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Re: The Final Word: ALL DC education in Canada is UNIVERSITY based as of 2005
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Re: The Final Word: ALL DC education in Canada is UNIVE... - January 17, 2007 5:39:00 PM
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Marc Bronson
Posts: 113
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From: Toronto
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ON....
I know you mean to reopen the debate, and again, as in other threads I will patiently answer your question despite the fact that you really seem to be egging me on or are incredibly naive. You pick which one... ;)
I don't really know what's left to say other than I appraise any and every piece of literature that is at all relevant to the clinical question we have developed regarding our cases. What kind of research do I appraise? Anything that has to do with conservative treatment of the human body for NMSK conditions. It's wide and varied. You seem to have that chiropractors can and should only look at "chiropractic" research by which I assume you mean manipulation. That simply isn't the case.
You said you had a friend at CMCC, and if this is true, you should pop by for a few classes one day and swing by the clinic and see what it's about. Otherwise, you'll see soon enough that when your friend begins his clinical experience that its a good quality learning environment. Although I commend you for sticking to the research, quantitative studies that tries to reduce every lit bit of manual therapy isn't always the most valid and meaningful approach.
Cheers,
M.
_____________________________
BSc (Hon), DC, Dipl. Med. Ac. CSCS
Integrative Manual Medicine
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Re: The Final Word: ALL DC education in Canada is UNIVE... - January 17, 2007 5:50:00 PM
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Marc Bronson
Posts: 113
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From: Toronto
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Buddy T
Good post. I'd like to take it a little further and ask ON about a clinical question:
ON, as you are aware, instability, or more specifiically dynamic/functional instability for certain subpopulations of mechanical LBP which is likely due to a lack of proper motor control is a possible mechanism leading to the eventual experience of low back pain.
Anywho, my question is, are you familar with and would you use the prone instability test as part of your low back core exam? If so, do you feel you would be justified in using that test since it was developed by a Ph.D who is neither a PT, DC, MD, OT? I'm curious as to your answer. I hope you are following the logic of my post and will see where Buddy and I, and anyone who is appropriately trained in NMSK management, is coming from.
_____________________________
BSc (Hon), DC, Dipl. Med. Ac. CSCS
Integrative Manual Medicine
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Re: The Final Word: ALL DC education in Canada is UNIVE... - January 17, 2007 6:12:00 PM
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ONstudentPT555
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Buddy,
Evidence based does not = level 1A evidence. You are right it doesnt .. but I never said it did.. do you understand and follow EBM.. It has more to do with following the best available evidence..level 1A being the highest level.
We are talking about treatment based research..Stu is a PhD and PTs could use his research to do furthur research and validate his research by having PTs perform those treatment in a controlled randomized study.
Anyone who understands proper research study design will understand you cannot automatically assume that chiropractics approach will give the same results then research done by PTs on treatments carried out by PTs ... these things have to be controlled for ..these are two different professions with different philosopies, eduation and training. Do you understand what proper research study design is?
The fact still remains that there is a lack of quality research done in the chiropractic field why is this?
Chiros have beening treating low back pain with manips for a long time .. yet it was PTs research who came up with quality studies to validate classification based treatment for low back pain..
Marc
We are talking about therapy and treatment here not diagnostic testing.
Marc posts:
"quantitative studies that tries to reduce every lit bit of manual therapy isn't always the most valid and meaningful approach"
I thought you said you were familiar with EBM.. so wouldnt you follow the best available research.
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Re: The Final Word: ALL DC education in Canada is UNIVE... - January 17, 2007 6:17:00 PM
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drbuddy
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From: Pennsylvania
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So you're going to wait for a PT to repeat McGill's research before using it to guide your care and recommendations?
Does someone want to bail out your (future) collegue?
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Re: The Final Word: ALL DC education in Canada is UNIVE... - January 17, 2007 6:19:00 PM
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Marc Bronson
Posts: 113
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From: Toronto
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ON,
1A is the highest level? I thought it was 26Z. I know you're keen, but you have, maybe inadvertently, a condescending tone.
I am familar with EBM, but name me a study that for low back pain simulateously uses soft tissue techniques (ART), sensorimotor retraining (Trigenics) with a dash of acupuncture as required followed by some exercises and low back education/prevention tips. Also, SMT if necessary, but not necessarily SMT (if you can tell me where the spirit of that quote comes from I'll send you 5 bucks via paypal).
This has proven to be incredbily effective for me. This is my "chiropractic" approach for a general case of non-specific mechanical LBP.
_____________________________
BSc (Hon), DC, Dipl. Med. Ac. CSCS
Integrative Manual Medicine
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Re: The Final Word: ALL DC education in Canada is UNIVE... - January 17, 2007 6:20:00 PM
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ONstudentPT555
Posts: 224
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marc posts:
<<
that sounds a lot like a PTs approach ... so like I said before if DCs start to try to practise like and imitate PTs ..what would be the point of going to chiro school .. you could go to physio school and get that type of NMSK education from the profession that began it.. and wouldnt this switch to PTs approach completely contradict chiropractics core philosophies .. the philosophies which the profession was built on?
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Re: The Final Word: ALL DC education in Canada is UNIVE... - January 17, 2007 6:21:00 PM
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ONstudentPT555
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Buddy,
You didnt address my most important point:
"Anyone who understands proper research study design will understand you cannot automatically assume that chiropractics approach will give the same results then research done by PTs on treatments carried out by PTs ... these things have to be controlled for ..these are two different professions with different philosopies, eduation and training. Do you understand what proper research study design is?"
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Re: The Final Word: ALL DC education in Canada is UNIVE... - January 17, 2007 6:26:00 PM
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ONstudentPT555
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Marc,
Perhaps you could design a quality research study and get some funding have some chiropractor collegues perform the study?
I would be interested in the results.
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Re: The Final Word: ALL DC education in Canada is UNIVE... - January 17, 2007 6:28:00 PM
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ONstudentPT555
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Buddy,
Can you let me know which study by stu you exactly referring too?
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Re: The Final Word: ALL DC education in Canada is UNIVE... - January 17, 2007 6:35:00 PM
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Marc Bronson
Posts: 113
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From: Toronto
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ON,
It's not a 'PT' approach. After all, I didn't go to PT school, remember? ;)
I'm not sure of you are aware, but CMCC was founded and rejected the Palmers principles back in 1945. If you fish around on google, you'll find that.
Anywho, all I know is that I work with my HANDS on the patient for every treatment. I don't know if I would honestly get the same HANDS ON skills at PT school. Also, although I've donwplayed SMT, it's still a very powerful and effective tool. I wouldn't want someone who's only learned SMT from a weekend seminar or even a semester to be hammering away at me. Good SMT, just like good soft tissue skills, should be relatively pain free, competent, confident, caring, quick and most importantly safe. A skilled adjuster is practically effortless as this motor program has been refined by the motor centers of the cortex and cerebellum.
I don't doubt the value of your education and you perhaps should be too quick to dismiss the value of mine. Don't forget, I've mentioned NOTHING of the organic pathology/diagnosis stuff I've learned which was a heavy part of my curriculum as well. Toss in the fact that I had 3 years of radiology interpretation with and some experiences with MRI and CT scans and NMSK DC's are probably not as incompetent as you think.
The only thing that I will say that sucks 100% is that I have to always differentiate NMSK DC from subluxation DC because their clinical and diagnositic skills are pretty different. Sometimes I feel the title just isn't fair to us NMSK DC's. That unfortunate tale isn't for this site though. Sigh.....
_____________________________
BSc (Hon), DC, Dipl. Med. Ac. CSCS
Integrative Manual Medicine
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Re: The Final Word: ALL DC education in Canada is UNIVE... - January 17, 2007 6:42:00 PM
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drbuddy
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From: Pennsylvania
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"Anyone who understands proper research study design will understand you cannot automatically assume that chiropractics approach will give the same results then research done by PTs on treatments carried out by PTs ... "
I bet as an EB musculoskeletal clinician, I practice a lot more like you than many of your collegues do. Who says our approach is all that different?
"that sounds a lot like a PTs approach ..."
Bingo.
"so like I said before if DCs start to try to practise like and imitate PTs .."
Do PTs practice the same that they did even 20 years ago? Dont forget, or maybe I should inform you, that DC colleges were teaching rehab, modalites, and manual therapy all along. You may only be familiar with straight colleges. Even so, some of them have been teaching that other stuff.
"what would be the point of going to chiro school .."
To become a chiropractor! Really though, it's just a matter of a difference of opion. In my state in the USA, I have more freedom than a PT. No, I cant perform wound care or do post stroke rehab, but within my realm of NMSK conditions, I do have more freedom.
"you could go to physio school and get that type of NMSK education from the profession that began it.."
See above.
"and wouldnt this switch to PTs approach completely contradict chiropractics core philosophies .. "
Again, see above. In no way would I say it contradicts chiropractics core philosophies.
Here's my core philosophy as a chiropractor. When a person comes in with a problem, treat them as a person and not as a set of symptoms. If it's back pain, check their level of activity, ADLs, nutritional status, amt of sleep they get, etc., and not just their back. If someone has headaches, check all of the above, check the muscles and joints of the head and neck, check their deep cervical flexors, etc. Look for things that are abnormal (found in research), make them more normal, and see if they person gets better.
There it is, if I had to some up my core philosophy as a chiropractor, I look for abnormal conditions of the NMSK system (and major related areas such as sleep, nutrition, etc.) and try to restore normal function. I'd say about 90% of the time (maybe more), people will get better if you do just that.
Maybe there is a difference in approach. If you see a patient with LBP, do you ask about their sleep habits (how much, quality, etc)? Do you ask about their life in general (are they happy/depressed)? Do you ask what they are eating (are they drinking a six pack of Mt Dew everyday or 3 pots of coffee)?
Hopefully I've answered your question (and probably much more than you wanted!).
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Re: The Final Word: ALL DC education in Canada is UNIVE... - January 17, 2007 6:43:00 PM
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drbuddy
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From: Pennsylvania
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"Buddy,
Can you let me know which study by stu you exactly referring to?"
Stu McGill has a lot of stuff out there. Pick one.
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Re: The Final Word: ALL DC education in Canada is UNIVE... - January 17, 2007 6:44:00 PM
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Marc Bronson
Posts: 113
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From: Toronto
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ON
That study would have too many confounding factors. What would ultimately be responsible for getting the patient better?
Soft tissue? The exercise? SMT? Patient education? Sensorimotor retraining? Notwitstanding, there's tons of different subgroups now of LBP patients, and then there's the psychosocial factors, etc.
The design would be extremely hard, and attributing the treatment effect to one thing would required a lot of different treatment groups.
I'm considering doing my MSc. and PhD specifically looking into sensorimotor retraining loosely based on a trigenics protocol. I've seen clinically just astounding, unbelievably results that needs to be validated and researched. I have contacts at Mac, U/T and UWO but I'm trying to get a practice going and have a large student debt. It's a tough choice. Regardless, DC's need to be more active in research period, CMCC is a good role model for this, and I want to look beyond the spine because SMT research to me isn't that exciting and there's great guys like Cleland, Flynn, Childs and so on who are doing good work. I want to look at more neurological models that have to do with motor control problems.
_____________________________
BSc (Hon), DC, Dipl. Med. Ac. CSCS
Integrative Manual Medicine
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Re: The Final Word: ALL DC education in Canada is UNIVE... - January 17, 2007 6:45:00 PM
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drbuddy
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From: Pennsylvania
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Careful Marc, according to ON, manipulation doesnt take skill (or at least doesnt matter). There's a study out there that says so.
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Re: The Final Word: ALL DC education in Canada is UNIVE... - January 17, 2007 6:55:00 PM
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drbuddy
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From: Pennsylvania
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Oh, even though I rambled on above I missed an important point. As EB NMSK clinicians, it's inevitable that our paths will cross in terms of our approach and treatment methods. It only makes sense. Ankle pain is ankle pain whether you or I treat it. Exercises are exercises no matter who prescribes it. I guess the bottom line is that I do use PT research to guide my approach. Just like you use Aussie PT research to guide your approach, despite a slight difference in training.
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Re: The Final Word: ALL DC education in Canada is UNIVE... - January 17, 2007 6:55:00 PM
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ONstudentPT555
Posts: 224
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Although I do enjoy debating with you guys its getting late and I am devoting too much time to this. So this will be last post. Oh I can assure you that PTs dont just take weakend courses in manual therapy ..its a little more indepth than that.
My main points were to summarize:
1) There is a lack quality research carried out by the chiropractic field .. neither of you guys refuted that.
2)PTs do research and you guys just say .. well we could have done that too .. well thats great prove it.. or why did you wait for PTs to prove it? Marc you just admitted in your last post that there are differences between the PT and DC approach .. so how do you transfer results so easily..
3) PTs continue to lead the research in the rehab field.. example classification based treatment for low back pain.. still waiting for some new quality chiro research to come out.. or I guess they can wait till PTs do it and just say ..well we could have done that too.
5) buddy and marc have rejected the core pholosophies of the chiro profession but most chiro schools still stick to the same old philosophies...maybe that has something to do with the lack of quality research..
Anyways good night guys
take care
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Re: The Final Word: ALL DC education in Canada is UNIVE... - January 17, 2007 6:56:00 PM
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Marc Bronson
Posts: 113
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From: Toronto
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ON
[QUOTE] We are talking about therapy and treatment here not diagnostic testing. [/QUOTE]Just noticed that upon reviewing this thread. Diagnostic testing should most definitely factor into what kind of therapy you will be carrying out. Not only does it rule in/rule diagnoses/DDx's it gives you a general idea about prognosis as well.
Also, it helps specify the treatment approach. For example, a Dx of functional/dynamic instability would require core stabilization/motor control approaches as opposed to SMT. So, diagnostic testing is important altbough the sensitivies and specificities of clinical orthopaedic testing is lacking IMO.
_____________________________
BSc (Hon), DC, Dipl. Med. Ac. CSCS
Integrative Manual Medicine
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Re: The Final Word: ALL DC education in Canada is UNIVE... - January 17, 2007 7:06:00 PM
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drbuddy
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From: Pennsylvania
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"1) There is a lack quality research carried out by the chiropractic field .. neither of you guys refuted that."
I dont refute that. There is some there, but not enough. The major factor is money. Up until recently, we've been shut out of most universities (for political reasons or whatever), so it's not like we have access to the same amount of public funding or PhD's on the payroll to help in research design and analyze data. Plus, no one really goes into DC college with the intentions of going into research. Why work for a chiro college doing research for $40,000 per year when you can open a practice and make 6 figures and do what you went to school to do, help patients?
All of the above are not great excuses for why the field hasnt done as many high quality studies as you would like to see, but it's the reality. There is, however, a large number of pilot studies, case reports, and small scale studies.
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Re: The Final Word: ALL DC education in Canada is UNIVE... - January 17, 2007 7:34:00 PM
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ONstudentPT555
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Sorry I couldnt resist .. one last point.. just sticking with original topic of the thread.. A large requirement for univeristies and university based programs is research...
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Re: The Final Word: ALL DC education in Canada is UNIVE... - January 17, 2007 8:35:00 PM
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Marc Bronson
Posts: 113
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From: Toronto
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ON
In case you missed it the first time
http://www.cmcc.ca/research.htm
Specifically the latest one
http://registrar.cmcc.ca/NewCmcc/pdf2006/2006ResearchReport.pdf
Don't see too much SMT studies, do you? There's a convergence happening, ON... Proud, aka, Evidencewhat at chirotalk, are you reading? Don't forget to look at that St-Mikes business.... this project is going to expand soon.
(btw, try to actually READ some of it but I'm sure you'll only focus on the negatives). CMCC has been accused by straight/subby schools of being too "medical" and not "holistic" enough, as though it were a bad thing. Just have to shake my head at that one...
My personal fav that was recently published was the Injeyan study looking at some of the neuroimmunological effects that were anti-inflammatory with SMT. Dr. Teodorzkik (sp?), who is an PhD. in immunology and was my professor was pretty excited about this paper and planning to do a larger scale follow up in the same vein (pardon the pun)
Considering its a relatively small school (650-800 students total) and its privately funded and has only recently received federal/provincial research grants it's a great feat, IMHO.
Another reason why DC research is lacking is the fact that there's only 5 (of 19) chiro schools in North America who commited to and have the staff to produce top notch research. If you look at the number of PT schools in North America I'm sure it's more than 19 although I could be wrong.
_____________________________
BSc (Hon), DC, Dipl. Med. Ac. CSCS
Integrative Manual Medicine
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