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Chiropractors?
Posted: 11 August 2007 12:41 PM   [ Ignore ]
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A friend of a friend reccently got into a car accident and did something strange to her leg. She doesn’t know what yet, but either way, she’s going to see a chinese chiropractor because apparently it’s cheaper since she doesn’t have medical insurance.

I know that chiropractors are frowned upon by most scientists, but I don’t quite exactly know what a chiropractor is. What is their philosophy? What is it that they do?

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Posted: 11 August 2007 12:55 PM   [ Ignore ]   [ # 1 ]
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Here is the wikipedia summary of chiropractic, and HERE is the Quackwatch page on the subject. Essentially, the theory of traditional (straight) chiropractic is that eveyr malady people suffer is due to misallignemnts (subluxations) of verterbrae int he spine, and that chiropractors can identify and correct (adjust) these to prevent or cure disease. Straight chiropracters often deny germ theory and most other medical principles. There are others (mixers) who try to make chiropractic somewhat more legitimate but treating it as co-equal with mainstream medical practices and tossing out the underlying doctrine.

Most big research studies have shown it is about as effective as physical therapy or massage for lower back pain of unknown origin. The theoretical underpinnings have been repeatedly proven false. Multiple chiropractors evaluating the same patients find “lesions” in the spine essentially consistent with chance, and the same chiropractor evaluating the same patients sequentially also does no better than chance, essentially randomly assigning “subluxations” in the spine. What symptomatic value it has is probably placebo, though it is possible it has some other mechanism not yet discovered for relieving pain. In one large trial, 30% of patients with idiopathic back pain went to a chiropractor, 30% to a general MD, and 30% to an orthopod. Improvement was the same for all groups. Orthopods did more surgery, GPs gave out more drugs, and chiropractors saw pateints about 3x as often and charged more. But, people were happier with the treatment they recieved from chiropractors.

I suspect if you just need relief from back pain and if conventianal medicine can’t find a specific cause for the pain, then chiropractic is as good as a decent massage or swimming or anything else you can pick to do. But I think because chiropractors and patients tend to go beyond this and believe all sorts of ridiculous things about the method and its effects, it leads people to see alternative medicine in general as juts as legitimate as real medicine, and this leads people away from true diagnosis and treatment and towards all sorts of nonsense. So indirectly, chiropractic is responsible for suffering. It may also be responsible directly for suffering and injuries in some cases, though I’m not sure this is frequent enough among most kinds of chiropractors to be a big issue. Certainly, aggressive, fast manipulations especially of the neck have killed people, but many chiropractors avoid these now.

All-in-all, I think it’s mostly rubbish, but again for symptomatic relief of idiopathic back pain it seems safe enough.

[ Edited: 07 November 2007 11:11 AM by mckenzievmd ]
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Posted: 11 August 2007 02:45 PM   [ Ignore ]   [ # 2 ]
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As an aside, HERE is an essay by HL Mencken on Chiropractic, written in 1924. It’s hilarious, but also pretty nasty in the Mencken style ...

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Posted: 17 August 2007 02:17 PM   [ Ignore ]   [ # 3 ]
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mckenzievmd - 11 August 2007 12:55 PM

Most big research studies have shown it is about as effective as physical therapy or massage for lower back pain of unknown origin. The theoretical underpinnings have been repeatedly proven false.

Does it have truths for back pains of known origin?  For example I experienced extreme back/neck pains a couple days after moving furniture that was soo bad I didn’t want to move from a sitting possition and even then I felt like I couldn’t hold my head up with out a makeshift splint.  They explained how the muscle that connects to the part of my spine that was out of line is connected in a triangle to my shoulder & neck and that when I over exerted them they got tense on one side and pulled the spine out of alignment which caused the muscles to tense more.  They massaged specific muscles & then popped my spine in place.  This was my first chiropractor visist and I was skeptical going in from all the horror stories of it creating chronic problems.  I find it hard to believe that I could recieve the same swift relief & long term success from a regular doctor or swimming.  Maybe I’m delusional?

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Posted: 17 August 2007 09:34 PM   [ Ignore ]   [ # 4 ]
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Well, all I know is that the research (and the personal stories I’ve heard) all suggest that short-term symptomatic relief from chiropractic is real. The problem is that the theory they use, and the stories they tell clients, are absolute BS. I had a rabbite with a fracture in the lower back, and the chiropractor identified a “subluxation” in the neck. When I pointed out the neurological signs and how they localized the lesion (which is first year med school stuff), he said, and I quote “I’ve just thrown out all those books, because they don’t work.” So while I have no doubt you felt better, I do doubt that your spine was misalligned. You probably had microtears in muscle or connective tissue, which causes inflammation and pain. A good massage and some prescirption NSAIDs would probably have worked just as well. SO, as I said, I don’t object to the practice of chiropractic for such symptomatic relief, only to the marketing of a completley n onsensical system of causes and relationships about the body, and the claims beyond simple pain relief they make.

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Posted: 21 August 2007 10:12 AM   [ Ignore ]   [ # 5 ]
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Thanks for your expertise Brennen.  I’m sure these questions are easily bridged with empirical evidence and I would love to read the article on the study, if anyone finds one.  I know the pain in my case was enough to make me explore options I would not normally try.  I always prefer to understand visually, as much is possible, what is going on with various medical problems, but in my situation I was ready for instant gratification.

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Posted: 07 November 2007 10:58 AM   [ Ignore ]   [ # 6 ]
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I’m not a physician but I have had years of experience seeing a chiropractor. I had back problems from lifting weights, exercising, and playing sports. My muscles in my back hurt all the time, I went to see a local chiropractor, (actually he was another gym rat like me but he had a license for chiropractise). He immediately put me on a maintenance program where I would see him three times a week, every week, charging $250 a visit. (And my insurance didn’t blink an eye over the bills). Each visit was the same, massage, heat therapy, electro therapy, sometimes he would give me cortizone shots from a big ass needle, and once every two weeks he would take xrays. In the three years I seen him he also had me buying these expensive vitamins, probably an extra $100 per month. The funny story is he had me raise my arms to the side then he would push down with force on them, I wasn’t expecting this move so there was no resistance, my arms fell to my side, next, he put the vitamins in my hands then pushed down on my arms, which this time I was ready for and my arms barely budged. Then he said, “See you need these vitamins”. True story. Any way three years later my back was hurting just as much as when I first saw him. So I went to a MD.

First my MD sent me to a specialist because this was out of his realm. I saw the specailist who took xrays and in a very short time diagnosed I had spondilosis (I hope the spelling is right). He immediately stopped me from participating in some activities, gave me muscle relaxers, and sent me to a physical therapist.

I think this story shows the big difference between chiropractors and MD. The chiropractor had no consultations with another specialist, he constantly made claims he had no knowledge on (he thought he could cure any ailment through chiropractise and homeopathy), he was satisfied with milking the insurance company every week without showing any results. The MD consulted with other doctors about my condition, deemed it needed a specialist, and found the best help for me, the specialist took one xray, sent me to therapist, who gave me a plan to avoid injuring my back.

Now, years later, I can see it was a total waste of time and money. But at the time I thought chiropractors were real doctors.

I told this story to a coworker who has her entire family seeing a chiropractor. Her, her husband, and her nine year old son see a chiropractor twice a week. I mentioned to her that this guy maybe ripping you and your insurance company off because even as a laymen I can’t see a healthy child and two perfectly healthy adults benefiting from chiropracty. That day she stopped talking to me.

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Posted: 18 November 2007 11:56 AM   [ Ignore ]   [ # 7 ]
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It’s important to separate “chiropractic” from “spinal manipulation therapy”.
The former is system of education, evaluation, and treatment. The latter is a kind of manual therapy administered by many different professions: physical therapists, osteopaths, and chiropractors, for example.

Spinal manipulation therapy is very useful and effective, but only for a certain subgroup of people with mechanical spinal pain. Knowing when and how to use it is very important, and it’s only one tool of many.
As a doctor of physical therapy, I’m not a physician but I am a real doctor, and an expert in rehabilitation, muscular-skeletal injury, and the treatment of mechanical pain.

The best research on the use of spinal manipulation therapy has been designed, performed, and reported by Physical Therapists.
To see the best links to some of the best research articles about manipulative therapy, go to PubMed, and search for “spinal manipulation flynn” or “spinal manipulation childs” and see the depth and range of topics that come up.
From a research quality perspective, Physical Therapists and (to a lesser degree) Osteopathic physicians own manipulation.

You are better off seeing someone for a complaint that sees manipulation as I do: one tool of many that may or may not be appropriate in an individual case.

For more on chiropractic:
ChiroTalk Forum - a forum run by chiropractors that takes a skeptical look. Don’t take anyone’s word for it, go to the chiropractors themselves for a view on things.
Samuel Homola, DC is a chiropractor who has also written many intelligent articles about his profession as well.

So - there are some good chiropractors out there. But they are very hard to find, and in my opinion you are better off with a physical therapist - bigger toolbox and they have a more balanced view of what can help - and they are skilled in many methods other than manipulation, as well as that.

Look for a physical therapist who has their board certification in Orthopedic therapy (designated “OCS”) and/or who has their Doctor of Physical Therapy (designated “DPT”) degree.

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Posted: 26 November 2007 06:41 PM   [ Ignore ]   [ # 8 ]
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Avoid Chiropractors.  I have never met one who isn’t a promoter of subluxation theory or some other kind of pseudoscience.  They are also anti-medicine, and against vaccination.  They’re quacks.  This is the general consensus view among skeptics. 

Here’s a list of sources that you should check out in regards to Chiropractic:

1. Chiropractic: Flagship of the Alternative Medicine fleet Part I and Part II by Steven Novella, MD and host of The Skeptics’ Guide to the Universe podcast
2. Chiropractic: A Skeptical Overview by William T. Jarvis.  Originally published in Skeptical Inquirer magazine
3. Also, watch the segment of the PBS documentary “A Different way to heal?” which covers Chiropractic.  Go down to “Adjusting the Joints” and make sure the clip is set to “drop that shoulder”
4. Also, listen to the episodes of the Quackcast which deal with Chiropractic. 

History and Theory of Chiropractic
Evidence and Efficacy of Chiropractic

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Posted: 12 February 2008 06:43 PM   [ Ignore ]   [ # 9 ]
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well i know this post is old, but i thought maybe i could give my tentative two cents and maybe get some feedback…

in general, i am a total skeptic when it comes to alt-med. when i was 16 i was dating someone whose mother was anti-pharmaceuticals and very pro-alt-med. i read up a little and decided to try and take something for my severe asthma… about 15 minutes after i took this miracle tincture, i had an asthma attack.

while i kept trying off and on, and i have discovered now at age 30 that distilled aloe vera juice is really helpful for my GERD (and doesn’t taste gross), in general i swear off the alt-med approaches to medicine.

a couple years ago at the urging of a total believer, i saw her chiropractor. the coworker who recommended it was totally anti-modern medicine, one of those people who thinks vaccines will kill you, that pharmaceuticals are made only to make us sicker, our bodies are overrun with yeast and that’s why obesity is so prevalent, she took all those chiro-supplements, etc, etc, etc. the BS goes on and on. however, i was having severe pain in my hips and numbness and tingling in my legs and no doctors would take me seriously.

the chiropractor was pretty decent. the one thing that rubs me the wrong way is that they’re always so christian and godly. i’m all for freedom of religion, but it gives me the willies when it’s in the waiting room with me. anyhow, my fiance noticed that i was walking easier and i was feeling a little better, but a few months later i changed jobs, moved, and lost my insurance, and just couldn’t afford to go any more.

also, this chiropractor said that his practice is a specific type of chiropractic medicine, called gonstead. (there’s more info at gonsteadseminar.com, but like most alt-med practicies, there aren’t very specific details, which is bothersome.) a month or so ago i broke down again because the pain and numbness is just unbearable most days (and again still no help with the two doctors i’d been able to afford to see before losing my insurance again) and found a gonstead-trained chiropractor not too far away. he made me a very reasonable payment arrangement because i am uninsured and a student right now, but waited a few weeks before suggesting i do it, because he wanted to get a feel for how i’d respond to what he was doing.

i saw my xrays, and even without him pointing out this or that or measuring with a ruler or whatever, i could see my spine wasn’t what it was supposed to be. i know my anatomy, and i know my spine is misaligned. in addition, we could both see osteoarthritis (again, i’m 30) and he thought he could help.

so i’ve been going three times a week since the beginning of the year or so, and i’m feeling better. for the first time since i met my fiance, he got tired of walking around an art show before i did this weekend. not only that, but a couple weeks ago, he said i’ve stopped snoring. (i’ve snored like crazy since i was a young kid.) i complain of fewer headaches and my asthma requires less “rescue inhaler” treatment.

i’m paranoid that this is a placebo effect… but the snoring! i have no control over snoring, and i honestly don’t much care if i snore or not. the fiance sleeps like the dead and it doesnt bother *me* any… but yet, i’ve stopped entirely. i have to think there’s something to this.

i’ve read quackwatch.com and it seems like what my chiropractor does is not the same as what the quacks do… and he never pushes those BS supplements. while i am not pain free by any means, my life has improved. and i suppose that’s all that matters, but i’m still confused, since i’m all anti-alt med and whatnot.

i think more research needs to be done about chiropractic medicine. real chiropractic medicine i guess, not those odd instruments or supplements or “subluxations” or whatever. but real true unbiased research. i haven’t been able to find any, and i really think it needs to be done.

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Posted: 12 February 2008 07:24 PM   [ Ignore ]   [ # 10 ]
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ghost,
As many cents as you want to contribute are welcome. The difficulty is, as you clearly understand, that individual case reports (aka anecdote) just isn’t reliable for deciding whether a therapy works even for that particular patient, much less in general. There’s a great book Snake Oil Science by R. Barker Bausell (which isn’t as inflammatory in its tone as the title suggests) which explains in great detail why. Placebo is certainly a consideration in your case, and the relief can be quite real even if the therapy isn’t. Impossible to account for that with just one person. Another consideration is something called “regression to the mean.” People seek therapy (alternative and conventional) when their symptoms are at their worst, and since most chronic diseases wax and wane over time, they inevitably feel better after treatment just because of the natural progression of the disease. If we kept strict records of pain, such as recording and VAS (visual analog score of pain), for example, we might see some trends like this. That is why treatments, especially CAM treatments, always seem to help at first and then less so over time.

Anyway, it’s nearly impossible to ignore one’s own experiences regardless of what reason says, and apart from some very dramatic neck manipulation, chiropractic isn’t especially harmful as long as it doesn’t bias you against real medicine, as in the case of the co-worker who recommended you seek it. So I wouldn’t necessarily say you shouldn’t keep doing it. I’m 100% sure the subluxation theory is nonsense, and the research on that is out there and ironclad. Chiropratcors are never internally consistent or consistent between them on where a subluxation is or which patients have one and which don’t.  I’m also fairly sure that chiropractic works largely by placebo and other confounding factors, though it is very difficult to do reliable research on this for many reasons (hard to find a convincing sham chripractic as placebo, subjects tend to join the trial because they are already sympathetic to the idea it might help and tend to drop out if it doesn’t help, skewing the final results, it is impossible to blind the practitioner to the treatment or placebo category for each patient, the measure of outcome is subjective, etc). So I think you’d do just as well with a good massage, but I appreciate why it’s hard to ignore feeling better and wonder if it means more than, I think it really does. Good luck to you, anyway!

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Posted: 28 February 2008 07:21 PM   [ Ignore ]   [ # 11 ]
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kinda disagree with some of what has been said about chiropractors here, i think the problem here is that it is a genuine field of study that is populated mostly by charlatans. have been a baker for decade or so, and kneading dough wreaks havoc on my back. when someone suggested chiropractic i decided to try it and completely ignored all those that offered “cures”, instead finding one that focused on enhancing performance. in addition to being a licensed chiropractor he was M.D. (sports medicine) and former head of sports medicine for U.S. national ski team among other achievements. impeccable credentials. imagine my delight when he explained that he could do nothing more than relieve my symptoms! for me the symptoms are the disease. if all you need is an aid to help with sports or whatever chiropractic might be beneficial, although no substitute for medicine. i think it’s yet another case of people not being aware of what they require in their particular circumstance, and not being able to separate the experts from the sophists even if they did.

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Posted: 28 February 2008 09:53 PM   [ Ignore ]   [ # 12 ]
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Well, essentially you’re right in that chiropractic clearly offers only symptomatic relief, not treatment of underlying disease. The problem, I think, is that it is largely through the placebo effect since we cannot establish and diagnostic or therapeutic between or within chiropractors on where the “lesion” is in a given patient or what precise manipulation is likley to be beneficial, nor can we identify any physiological mechanism or effects. It’s fair to say that, of course, there’s a lot we don’t know,  so such effects might exist, but a great deal of research has failed to turn them up yet.

If you ask 10 chiropractors to look at the same 5 patients, each of them at several different times, there is no correlation between them in what the identify as the problem (the “subluxation” or whatever other temrinology they prefer) and where it’s located, nor is there such a correlation even within the same chiropractor on subsequent examinations of the same patient. Sounds like a lot of nothing dressed up in a such a way as to generate a great placebo response. Not necessarily a bad thing in itself, but hard for most people to see it that way and a slippery slope to head down, away from evidence-based medicine.

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Posted: 29 February 2008 07:33 AM   [ Ignore ]   [ # 13 ]
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So long as chiropractors stick to doing what amounts to deep massage, I have no particular issue with it. But the root philosophy of the practice is that all human disease is due to a misalignment of the spine. My understanding is that any given chiropractor may be somewhere along a continuum between believing all of that nonsense and believing very little of it.

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Posted: 10 March 2008 02:01 PM   [ Ignore ]   [ # 14 ]
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I’m not sure about the basic theory, but I do think that spinal and joint manipulation definitely plays a role in pain relief and improving physical performance in certain situations, beyond the placebo effect.

For example, it’s very easy to see that increased range of motion can occur after an adjustment. I’ve had personal experience of this and have also observed enough that I’m pretty confident that it’s actually a good thing when a chiropractor forces a shoulder back into it’s correct position (when it’s appropriate to do so).

[ Edited: 10 March 2008 07:09 PM by Kaizen ]
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Posted: 10 March 2008 08:45 PM   [ Ignore ]   [ # 15 ]
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Well, the question is does a chiropractor put something back into position that has come out of position. There is no evidence that this happens. Radiograps and other imaging don’t show the “subluxations” chiropractors talk about, they cannot reliable and repeataly locate them, and the most likely conclusion is they don’t exist.

Now, this is different from saying do you feel less pain or more mobility after an adjustment. You very well might, for a variety of reasons, some psychological, some involving local changes in blood flow, endogenous opiate release, etc. A Doug points out, people feel more relaxed and more limber after a good massage too. Doesn’t mean the massage therapist “fixed” anything that was “wrong,” just that having someone rub your joints and muscles feels good. I’ve got no complaints about that, so long as chiropractors don’t keep pushing this idea, that the evidence is firmly against, that they are identifying and treating something abnormal or pathological.

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