What do you think of Chiropractic?

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ChiroGuy

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Hey there everyone,

I'm new to this forum, but thought I'd check it out after Dr. Mom piqued my curiosity on another website. I?m currently a chiropractic student in Canada (just finishing year 2 of 4) and am curious to hear about your opinions on my field. I know that there are very strong feelings for and against chiropractic, especially with medical doctors, and want to get a feel for how current med students view DC?s. In Canada, many of the old-timer doctors are pretty anti-chiro, but many of the newer grads are much more open to complementary care as the education system changes.

So before I ask any specific questions, what are people?s general views of the efficacy of Chiropractic care. Would you ever refer a patient to a DC?

Thanks,
ChiroGuy

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I think, like all other professions, there are good and bad chiropractors. So, let me preface what I'm about to say and let you know I'm not terribly interested in getting into a huge debate here (and I hope that wasn't the purpose of your starting this thread), but I think where the "image" of chiropractic runs into problems is when some chiropractors go from offering complementary treatment, which is fine, to alternative (i.e., unproven) treatments for some diseases where there is little scientific basis warranting the use of chiropractic. For instance, offering manipulations as the sole treatment for asthma and sinusitis, fibromyalgia, and other syndromes and diseases that have a high patient subjectivity of severity and/or intermittent courses with exacerbations and remissions, and then claiming high success rate without adequate study.

Chiropractors hate having the image that they are nothing more than "joint crackers" and wish to establish a legitimacy in their role as part of the healthcare team. In my opinion, sometimes in their zeal to be perceived as "real doctors" they employ a lot of questionable treatment and, at best, bad science in an attempt to further establish those treatments as legitimate. Whether they themselves actually believe some of these "alternative" treatments they are offering are effective or not is irrelevant. What those efforts often do winds up having the opposite of the intended effect in the greater medical community.
 
I somewhat agree with Skip. I think that there are some extremely good chiropractors and some extremely bad chiropractors. I actually just got home from my chiropractor's office - I have a reverse curve in my C-spine and chiropractic is about my only alternative to surgery. I also had a wreck this morning and was starting to feel the whiplash, so I went. My current chiropractor is great. He understands his realm of practice and stays within it. He does offer supplements, but I think that's ok too, since he has a degree in homeopathic meds too.

My old chiropractor, on the other hand, forced all of her patients to attend a class on "Chiropractic, Wellness, and You". During this "class", she asserted on several different occasions that "chiropractic can cure ANYTHING, including cancer", "traditional medicine doesnt know what it's doing", and other similar sentiments. She also encouraged people to bring their children in for regular checkups instead of going to the pediatrician. She also offered "awards" for referring people. Dont get me wrong, she was nice, but she was whacked out in some ways.

Star
 
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Interesting thread. I've got to ask a question of the OP, though. What do DC's and MD's from Canada think of osteopathic medicine here is the US? I'm curious about hearing a new angle on the played out MD/DO debate (which I am DEFINATELY not trying to start again.)

I agree with the previous posters about DC's.

Thanks
 
Thanks for the great feedback so far everyone ? I was curious to see if I was just going to accomplish starting up a chiro-bashing link, but am pleasantly surprised.

Skip Intro, I agree that the extremist chiropractors you refer to (who practice ?alternative? medicine) are the biggest force holding back our profession. It is unfortunate that this minority in our field is so vocal and their presence continually haunts us when we try to gain credibility. I can tell you from my own experience that most of my colleagues at CMCC are very happy to be in Chiropractic College and have no desire to be ?real doctors? as you say. My only critique would be that we are going to be real doctors, just not real medical doctors.

Starflyr, I?m sorry you had that experience with the previous chiropractor. I?ve been to a seminar where I saw one of these people speak, and must admit it was a scary sight. I was just glad there weren?t any journalists there ? they would have had a field day with the claims this guy was making. I assure you that, at least in my Canadian experience, the vast majority of chiropractors believe that chiro is a complementary care to be used as an adjunct with other health professions. We are fully trained to recognize when a referral is necessary, and just wish others were as well trained to know when a patient is a chiropractic candidate.

Daveswafford, an interesting question. In Canada, Osteopaths are very different from those in the States. We operate under a system which is very similar to the European model, as I understand it. Osteopathy is not even a regulated profession here, though there is a push to change that. Osteopaths function, for the most part, in a manner true to their foundations with Still ? they do not prescribe medications or perform any medical acts and focus mainly on manipulation. As for how Canadians view DO?s versus MD?s in the States, I?m sorry to report that we aren?t really aware for the most part of the difference. The only reason I know what DO?s are is because I thought at one point I wanted to go the medical route and checked out my options, and from what we have learned in our chiropractic Principles course. From my viewpoint, not being subjected to the internal debates and political stands that I?m sure most of you are, DO?s and MD?s are basically the exact same ? as I understand it there are subtle differences in the undergrad training, but residencies are the same and both use similar treatment methods, in general. Is this correct?

Thanks for the feedback,
ChiroGuy
 
Originally posted by ChiroGuy
... I can tell you from my own experience that most of my colleagues at CMCC are very happy to be in Chiropractic College and have no desire to be ?real doctors? as you say. My only critique would be that we are going to be real doctors, just not real medical doctors.

That's why I put it in quotes in my original response. In certain circles, the concept of what constitutes "real doctors" in the U.S. is often one that includes only white males who did their training at Harvard or Hopkins or Duke (etc.). Nonetheless, as a dentist friend I hadn't seen in a while told me this past weekend, "I know what I can do, and I know what I can't do. What I can't do, I refer out. But, even when I do refer out, I still always follow-up. Always." That's the real point here.

Chiropractors are licensed and regulated, both nationally and by individual states. They receive much of the same training in basic sciences that MD's and DO's receive. They are allowed to bill insurance. They are legally allowed to be called doctor. No arguments here. But, this doesn't exonerate them, just as it won't me, from offering anything other than the best possible care within the bounds of their training. And, if they can't do that, they are - at the very least - doing disservice to the healthcare profession, and - at the worst - doing harm.

Take clinical psychologists and optometrists - both also real doctors. Imagine if that licensed clinical psychologist started treating brain cancers with talk therapy, and presented questionable data to justify and support it's effectiveness. Imagine if an optometrist began putting his patients in overcorrected prescriptions claiming that it cured open-angle glaucoma, and advised them to stop taking their beta blocker drops.

I think you can see what I'm getting at.

-Skip
 
Sorry to jump back into this with another question, but this is turning into a really neat thread and I can't resist. How similar is the basic science training of DC's compared to MD/DO? How complete is the differential training for a DC? What of post-graduate training? I've never heard this sort of info before I'm pretty curious about it. Thanks again.

Dave
 
Originally posted by ChiroGuy
So before I ask any specific questions, what are people?s general views of the efficacy of Chiropractic care. Would you ever refer a patient to a DC?

I have nothing personally against people who choose to become chiropractors, but take issue with the profession and its teachings. From what I've been able to learn about the chiropractic profession, there is very little in the scientific literature to substantiate any of the claims made by chiropractors, so to comment on the "efficacy" of chiropractic, I would have to say that efficacy is nearly zero. But this is taking a purely scientific viewpoint of chiropractic. For one reason or another, however, many patients seem to believe in chiropractic and thus visit a chiropractor many times in a year suggesting that chiropractic care is somewhat efficacious.

Because I think the quality of chiropractors varies so much, as you and others point out, and because the scientific practice of chiropractic is still many, many years away, I could not refer a patient to a DC in good conscience. Exactly what I am referring the patient for is entirely a mystery. If a patient with LBP came to me asking about "manipulative therapy," I would promptly send him or her to an American-trained osteopathic physician specialized in osteopathic manipulative medicine.

The chiropractic profession needs to purge itself of the Sid E. Williams and the Life Colleges before it is taken seriously as a profession. As others have mentioned, the profession also needs to learn its place as a complementary field to medicine, not an alternative to the MD. Lastly the chiropractic profession must learn to establish a scientific basis for practice. If science does not support some aspect of chiropractic, move on to test the next aspect until you wittle away the nonsense and only keep what works. Anecdotal evidence and case reports are garbage in this regard.
 
Dr. Wu, I totally agree with you. I don?t blame you for referring your LBP patient to an osteopath who specializes in OMT. When you send a patient to a chiropractor you really do not know what your patient is going to get.

What if a chiropractor approached you and talked to you face to face. What if he/she said that they would like to develop a professional relationship with you? What if he/she explained to you that they only treat NMS complaints and didn?t believe in any of the hocus pocus garbage that many chiropractors do. What if they followed the NACM guidelines as another DC had mentioned on a previous thread? Would you give this person a chance? I guess what I?m asking is, what would you consider a good chiropractor that you wouldn?t think twice about referring to?

It would also be nice to get some responses from some of the other physicians on this board.
 
Originally posted by BackTalk
What if a chiropractor approached you and talked to you face to face. What if he/she said that they would like to develop a professional relationship with you? What if he/she explained to you that they only treat NMS complaints and didn?t believe in any of the hocus pocus garbage that many chiropractors do. What if they followed the NACM guidelines as another DC had mentioned on a previous thread? Would you give this person a chance? I guess what I?m asking is, what would you consider a good chiropractor that you wouldn?t think twice about referring to?

It would also be nice to get some responses from some of the other physicians on this board.

I'm not in a position to refer patients as a radiologist. However, if asked, I wouldn't hesitate to recommend a chiro who follows the NACM guidelines. I haven't specifically asked the guys I know from CMCC if they follow NACM guidelines, but they are all pure MSK guys. They're not the least bit interested in dealing with non-MSK cases. As such, I would conclude that they aren't subluxation-based and won't make fanciful claims, and I would expect that they provide evidence based care.

As you've pointed out, you don't always know what you're going to get with chiropractors. And the straights tend to speak the loudest, so that's our impression of chiros, for the most part. Heck, I read a newspaper article in which the president of the Ontario Chiropractic Association bragged about the pictures of children that he had in his office whom he'd 'cured' of ADHD, ear infections, etc. It leaves most MDs with a sour taste, unfortunately.
 
This goes with the above post.

From the chiroweb open forum:
Posted by Dr. T. Mirtz, DC

One can always count on a DC to come in and show how stupid they are thus causing us more reasonable ones to have to "explain him away".
It's like this:

MD: I am interested in understanding spinal manipulative therapy.

RDC (rational DC): The research on spinal manipulation is improving in which the studies have shown that for acute LBP with no neurological signs that patients will respond well.

MD: Thank you. I had heard about the efficacy of spinal manipulation being beneficial for that population.

IDC: (irrational DC): Yes, we are very good at adjusting subluxations. All people, regardless of condition will benefit from regular spinal hygeine.

MD: What the hell are you talking about?

IDC: You don't understand, what RDC said was totally fiction. He hasn't gotten the Big Idea. He wants you to accept him as one of your own; he is medically brainwashed. Manipulation is not chiropractic. Chiropractic is all about adjusting subluxations.

MD: Your looney as hell. RDC, how do explain this guy and his weirdoism?

RDC: I can't. He is one of those DC types that has weird beliefs.

MD: Geez, I think I will look for a PT who will do manipulation who I can talk to.

RDC: But you can talk to me.

MD: Sorry, but I don't want to be associated with people who have loonies running around their own profession.

RDC: Way to go IDC, you idiot.

IDC: You didn't want to work with him anyway. You will be much happier adjusting subluxations for the better expression of matter. I have a huge practice seeing millions of people and correcting their subluxations so they can better express LIFE. You just want to be a medical doctor and not a REAL chiropractor.

RDC: You would screw up a wet dream IDC.

IDC: Chiropractic is not concerned with wet dreams but the better expression of life from above-down, inside-out.

Moral of the story:

One idiot straight chiropractor or one idiot chiropractor for that matter can mess up the whole thing.

------------------




[/B][/QUOTE]
 
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This post IS too good to resist. Sad to say, but even as a chiropractor myself, I find it difficult to refer friends and family to other chiropractors because you just don't know what you're going to get. In my practice, I ended up practicing more like a physical therapist because that's the best evidence we have. However, I never wanted to be a PT in the first place so, med school here I come.

Originally posted by ******
For one reason or another, however, many patients seem to believe in chiropractic and thus visit a chiropractor many times in a year suggesting that chiropractic care is somewhat efficacious.
Wasn't there a recent article in AIM saying that spinal manipulation is just a effective as other medical treatments for back pain? IMHO, I would also hazard a guess that chiropractors are more likely to do other forms of manual medicine to decrease pain, restore range of motion and function, and to teach therapeutic exercises. And that's why I would go to a chiropractor.
 
Originally posted by awdc
Wasn't there a recent article in AIM saying that spinal manipulation is just a effective as other medical treatments for back pain? IMHO, I would also hazard a guess that chiropractors are more likely to do other forms of manual medicine to decrease pain, restore range of motion and function, and to teach therapeutic exercises. And that's why I would go to a chiropractor.

I'm not sure what you mean by "AIM," but there was an article in the NEJM in the late 1990s that showed OSTEOPATHIC manipulative therapy (OMT) was as effective in treating LBP as the use of drugs.
 
Originally posted by BackTalk
What if a chiropractor approached you and talked to you face to face. What if he/she said that they would like to develop a professional relationship with you? What if he/she explained to you that they only treat NMS complaints and didn?t believe in any of the hocus pocus garbage that many chiropractors do. What if they followed the NACM guidelines as another DC had mentioned on a previous thread? Would you give this person a chance? I guess what I?m asking is, what would you consider a good chiropractor that you wouldn?t think twice about referring to?

The issue with me is that most patients any of us will be dealing with lack the scientific sophistication to understand medicine, physiology, pathology, and the various disciplines that make up medical practice. Patients often confuse the dizzying array of letters and credentials of different practitioners. Case in point would be the continued identity problem DOs face in some areas. For those who see the DC as an MD who is a "specialist," any advice coming from the DC, whether qualified or not, will be accepted as the advice of the "doctor." And by the doctor I mean the MD, the primary care guy -- the go to guy with any of your health problems.

If the DC is an honest individual, he will simply refrain from advising the patient on matters not concerning musculoskeletal pain and educate the patient on the DC's role in relation to the MD. If the DC is a Sid E. Williams, a William H. Koch, or any of these other chiropractic characters, you now have a "doctor" battling and often contradicting the advice given by the patient's primary MD. For some patients the chiropractic that Williams and Koch practice may be much more appealing. Talk of "releasing a life force" and the treatment of disease without drugs or surgery sounds beautiful and even poetic, but it's a farce and we know it -- but the impressionable patient doesn't.

I think that if a DC explained to me in the manner you described, and was a member of the NACM, he deserves a chance. The DC profession has a place in healthcare but it must advance its base of knowledge and begin research to establish a scientific practice.
 
Here's an excerpt from Chiropractic: The Superior Alternative by William H. Koch, DC (1995 Bayeux Arts Inc., pages 30-32). Koch is a self-described "Classical Chiropractor" and a good friend of Sid E. Williams, the former President of Life University Chiropractic College, who was recently indicted on charges of fraud and all sorts of nasty stuff.

From the book jacket, a brief word on Koch: DR. WILLIAM H. KOCH, the son of a pharmacist, grew up as a sickly child diagnosed with bronchial asthma when he was only two-months old. When Bill was ten, his father -- desperate to give him a healthy childhood -- committed an act of medical treason. His father took him to see a chiropractic, at a time when the practice of chirorpractic was illegal in New York. The lession was not lost on the younger Koch. William Koch later trained as a chiropractor and over the intervening years he has spread the word about The Superior Alternative through his successful practice on Eastern Long Island, on his own radio program and on board his yacht, The Coastal Chiropractor.

---

Comparing Paradigms

The differences between the medical and the chiropractic health care models are very interesting and are best illustrated by direct comparison.

The Old Paradigm: Medicine (MD): The old paradigm traces its roots back to earliest civilization and culture when the tribal medicine man or witch doctor was an authoritarian figure on par with the tribal chief. The doctor tolerated no challenged his authority, and was held in awe and sometimes fear by his community. Few, if any, dared to offend the tribal doctor.

The New Paradigm: Chiropractic (DC): Chiropractic was born at the very end of the 19th century but its growth and development has occured entirely in the 20th century. Chiropractic is egalitarian rather than authoritarian. The Doctor of Chiropractic (DC) sees himself and the patients as equals, partners in the endeavor of establishing the patient's health. The Doctor of Chiropractic knows and openly acknowledges that the healer is the patient's own life force, that he, the DC, is only there to assist in releasing that healing force imprisoned by [Vertebral Subluxation Complex (VSC)]. The chiropractor sees himself as a servant of the patients who entrust themselves to his care.

The Old Paradigm: MD: Says: How dare you, the patient, challenge the Doctor with a question? You are not smart enough to even ask an intelligent question. I am educated, so you don't need to be.

The New Paradigm: DC: Says: You have a right to have your questions answered. It is your body and your health at stake. The only stupid question is the one not asked. If your doctor fails to honestly address your concerns and questions, then you should look for a new doctor.

The Old Paradigm: MD: Treats a disease that has a patient.

The New Paradigm: DC: Cares for a patient who has a disease.

The Old Paradigm: MD: Sees disease as uni-dimensional. The germ theory.

The New Paradigm: DC: Sees disease as multi-dimensional. Metabolic ecology, a complex system of interactions.

The Old Paradigm: MD: Sees disease caused from outside the body.

The New Paradigm: DC: Sees disease caused from inside the body.

The Old Paradigm: MD: Robert Koch said, "It is the virulence of the germ which determines whether or not you get sick."

The New Paradigm: DC: Claude Bernard has said, "It is the strength or weakness of your own resistance which determines whether or not you get sick."

The Old Paradigm: MD: Emphasizes fighting disease.

The New Paradigm: DC: Emphasizes maintenance of health and prevention of disease.

The Old Paradigm: MD: Sees drugs and surgery as the best solution.

The New Paradigm: DC: Sees drugs and surgery not as a solution but as damage control to save a life in crisis.

The Old Paradigm: MD: Is destructive. It uses toxins and asks how much the body can take without killing it. Thinks that removing vital parts can make you healthy.

The New Paradigm: DC: Is constructive. It knows that healing is a rebuilding process. Knows that toxins suppress the body's healing potential and stresses the immune system. Knows that health is a condition of wholeness in which all parts are present and working for the benefit of the whole.

The Old Paradigm: MD: Sees health as a lack of disease and symptoms.

The New Paradigm: DC: Sees health as a state of optimum physical, mental, spiritual, and social well-being, not just the absence of disease and symptoms.

The Old Paradigm: MD: Sees disease as inevitable.

The New Paradigm: DC: Sees health as normal.

The Old Paradigm: MD: Is authoritarian. It requires patient surrender.

The New Paradigm: DC: Is egalitarian. Encourages patient participation in the health care process.

The Old Paradigm: MD: Sees the doctor as the healer.

The New Paradigm: DC: Sees the patient as the healer.

The Old Paradigm: MD: Sees the doctor as a benevolent dictator.

The New Paradigm: DC: Sees the doctor as a teacher and life releaser.

The Old Paradigm: MD: Asks: How much can we doctors do? How much can the body take?

The New Paradigm: DC: Asks: How much can the body do? How much can the body give?

The Old Paradigm: MD: Is systemic. Sees the whole as the sum of its parts.

The New Paradigm: DC: Is holistic. Sees the whole as greater than the sum of its parts.

The Old Paradigm: MD: Sees surgery as the ultimate expression of its art.

The New Paradigm: DC: Sees surgery as the evidence of the failure to prevent the need for it.

The Old Paradigm: MD: Seeks to discredit that which it does not control.

The New Paradigm: DC: Sees condemnation prior to honest, unbiased investigation as the last refuge of the intellectually destitute.

The Old Paradigm: MD: Thinks the ultimate solutions to disease will come from the doctor.

The New Paradigm: DC: Kows that the ultimate solutions to disease must come from within the patient.

The Old Paradigm: MD: Sees the diagnosis and treatment of disease as an applied science.

The New Paradigm: DC: Sees classifying disease by characteristic and naming does not constitute effective therapy.

The Old Paradigm: MD: Views artificial suppression of pain and symptoms with drugs to be a desirable goal and acceptable outcome.

The New Paradigm: DC: Views suppression of pain and symptoms without the investigation and correction of the cause to be a fool's paradise.

The Old Paradigm: MD: Views drugs as scientifically correct.

The New Paradigm: DC: Says that you cannot take a chemical compound, a pharmaceutical which is a constant, place it into a living man which is a variable and expect a predictable reaction. Such reasoning is not mathematically sound, and therefore not scientific, but arbitrary and empirical.

The Old Paradigm: MD: Believes in the healing power of medicine.

The New Paradigm: DC: Believes that the power that made the body is the only power that can healh the body.

I can make many more such comparisons, but I think you get the idea. These comparisons help define the prevailing attitudes towards health care in the respective professions.
 
Thanks for posting that Chiropractic 'propaganda', Tim. That's all it really is.

And, the funny thing is that, as any of you who are currently in med school/recent grads (etc.) know, most of the things that the - ahem - "New Paradigm" (and, read that "New Age") Chiropractor claims to have the monopoly on are actually the fundamental concepts of modern, preventive medicine where the patient plays the primary role in deciding what's best for him/herself.

As he's described one, I personally wouldn't go to an "Old Paradigm" MD either! I think a few of these dinosaurs are still around, but they certainly are not the norm. Maybe where he fails is making the distinction between the "Old Paradigm" and "New Paradigm" M.D.! (But, then again I don't think he likely knows that much about the subject.)

-SI

(P.S. Just as a side note, people should generally avoid throwing the word "paradigm" around unless they want to sound like a new-age yahoo.)
 
Originally posted by awdc

Wasn't there a recent article in AIM saying that spinal manipulation is just a effective as other medical treatments for back pain? IMHO, I would also hazard a guess that chiropractors are more likely to do other forms of manual medicine to decrease pain, restore range of motion and function, and to teach therapeutic exercises. And that's why I would go to a chiropractor.
I think that these are the studies that you're referring to:

A review of the evidence for the effectiveness, safety, and cost of acupuncture, massage therapy, and spinal manipulation for back pain.

Cherkin DC, Sherman KJ, Deyo RA, Shekelle PG.

Center for Health Studies, Group Health Cooperative, 1730 Minor Avenue, Suite 1600, Seattle, WA 98101.

BACKGROUND: Few treatments for back pain are supported by strong scientific evidence. Conventional treatments, although widely used, have had limited success. Dissatisfied patients have, therefore, turned to complementary and alternative medical therapies and providers for care for back pain. PURPOSE: To provide a rigorous and balanced summary of the best available evidence about the effectiveness, safety, and costs of the most popular complementary and alternative medical therapies used to treat back pain. DATA SOURCES: MEDLINE, EMBASE, and the Cochrane Controlled Trials Register. STUDY SELECTION: Systematic reviews of randomized, controlled trials (RCTs) that were published since 1995 and that evaluated acupuncture, massage therapy, or spinal manipulation for nonspecific back pain and RCTs published since the reviews were conducted. DATA EXTRACTION: Two authors independently extracted data from the reviews (including number of RCTs, type of back pain, quality assessment, and conclusions) and original articles (including type of pain, comparison treatments, sample size, outcomes, follow-up intervals, loss to follow-up, and authors' conclusions). DATA SYNTHESIS: Because the quality of the 20 RCTs that evaluated acupuncture was generally poor, the effectiveness of acupuncture for treating acute or chronic back pain is unclear. The three RCTs that evaluated massage reported that this therapy is effective for subacute and chronic back pain. A meta-regression analysis of the results of 26 RCTs evaluating spinal manipulation for acute and chronic back pain reported that spinal manipulation was superior to sham therapies and therapies judged to have no evidence of a benefit but was not superior to effective conventional treatments. CONCLUSIONS: Initial studies have found massage to be effective for persistent back pain. Spinal manipulation has small clinical benefits that are equivalent to those of other commonly used therapies. The effectiveness of acupuncture remains unclear. All of these treatments seem to be relatively safe. Preliminary evidence suggests that massage, but not acupuncture or spinal manipulation, may reduce the costs of care after an initial course of therapy.



Spinal manipulative therapy for low back pain. A meta-analysis of effectiveness relative to other therapies.

Assendelft WJ, Morton SC, Yu EI, Suttorp MJ, Shekelle PG.

Dutch College of General Practitioners, Lomanlaan 103, Utrecth, the Netherlands.

BACKGROUND: Low back pain is a costly illness for which spinal manipulative therapy is commonly recommended. Previous systematic reviews and practice guidelines have reached discordant results on the effectiveness of this therapy for low back pain. PURPOSE: To resolve the discrepancies related to use of spinal manipulative therapy and to update previous estimates of effectiveness by comparing spinal manipulative therapy with other therapies and then incorporating data from recent high-quality randomized, controlled trials (RCTs) into the analysis. DATA SOURCES: MEDLINE, EMBASE, CINAHL, the Cochrane Controlled Trials Register, and previous systematic reviews. STUDY SELECTION: Randomized, controlled trials of patients with low back pain that evaluated spinal manipulative therapy with at least 1 day of follow-up and at least one clinically relevant outcome measure. DATA EXTRACTION: Two authors, who served as the reviewers for all stages of the meta-analysis, independently extracted data from unmasked articles. Comparison treatments were classified into the following seven categories: sham, conventional general practitioner care, analgesics, physical therapy, exercises, back school, or a collection of therapies judged to be ineffective or even harmful (traction, corset, bed rest, home care, topical gel, no treatment, diathermy, and minimal massage). DATA SYNTHESIS: Thirty-nine RCTs were identified. Meta-regression models were developed for acute or chronic pain and short-term and long-term pain and function. For patients with acute low back pain, spinal manipulative therapy was superior only to sham therapy (10-mm difference [95% CI, 2 to 17 mm] on a 100-mm visual analogue scale) or therapies judged to be ineffective or even harmful. Spinal manipulative therapy had no statistically or clinically significant advantage over general practitioner care, analgesics, physical therapy, exercises, or back school. Results for patients with chronic low back pain were similar. Radiation of pain, study quality, profession of manipulator, and use of manipulation alone or in combination with other therapies did not affect these results. CONCLUSIONS: There is no evidence that spinal manipulative therapy is superior to other standard treatments for patients with acute or chronic low back pain.






I suppose that if the chiropractor practices massage and PT as well, then the chiro might represent the best choice because he/she could offer numerous therapies that are effective. I know that some chiros do practice massage and some PT modalities.
However, I've heard some chiropractors state that spinal manipulation is clearly the most effective treatment for back pain and that chiropractic is more cost effective than PT. These studies would seem to refute those notions. The point seems to be that based on the available data, manipulation is of limited benefit no greater than that of several other safe therapies.
 
Originally posted by russellb
I think that these are the studies that you're referring to:

(sic)

I suppose that if the chiropractor practices massage and PT as well, then the chiro might represent the best choice because he/she could offer numerous therapies that are effective. I know that some chiros do practice massage and some PT modalities.
However, I've heard some chiropractors state that spinal manipulation is clearly the most effective treatment for back pain and that chiropractic is more cost effective than PT. These studies would seem to refute those notions. The point seems to be that based on the available data, manipulation is of limited benefit no greater than that of several other safe therapies.


Well, as you state, it's obvious that neither of these studies are resounding endorsements of chiropractic. And, these only touch on the treatment modality, excluding all of the other supposed treatment modalities (e.g., cancer, asthma, etc.), that chiropractors are supposed to be the experts at!

I would suspect that, if it was possible to somehow incorporate a double-blind into a study design, any positive result in favor of chiropractic methodology shown in current randomized trials over a "traditional" medicine approach, however slight, would be ultimately be nullified. That wouldn't mean there's no place for chiropractic, it would just mean that the treatments offered are in no way superior to standard medicine, an often bogus claim made by some chiropractors.
 
Originally posted by Skip Intro
Well, as you state, it's obvious that neither of these studies are resounding endorsements of chiropractic. And, these only touch on the treatment modality, excluding all of the other supposed treatment modalities (e.g., cancer, asthma, etc.), that chiropractors are supposed to be the experts at!

I would suspect that, if it was possible to somehow incorporate a double-blind into a study design, any positive result in favor of chiropractic methodology shown in current randomized trials over a "traditional" medicine approach, however slight, would be ultimately be nullified. That wouldn't mean there's no place for chiropractic, it would just mean that the treatments offered are in no way superior to standard medicine, an often bogus claim made by some chiropractors.

To the credit of the chiropractors participating in this thread, none are claiming to have any expertise outside of the Neuro/MSK realm and none of them view the 'chiropractic adjustment' in the manner that 'straight' chiros do.
I think that double blinding is impossibe in chiropractic trials because the practitionner will always know whether the treatment is real or not. Single blinding is possible if the patient lacks sufficient knowledge of chiropractic techniques to distinguish real from sham. I think that the controlled trials of chiropractic employ observers for the treatment in order to make sure that the practitionner behaves the same way for both sham and real treatments, thus controlling for placebo effects which may be related to the practitionner's demeanor.
Personally, I doubt that spinal manipulation will ever be found to have significant clinical benefit outside of the Neuro/MSK realm, but I'll be willing to change my opinion if rigorous studies eventually prove me wrong.

This is the American Chiropractic Association's take on the studies:

American Chiropractic Association: New Study is Further Support for Safe Alternatives to Drugs

ARLINGTON, VA -- A new study showing that spinal manipulation is just as effective as traditional medical care for treating back pain should come as welcome news to patients looking for safe, drug-free alternatives to medical treatment, according to the American Chiropractic Association (ACA).

The June 3 study in the Annals of Internal Medicine proves what the chiropractic profession has known for decades -- that spinal manipulation, or chiropractic adjustment, is an effective alternative to drugs and surgery for back pain, one of the most pervasive conditions afflicting Americans today.

"Our society has become more and more health-conscious in recent years. In keeping with that trend, people are making better food choices, exercising more, and beginning to question the number of potentially harmful drugs they might be taking," said Daryl D. Wills, DC, President of the American Chiropractic Association. "This study indicates to me that consumers can avoid taking drugs for back pain in favor of a safer form of care, without sacrificing any of the benefit. Nowhere does the study indicate that analgesics or any other treatment is more effective than chiropractic care."

Because of the increased attention back pain has attracted in recent years, medical doctors have been referring patients to doctors of chiropractic more than ever before. For years, doctors of chiropractic have advised their patients on prevention of back pain through exercise, proper ergonomics and other active solutions.

According to Dr. Wills, however, the study is not without limitations. "A problem with this study is its very narrow evaluation of the available research. For example, it does not mention the Canadian Manga Reports which found that chiropractic care is more effective, safer and less costly than medical care and that many medical treatments for low back pain are untested, questionable or harmful in nature. The study also failed to address the federal government's guidelines on low back problems which found that spinal manipulation was the only treatment that can relieve symptoms, increase function and hasten recovery."






A bit deceptive, I think. Dr. Willis mentions that only a narrow scope of the available research was used. He's correct----they included the high quality research and tried to exclude the garbage that would purportedly support his viewpoint. He mentions the Manga report, but neglects to mention why it was excluded----from what I've read, there are no health economists who agree with Manga's analysis (Manga P. Enhanced chiropractic coverage under OHIP as a means for reducing health care costs, attaining better health outcomes and achieving equitable access to health services. Report to the Ontario Ministry of Health, 1998. ) and most consider it a low-quality study. That's why it was excluded!
 
No, it's much easier than that. (There's too much focus on "sham this" and "sham that" in attempting to create a blind for the patient/practitioner, which I agree with you is technically impossible.)

You get a independent review panel of chiropractors to agree based on x-rays of spines of specific patients, based on their impression, of who should receive chiropractic therapy. When they all agree that a cohort of patients qualifies for chiropractic therapy, you simply randomly assign patients to either standard chiropractic care or traditional treatment.

When a defined treatment period is over, patient's spines are re-x-rayed and submitted to the independent panel in blinded fashion along with a clinical description of the patient's improvement (or lack thereof). A determination is made by the independent panel whether or not each invidual received either chiropractic or traditional therapy, based on the treatment outcomes.

It's just that simple. I would predict that, statistically, there would be no detectable difference between the chiropractically treated and standard treated groups.

-Skip
 
Originally posted by Skip Intro
No, it's much easier than that. (There's too much focus on "sham this" and "sham that" in attempting to create a blind for the patient/practitioner, which I agree with you is technically impossible.)

You get a independent review panel of chiropractors to agree based on x-rays of spines of specific patients, based on their impression, of who should receive chiropractic therapy. When they all agree that a cohort of patients qualifies for chiropractic therapy, you simply randomly assign patients to either standard chiropractic care or traditional treatment.

When a defined treatment period is over, patient's spines are re-x-rayed and submitted to the independent panel in blinded fashion along with a clinical description of the patient's improvement (or lack thereof). A determination is made by the independent panel whether or not each invidual received either chiropractic or traditional therapy, based on the treatment outcomes.

It's just that simple. I would predict that, statistically, there would be no detectable difference between the chiropractically treated and standard treated groups.

-Skip

There' a bit of a problem with this methodology, though. Placebo effects are not controlled for.
As well, I'm not sure how important the pre and post x-rays would be. Let both groups of practitionners use whatever means necessary to determine the need for treatment and establish a scientifically valid measure of clinical improvement from pre to post treatment (i.e. the patient saying "I feel better" would not constitute a valid measurement).
For example, from N Engl J Med. 1998 Oct 8;339(15):1013-20:

A comparison of active and simulated chiropractic manipulation as adjunctive treatment for childhood asthma.

Balon J, Aker PD, Crowther ER, Danielson C, Cox PG, O'Shaughnessy D, Walker C, Goldsmith CH, Duku E, Sears MR.

Division of Graduate Studies and Research, Canadian Memorial Chiropractic College, Toronto, ON, Canada.

BACKGROUND: Chiropractic spinal manipulation has been reported to be of benefit in nonmusculoskeletal conditions, including asthma. METHODS: We conducted a randomized, controlled trial of chiropractic spinal manipulation for children with mild or moderate asthma. After a three-week base-line evaluation period, 91 children who had continuing symptoms of asthma despite usual medical therapy were randomly assigned to receive either active or simulated chiropractic manipulation for four months. None had previously received chiropractic care. Each subject was treated by 1 of 11 participating chiropractors, selected by the family according to location. The primary outcome measure was the change from base line in the peak expiratory flow, measured in the morning, before the use of a bronchodilator, at two and four months. Except for the treating chiropractor and one investigator (who was not involved in assessing outcomes), all participants remained fully blinded to treatment assignment throughout the study. RESULTS: Eighty children (38 in the active-treatment group and 42 in the simulated-treatment group) had outcome data that could be evaluated. There were small increases (7 to 12 liters per minute) in peak expiratory flow in the morning and the evening in both treatment groups, with no significant differences between the groups in the degree of change from base line (morning peak expiratory flow, P=0.49 at two months and P=0.82 at four months). Symptoms of asthma and use of 3-agonists decreased and the quality of life increased in both groups, with no significant differences between the groups. There were no significant changes in spirometric measurements or airway responsiveness. CONCLUSIONS: In children with mild or moderate asthma, the addition of chiropractic spinal manipulation to usual medical care provided no benefit




Demonstrating radiographic change pre and post treatment is very much secondary to demonstrating a real clinical benefit.
 
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