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Re: Fun with Chiropractors on Chiroweb
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Re: Fun with Chiropractors on Chiroweb - January 19, 2003 8:51:00 AM
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Andrew M. Ball PT PhD
Posts: 855
Joined: July 28, 2002
From: Charlotte, NC
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Function, Function, Function,
You're missing the point, this is not an issue of skill. The PT either simply wasn't skilled (or given the fact that, surprisingly, most ergo research does not pan out in terms of injury reduction), unlucky.
That doesn't mean that it's a chiropractor's place, with limited training in that area, to assume the role --- despite what in your case appears to be more lucky outcomes. If that's your perspective, I that's fine and you're entitled to it --- but I expect for you to, in kind, attack your colleages who think that they own manipulative medicine.
Your profession needs to pick a philosophy and stick with it. If you think that chiropractors have right to turf raid other professions, then they've no right to cry to legislators when PT's, DO's, or MD's perform manipulations. It's high-time that these chiropractic double standards be confronted and terminated. I'm willing to support chiropractors in whatever choice they make --- but continued failure to make such a choice, and then cry out that THEY are being turf-raided can no longer be tolerated.
So, my friend, make your choice and take the responsiblity of solidifying the viewpoint among all chiropractors --- and don't blame me for pointing out the injustice of double-standard that your profession created in the first place.
Drew
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Re: Fun with Chiropractors on Chiroweb - January 19, 2003 10:28:00 AM
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function
Posts: 29
Joined: October 5, 2002
Status: offline
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Dr. Ball,
How do you come to the conclusion that I was just lucky and the PT was unlucky? What evidence do you have to back that up? None, because you know absolutely nothing about my particular situation. You analysis just goes to show your extreme bias.
If a chiropractor is successful, then it is luck. If a PT is not successful then he/she is unlucky. Please explain then why Pepsi utilizes my services in rehab over the PT at their own occupational medicine center. Is it because I am always lucky and the PT they used to use was always unlucky? The company doesn't care what professional provides the care, they just want results and I guess that I provide better results than the PT they were using. I know that must bug the hell out of you trying to find a way to fit that in your little world.
Please explain the classes that are required in PT school that makes ergonomics the domain of PT and/or OT? There aren't any. The idea that ergonomics is the domain of PT/OT is a fantasy in your brain and would make the researchers at the ergonomics department at the University of Michigan shake their head in digust. By the way, I mention U of M because they have one of the top flight ergonomic centers in the world...and not a PT among them, nor a DC for that matter either and it makes no difference to them who they train anyway.
And to end with.....I use the handle "Function" because that is how I practice. Functionally based! Are you going to report me to the state PT board because I use the handle "Function", because it is a PT word and Chiropractors have no right to steal that word from the physical therapy profession.
I hope all you PTs out there are proud to have Dr. Ball as your spokesman. He now is going to the extreme as to suggest that a chiropractor should not use the handle "Function". Can I say Fascist? With the amount of bias in you Dr. Ball, I would never trust any research that you do and can understand why the chiropractic researchers shined you on....
I do have one compliment for you however...you were able to get through a whole post withour stating "as a clinician and Ph.D. in healthcare management..." Good Job....
and please answer the questions I posed in this post...don't just go on a rant, we know what you think of chiropractic. I would like to see you answer these two questions...
How do you come to the conclusion that I was lucky and the PT was unlucky?
Please explain the classes that make ergonomics the domain of PT and OT?
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Re: Fun with Chiropractors on Chiroweb - January 19, 2003 12:54:00 PM
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NYDC67
Posts: 49
Joined: December 19, 2002
Status: offline
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"It's chiropractors who are living in paranoid fear --- so much in fact that they are unwilling to participate in an objectively constructed study. I've got several ideas for such research, and if you know of any DC, Ph.D. up to the task --- have 'em step up to the plate --- you know where to find me.
If chiropractic wants to make such grand claims, they need to put up or shut up."
Drew,
The research is there. Your just not happy with the outcomes. You can start your own research without the help of DC's. Aren't there PT's, MD's, and DO's that use manipulation regularly? Why don't y'all grab your buddies and do it already. You don't need our help!
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Re: Fun with Chiropractors on Chiroweb - January 19, 2003 3:27:00 PM
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swoodard23
Posts: 36
Joined: March 18, 2002
From: Abilene
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It has been done and then chiro takes credit for it even though it was not their techniques used.
Search under chiroweb for "Manual Therapy favored over PT and GP"
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Re: Fun with Chiropractors on Chiroweb - January 19, 2003 5:07:00 PM
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Andrew M. Ball PT PhD
Posts: 855
Joined: July 28, 2002
From: Charlotte, NC
Status: offline
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Function,
A word of advice --- NEVER call a religous jew a fascist. That crosses the line. Feel free to disagree. Feel free to do so in a lively and colorful manner, but keep it professional or I'll request you banned from RehabEdge. Besides, why ya'll contine to request research, thinking I've no literature "ammo" is beyond me.
You want to dance? Okay, let's dance . . .
There is conflicting evidence on the subject of ergonomic training being an effective tool in the prevention of injury --- much less demonstration of ergonomic training being cost effective. Furthermore, studies that ergonomic practitioners typically point to as “proof” are typically not truly ergonomic in the first place. Larsen, et al, 2000 is a good example. All subjects in the intervention group did have one 40-minute theoretical lesson on back problems and ergonomics; and had to perform passive prone extensions of the back daily during the rest of their military duty. The researchers conveniently failed to determine an interaction effect between their two interventions (e.g. ergonomic training vs. mandating periodic passive back extensions). As such, I choose to believe that the effects (which were significant) had more to do with the extension exercises than the ergonomic training and workstation modification.
An additional, so called positive study on ergonomics, by Shinn et al. Concluded that, “Ergonomic education is one way to help students to reduce their risks of developing musculoskeletal injury in a classroom environment that impedes correct positioning,” yet that study merely tested whether or not children would improve their pre-test and post-test scores on an ergonomic quiz following ergonomic training --- not whether or not injuries were decreased. The title “The effectiveness of ergonomic intervention in the classroom,” is therefore a bit of a misnomer, but conducted by occupational therapists, so I can’t very well hold that against chiropractors. Williams and Jacobs did the same thing, testing if parents and students increased their knowledge of ergonomic theory after ergonomic training and titled their study, “The effectiveness of a home-based ergonomics intervention on the proper use of computers by middle school children,” when they were in fact testing the training program --- not the effectiveness of ergonomics. The list of these kinds of studies goes on, and on, and on.
Getting back to that does the savings in injuries justify the cost of an ergonomics programs question, May reported that the OSHA local ergonomics program (LEP) decreased the CTS worker’s compensation claims of the participating employers from 17% of New Hampshire CTS claims in 1997 to less than 5%. Those selling ergonomic programs proudly proclaim this as justification for their work. What they leave out (or don’t know) is that while the incidence among participating employers fell from 38/10,000 in 1992 to 3.8/10,000 in 1997 --- that those employers who did not participate in the LEP had a drop in CTS claims as well, from 6.6/10,000 to 3.4/10,000. Given the small numbers that we’re talking about, it must be asked if an ergonomics program is justified by the cost. Furthermore, although a 90% decrease in injury rates is impressive, when we’re talking about 38 people per 10,000 --- and the fact that those who didn’t participate enjoyed a 50% decrease in CTS injuries anyhow --- your testimonial of your experience with 20 people doesn’t seem all that impressive.
Pulling more wind from your sails is this next study. Assuming, for a moment, that ergonomic training and workspace modification does in fact prevent injury, the Berner and Jacobs study suggests that because of the huge gap between initial ergonomic training and implementation of those recommendations, (60% of respondents had exposure to computer workstation ergonomics information, but less than 10% reported implementing their knowledge of computer workstation ergonomics in their tasks), odds are that a major effect that you’ve no control over, but are taking credit for, is the fact that an additional bout of ergonomic training increased compliance and, perhaps, decreased injury as a result. That doesn’t make you more effective than the PT, just lucky enough to have been second. Furthermore, the showmanship of most chiropractors surpasses that of most PT’s --- as such, your results may also have been a function of not the communication of the information, but how it was received and utilized after the PT “loosened the top” so to speak, on the jar that you later opened. Lucky.
That’s not to say that ergonomic programs don’t work, only that chiropractors, true to character, seem to exaggerate effectiveness or value of the intervention. One positive study on ergonomic intervention may be the McSweeny, et al. study. This is a journal that my online library doesn’t have, so I’m not able to review it beyond the abstract, but there appears to be a genuine study of how an ergonomic program can be both cost-effective and prevent injury.
The most damming study for your chiropractic ergonomic practice (or any preventative ergonomic program for that matter, is the Litnton and Tulder study published in Spine. Interestingly, I can’t recall a chiropractor ever being published in this upper tier peer-reviewed journal. Isn’t spinal care what ya’ll claim to be experts in??? Anyway, the study is a good one-stop-shopping for you if you choose to review but one article. It’s a literature review on use of ergonomic intervention to preventprevent back and neck pain problems as well as what the evidence is for their utility. The literature was “systematically searched to locate all investigations that were: 1) specifically designed as a preventive intervention; 2) randomized or nonrandomized controlled trials; and, 3) using subjects not seeking treatment. Outcome was evaluated on the key variables of reported pain, report of injury, dysfunction, time off work, health-care utilization, and cost.” Of the 27 studies meeting peer-review criteria, several clear themes emerged. 1) There was strong evidence that back schools are not effective in prevention. 2) There is strong evidence that lumbar rolls are not effective in prevention. 3) As this study was published before the McSweeny study it’s not surprising that they found NO PROPERLY CONTROLLED TRIALS FOR ERGONOMIC INTERVENTIONS OR RISK FACTOR MODIFICATION. 4) The hallmark of physical therapy --- Therapeutic Exercise, showed stable positive results in randomized controlled trials, giving consistent evidence of relatively moderate utility in prevention. As therapeutic exercise is the clear domain of physical therapists, not chiropractors, I submit that chiropractors have less business in ergonomics than physical therapists.
Given these realities, I reiterate that your results were luck of being second, and/or your salesmanship/marketing skill. I’m not really interested in going another round with this, but I am expecting for you to back up your claims of effectiveness with some research, instead of your testimonial of decreasing injuries in two sites of 20 people.
Oh yeah, according to the 2001 article in SPINE there are no RCT's showing the effectiveness of prevenative ergonomics. Are you and NYDC misprepresenting case studies and testimonials to potential clients, or did a slew of evidence come out in 2002 that I'm not aware --- much less "not liking the results of?" Don't try to charge me fascist and biased when it's clear that you either have no idea what you're talking about, or are flat out lying.
Objectively,
Dr. Andrew M. Ball
REFERENCES:
Berner K, Jacobs K. The gap between exposure and implementation of computer workstation ergonomics in the workplace. Work 2002;19(2):193-9
Larsen K, Weidick F, Leboeuf-Yde C. Can passive prone extensions of the back prevent back problems?: a randomized, controlled intervention trial of 314 military conscripts. Spine 2002 Dec 15;27(24):2747-52
Linton SJ, van Tulder MW. Preventive interventions for back and neck pain problems: what is the evidence? Spine 2001 Apr 1;26(7):778-87
May DC. Results of an OSHA ergonomic intervention program in New Hampshire. Appl Occup Environ Hyg 2002 Nov;17(11):768-73
McSweeney KP, Craig BN, Congleton JJ, Miller D. Ergonomic program effectiveness: ergonomic and medical intervention. Int J Occup Saf Ergon 2002;8(4):433-49
Shinn J, Romaine KA, Casimano T, Jacobs K. The effectiveness of ergonomic intervention in the classroom. Work 2002;18(1):67-73
Williams CD, Jacobs K. The effectiveness of a home-based ergonomics intervention on the proper use of computers by middle school children. Work 2002;18(3):261-8
[This message has been edited by Andrew M. Ball PT PhD (edited January 19, 2003).]
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Re: Fun with Chiropractors on Chiroweb - January 19, 2003 5:55:00 PM
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function
Posts: 29
Joined: October 5, 2002
Status: offline
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Dr. Ball,
When you question the right of a person to use a certain word I will call you a fascist. And I will stand behind that especially since you then threaten to have me banned. As far as I know this is still America. And please don't hide behind the professional banner, you gave that up a long time ago.
You admit that there is conflicting evidence regarding ergonomic training, yet only present that which supports your argument. You sir are more politician than clinician.
As a researcher, you of all people should know the danger in making assumptions. You assume that the PT in my post conveyed the proper ergonomic information during his training. You do not even stop to ask questions regarding this specific case, you just race to find some studies to back up your position.
You also fail to even attempt to answer the second question I posed.
Your logic is so flawed that you cancel yourself out....on one hand you state ergonomics is the "domain of PT and OT and chiropractors steal it"...and on the other hand you say that ergonmic training is not effective.
If ergonomic training is proven to be ineffective, why are you so adamant about it being the domain of PT and OT? Wouldn't the professions disgard something so ineffective.
Your absolute suicidal logic has tied you up again. You have forcefully demanded ownership of what you have just as forcefully ****ed as flawed....don't you see the ridiculous stance you have just taken...
To end with, I will give you another chance to answer my second question. Please explain how ergonomics is the domain of PT and OT?...and please use research to back up your answer...
[This message has been edited by David Adamczyk (edited January 25, 2003).]
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Re: Fun with Chiropractors on Chiroweb - January 19, 2003 5:59:00 PM
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function
Posts: 29
Joined: October 5, 2002
Status: offline
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for the censured out word in the 2nd to last paragraph...place the word condemned...I didn't know that the word I used would be censured... FYI...it wasn't a real bad word
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Re: Fun with Chiropractors on Chiroweb - January 19, 2003 6:08:00 PM
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coloradojulie
Posts: 413
Joined: November 10, 2002
From: colorado usa
Status: offline
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WOO HOO! This ones rocking!!
To defend myself a little...my paultry reply...in the beginning of my first reply I did state that just like in any profession their are good and bad...so alas...function (I think) I did add my own grain of salt.
I also had the opportunity to share an office with a chiro for 2 years...and found he would ask me to show him some exercises for a particular problem and then not two minutes later I would hear him teaching them to his client...instead of referring to PT. He came back once from a weekend "rehab" class...all set to perscribe exercise to one and all, feeling that was sufficient training. I like the guy fine...he is a much better business man than I...and that was a focus! I saw one of his clients...finally after he manipulated him for 7 months, and in the first 3 minutes told him he had one possibly two herniated lumbar discs and he needed an MRI...he got one...and alas had two levels gone...
So their are two sketchy experiences...I think DCs do have some egotistical based knowledge that stops them from seeing their own limitations...often to the detriment of the patient. I had another chiro give a woman with back pain hamstring stretchs...because everyone knows when you have back pain you need to stretch the hamstrings, despite the fact that in SLR exam I could put her ankle beside her ear...
I don't crack backs without training...Exercise is more than lifting weights and stretching the chest...how many chiros give a corner or doorway chest stretch to patients with anterior shoulder laxity? That is a stupid stretch to begin with!!
ALas...we are all biased to some extent, however I have to admire Dr. Ball for being on the ball...pun intended. HOw many of us can come up with literature impromtu to support our opinion! We can only vaguely recall things we read without reference...I applaud that!
I agree that we both lash out at each other for taking turf rights...but a weekend rehab course doesn't compare to the rigourous training PTs must undergo to become manipulative therapists...
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Re: Fun with Chiropractors on Chiroweb - January 19, 2003 6:29:00 PM
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Andrew M. Ball PT PhD
Posts: 855
Joined: July 28, 2002
From: Charlotte, NC
Status: offline
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Function,
I think I've stated my position quite clearly and have no further interest in continuing. If others wish to, so be it.
I find it comical that you suggest that I should do your own research of the literature for you. I'm a pediatric therapist, not an ergonomist, and here I'm the one presenting the literature. I did, by the way, try to offer a balanced response and did in fact point out the McSweeny study --- the only RCT, to my knowledge, on the subject. All other positive research on the subject of preventative ergonomics is testimonial and case study. As chiropractors usually don't have a clue as to the Sackett levels of evidence, rather proclaiming "pro-chiropractic good, anti-chiropractic bad", I don't expect for you to be within the handful of chiropractors who can actually tell the difference between the two. That's not an insult, just playing the odds.
I didn't present any pro-ergonomic RCT's beyond the McSweeny study (and I don't know how good that one is, not having seen it), because to my knowledge, no others exist. You're the self-proclaimed ergonomics expert here, put up or shut up.
I answered your second question quite plainly --- physical therapists, not chiropractors, are the neuromusculoskeltal provider of choice for rehabilitation and therapeutic exercise. Julie explains why quite nicely. Being that's the only demonstrated preventative intervention shown to decrease low-back injury on the job --- no one, not chiropractor nor physical therapist, has any business doing anything else --- unless of course you're a skilled salesman performing healthcare entertainment --- which brings me back to my original point.
I don't know how I can make it any clearer. I can't help it if you don't like what you're hearing, and I'm not interested in continuing with your unprofessional personal attacks.
Drew
[This message has been edited by Andrew M. Ball PT PhD (edited January 19, 2003).]
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Re: Fun with Chiropractors on Chiroweb - January 20, 2003 2:25:00 AM
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Sebastian Asselbergs
Posts: 1205
Joined: September 29, 1999
From: Barrie, Canada
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Wow! This is a toasty debate!
It may be of interest to know that on the Chiroweb site lively discussions take place between students, experienced DCs and ex-Dcs - especially one who went from practising chiro to MD. A lot of eye-opening discussion! It shows that there are a few chiros who share Dr. Ball's concerns for the weaknesses in their profession. For those opposed to Dr. Ball's opinions here, let me tell you that he has been equally critical of some of PT's shortcomings, and challenged us (PTs) as well. I have some trouble with your style, choice of words and rather nose-in-the-air attitude, Dr. Ball, but that does not take away from the validity of your points. It has been my experience that there are "bad" PTs and "bad" chiros out there - the issue is not the individual professional, it is the basis of the education and the philosophy of the chiropractic profession that is under fire here.
Sebastian
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Re: Fun with Chiropractors on Chiroweb - January 20, 2003 2:44:00 AM
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NYDC67
Posts: 49
Joined: December 19, 2002
Status: offline
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Drew,
It seems as if you're also doing a great job of "healthcare entertainment." When you treat children, do you wear barney or elmo costumes? I think you should.
You really haven't answered function's question or mine. As I said before, you don't need chiros help to research the benefits of PT over chiro. I don't blame chiros for not wanting to help you. You can find plenty of PT's, DO's, etc. who manipulate that can help.
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Re: Fun with Chiropractors on Chiroweb - January 20, 2003 4:35:00 AM
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Andrew M. Ball PT PhD
Posts: 855
Joined: July 28, 2002
From: Charlotte, NC
Status: offline
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NYDC,
Do you have any idea what pediatric physical therapy is all about? Sure doesn't sound like it. If you'd like to know, just ask, I'd be happy to explain what it is that we do.
As for your question, and I think I've said this quite plainly as well, the problem with chiropractors doing research that compares chiropractic to any other profession is that they narrowly define the scope of the other's profession, and then run their study either having DC's perform what they think to be the procedures of the other profession, or rather tease out a specific procedure for the other professional and compare it to whatever the hell the DC wants to do. It's either professional ignorance, the knowledge that DC's and PT's (for example) can't get along for an objective purpose, or a biased intent to stack the deck.
Recognizing that limitation, it is imperative that in order to be objective, that chiropractors participate in adminitering chiropractic techniques and procedures --- otherwise, I'd be guilty of the same biasing and deck-stacking that I'm accusing chiropractic researchers of. I can't have PT's or DO's doing manipulations only to have DC's scream that it's not the same thing as a specific adjustment. I'm not going to give anyone reason to dismiss a peer-reviewed publication of mine.
Furthermore, because the results may not end up pro-chiropractic (they surely may, but I can't predict that), it wouldn't end up in JMPT if it were not pro-chiropractic, and because it had so many design flaws, it wouldn't end up anywhere else regarless of outcomes, due to the same biased study design that I accuse most of the pro-chiropractic studies.
I'd like to produce a study that is clear and objective, not produce one that's essentially professional masterbation. As no one else other than those within the profession would read it, and as most outside the profession would see it for the poor study that it would be, what's the point in a study under your design other than to ego inflate one's profession?
What training in research do you actually have?
Drew
[This message has been edited by Andrew M. Ball PT PhD (edited January 20, 2003).]
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Re: Fun with Chiropractors on Chiroweb - January 20, 2003 4:44:00 AM
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function
Posts: 29
Joined: October 5, 2002
Status: offline
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As in past instances, trying to get Dr. Ball to answer questions is a waste of time. He uses circular logic that leads nowhere and loves to put words into the mouths of those on this board. I never stated I was an expert in ergonomics, so please don't state that. I merely questioned the idea that ergonomics is the domain of PT and OT. Once you come across something you can't answer you quit. From past experience, I knew going into this that it was probably worthless, but I couldn't just sit idly by and watch you insult a whole profession on your opinion.
The world according to Dr. Ball
PT OWNS(chiropractors should never do):
-rehab
-ergonomic training/advice
-therapeutic exercise
-gait training
Chiropractors can do, but don't own:
-Manipulation
Chiropractors own:
-Healthcare entertainment
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Re: Fun with Chiropractors on Chiroweb - January 20, 2003 4:49:00 AM
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function
Posts: 29
Joined: October 5, 2002
Status: offline
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Shoot...how could I forget the most important thing in the world according to Dr. Ball
PT owns and chiropractors should never use the handle "function"...any chiropractor using this handle is obviously post PT without a license and should be reported immediately.
come to think of it...there are plenty of other words we shouldn't use:
-exercise
-gait
-modalities
-ergonomic
-nutrition
-functional
....hmmm, I know that there are others..perhaps Dr. Ball could write his list down. I am sure he has it handy for the day he rules the world....
...sometimes to expose the absurd, one must be absurd...
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Re: Fun with Chiropractors on Chiroweb - January 20, 2003 4:57:00 AM
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Andrew M. Ball PT PhD
Posts: 855
Joined: July 28, 2002
From: Charlotte, NC
Status: offline
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Function,
That's not at all absurd, with a few exceptions, you're right on the money. What's absurd is that someone told you a long time ago that this is and always was chiropractic practice, and that you have a right to practice physical therapy as long as you call it something else.
I've answered every question you've asked only to have you dodge every one that I've posted. "Hello Function, yeah, this is kettle. You're black." That's been my experience with most chiropractors though, can't answer a simple question and then charge he who is asking the questions with being unreasonable and engaging in a circular argument. Just because it's not coming around to a pro-chiropractic stance does not mean that my position has been circular nor evasive.
I've answered both of your questions, and one multiple times. Either you're not reading, not processing, or engaging in a feeble debate tactic to try to divert members of this board from the truth that while I've answered every one of your questions, you've failed to answer any of mine.
Yes. PT's own rehab and DC's have no business there, they own therapeutic exercise, and they certainly own gait training and DC's CERTAINLY have no business whatsoever doing gait training. The crime is that your professors told you that this is and always was chiropractic, you bought it --- and there wasn't anyone there to call them on the lie. You're just upset at being confronted with the idea that not everyone agrees with the brainwashing that you received in chiropractic school.
DC's doing this are practicing without adequate training, supervision by, or licensing as a physical therapist. Yes, that's right, I said it. Chiropractors are not physicians nor are they licensed as physical therapist assistants. If they want to go and peform physical therapy procedures beyond modalities, it it my interpretation that chiropractors are physical therapy aides under most state laws, and should have on-site supervision of a licensed physical therapist. Frankly, I believe that to be fair, the reverse should also go for PT's wanting to do manipulation.
I don't think anyone should try to own preventative ergonomics as a valid clinical procedure --- it's not been shown to be effective other than the therapeutic exercise piece, which a DC is while boarding upon chiropractic practice, still out of scope of expertise. Anything beyond that, by PT or DC, is health entertainment.
I believe that chiropractors should own manipulation, and I get a lot of heat from my own colleagues for that position --- but if DC's like yourself continue to turf-raid on the above physical therapy techniques and procedures --- manipulation is fair game.
The only physical therapy procedure that a DC could and has a right to use is modalities, but ability to use passive modalities in no way gives DC's the right to expand beyond their license and training.
Drew
So, I'll give you one more time, what research do you have on preventative ergonomics that shows a positive effect --- without expanding into physical therapy practice by administering therapeutic exercise?
[This message has been edited by Andrew M. Ball PT PhD (edited January 20, 2003).]
[This message has been edited by Andrew M. Ball PT PhD (edited January 20, 2003).]
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Re: Fun with Chiropractors on Chiroweb - January 20, 2003 10:53:00 AM
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function
Posts: 29
Joined: October 5, 2002
Status: offline
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I know that this will probably be an exercise in futility, but here goes...
To begin with, my contention in this whole issue was the idea that ergonomic training is in the domain and only the domain of PTs/OTs. I disagreed with that and still do. And by the way, you have not shown any research to prove otherwise. The Engineers out there, the Certified Safety Professionals, and the Certified Professional Ergonomists would be insulted at the insinuation that ergonomics is the domain of the PT/OT world. The would be insulted after they stopped laughing.
I never stated that I was an expert in ergonomics nor did I state an opinion on the proven effectiveness of ergonomic training. You want a research citation...fine..
Loisel et al study in Spine 1997..RCT study done in Sherbrooke, Canada comparing 4 interventions in the ability to decrease days lost per year. Of the 4 interventions the ergonomic only intervention demonstrated the best results.
Next one was done by NIOSH and the UC Division of Agriculture and Natural Resources as an Ergonomic Intervention Research in California Labor Intensive Agriculture(Farm Laborers)...conclusions of study 1. Agricultural workers suffer excessively high incidence of MSDs.
2. Priority risk factors in agriculture are: Stooped posture, heavy lifting and carrying, and rapid hand work.
3. Task specific engineering changes to tools (ergonomic changes) have been shown to be effective in reducing job hazard.
Does that prove that ergonomic training is always beneficial? No. One has to be careful about extrapolating from one industry to another because there are numerous factors that determine job injury rates that go beyond ergonomics.
Risk factors have been identified however...you might want to read up on it Dr. Ball...try this article
Ergonomic Job Analysis: A Structured Approach for Identifying Risk Factors Associated with Overexertion Injuries and Disorders by William Keyserling, Thomas Armstrong, and Laura Punnett. Center for Ergonomics, The University of Michigan. Appl. Occup Environ. Hyg. May 1991.
The point is that ergonomic training can be effective at certain times if one has properly identified the risk factors. If you would have taken the time to ask Dr. Ball you would have learned that the PT I followed did not identify the risk factors involved. He just took some body mechanic ideas and threw them against the wall hoping that they would stick...and they didn't. However, in your arrogance you didn't ask and went off trying to describe a situation you obviously knew nothing about.
The PT in this situation did a horrible job. However, you will not find me using him as an example to stop PTs from doing ergonomic training. As long as they know what they are doing, I have no problem with it. Unlike you, I do not aspire to be the thought police in the healthcare world.
So both of us have cited research and neither of us have proved anything about ergonomics except that more research needs to be done. However, you have stated that ergonomics is the domain of PT/OT without anything to back it up but your opinion. Well your opinion does not make it reality.
Please realize that I get paid by insurance for gait training, therapeutic exercise, and rehab of post surgical cases. In fact I just treated a very nice lady this morning who was referred to me from the Ortho who did the surgery to repair her torn common extensor tendon of her right forearm. I am a chiropractor performing what you say I can't perform and I get paid by insurance for this... This is reality and no matter what you say it is so. Whether you like it or not I am doing a better job than the PT at Pepsi's occupational medicine clinic which is why they are sending me all the rehab...not the PT. And it isn't because of my supposed excellent marketing skills...As an MBA you of all people should know that companies act on the bottom line and I am more effective and returning their injured workers to full function than the PT is. Like it or not...that is reality. That doesn't mean that I think I am better than all PTs. I could care less about that. I just try to do the best that I can and I am happy for the business and happy to help people. If that upsets you and doesn't fit into your world, then I feel sorry for you.
I especially feel sorry for someone that wants to limit the words that a profession can use....
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Re: Fun with Chiropractors on Chiroweb - January 20, 2003 11:23:00 AM
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NYDC67
Posts: 49
Joined: December 19, 2002
Status: offline
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Enlightened DC,
Sorry about your education. But don't speak for all DC's. You should request a refund on your tuition. The same goes for Sherman grads.
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Re: Fun with Chiropractors on Chiroweb - January 20, 2003 11:46:00 AM
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coloradojulie
Posts: 413
Joined: November 10, 2002
From: colorado usa
Status: offline
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I am curious to the extent of the rehabilitation training you have received, flexion and NYDC...perhaps this will change our perceptions of the rehabing DCs. You know that old saying "Jack of all trades, master of none." and my personal favorite "a little knowledge is a dangerous thing."
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Re: Fun with Chiropractors on Chiroweb - January 20, 2003 11:51:00 AM
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NYDC67
Posts: 49
Joined: December 19, 2002
Status: offline
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All I have to say about Rehab training is Craig Liebenson, D.C. Better than most PT's.
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