The evaluation? How do you do it?

[lawguil]

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I think it would be interesting to expose the differences of how a physical therapist would evaluate a shoulder injury (could be anything, but we'll use shoulder injury) vs. a chiropractor. If a person with a shoulder injury comes into an outpatient physical therapy/chiropractic clinic with a shoulder injury referred by an MD, how do you evaluate it? What is the physical therapist going to measure vs. what is the chiropractor going to measure?

Let’s say the person is a 45 year old active male, who has a desk job and also coach’s baseball. They think they may have dislocated the shoulder some time in the past when they were in college playing baseball, but don't really know. Further, they are having sharp pain when they move their arm above their head and they can't throw a baseball without pain or symptoms and they feel weakness throughout their upper extremity on the affected side. They have had pain for one month that is not getting better. The person is average in weight and height.

I'm interested in how each profession is going to evaluate this person.
What are you going to look for? How are you going to test him? How are you going to measure his dysfunction? How are you going to identify what his problem is using your evaluation and manual skills to assess him?

 

[FoughtFyr]

I think it would be interesting to expose the differences of how a chiropractor would evaluate a shoulder injury (could be anything, but we'll use shoulder injury) vs. a chiropractor. If a person with a shoulder injury comes into an outpatient clinic with a shoulder injury referred by an MD, how do you evaluate it? What is the physical therapist going to measure vs. what is the chiropractor going to measure?

Let’s say the person is a 45 year old active male, who has a desk job and also coach’s baseball. They think they may have dislocated the shoulder some time in the past when they were in college playing baseball, but don't really know. Further, they are having sharp pain when they move their arm above their head and they can't throw a baseball without pain or symptoms and they feel weakness throughout their upper extremity on the affected side. They have had pain for one month that is not getting better. The person is average in weight and height. X-rays and MRI won't be performed for 2 more weeks.

I'm interested in how each profession is going to evaluate this person.
What are you going to look for? How are you going to test him? How are you going to measure his dysfunction? How are you going to identify what his problem is using your evaluation and manual skills to assess him?

Your scenario is erroneous at it's face. The key difference is that the patient seeing the PT will have been first evaluated by an MD. Things such as pathologic fractures, non-NMS injury, or even atypical chest pain will have already been ruled out. And the x-ray will not have waited two weeks if indicated.

And, oh yeah, if the PT discovers a serious injury or non-NMS problem, they will refer the patient back to an MD - not crack his back to "fix it".

- H

 

[lawguil]

Your scenario is erroneous at it's face. The key difference is that the patient seeing the PT will have been first evaluated by an MD. Things such as pathologic fractures, non-NMS injury, or even atypical chest pain will have already been ruled out. And the x-ray will not have waited two weeks if indicated.

And, oh yeah, if the PT discovers a serious injury or non-NMS problem, they will refer the patient back to an MD - not crack his back to "fix it".

- H

Understandable, I already know this! I'm looking to compare the orthopedic evaluation skills between the two professions. Surely the scenerio is modeled after problem based learning. In many posts, chiropractors imply that their manual skills and training is far more extensive than the PT's. The scenerio isn't meant to be realistic. Lets just say that Xrays aren't indicated. Point blank, how does a physical therapist evaluate a shoulder injury and how does a chiropractor? Surely, there are differences, Right?

 

[Febrifuge]

So we're postulating a world in which xrays are expensive or difficult to obtain?

Sorry; I'm having the same mental block as FF. I work in an ED and therefore my brain goes right to "this guy gets an AP and maybe a standing oblique or a swimmer's view." I must be misunderestimating the question. 😉

 

[FoughtFyr]

Understandable, I already know this! I'm looking to compare the orthopedic evaluation skills between the two professions. Surely the scenerio is modeled after problem based learning. In many posts, chiropractors imply that their manual skills and training is far more extensive than the PT's. The scenerio isn't meant to be realistic. Lets just say that Xrays aren't indicated. Point blank, how does a physical therapist evaluate a shoulder injury and how does a chiropractor? Surely, there are differences, Right?

I don't think anyone is suggesting chiropractors cannot perform NMS exams. I think the major problem most MDs have with chiropractic is in their ability (or lack thereof) to primarily assess a patient as the first point of access. The "second" issue (if you will) is if a chiropractor does directly or incidently come across a non-NMS problem, will the patient be appropriately cared for?

For example, this study http://www.ncbi.nlm.nih.gov/entrez/...ve&db=pubmed&dopt=Abstract&list_uids=10768681 suggests that 17 % of chiropractors who treat children do not appropriate refer neonatal fever.

- H

 

[lawguil]

So we're postulating a world in which xrays are expensive or difficult to obtain?

Sorry; I'm having the same mental block as FF. I work in an ED and therefore my brain goes right to "this guy gets an AP and maybe a standing oblique or a swimmer's view." I must be misunderestimating the question. 😉

Febrifuge and FoughtFyr, What are your backgrounds? This could be a more enlightening experience than I thought!

 

[FoughtFyr]

Febrifuge and FoughtFyr, What are your backgrounds? This could be a more enlightening experience than I thought!

Ferbi is an ED tech in a major county ED.

I am an MD, with 10 years of paramedic experience prior to medical school, an undergraduate degree in Health Policy from a Big 10 school, and an MPH in Environmental Toxicology, who is currently finishing my first year of an emergency medicine residency at a very academic institution.

- H

 

[PublicHealth]

For example, this study http://www.ncbi.nlm.nih.gov/entrez/...ve&db=pubmed&dopt=Abstract&list_uids=10768681 suggests that 17 % of chiropractors who treat children do not appropriate refer neonatal fever.

Still hung up on this biased and methodologically flawed study, huh?

What are your thoughts about the following comment:

Universal Childhood Vaccinations: A Faustian Bargain?

Arch Pediatr Adolesc Med. 2000;154:1063-1064.

Although the article by Lee et al1 is generally well balanced, the authors' portrayal of the childhood immunization issue is decidedly one-sided. Lee and colleagues state that "safety" and "failure to promote childhood immunization" are major concerns in pediatric health care, yet they don't acknowledge the known risks associated with vaccinations, which may be responsible for many chiropractors' decision to educate parents about the benefits and possible adverse effects of vaccines rather than actively promote immunizations.

Vaccines have contributed greatly to the decreased burden of diphtheria, polio, and other infectious diseases, and without continued high vaccination-coverage rates, vaccine-preventable diseases are likely to become much more prevalent. However, mass childhood immunization programs are not without risk. While the authors focus on extremely rare complications resulting from spinal manipulation, they appear critical of the International Chiropractors Association's policy statement on vaccination, which "supports each individual's right to be made aware of the possible adverse effects of vaccines." Immediate adverse reactions associated with vaccinations, while rare, are more common than serious manipulation-related complications, and long-term adverse outcomes are biologically plausible and may be occurring given findings from recent epidemiologic studies.

Two committees convened by the Institute of Medicine concluded that there are causal relationships of measles-mumps-rubella (MMR) and diphtheria-tetanus-pertussis (DTP) vaccines with anaphylaxis.2-3 The estimated rates of anaphylaxis range from 50 per million children for MMR to 60 per million children for 3 doses of DTP. The death rate from anaphylaxis is about 5%,4 thus for every million children given MMR or 3 doses of DTP, 2 to 3 children are expected to die. Furthermore, there is evidence that components of DTP vaccines have adjuvant effects,5 may cause a Th1 to Th2 shift in CD4 cells,6 and that exposure to allergens in early life may be critical to proper Th1-Th2 balance.7-8 Of the 7 recent studies addressing the possible association of pertussis or DTP immunization with subsequent development of asthma or other allergies,9-15 findings from 4 studies10-12,15 are suggestive of an increased risk of allergic disease with immunization. Evidence from animal and human studies support the hypothesis that vaccinations may be 1 of many genetic and environmental factors contributing to the increasing prevalence of atopic disease in recent years.16

I could not agree more with the authors' call for "strengthening collaboration and research between the chiropractic, medical, and public health communities." Given our increasing reliance on mandatory vaccinations for infectious-disease prevention and the paucity of long-term safety data, we should work together to implement surveillance systems and design rigorous studies to generate the scientific data necessary for evidence-based decision making. If vaccine development is a Faustian bargain between life in the developed, overpopulated world and the natural world, let's have the courage to challenge and modify public-health policies and clinical practices while encouraging novel approaches for dealing with existing and emerging diseases.

Eric L. Hurwitz, DC, PhD
Department of Epidemiology
UCLA School of Public Health, Box 951772
Los Angeles, CA 90095-4047

REFERENCES

1. Lee ACC, Li DH, Kemper KJ. Chiropractic care for children. Arch Pediatr Adolesc Med. 2000;154:401-407. ABSTRACT/FULL TEXT
2. Howson CP, Howe CJ, Fineberg HV. Adverse Effects of Pertussis and Rubella Vaccines: A Report of the Committee to Review the Adverse Consequences of Pertussis and Rubella Vaccines. Washington, DC: National Academy Press; 1991.
3. Stratton KR, Howe CJ, Johnston RB. Adverse Events Associated With Childhood Vaccines: Evidence Bearing on Causality. Washington, DC: National Academy Press; 1994.
4. Yocum MW, Khan DA. Assessment of patients who have experienced anaphylaxis: a 3-year survey. Mayo Clin Proc. 1994;69:16-23. ISI | MEDLINE
5. Kosecka U, Berin MC, Perdue MH. Pertussis adjuvant prolongs intestinal hypersensitivity. Int Arch Allergy Immunol. 1999;119:205-211. CrossRef | ISI | MEDLINE
6. Mu HH, Sewell WA. Enhancement of interleukin-4 production by pertussis toxin. Infect Immun. 1993;61:2834-2840. ABSTRACT
7. Prescott SL, Macaubas C, Yabuhara A, et al. Developing patterns of T cell memory to environmental allergens in the first two years of life. Int Arch Allergy Immunol. 1997;113:75-79. ISI | MEDLINE
8. Prescott SL, Macaubas C, Holt BJ, et al. Transplacental priming of the human immune system to environmental allergens: universal skewing of initial T-cell responses towards the Th-2 cytokine profile. J Immunol. 1998;160:4730-4737. ABSTRACT/FULL TEXT
9. Nilsson L, Kjellman NI, Bjorksten B. A randomized controlled trial of the effect of pertussis vaccines on atopic disease. Arch Pediatr Adolesc Med. 1998;152:734-738. ABSTRACT/FULL TEXT
10. Odent MR, Culpin EE, Kimmel T. Pertussis vaccination and asthma: is there a link? JAMA. 1994;272:592-593. ISI | MEDLINE
11. Kemp T, Pearce N, Fitzharris P, et al. Is infant immunization a risk factor for childhood asthma or allergy? Epidemiology. 1997;8:678-680. ISI | MEDLINE
12. Farooqi IS, Hopkin JM. Early childhood infection and atopic disorder. Thorax. 1998;53:927-932. ABSTRACT/FULL TEXT
13. Nilsson L, Kjellman IM, Storsaeter J, Gustafsson L, Olin P. Lack of association between pertussis vaccination and symptoms of asthma and allergy [letter]. JAMA. 1996;275:760. CrossRef | ISI | MEDLINE
14. Henderson J, North K, Griffiths M, Harvey I, Golding J. Pertussis vaccination and wheezing illnesses in young children: prospective cohort study. BMJ. 1999;318:1173-1176. ABSTRACT/FULL TEXT
15. Hurwitz EL, Morgenstern H. Effects of diphtheria-tetanus-pertussis or tetanus vaccination on allergies and allergy-related respiratory symptoms among children and adolescents in the United States. J Manipulative Physiol Ther. 2000;23:81-90. CrossRef | ISI | MEDLINE
16. Parronchi P, Brugnolo F, Sampognaro S, Maggi E. Genetic and environmental factors contributing to the onset of allergic disorders. Int Arch Allergy Immunol. 2000;121:2-9. CrossRef | ISI | MEDLINE

 

[FoughtFyr]

Still hung up on this biased and methodologically flawed study, huh?

What are your thoughts about the following comment:

Universal Childhood Vaccinations: A Faustian Bargain?

My issue with this article is NOT the immunizations but rather the question of recognizing a critical emergency, in this case neonatal fever. And that is the reason I post it here.

BTW - How is this study flawed? This was a questionnaire based study with response rates and selection criteria reported. This is a standard methodology well proven and well described.

- H

 

[Febrifuge]

Febrifuge and FoughtFyr, What are your backgrounds? This could be a more enlightening experience than I thought!

What the doc said. I'm older, more experienced, and I've had exposure to a really excellent EM program... but at the end of the day, I'm a pre-med. Anything enlightening that comes out of a discussion with me is likely due to me synthesizing something from my very tiny inventory of medical knowledge together with something from my huge store of trivia.

 

[lawguil]

Ferbi is an ED tech in a major county ED.

I am an MD, with 10 years of paramedic experience prior to medical school, an undergraduate degree in Health Policy from a Big 10 school, and an MPH in Environmental Toxicology, who is currently finishing my first year of an emergency medicine residency at a very academic institution.

- H

AS you may be well suited to emergency medicine, I suspect you may be unfamiliar with evaluations that a PT would perform to assess NMS dysfunction. I agree that only physicians or medically trained mid-levels should have direct access, but that is NOT what the question is about. It might help to re-read what I initially wrote at the top of the tread.

What I am trying to compare is a chiropractor’s evaluation of the shoulder vs. the Physical therapists evaluation of the shoulder. Example:

A physical therapist would begin with a thorough history including medical history, medications, employment, level and type of activity (physically), how injury developed occurred, What makes it worse/better, when having pain, where having pain/symptoms, type of pain ect.
Followed by:
Observation - discoloration, deformity, edema, texture, posture, scars and sinuses, biomechanics or movement and/or gait spinal alignment, ect
Followed by:
Palpation for tenderness, shape of bones and soft tissue shape/density/feel., muscle deformities, contour changes, relationship to other structures.
Followed by
Neurological and vascular - cranial nerve, dermatome, myotome, paresthesia, reflexes, skin color, temp. Hair Growth, Pulse ect.
Followed by
Movement - Active Range of Motion (apleys), Resistive Range of motion, Passive Range of motion, manual muscle tests, Strength, and limitations or pain/symptoms flexibility static stability ect.
Followed by
Special Tests: for the shoulder may include, Anterior Drawer (Glide), Posterior drawer (glide), sulcus sign, apprehension test, relocation test, biceps loading test, Speeds test, Ludingtons's test, Abbott-Saunders test, Yergason's test, Empty can test, Subacromail Push button test, Hawkins test, Neer Impingement test, Drop arm test, assessment of scapula/humeral rhythm, Load and shift test, Fulcrum test, clunk test, grind test, halsteads, hyperabduction test, costoclavicular test, Distraction test, sterno-clavicular shearing tests, adson test allens test, sitting roos test, ect.


You then extrapolate the data and formulate an assessment of the pathomechanics from your assessment of the anatomy and biomechanics, reproduction of symptoms, location of pain symptoms and dysfunction. Further, based on your assessment, it may lead you in a variety of directions based on differential diagnosis, referred pain, neck and posture issues, TMJ, ect. This is in a nut shell the basic evaluation process that a physical therapist would use to do an initial orthopedic evaluation on a patient to identify what injury has transpired. I'm sure that many therapists would be able to look at what I have written and make many additions to the evaluation. My question is, what does a chiropractor evaluate before they decide to start treatment aka.- start cracking things? Physical therapist are trained very well in the art of physical evaluation of NMS related conditions as well as other health problems not limited to stroke, cardio-pulmonary conditions, diabetes and wound care, surgery (especially orthopedic) all from inpatient treatment, pre and post surgery care, conservative treatment of acute, chronic and overuse injuries, ect . Let’s hear a little about the chiropractic evaluation a shoulder injury since NMS seems to be your "hallmark" trade. L.

 

[awdc]

Dang! That's exactly how we were taught in chiro school! Literally no difference. Go figure... I assume the "empty can test" is the test for the supraspinatus muscle? The only thing I would add is that we were taught when imaging (including CTs, MRIs) and labs were indicated and order the appropriate study. Okay... so a little different. But all those ortho tests brings back memories... haven't really done some of those in years. In chiro school, we had a physical diagnosis class similar to what we have in med school and we had two semesters of ortho/neuro diagnosis class before moving onto clinics. With regards to evaluating functional musculoskeletal problems, that was taught longitudinally throughout the curriculum although there was one class that we had that really put a lot of it together.

 

[PublicHealth]

AS you may be well suited to emergency medicine, I suspect you may be unfamiliar with evaluations that a PT would perform to assess NMS dysfunction. I agree that only physicians or medically trained mid-levels should have direct access, but that is NOT what the question is about. It might help to re-read what I initially wrote at the top of the tread.

What I am trying to compare is a chiropractor’s evaluation of the shoulder vs. the Physical therapists evaluation of the shoulder. Example:

A physical therapist would begin with a thorough history including medical history, medications, employment, level and type of activity (physically), how injury developed occurred, What makes it worse/better, when having pain, where having pain/symptoms, type of pain ect.
Followed by:
Observation - discoloration, deformity, edema, texture, posture, scars and sinuses, biomechanics or movement and/or gait spinal alignment, ect
Followed by:
Palpation for tenderness, shape of bones and soft tissue shape/density/feel., muscle deformities, contour changes, relationship to other structures.
Followed by
Neurological and vascular - cranial nerve, dermatome, myotome, paresthesia, reflexes, skin color, temp. Hair Growth, Pulse ect.
Followed by
Movement - Active Range of Motion (apleys), Resistive Range of motion, Passive Range of motion, manual muscle tests, Strength, and limitations or pain/symptoms flexibility static stability ect.
Followed by
Special Tests: for the shoulder may include, Anterior Drawer (Glide), Posterior drawer (glide), sulcus sign, apprehension test, relocation test, biceps loading test, Speeds test, Ludingtons's test, Abbott-Saunders test, Yergason's test, Empty can test, Subacromail Push button test, Hawkins test, Neer Impingement test, Drop arm test, assessment of scapula/humeral rhythm, Load and shift test, Fulcrum test, clunk test, grind test, halsteads, hyperabduction test, costoclavicular test, Distraction test, sterno-clavicular shearing tests, adson test allens test, sitting roos test, ect.


You then extrapolate the data and formulate an assessment of the pathomechanics from your assessment of the anatomy and biomechanics, reproduction of symptoms, location of pain symptoms and dysfunction. Further, based on your assessment, it may lead you in a variety of directions based on differential diagnosis, referred pain, neck and posture issues, TMJ, ect. This is in a nut shell the basic evaluation process that a physical therapist would use to do an initial orthopedic evaluation on a patient to identify what injury has transpired. I'm sure that many therapists would be able to look at what I have written and make many additions to the evaluation. My question is, what does a chiropractor evaluate before they decide to start treatment aka.- start cracking things? Physical therapist are trained very well in the art of physical evaluation of NMS related conditions as well as other health problems not limited to stroke, cardio-pulmonary conditions, diabetes and wound care, surgery (especially orthopedic) all from inpatient treatment, pre and post surgery care, conservative treatment of acute, chronic and overuse injuries, ect . Let’s hear a little about the chiropractic evaluation a shoulder injury since NMS seems to be your "hallmark" trade. L.

You can save a lot of time and text by stating that PTs pull people out of bed and move their limbs for them. A substantial proportion of PTs end up needing PT themselves.

 

[truthseeker]

You can save a lot of time and text by stating that PTs pull people out of bed and move their limbs for them. A substantial proportion of PTs end up needing PT themselves.

Yeah, and we wear Tshirts to work, give massages all day and apply hot packs. That was just a stupid post.

 

[truthseeker]

"But all those ortho tests brings back memories... haven't really done some of those in years."

Does this mean you haven't practiced in years? or does it mean that you were taught the tests but don't use them?

 

[FoughtFyr]

You can save a lot of time and text by stating that PTs pull people out of bed and move their limbs for them. A substantial proportion of PTs end up needing PT themselves.

Wow, if we are just going to generalize like this, the conversation is easy. Chiropractors just crack backs and talk to people for a long time to market their profession. I mean really, it was Voltaire who founded chiropractic, not Palmer (paraphrasing) - "It is the job of medicine to entertain the patient while the body heals itself". Nothing more entertaining to me than Palmer's minions trying to defend subluxation theory.

Q: How many chiropractors does it take to change a lightbulb?
A: One. But it will take him 27 visits to do it.

- H

 

[Science_Guy]

Still hung up on this biased and methodologically flawed study, huh?

What are your thoughts about the following comment:

Universal Childhood Vaccinations: A Faustian Bargain?

Arch Pediatr Adolesc Med. 2000;154:1063-1064.

Although the article by Lee et al1 is generally well balanced, the authors' portrayal of the childhood immunization issue is decidedly one-sided. Lee and colleagues state that "safety" and "failure to promote childhood immunization" are major concerns in pediatric health care, yet they don't acknowledge the known risks associated with vaccinations, which may be responsible for many chiropractors' decision to educate parents about the benefits and possible adverse effects of vaccines rather than actively promote immunizations.

Vaccines have contributed greatly to the decreased burden of diphtheria, polio, and other infectious diseases, and without continued high vaccination-coverage rates, vaccine-preventable diseases are likely to become much more prevalent. However, mass childhood immunization programs are not without risk. While the authors focus on extremely rare complications resulting from spinal manipulation, they appear critical of the International Chiropractors Association's policy statement on vaccination, which "supports each individual's right to be made aware of the possible adverse effects of vaccines." Immediate adverse reactions associated with vaccinations, while rare, are more common than serious manipulation-related complications, and long-term adverse outcomes are biologically plausible and may be occurring given findings from recent epidemiologic studies.

Two committees convened by the Institute of Medicine concluded that there are causal relationships of measles-mumps-rubella (MMR) and diphtheria-tetanus-pertussis (DTP) vaccines with anaphylaxis.2-3 The estimated rates of anaphylaxis range from 50 per million children for MMR to 60 per million children for 3 doses of DTP. The death rate from anaphylaxis is about 5%,4 thus for every million children given MMR or 3 doses of DTP, 2 to 3 children are expected to die. Furthermore, there is evidence that components of DTP vaccines have adjuvant effects,5 may cause a Th1 to Th2 shift in CD4 cells,6 and that exposure to allergens in early life may be critical to proper Th1-Th2 balance.7-8 Of the 7 recent studies addressing the possible association of pertussis or DTP immunization with subsequent development of asthma or other allergies,9-15 findings from 4 studies10-12,15 are suggestive of an increased risk of allergic disease with immunization. Evidence from animal and human studies support the hypothesis that vaccinations may be 1 of many genetic and environmental factors contributing to the increasing prevalence of atopic disease in recent years.16

I could not agree more with the authors' call for "strengthening collaboration and research between the chiropractic, medical, and public health communities." Given our increasing reliance on mandatory vaccinations for infectious-disease prevention and the paucity of long-term safety data, we should work together to implement surveillance systems and design rigorous studies to generate the scientific data necessary for evidence-based decision making. If vaccine development is a Faustian bargain between life in the developed, overpopulated world and the natural world, let's have the courage to challenge and modify public-health policies and clinical practices while encouraging novel approaches for dealing with existing and emerging diseases.

Eric L. Hurwitz, DC, PhD
Department of Epidemiology
UCLA School of Public Health, Box 951772
Los Angeles, CA 90095-4047

REFERENCES

1. Lee ACC, Li DH, Kemper KJ. Chiropractic care for children. Arch Pediatr Adolesc Med. 2000;154:401-407. ABSTRACT/FULL TEXT
2. Howson CP, Howe CJ, Fineberg HV. Adverse Effects of Pertussis and Rubella Vaccines: A Report of the Committee to Review the Adverse Consequences of Pertussis and Rubella Vaccines. Washington, DC: National Academy Press; 1991.
3. Stratton KR, Howe CJ, Johnston RB. Adverse Events Associated With Childhood Vaccines: Evidence Bearing on Causality. Washington, DC: National Academy Press; 1994.
4. Yocum MW, Khan DA. Assessment of patients who have experienced anaphylaxis: a 3-year survey. Mayo Clin Proc. 1994;69:16-23. ISI | MEDLINE
5. Kosecka U, Berin MC, Perdue MH. Pertussis adjuvant prolongs intestinal hypersensitivity. Int Arch Allergy Immunol. 1999;119:205-211. CrossRef | ISI | MEDLINE
6. Mu HH, Sewell WA. Enhancement of interleukin-4 production by pertussis toxin. Infect Immun. 1993;61:2834-2840. ABSTRACT
7. Prescott SL, Macaubas C, Yabuhara A, et al. Developing patterns of T cell memory to environmental allergens in the first two years of life. Int Arch Allergy Immunol. 1997;113:75-79. ISI | MEDLINE
8. Prescott SL, Macaubas C, Holt BJ, et al. Transplacental priming of the human immune system to environmental allergens: universal skewing of initial T-cell responses towards the Th-2 cytokine profile. J Immunol. 1998;160:4730-4737. ABSTRACT/FULL TEXT
9. Nilsson L, Kjellman NI, Bjorksten B. A randomized controlled trial of the effect of pertussis vaccines on atopic disease. Arch Pediatr Adolesc Med. 1998;152:734-738. ABSTRACT/FULL TEXT
10. Odent MR, Culpin EE, Kimmel T. Pertussis vaccination and asthma: is there a link? JAMA. 1994;272:592-593. ISI | MEDLINE
11. Kemp T, Pearce N, Fitzharris P, et al. Is infant immunization a risk factor for childhood asthma or allergy? Epidemiology. 1997;8:678-680. ISI | MEDLINE
12. Farooqi IS, Hopkin JM. Early childhood infection and atopic disorder. Thorax. 1998;53:927-932. ABSTRACT/FULL TEXT
13. Nilsson L, Kjellman IM, Storsaeter J, Gustafsson L, Olin P. Lack of association between pertussis vaccination and symptoms of asthma and allergy [letter]. JAMA. 1996;275:760. CrossRef | ISI | MEDLINE
14. Henderson J, North K, Griffiths M, Harvey I, Golding J. Pertussis vaccination and wheezing illnesses in young children: prospective cohort study. BMJ. 1999;318:1173-1176. ABSTRACT/FULL TEXT
15. Hurwitz EL, Morgenstern H. Effects of diphtheria-tetanus-pertussis or tetanus vaccination on allergies and allergy-related respiratory symptoms among children and adolescents in the United States. J Manipulative Physiol Ther. 2000;23:81-90. CrossRef | ISI | MEDLINE
16. Parronchi P, Brugnolo F, Sampognaro S, Maggi E. Genetic and environmental factors contributing to the onset of allergic disorders. Int Arch Allergy Immunol. 2000;121:2-9. CrossRef | ISI | MEDLINE

An interesting read, but it begs the question.......with many chiropractors advocating that their patients NOT receive vaccinations, what percentage of the population would suffer mortality and morbidity due to these diseases without vaccination?

Also, for chiropractors to make these recommendations, are they trained in immunology in the chiropractic curriculum?

I think that the risk of anaphylaxis is one that we in the health care business have to accept. Unless there is prior history, predicting a specific basophil or mast cell response to an antigen is pretty difficult, but with any pharmacotherapy, the risk of an allergic reaction is always present. The idea of telling patients NOT to consider immunization is myopic at best. I believe that parents should consult with experts if they have concerns, such as immunologists, before making such a critical decision.

And the 17% of chiropractors who would treat a 2-week old neonate with fever themselves?? By doing what?? Wow, this is very irresponsible.

 

[awdc]

"But all those ortho tests brings back memories... haven't really done some of those in years."

Does this mean you haven't practiced in years? or does it mean that you were taught the tests but don't use them?

It means I haven't practiced in awhile. I did use them when I was in chiro practice.

 

[zenman]

Well, let's make this boring thread more interesting and throw in your friendly Zen Shiatsu therapist (me). An example: A nurse friend of mine (who had missed a month of work due to a shoulder injury suffered while trying to assist a patient) who had consulted several doctors, received x-rays and a CAT scan as well as physical therapy, enjoyed a 90 percent reduction in pain and a 90 percent improvement in movement with approximately 15 minutes of Zen Shiatsu! What can I say? 😀 Western medicine is so boring!

 

[lawguil]

Well, let's make this boring thread more interesting and throw in your friendly Zen Shiatsu therapist (me). An example: A nurse friend of mine (who had missed a month of work due to a shoulder injury suffered while trying to assist a patient) who had consulted several doctors, received x-rays and a CAT scan as well as physical therapy, enjoyed a 90 percent reduction in pain and a 90 percent improvement in movement with approximately 15 minutes of Zen Shiatsu! What can I say? 😀 Western medicine is so boring!

LOL!

 

[Febrifuge]

Well, let's make this boring thread more interesting and throw in your friendly Zen Shiatsu therapist (me). An example: A nurse friend of mine (who had missed a month of work due to a shoulder injury suffered while trying to assist a patient) who had consulted several doctors, received x-rays and a CAT scan as well as physical therapy, enjoyed a 90 percent reduction in pain and a 90 percent improvement in movement with approximately 15 minutes of Zen Shiatsu! What can I say? 😀 Western medicine is so boring!

That's great! I'm glad to hear your friend got a good result. But if I may, and respectfully, some questions:

1) How's your friend doing now?
2) What did you do that was different from the earlier PT?
3) Why did it work?
4) How did it work?

 

[zenman]

That's great! I'm glad to hear your friend got a good result. But if I may, and respectfully, some questions:

1) How's your friend doing now?
2) What did you do that was different from the earlier PT?
3) Why did it work?
4) How did it work?

I haven't seen her since I left the Republic of Texas but she was back at work when I left. Remember I'm working from an energetic perspective and totally outside the realm of what some people can't or refuse to believe. I was working at the hospital last night and worked on another nurse who had injured her shoulder either carrying a dive tank or a pedi ventilator. This was a quick treatment but what I normally do is get the person to tell me what happened. I'm not just interested in their story but also what they're not saying and trying to understand what meaning the injury has for them (In earlier years I was a trauma junkie but now stubborn chronic conditions turn me on!) I listen to the way they talk and the sound of their voice. I observe their color, hue, way they present themselves, postural patterns and energetic pattern. I use touch to feel the meridians or what we call "ashi points" (tender points). If I'm doing a full treatment, I check the meridian diagnostic areas in the abdomen for (acute here and now problems) and the back diagnostic areas for more chronic conditions. I can also assess for meridian energetic excess or deficiency around the injured area. So, for this nurse last night (she had injured right shoulder) I worked down along side her spine (Bladder and Kidney meridians) then her left shoulder around the Gall Bladder and Small Intestine meridians and then down part of the Stomach and Gall Bladder meridians in her left leg. By then she had a lot less pain in her right shoulder, which I haven't touched yet. I then did the same treatment to her right shoulder finishing by just holding her shoulder for a few minutes. Her comment then was, "I can feel stuff moving in my shoulder."

While this might be far out for some and it was for me at one time because of my Western background, if you just keep the two systems separate you get it faster. (There is a German physician who was taught by my teacher who has written some good articles on shiatsu. He mostly does it now and a little doctoring on the side! If you want his website, let me know.) Like I said earlier, I prefer working with people who have found no relief. This has included some IM docs, ER docs, PM & R docs, and even a chief of ortho surgery.

 

[Febrifuge]

Hm. Well, if you answered questions #3 or #4, then it was done in a way that I can't recognize. There's a lot about what you describe that sounds to me like attentive care and good practice, but I'm not equipped to really get what it is you're practicing. I just fail to comprehend how meridians work, and I can't wrap my brain around the idea that physics and biology as we understand them will apply in one setting and then not apply in another. I'm willing to accept that this is a limitation of mine, though, and no offense meant. Thanks!

 

[zenman]

Hm. Well, if you answered questions #3 or #4, then it was done in a way that I can't recognize. There's a lot about what you describe that sounds to me like attentive care and good practice, but I'm not equipped to really get what it is you're practicing. I just fail to comprehend how meridians work, and I can't wrap my brain around the idea that physics and biology as we understand them will apply in one setting and then not apply in another. I'm willing to accept that this is a limitation of mine, though, and no offense meant. Thanks!

Why and how? From Asian Medicine perspective by balancing the energy (ki) in the meridians. Of course, since you're touching someone you could also explain it from a Western standpoint. However, it works better I've found if you stay with the original viewpoint.

 

[lawguil]

Why and how? From Asian Medicine perspective by balancing the energy (ki) in the meridians. Of course, since you're touching someone you could also explain it from a Western standpoint. However, it works better I've found if you stay with the original viewpoint.

I'm not overly inspired by alternative "medicine", but have never discouraged anybody from experimenting with it. God knows there is far more about the body that we don't know than we do know. What I want to say is that with my limited experience with people who have had "success" with alternative treatment, they usually had a few more problems than I was treating them for! THey usually needed that kind of emotional and psychological attention that they could only get from something alternative! Just my experience! L.

 

[zenman]

I'm not overly inspired by alternative "medicine", but have never discouraged anybody from experimenting with it. God knows there is far more about the body that we don't know than we do know. What I want to say is that with my limited experience with people who have had "success" with alternative treatment, they usually had a few more problems than I was treating them for! THey usually needed that kind of emotional and psychological attention that they could only get from something alternative! Just my experience! L.

Our current health care (illness care) system is just not set up to reward practitioners in providing what patients want/need. But the psychological attention (bedside manner) is justified in any system and is a plus. Touching is what I do and it's what few docs even do, other than with an instrument of some sort.