All possible components of OMT including those that claim it can treat asthma.

And for the neck pain and spinal manipulation it is still controversial.

http://onlinelibrary.wiley.com/doi/10.1111/j.1742-1241.2010.02352.x/abstract

Keep in mind that this is a systematic review and looks at all studies published that are relevant to the topic in question.

Ah, yes, Dr. Ernst. He's a big fan of chiropractic...not! You have to take his anti-chiro publications with a grain of salt given his bias. And he's been known to cherry-pick, and was accused of such by a co-author no less! But anyway, the manipulation-related stroke issue is by far the most controversial issue relating to chiropractors, so you've chosen a good one. If we take him at his word, Ernst says he finds 26 cases of death relating to chiropractors...ever...in history. Of course, one death is too many. But 26 ever? That's not all that incriminating. But besides that, there is a more important aspect to all of this. The largest study of manipulation-related stroke yet, published in Spine in 2008, has changed the way we think about the causal relationship between manipulation and stroke (namely vertebral artery dissection). In brief, that particular study examined the risk of having seen either a chiro or an MD around the time of the stroke, and they came to the conclusion that a patient was just as likely (a bit more likely, in fact) to have seen an MD in the time leading up to their stroke than they were to have seen a DC. No researchers had ever done a study like that before. All we had before this was patient sees chiro and at some point later has a stroke, therefore the chiro treatment caused the stroke. And even that evidence was thin because these strokes happen so rarely they are very difficult to study. But now the thought is this: a patient's vertebral artery begins to dissect PRIOR to presenting for evaluation/treatment, creating neck pain and/or headache. (Remember, there are lots of documented stroke cases induced by laying ones head back in a hairdresser's sink, stargazing, turning one's head while driving, or even spontaneous dissection; so this does happen.) They may go to their MD at that point, or they may go to their DC. The end result doesn't matter, as the incidence of stroke is the same regardless of provider chosen. I will concede that the dissection could possibly be made worse if that patient is then manipulated, but we don't know that for sure. The focus now is shifting more toward recognizing these patients when they do present in this condition.

Interestingly, a number of years ago, one researcher (A. Terrett) went back and checked the details of stroke cases that had been attributed to chiropractic manipulation in the literature. And he found that many of them had nothing at all to do with a chiropractor, but chiropractic was blamed nonetheless. So perhaps there's more over-reporting than under-reporting in the literature.

OK, that went on too long. So I'll just say that the literature for spinal manipulation's benefit in neck and especially low back pain cases is much more straightforward and isn't really debatable anymore. Whether that applies to OMT depends I guess on how you define OMT.

 

[Pansit]

All possible components of OMT including those that claim it can treat asthma.

And for the neck pain and spinal manipulation it is still controversial.

http://onlinelibrary.wiley.com/doi/10.1111/j.1742-1241.2010.02352.x/abstract

Keep in mind that this is a systematic review and looks at all studies published that are relevant to the topic in question.

I dont think you understand what "OMT" is. It is a vast array of manual techniques many of which are also used by Physical therapists, and many of which are used my sports medicine/ orthopedic doctors. Saying "OMT" is akin to like saying "drugs". There are many different types, some of which are controversal (Cranial..etc) some of which are entrenched in the medical community, some of which are researched, some of which are not. You need to clarify yourself.

 

[facetguy]

Just curious ...

-Are there any studies that examine these rates based solely off osteopathic cervical manipulation (as I'm sure you're aware of the differences between the mechanisms performed by DCs and DOs) performed by DOs? If so, what did these say?

HVLA is HVLA, whether it's a DC, a DO, or whoever. There's an argument for expertise, of course, but it's apples to apples technique-wise. And we shouldn't forget that just as OMT is a whole basket of possible techniques, 'chiropractic care' is similarly a whole variety of possible techniques, only one of which is HVLA (which happens to be the most heavily studied). The differences aren't as different as you may be thinking.

 

[JaggerPlate]

HVLA is HVLA, whether it's a DC, a DO, or whoever. There's an argument for expertise, of course, but it's apples to apples technique-wise. And we shouldn't forget that just as OMT is a whole basket of possible techniques, 'chiropractic care' is similarly a whole variety of possible techniques, only one of which is HVLA (which happens to be the most heavily studied). The differences aren't as different as you may be thinking.

The only reason I brought it up is because I've talked to a DC -> DO student in my class pretty regularly throughout OMM this year, and he's pointed out some differences along the way.

Altogether, I agree with you, but I was curious as to whether or not there was a study that looked at DOs performing cervical HVLA as they are taught and the outcomes from this (though I couldn't really find one).

 

[facetguy]

The only reason I brought it up is because I've talked to a DC -> DO student in my class pretty regularly throughout OMM this year, and he's pointed out some differences along the way.

Altogether, I agree with you, but I was curious as to whether or not there was a study that looked at DOs performing cervical HVLA as they are taught and the outcomes from this (though I couldn't really find one).

Yeah, I think those would be harder to find. Which is what got me thinking about the OMT literature in general. There's clearly not a whole lot out there on OMT specifically, but lots regarding spinal manip. So I wondered why I don't see DOs mentioning that spinal manip literature more. Not a big deal, just curious. (And hang out with that DC/DO guy as much as possible; he's likely a good influence🙂)

 

[JaggerPlate]

Yeah, I think those would be harder to find. Which is what got me thinking about the OMT literature in general. There's clearly not a whole lot out there on OMT specifically, but lots regarding spinal manip. So I wondered why I don't see DOs mentioning that spinal manip literature more. Not a big deal, just curious. (And hang out with that DC/DO guy as much as possible; he's likely a good influence🙂)

Hahah, well, he definitely doesn't have the nicest things to say about Chiro in general, but I do agree with you that a lot of the good evidence for HVLA in the thoracic and lumbar (from DC research) with regard to pain supports OMT as well.

In fact, I shared a bunch of vertebral artery dissection references with Brigade earlier that my OMM professor gave to us a while back, and some of them were from DC sources.

I think one of the problems with sharing too many sources though is that while the HVLA techniques, as you noted, are very similar, not too many others seem to be (with regard to the MSK stuff at least, like I've said before, I'm not a 'cranial omm cures AIDS' kind of DO student).

 

[Bacchus]

Just don't extend the neck and all will be fine.

 

[facetguy]

Hahah, well, he definitely doesn't have the nicest things to say about Chiro in general, but I do agree with you that a lot of the good evidence for HVLA in the thoracic and lumbar (from DC research) with regard to pain supports OMT as well.

In fact, I shared a bunch of vertebral artery dissection references with Brigade earlier that my OMM professor gave to us a while back, and some of them were from DC sources.

I think one of the problems with sharing too many sources though is that while the HVLA techniques, as you noted, are very similar, not too many others seem to be (with regard to the MSK stuff at least, like I've said before, I'm not a 'cranial omm cures AIDS' kind of DO student).

I recognized a few of those. The Murphy article is a nice review of the topic and is worth reading.

And can you prove that cranial DOESN'T cure AIDS??😛

And if you've got room in your PM inbox I'll tell you about my DC-to-DO pursuit.

 

[JaggerPlate]

And can you prove that cranial DOESN'T cure AIDS??😛

Hahah, very true.

PM away!

 

[Brigade4Radiant]

I dont think you understand what "OMT" is. It is a vast array of manual techniques many of which are also used by Physical therapists, and many of which are used my sports medicine/ orthopedic doctors. Saying "OMT" is akin to like saying "drugs". There are many different types, some of which are controversal (Cranial..etc) some of which are entrenched in the medical community, some of which are researched, some of which are not. You need to clarify yourself.

The "vast" array of OMT techniques claims that it can do many things not just one. I want people to show research for all the findings it states it can do. Sure some aspects of a technique may do one thing but I stated that I am curious about the claims that it can treat asthma and such. Your comparison to drugs would be correct if I was just including "treatment" which can include massage and many techniques, but OMT is a specific set of techniques. Even then, drugs that are consumed by patients must have strong evidence of having all the effects that it states.

So if you want me to be more specific, then other OMT techniques other than HVLA, if that will help you.


http://www.osteopathic.org/osteopathic-health/treatment/Pages/default.aspx

 

[JaggerPlate]

The "vast" array of OMT techniques claims that it can do many things not just one. I want people to show research for all the findings it states it can do. Sure some aspects of a technique may do one thing but I stated that I am curious about the claims that it can treat asthma and such. Your comparison to drugs would be correct if I was just including "treatment" which can include massage and many techniques, but OMT is a specific set of techniques. Even then, drugs that are consumed by patients must have strong evidence of having all the effects that it states.

So if you want me to be more specific, then other OMT techniques other than HVLA, if that will help you.


http://www.osteopathic.org/osteopathic-health/treatment/Pages/default.aspx

A few points (as it seems like things are more civil now):

1. To make a very long story short, the AOA is very, very closely affiliated with the American Cranial Academy (or whatever it's called), so it doesn't surprise me that they would advertise some of these views on their website.

Frankly, I tried to do a pubmed search for even a JAOA article related to OMT and asthma, but didn't get any useful results. Although we haven't studied it yet, I know there are certain 'rib raising techniques' that probably related to this 'asthma treatment,' but, as you've seen and I've learned with OMT, you should be skeptical until you've researched the issue and determined its validity (ironically enough, an OMM professor told us this one of the first days of lab).

Now, I'm not even sure if this is what they're referring to, as I can't find much, except for one trial via the JAOA (that I don't have time to analyze at the moment):

http://www.jaoa.org/cgi/content/full/105/1/7

2. As far as your other comments are concerned, just to clarify, are you stating that because there are certain aspects of OMM that aren't as conclusive as they should be, that even the more rational, research backed methods should be dropped as well? Do you feel like things like HVLA for thoracic/lumbar is legitimate (after today's discussion, Facet's involvement, etc) and therefore that alone should be practiced with regard to OMT?? Or is it all just not researched/evidence based enough, ergo patients shouldn't be subjected to it and/or billed for it??

 

[fozzy40]

Here's one for AOM:
http://www.ncbi.nlm.nih.gov/pubmed/12963590

 

[JaggerPlate]

Here's one for AOM:
http://www.ncbi.nlm.nih.gov/pubmed/12963590

Interesting. I was actually a bit skeptical toward OMM treatment of AOM (just based on what I've learned about AOM thus far). Do you know which manipulations are used to treat it?

 

[fozzy40]

Interesting. I was actually a bit skeptical toward OMM treatment of AOM (just based on what I've learned about AOM thus far). Do you know which manipulations are used to treat it?

15-25 minute sessions
myofascial release
balanced membranous and ligamentous tension
facilitated positional release
counterstrain
NO HVLA

 

[facetguy]

15-25 minute sessions
myofascial release
balanced membranous and ligamentous tension
facilitated positional release
counterstrain
NO HVLA

Galbreath technique?

 

[fozzy40]

Galbreath technique?

It was not one of the listed techniques but could have been done indirectly.

 

[redsquareblack]

The safety of cervical spine manipulation is well established, as you note.

Ima just call this one out as the BS it is. In terms of incidence, yes, complications are rare. The severity of those complications, however, is another matter. Carotid and vertebral artery dissections, strokes, etc., rare though they may be, don't really sound like particularly attractive potential effects of a so-called "treatment" that accomplishes NOTHING.

 

[facetguy]

Ima just call this one out as the BS it is. In terms of incidence, yes, complications are rare. The severity of those complications, however, is another matter. Carotid and vertebral artery dissections, strokes, etc., rare though they may be, don't really sound like particularly attractive potential effects of a so-called "treatment" that accomplishes NOTHING.

I'll simply respond with a quote from neurologist/researcher Scott Haldeman, MD, DC, PhD and researcher Martin Underwood, MD (author of the UK BEAM Trial, not that you know what that is Reds...):

"Chiropractors are extremely fortunate in these times of evidence based health care. There was a time, not long ago, when there was little or no evidence to support the practice of manipulation that is the mainstay of chiropractic practice. There were also widely advertised claims that manipulation could have very serious complications and therefore should not be offered patients in the absence of evidence. There has, however, been a rapid growth in the number of clinical trials that have studied the effectiveness of manipulation, mobilization and massage over the past 20 years and, as this document demonstrates, there is now little dispute amongst knowledgeable scientists that manipulation is of value in the management of back pain, neck pain and headaches that make up 90% or more of all patients who seek chiropractic care. At the same time, a close review of the evidence, including the recent large population studies in Ontario [2], have demonstrated that the incidence of serious side effects such as stroke following chiropractic care is extremely rare and is probably not related to manipulation in most patients but due to the fact that patients develop neck pain or headache as a result of a dissection of a vertebral artery that progresses through the natural history of dissection to stroke irrespective of the clinician the patient consults."

This quote came from this: http://chiromt.com/content/18/1/4

Time to update, Reds. (And did they just call you an unknowledgeable scientist??)🙂