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[fozzy40]

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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.

Another "quality" post packed with evidence!

 

[redsquareblack]

Another "quality" post packed with evidence!

Funny thing is, the world is still waiting for evidence of the so-called "subluxations" that chiropractic is supposed to be treating in the first place.

 

[fozzy40]

Funny thing is, the world is still waiting for evidence of the so-called "subluxations" that chiropractic is supposed to be treating in the first place.

"Subluxations" is really semantics. There is a variety of terms like this that manual medicine practitioners (DOs, chiropractors, physical therapists) to describe segmental physical findings. Mal-aligned, dysfunctional segments, take your pick.

The "world" is full of literature as demonstrated on this thread. Let me know if you have any questions about the references I cited in this thread or help interpreting some of the studies.

 

[redsquareblack]

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...):

The BEAM trial? What a crock. A sober analysis of the BEAM trial does not support the efficacy of manipulation to produce clinically meaningful results in back pain. Sorry, it just doesn't.

"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??)🙂

Given the relatively lax standard of science among chiros, I couldn't care less what a chiro (with or without an MD) calls me.

 

[facetguy]

The BEAM trial? What a crock. A sober analysis of the BEAM trial does not support the efficacy of manipulation to produce clinically meaningful results in back pain. Sorry, it just doesn't.

Directly from BMJ, in which the study was published:


BMJ 329 doi: 10.1136/bmj.329.7479.0-c (Published 9 December 2004)

• This Week In the BMJ

Spinal manipulation gives value for money

Most patients with acute back pain improve over time, but adding spinal manipulation followed by exercise to standard care moderately improves results. The UK BEAM trial team (p 1377) randomised 1334 patients with low back pain to additional exercise classes, spinal manipulation, or manipulation followed by exercise or to “best care” in general practice. Manipulation, with or without exercise, improved symptoms more than best care alone after three and 12 months. However, analysis of the cost utility of different strategies shows that manipulation alone probably gives better value for money than manipulation followed by exercise (p 1381).



That doesn't sound all that bad to me. Besides, it's but one study of many that supports my position.

Given the relatively lax standard of science among chiros, I couldn't care less what a chiro (with or without an MD) calls me.

Is it really that difficult to accept the fact that spinal manipulation is supported by some good evidence these days? Why does that bother you? You should be happy for your future patients that they have another therapeutic option.

 

[redsquareblack]

Directly from BMJ, in which the study was published:


BMJ 329 doi: 10.1136/bmj.329.7479.0-c (Published 9 December 2004)

• This Week In the BMJ

Spinal manipulation gives value for money

Most patients with acute back pain improve over time, but adding spinal manipulation followed by exercise to standard care moderately improves results. The UK BEAM trial team (p 1377) randomised 1334 patients with low back pain to additional exercise classes, spinal manipulation, or manipulation followed by exercise or to “best care” in general practice. Manipulation, with or without exercise, improved symptoms more than best care alone after three and 12 months. However, analysis of the cost utility of different strategies shows that manipulation alone probably gives better value for money than manipulation followed by exercise (p 1381).



That doesn't sound all that bad to me. Besides, it's but one study of many that supports my position.

But again, it doesn't support your position. The fact is that the Roland Morris questionnaire has a threshold of 2.5 for clinical relevance of intergroup difference, and the best that could be mustered was, what, 1.6 versus best care alone? And that's at 3 months. At a year, it was 1.0. So, in fact, there was no clinically significant difference between the groups (and what difference existed was pretty much only in the psychological measures).

These differences are miniscule, and could very well be due to the fact that, of necessity, patients could not be blinded.

On top of all of this, there was a huge number of patients lost to follow up, distributed unequally among the groups.

In short, just as with most other research supposedly validating chiropractic: This is pretty weak-sauce, and if it's the best chiro can come up with, then, really, why are we wasting our time talking about it?

Is it really that difficult to accept the fact that spinal manipulation is supported by some good evidence these days? Why does that bother you? You should be happy for your future patients that they have another therapeutic option.

Well, yes. It's difficult to accept because it is not supported by some good evidence these days. That's why it bothers me, full-stop. And so it gets my blood boiling when charlatans try to dress their woo in the trappings of science in order to give their brand of crap a patina of respectability.

Not saying I'm gonna yell at my patients should they choose to go to a chiro. But neither am I going to lie if I am asked about its scientific basis.

 

[p1acebo]

Well, yes. It's difficult to accept because it is not supported by some good evidence these days. That's why it bothers me, full-stop. And so it gets my blood boiling when charlatans try to dress their woo in the trappings of science in order to give their brand of crap a patina of respectability.

Blah blah blah, you have an opinion cool. What does this have to do with what the OP posted? This thread got completely derailed, probably should be closed considering the majority of people on here are talking in circles.

 

[facetguy]

But again, it doesn't support your position. The fact is that the Roland Morris questionnaire has a threshold of 2.5 for clinical relevance of intergroup difference, and the best that could be mustered was, what, 1.6 versus best care alone? And that's at 3 months. At a year, it was 1.0. So, in fact, there was no clinically significant difference between the groups (and what difference existed was pretty much only in the psychological measures).

These differences are miniscule, and could very well be due to the fact that, of necessity, patients could not be blinded.

On top of all of this, there was a huge number of patients lost to follow up, distributed unequally among the groups.

In short, just as with most other research supposedly validating chiropractic: This is pretty weak-sauce, and if it's the best chiro can come up with, then, really, why are we wasting our time talking about it?



Well, yes. It's difficult to accept because it is not supported by some good evidence these days. That's why it bothers me, full-stop. And so it gets my blood boiling when charlatans try to dress their woo in the trappings of science in order to give their brand of crap a patina of respectability.

Not saying I'm gonna yell at my patients should they choose to go to a chiro. But neither am I going to lie if I am asked about its scientific basis.

As long as you've done your due diligence and actually familiarized yourself with the relevant literature, then that's your prerogative. My hunch is you are nowhere near that point and as such would simply be offering biased rehashed opinion.

If the data were really lacking, as you suggest, why would the North American Spine Society, the American Pain Society, the American College of Physicians, and more than a dozen (non-chiropractic) clinical practice guidelines from multidisciplinary groups from around the world, among others, recommend spinal manipulation for neck and LBP? Because they don't know what you know? Or because they, having reviewed all the literature, know something you don't know? Which is the more plausible reality?

 

[facetguy]

Blah blah blah, you have an opinion cool. What does this have to do with what the OP posted? This thread got completely derailed, probably should be closed considering the majority of people on here are talking in circles.

As often happens, the discussion about OMM turned into a discussion about evidence behind OMM. As an extension of that, evidence of spinal manipulation (a component of OMM) came up, bringing the thread to where it is now.

 

[BlackSwan]

Okay, I have no horse in this race, but I just read through this baby front to back, and that motomed dude basically ripped fozzy a new one and probably made AT Still poo his pants in his grave. The posts got a lot less interesting since he left. RIP motomed. You are missed.

 

[fozzy40]

Okay, I have no horse in this race, but I just read through this baby front to back, and that motomed dude basically ripped fozzy a new one and probably made AT Still poo his pants in his grave. The posts got a lot less interesting since he left. RIP motomed. You are missed.

I'm sorry...where did her "rip me a new one"? I posted a lot of studies with actual clinical experience to back it up...and he/she basically said..."but...nuh uh..." I always find it fascinating when people can be so adamant about something not working without having actual clinical experience. My argument is in the thread where I argued facts and not subjective opinion. Please feel free to read the articles I cited and then we can start a discussion.

Just because I have not said anything in a while doesn't mean that I submitted. I just know when someone isn't listening or open minded.

 

[flodhi1]

I'm sorry...where did her "rip me a new one"? I posted a lot of studies with actual clinical experience to back it up...and he/she basically said..."but...nuh uh..." I always find it fascinating when people can be so adamant about something not working without having actual clinical experience. My argument is in the thread where I argued facts and not subjective opinion. Please feel free to read the articles I cited and then we can start a discussion.

Just because I have not said anything in a while doesn't mean that I submitted. I just know when someone isn't listening or open minded.

You're getting trolled lol just ignore it