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Re: Things we have to get over
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Re: Things we have to get over - June 10, 2007 12:26:00 PM
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Marc Bronson
Posts: 113
Joined: January 13, 2007
From: Toronto
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Tim,
Nice to see again that rather than intelligently debate the details of your chiropractic assessment, your label "us chiros" as if we're the next incarnation of the black plague.
Quite frankly, I don't really see a difference in your attitude towards DC's and someone who is racist or homophobic. Clearly your personal ethics don't seem to match your professional ones.
If ever you care to activate that frontal lobe of yours and learn to selectively filter some of your hate towards DC's maybe these threads could become more purposeful. Until then, I suggest you at least get an oxygen mask, the air must be thin up there...
Warms regards,
Marc.
_____________________________
BSc (Hon), DC, Dipl. Med. Ac. CSCS
Integrative Manual Medicine
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Re: Things we have to get over - June 10, 2007 12:27:00 PM
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OAK
Posts: 184
Joined: September 1, 2003
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JCOY wrote:
"I think there is a difference between a PT perscribing the same exercises for patients and chiros performing spinal manips on infants, claiming to cure arthritis and telling patients they have to come back for ever....
Is this response for real?----------REALLY????"
The latter Tx would obviously be considered QUACKERY by anyone with any basic medical knowlege.
Secondly, how is prescribing exercises for your Father's condition not "competent care"? Were these dangerous exercises?
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Re: Things we have to get over - June 10, 2007 12:58:00 PM
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physioo
Posts: 184
Joined: June 26, 2006
From: Canada
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Easy Marc
I do not think Tim was referring to all chirod
but i say that 90% of them are using chiro as a business rather than to give Quality of care
jmho
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Re: Things we have to get over - June 10, 2007 1:31:00 PM
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nari
Posts: 1568
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From: Australia
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Tim started the thread listing reasons why manipulation is a good idea for some conditions. That seems fair enough - then the inevitable barney broke out.
It is fair to say that incompetent and lazy practitioners inhabit both the PT AND the chiro world; as with attorneys, solicitors, car salesmen, nurses, teachers et al. Unfortunately they taint the public's perception of their careers, because the public likes to relay bad experiences - not good ones.
What can we do about this? Avoid those who are lazy and incompetent, observed often by hardwon experience; there is nothing else we can do. But let's be fairminded and have enough nous not to say an entire profession is 'bad' or dangerous or ineffective.
As an aside, the 'prescribed exercises for a leg' sound as though they don't work anyway, if the problem remains a year later.
Nari
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Re: Things we have to get over - June 10, 2007 2:06:00 PM
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treybien
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From: Milwaukee, WI
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I think Tim's post is right on. It seems to me on point 5 the question is...........philosophically are we manipulating/mobilizing as PT's for the same reason as chiros?? Maybe this is a different topic. Manipulation does have some good evidence to support it and as PT's, to do our job well, we need to know how to use it.
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Re: Things we have to get over - June 10, 2007 2:21:00 PM
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Jon Newman
Posts: 1708
Joined: April 24, 2004
From: Amherst, WI
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Hi Nari,
I inferred from Tim's comments that he meant the position of the chiropractic professional association (ACA) as well as many many individual chiropractors as it pertains to their stance on subluxation and the importance of manipulation for "wellness." I know Marc shares this same disdain.
Chiropractic has a looong history of non-acceptance and subsequent victimization. You can see it reflected in [URL=http://www.amerchiro.org/content_css.cfm?CID=201]this document[/URL] for example. The touchy responses to chiropractic criticism in that light begins to make sense and I don't see much changing until the professional organization itself abandons some of the concepts it promotes in addition to a change in individual practices. Tick tock.
_____________________________
[URL=http://www.sonymusic.com/clips/selection/30/064887/064887_03_03_30.wav]Evidence[/URL]
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Re: Things we have to get over - June 10, 2007 4:03:00 PM
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proud
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Marc,
Can you explain what it is about Tim's thoughts that you take offense?
Tim,
I agree with all your thoughts. I utilize manipulation. A variety of techniques and with the correct patient, it is a useful little tool. I side with Steve however when it comes to the C-spine...for now. But I will let the research in that area guide me...
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Re: Things we have to get over - June 10, 2007 5:09:00 PM
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TMondale
Posts: 131
Joined: January 3, 2005
From: Newton-Wellelsley Hospital
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Chiros,
This isn't about you. Debating what we as PT's should think about you has been done to death by myself and others in this forum. Rest assured I don't know you from adam, but I do know what your state and national organizing bodies do to make life difficult for our legislative advancement. John's comments are spot on.
In my original post I was trying to throw you a bone. You got it right, at least as it pertains to manipulation. I'm trying to urge my colleagues to throw off the sludge of our resistence to manipulation and allow ourselves to build a foundation of research and practice that allows thrust manipulation a place without equivocation or apology.
Proud and Steve,
I hope one day we do agree on the c-spine part.
Tim
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Re: Things we have to get over - June 10, 2007 5:39:00 PM
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goodlooks58
Posts: 425
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From: CA
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"Rest assured I don't know you from adam, but I do know what your state and national organizing bodies do to make life difficult for our legislative advancement"
That is exactly what the Calif Chiro Association did with the help from AMA and AAOS and derailed the strong efforts of the California APTA to get us Direct Access. They brought about the dirty scare tactic of "The consumer will start diagnosing their MS problems" What kind of crap is that?!!
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Re: Things we have to get over - June 11, 2007 5:44:00 AM
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orthotherapist
Posts: 218
Joined: February 6, 2007
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Marc,
Over on the other thread you stated that if you had to do it all over again you would have gone into PT - I have not heard one PT say they wish they had gone to chiro school. Obvioulsy there are things in your own profession that you do not agree with.
Tim's post are well written and if therapists embrace manipulations (when appropriate) the profession (PT) will be in a position to be the provider of choice for NMSK complaints.
Unfortunately like the old saying goes a few bad apples can spoil the bunch but in the case of chiros a lot of bad apples spoil the few good ones (at least this is my impression in the area that I practice in the states).
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Re: Things we have to get over - June 11, 2007 6:27:00 AM
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Alex Brenner PT MPT OCS
Posts: 1057
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From: Kentucky
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Tim,
This is the post of the year and should go into the rehabedge hall of fame. Outstanding.
We have made great advances in "throwing off the sludge of our resistence to manipulation" especially in the treatment of the lumbar spine. This is mostly in part to recent evidence produced by physical therapists. I agree with proud and Steve and I hope that we can make these same advancements in the safety and efficacy of manipulation of the cervical spine.
_____________________________
Alex Brenner, PT, MPT, OCS
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Re: Things we have to get over - June 11, 2007 9:11:00 AM
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Jon Newman
Posts: 1708
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From: Amherst, WI
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I don't think it is a matter of a few bad apples. I think it is, as [URL=http://en.wikipedia.org/wiki/Philip_Zimbardo]Philip Zimbardo[/URL] describes it, [URL=http://www.edge.org/3rd_culture/zimbardo05/zimbardo05_index.html]a bad barrel[/URL].
As can be seen in my previous post, the chiropractic profession is bound to uphold the concept of "subluxation" as least in part because that is what it can bill for. The cultural artifact drives the what care looks like. It's frustrating for any profession.
_____________________________
[URL=http://www.sonymusic.com/clips/selection/30/064887/064887_03_03_30.wav]Evidence[/URL]
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Re: Things we have to get over - June 11, 2007 9:17:00 AM
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physioo
Posts: 184
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From: Canada
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I have spoken to a number of chiros in Canada..
they all tell me that PT is better as a profession!
I even know one who does not manipulate anymore, but just does soft tissue work!
Wierd, strange but true!
Great post Tim
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Re: Things we have to get over - June 11, 2007 10:39:00 AM
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Marc Bronson
Posts: 113
Joined: January 13, 2007
From: Toronto
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I would agree with your assessments regarding the barrel of bad apples spoiling the good ones. It's been my observation so far too. It's quite disheartening at times when I have to introduce myself as a manual therapist instead of a DC because I'll get "the look".
My point of contention, however, was that implication that somehow, all chiropractic schools have a vastly inferior curriculum to a PT programme. Indeed, a fellow DC is doing is MPT in Alberta and told me that the chiropractic programme he attended in the US (Parker?) was much more challenging (his words, not mine).
Same goes for me when I get MD's and PT's look at me in amazement when I rhyme off the latest labral tests for the hip or blurb what lab tests I'd order if I suspected a liver problem. The rule of thumb is this: the more northern the chiro school, the more evidence-based or scientific is it. The fact that this type of thing even exists is a problem in itself.
To be honest, my biggest disatisfaction with the entire profession lies in the regulatory colleges. They're chalked full of subluxation-based chiro's who turn a blind eye to the most ridiculous things like yearly treatment plans, mall screenings, quackery treatment methods (iridology, AK, etc...). My professor at CMCC recently won a seat at the College and told me how there's a "civil war" going on right now between the philosophy faction and the evidence based faction.
A house divided amongst itself cannot stand. I'm making contigency plans to inquire about PT school but my student loans are already through the roof. I'm moderately busy at work, but have had several potential patients dismiss me because of previous bad experiences with a DC and just the stigma attached to my title.
Oh yeah, back to the thread. Manips, used appropriately (subgroupings) and judiciously are good, low risk, high reward, even for the cervical spine. Yea for PT's doing this and putting another nail in the chiropractic coffin. Where's my parachute?
;)
M.
_____________________________
BSc (Hon), DC, Dipl. Med. Ac. CSCS
Integrative Manual Medicine
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Re: Things we have to get over - June 11, 2007 10:46:00 AM
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ONstudentPT555
Posts: 224
Joined: July 25, 2006
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Jon,
I think you made a very good and important point. The problem is that it seems like it is not just a few misguided chiros who are involved in questionable and unethical practises. In 10 kms radius from my house I can find not just one but several chiros who claim they can cure systemic diseases, promote infant manipulation and are telling thier patients that need chiropractic treatment for the rest of thier lives to be healthy and I dont live in an extremely large city. This should not really be a surprise since these are the philosophies the profession was built on in the beginning.
Several of these chiros are graduates of CMCC which is thought to be a more evidence based school. So even though thier are taught to be evidence based they still decide not to practise that way for some reason. I could post links to the websites of these chiros but I not going to target specific people.
Now there are some chiros who are ethical and treat patients in similar ways to a PT but these might be the ones who are the exceptions which is unfortuante for them since their collegues practises are soo different. I am nots sure what the percentages are of straight chiros subluxation based chiros to non sublux chiros is but by saying its only a few bad apples we may be down playing the actual reality.
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Re: Things we have to get over - June 11, 2007 10:54:00 AM
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ONstudentPT555
Posts: 224
Joined: July 25, 2006
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Marc,
If you have any questions about PT school admissions and costs in Canada .. IM me. You can get your MScPT in Canada for under 20k.
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Re: Things we have to get over - June 11, 2007 10:58:00 AM
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Lehmkuhler
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I agree that there is indeed a civil war of sorts going on within the chiropractic profession. I can imagine that it will someday completely divide into the straights and e-based factions. I went to one of the northern schools and practice more similarly to PT's than straight DC's. I believe the majority of new graduates are similar to myself and that straight DC's will become a smaller and smaller minority. I'm glad to see the changes that I'm seeing. As the US reimbursement system moves towards less third party payor and more towards cash, it may be the group with the sharpest business skills that will eventually win the day... We'll see I guess.
I've honestly considered going to get a DPT but after researching it, I doubt I'd practice much differently, nor have any large financial change from the additional time spent in school. So for now, I'll stay put...
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Re: Things we have to get over - June 11, 2007 1:05:00 PM
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Marc Bronson
Posts: 113
Joined: January 13, 2007
From: Toronto
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ONPTStudent,
I have classmates too who went the subluxation route. The reasons are purely financial.
First, no regulatory college is going to punish you for doing the subluxation thing.
Second, the subluxation myth is profitable. The classmates of mine who went that way, and whom I know personally and are for all intents and purposes, bright, smart people are doing so because they're on the verge of defaulting on their loans. Unlike PT, DC's have no chance (currently) at getting public funding to work. If I could work in a hospital or community setting I'd be there in a heartbeat, regardless of how much I can make, potentially, in the private sector.
Third, somewhere down the line marketing groups somehow took over the profession. I couldn't give 2 hoots about philosophy and the founding fathers, but I was shocked to read that BJ Palmer the "developer" of chiropractic would charge only by the week and not by the month (unlike MD's and DO's back in the day) because he could "fix" them that fast. It seems like many of the chiropractic colleges, regulatory boards and marketing groups have selective amnesia about that one.
So, really, its moreso financial for many new grads, particularly those from EB schools. To be fair, however, there have been a lot of cases whereby SMT had an unexpected benefit to a non MSK problem that had previously been recalcitrant to conventional medical management. But, so far it seems to be the exception and not the norm.
I also agree with Lehmkuhler (that was difficult to spell correctly) that there is a shift torwards e-based practice amongst new grads, but it might be too little too late. How certain US schools from down south can remain accredited is beyond me. Time for a Flexner report for chiro colleges.
But back to the chase, it's nice to see that manipulation is increasingly gaining traction as a valid choice for dealing with MSK syndromes and that I think that, in time, the research will begin to bear out some additional non MSK benefits but nowhere near as broad as the subluxation evangelicals claim.
Over and out,
M.
_____________________________
BSc (Hon), DC, Dipl. Med. Ac. CSCS
Integrative Manual Medicine
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Re: Things we have to get over - June 11, 2007 1:07:00 PM
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Marc Bronson
Posts: 113
Joined: January 13, 2007
From: Toronto
Status: offline
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ONPTStudent,
I have classmates too who went the subluxation route. The reasons are purely financial.
First, no regulatory college is going to punish you for doing the subluxation thing.
Second, the subluxation myth is profitable. The classmates of mine who went that way, and whom I know personally and are for all intents and purposes, bright, smart people are doing so because they're on the verge of defaulting on their loans. Unlike PT, DC's have no chance (currently) at getting public funding to work. If I could work in a hospital or community setting I'd be there in a heartbeat, regardless of how much I can make, potentially, in the private sector.
Third, somewhere down the line marketing groups somehow took over the profession. I couldn't give 2 hoots about philosophy and the founding fathers, but I was shocked to read that BJ Palmer the "developer" of chiropractic would charge only by the week and not by the month (unlike MD's and DO's back in the day) because he could "fix" them that fast. It seems like many of the chiropractic colleges, regulatory boards and marketing groups have selective amnesia about that one.
So, really, its moreso financial for many new grads, particularly those from EB schools. To be fair, however, there have been a lot of cases whereby SMT had an unexpected benefit to a non MSK problem that had previously been recalcitrant to conventional medical management. But, so far it seems to be the exception and not the norm.
I also agree with Lehmkuhler (that was difficult to spell correctly) that there is a shift torwards e-based practice amongst new grads, but it might be too little too late. How certain US schools from down south can remain accredited is beyond me. Time for a Flexner report for chiro colleges.
But back to the chase, it's nice to see that manipulation is increasingly gaining traction as a valid choice for dealing with MSK syndromes and that I think that, in time, the research will begin to bear out some additional non MSK benefits but nowhere near as broad as the subluxation evangelicals claim.
Over and out,
M.
_____________________________
BSc (Hon), DC, Dipl. Med. Ac. CSCS
Integrative Manual Medicine
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Re: Things we have to get over - June 11, 2007 1:15:00 PM
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Lehmkuhler
Posts: 69
Joined: December 14, 2005
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While I am no proponent of subluxation theory, it is interesting that Osteopathy is now producing research on the role of manipulation in hypertension... There MAY be more to the story than we currently know, or are able to know. Science is continually changing... What was complete quackery (manipulation) is now quite mainstream.
Many of us (DC's) have patients that will swear up and down that when they receive manipulation for musculoskeletal conditions, some systemic issue or another will be vastly improved. I have people tell me these things regularly and I never mention subluxation or any systemic disease as something that I treat with manipulation. Maybe these people have been trained in subluxation by another DC, or friend who goes to another DC, who knows. But when it happens dozens of times, you can't help but wonder...
Anyway, excellent discussion.
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