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Re: Things we have to get over
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Re: Things we have to get over - June 11, 2007 2:24:00 PM
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ONstudentPT555
Posts: 224
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Hey marc,
I know that the subluxation chiros were making incredible amounts of money about 10 years ago (90s and 80s) even more than MDs at times but is it really still profitable to be a sublux based chiro now a days..arent the insurance companies and the public begining to catch on...I really dont know .. I am just wondering..
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Re: Things we have to get over - June 11, 2007 3:05:00 PM
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proud
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The notion that manipulation can cure systemic disease is laughable. The fact is that humans are a strange lot...we love the idea of a "magical" cure for things. Thus the money making machine called alternative medicine...or junk medicine continues to thrive.
It's not suprising that humans report anecdotal claims to be "cured" by manipulation. The "poping" sound sends people into some strange euphoria that something was "put back into place"...despite the most diligent practitioners explanation to the contrary. And imagine what impact the idea that someone "found something" might have on hypertension...
Also, I have come to realize that CMCC does strive towards an evidence based approach. The amazing thing is that despite this fact, I too know a few recent CMCC grads in my area who subscribe to the subluxation theory. What is going on there?
I also do not think the benefits of manipulation was ever really in question. But most educated people understood that you could not base a profession on it. In fact, it is likely that less than 15% of patients will benefit over any other mode of treatment. And most educated people understood that the proposed specificity of manipulation was bogus. It is easily learned and safely applied by those who understand the literature.
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Re: Things we have to get over - June 11, 2007 4:13:00 PM
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TMondale
Posts: 131
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From: Newton-Wellelsley Hospital
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Alex,
Thanks for the praise, but you and your ilk should get the praise for producing the evidence that progresses our understanding of the effects of manipulation. Very improtant stuff to realize that manipulation can be a strong tool in the activation of deep core muscles that aid in stabilization; far from the notion that manipulation will harm someone or be counter-productive for patients that meet a cpr for instability.
Proud,
I think it really is our charge to take manipulation out of the lunatic fringe and put it in it's rightful place in neuromusculoskeletal care, with science based practitioners.
We could certainly argue what percentage of the time manipulation of the spine is appropriate, but there should be no disagreement that it is imparative that we carry the standard to our medical colleagues.
Medicine has had years and years of propegated fear of manipulation and general disrespect for those it saw as the primary providers of same.
At the hospital I work the physiatrists want us to retrospectively fill out incidence reports on patients that involved manipulation and resulted in complaints of soreness (which happens very rarely) back to them. We say you can't single out one modality that way, and if that's the standard you want to set it's a very slippery slope. It's all because they are so fearful of manipulation. We've got a lot of work to do.
Tim
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Re: Things we have to get over - June 11, 2007 4:38:00 PM
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Jon Newman
Posts: 1708
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From: Amherst, WI
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It's ironic that subluxation theory is both absurd and also likely contributes to the observed benefit of manipulation. What a paradox.
How do those utilizing manipulation help dispel the magical subluxation myth?
Since there is quite a bit of wiggle room for the use of manipulation in CPR qualifying patients, does anybody try more active (or less passive force) techniques first?
_____________________________
[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 5:12:00 PM
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Marc Bronson
Posts: 113
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From: Toronto
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Tim,
Lunatic fringe. Wow. Rightful place among science based practitioners? I mean, common. You've really hit a new low there.
Whether you acknowledge it or not, manipulation will always be associated with chiropractors. It's these lunatics who've said time and time again it works, despite the almost be universally derided for doing so, even jailed in the early years. Get real, Tim, I'll put my training and skills against yours any day, anytime, anywhere. From assessment, to diagnosis, differential diagnosis and to finally my bread and butter manual treatment methods, I'm confident that you have nothing new to show me. I mean that will 100% sincerity too. So, climb down from that high horse of yours, STOP refering to me as "chiros" and show a bit of humility and class for other health care professionals, OK, Tim?
Let me remind you, Tim, that it's only the quacks who get the press coverage and scorn. In fact, if you ever listened to the Dr. Steven Novella, MD and his podcasts you'd know that less than 20% of practicing DC's in the US follow the straight model. They're the most vocal, but the statistics show a 20/40/40 split (straight, mixer, reform)
Scientific and chiropractic is not an oxymoron like you're making it out to be. That last post of yours really crossed the line. You can call a LIFE grad a lunatic, but to imply that for all DCs really pisses me off. Clearly your biased, anti-chiropractic jabs seems to be nothing more than a petty attempt by yourself to discredit every DC out there so that manipulation can have it's "rightful place". How completely arrogant and intellectually dishonest.
I'm in Canada and PT's have direct access and can manipulate, and I think it's all good, but with your attitude I can see why DC's in certain US States are in no hurry to do you favours...
_____________________________
BSc (Hon), DC, Dipl. Med. Ac. CSCS
Integrative Manual Medicine
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Re: Things we have to get over - June 11, 2007 5:29:00 PM
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Marc Bronson
Posts: 113
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From: Toronto
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Jon,
Prior to manipulation I always do some soft tissue work. Typically I follow ART protocols, but don't subscribe to their "adhesion" theory and know that I'm working on peripheral nerves, activating mechanoreceptors, etc...
I also use muscle relaxation techniques such as deep breathing, mechanoreceptor manipulation (i.e. deforming the skin/muscle) with light resisted movements to engage the reciprocal inhibition reflex for tight/hypertonic musculature. So, the patient is active in some kind of form through my soft tissue protocols.
I've also recently been incorporating some of Shacklocks Clinical Neurodynamics protocols as well. I've also used Mulligan Mobilzations from time to time as well.
Another point of contention, is that "subluxation" has a lot of different meanings to different chiropractic colleges and chiropractors. Some use it just to refer to aberrant segmental mechanics which is what PT's, DO's and other manipulative therapists use it as. Some still subscribe to the nerve root being impinged in some way, but there's already a word for that: radiculopathy ;)
However, since I know you're interested with the nervous system and pain, are those DC's who call subluxations incorrect when they say that there may be mechanical irritation of neural tissue?
It seems like the bone out of joint theory impingement the nerve root is completely false, but what about excessive tension/compression of small afferents (C fibers, for example) in the capsule, ligaments, or deep muscles?
Is this a plausible explanation for the immediate relief of mechanical pain that is accompanied with manipulation?
_____________________________
BSc (Hon), DC, Dipl. Med. Ac. CSCS
Integrative Manual Medicine
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Re: Things we have to get over - June 11, 2007 5:44:00 PM
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Jon Newman
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[QUOTE]Is this a plausible explanation for the immediate relief of mechanical pain that is accompanied with manipulation?--Marc[/QUOTE]I do think it's plausible.
_____________________________
[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 6:25:00 PM
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nari
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From: Australia
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It would seem to be a very plausible explanation for sometimes instantaneous relief of pain following mobilisation and manipulation.
I think some researchers are following this line of thinking.
Nari
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Re: Things we have to get over - June 11, 2007 6:28:00 PM
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jlharris
Posts: 477
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From: Nebraska
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[QUOTE]
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.
[/QUOTE]I had a patient swear they got better after an US that I forgot to start (no I didn't charge them for it). One of the biggest reasons I don't do US for pain of "inflammation" relief.
Patient's are not the best judges as to what is making them better. That's why we must use outcome measures (we all do this, right?) instead of subjective pt reports to gauge pt response and improvement.
_____________________________
Jason L. Harris, PT, DPT
My PT Blog
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Re: Things we have to get over - June 11, 2007 9:43:00 PM
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3.5fig
Posts: 97
Joined: July 13, 2005
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Proud,
Your post is too quick to denounce what is not known about the effects of manipulation on the human nervous system. Once again I reference the recent study relating to upper cervical adjustments and hypertension. Obviously this needs more research to prove or disprove a link between the two, but to ignore those findings is not following the EBM profile that is stressed here.
I do not know the full extent that manipulation has on the human nervous system and the rest of the body...none of us do. It is precisely because of this I have an open/critical mind regarding the likely effects. I do not immediately denounce a patient when he/she relates a positive effect of the manipulation that is not musculoskeletal. You have to remember there are viscero-somatic and somato-visceral reflexes in the body that we have yet to fully understand.
You seem to consider patients as simpletons that will follow whatever is put in front of them and give too much credit to Chiropractors as salesmen. It reminds me of what the AMA used to say about the whole profession...that we were a cult. Not that some were a cult, but that the whole profession was a cult. Medical doctors were banned from referring or accepting a referral from a Chiropractor. It amazes me that the profession survived. We must have been doing something right all those years when people came to us and paid cash. Back in the old days, Chiropractors used to brag about how few visits their patients needed to get well. It wasn't until the insurance days of the 80s that practice management groups sprung up and started to change things. I actually think we would be better off if we went back to a cash based practice.
The studies I have seen over the years regarding patient demographics depict the typical Chiropractic patient as a professional with a college degree. And Chiropractors have always topped the other health care professions when it comes to patient satisfaction surveys.
The point is that the majority of Chiropractors practice ethically and have the interests of their patients at heart. If we didn't we would have never survived. Our past struggles against the AMA boycott forced us to develop outside of the mainstream health care system and much of what we stressed...exercise, proper nutrition, and manipulation was considered quackery at worst and useless at best. It wasn't that long ago that the mainstream health care system, of which PTs were part of, recommended bed rest for back pain...all the while the lonely nutty chiropractor was telling patients "No, get your ass up and start moving".
How much do all of us in the health care professions do that is scientifically proven? I remember back when I was in school that some researchers at Duke University did a study that basically showed that only 15% of all that was done in health care was scientifically proven...15%!!!! That was and is amazing. In our little worlds we all think we have a good idea of what we are doing and pat ourselves on the back when our patients get well. When in reality, if we base what we are doing on the scientific method...we suck....we don't know jack about the human body. What we know pales in comparison to what we don't know. Yes, we are learning everyday more and more, but as we learn more we also learn how much we don't know...so for you to say that "the notion that manipulation can cure systemic disease is laughable"...would be laughable if it wasn't so sad. That you think you are so intelligent that you would close your mind so sharply is sad to me....You have no clue what you don't know. I always say that the best clinician is the one who "knows what he/she doesn't know".
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Re: Things we have to get over - June 12, 2007 1:18:00 AM
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proud
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"...so for you to say that "the notion that manipulation can cure systemic disease is laughable"...would be laughable if it wasn't so sad. That you think you are so intelligent that you would close your mind so sharply is sad to me....You have no clue what you don't know. I always say that the best clinician is the one who "knows what he/she doesn't know"..."
Oh..okay.
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Re: Things we have to get over - June 12, 2007 3:04:00 AM
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ONstudentPT555
Posts: 224
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The scary thing is that 3.5 is probably not the exception and many DCs most likely have the same beliefs.
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Re: Things we have to get over - June 12, 2007 3:34:00 AM
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TMondale
Posts: 131
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From: Newton-Wellelsley Hospital
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fig,
I agree with the cash based practice model, then we would really have to justify our worth. And I find your coments about the overall effects of manipulation on the nervous system intriguing. Certainly room for growth in our understanding.
Tim
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Re: Things we have to get over - June 12, 2007 6:09:00 AM
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3.5fig
Posts: 97
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ONstudentPT555,
What is it I said that scares you?...just interested. Please expound on it...
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Re: Things we have to get over - June 12, 2007 6:16:00 AM
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orthotherapist
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Cant we all just get along? We all know there are bad apples and good apples in every profession. Beating each other up serves no purpose - worry about your own profession and your own practice/career development. If you focus on this you, your patients, and your profession will prosper.
From a PT standpoint it seems we are always picking on the chiros. We are trying to keep/get that piece of the pie while other aspects of our profession are eroding away as other providers step into the areas we vacate/do not focus on.
The private practice section of the APTA is having a "Athletic Physical Performance Therapist" talk at the national meeting - does anybody besides me see something wrong with this?
If you know of fradulent billing practices by chiros (or PT) let your local chapter/state licensing agency know this. To just turn the other way is not acceptable.
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Re: Things we have to get over - June 12, 2007 8:16:00 AM
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Sebastian Asselbergs
Posts: 1206
Joined: September 29, 1999
From: Barrie, Canada
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OK, I have to pipe up. I get picky about word-usage and such, so bear with me.
"the notion that manipulation can cure systemic disease is laughable"... Should be seen for what it is - a criticism of a very tall claim.
The statement does NOT say manipulation can not affect the body in a way that may benefit recovery, or benefit the nervous/immune/autonomic nervous system: it plainly states that "curing systemic disease" is a laughable claim. And it is. Manipulation does not cure anything.
_____________________________
Mundi vult decipi
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Re: Things we have to get over - June 12, 2007 8:24:00 AM
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3.5fig
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ok...I see your point and agree with you on that. Manipulation does not cure...I guess I was being more critical of the implied notion that manipulation has no effect on systemic disease when we don't fully understand it yet. Taken alone the statement about manipulation curing systemic disease does make sense on further thought...
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Re: Things we have to get over - June 12, 2007 8:48:00 AM
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JCOY
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My pet peeve is the word "cure". It was a word we were taught in DC school never to use(The only thing you can cure is a ham"). I gag when ever I hear "a cure" for anything, used by any healthcare provider, or referring to any healthcare treatment.
Words DO have strong meaning-
"the notion that manipulation can cure systemic disease is laughable"... Is a very strong statement, especially when it was proud who chose to use the word "cure".....NOT any DC posting here. In fact, I don't even recall a DC posting here: "systemic disease"(another of proud's personal word choices?)
I agree with fig as far as the possibilities of manipulation influencing non-NMS conditions: We just don't know what we don't know yet.
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Re: Things we have to get over - June 12, 2007 10:58:00 AM
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ONstudentPT555
Posts: 224
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"I agree with fig as far as the possibilities of manipulation influencing non-NMS conditions: We just don't know what we don't know yet."
Can someone reference some good quality evidence(level 1) perhaps an RCT that points to some potential of manipulation having influence on non-NMS conditions (benefit the nervous/immune/autonomic nervous system)???
I would be interested in reading it if anyone knows of any?
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Re: Things we have to get over - June 12, 2007 11:35:00 AM
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nari
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I think the use of the word "cure" is dodgy in any field of health care. It would be appropriate to think of medications perhaps alleviating symptoms and assisting in restoring homeostasis; and for all we know, the person who comes in for one manipulation and walks out painfree and fully functional for years, may exist. We just DON'T know for sure.
Any action which has a neurophysiological effect can affect body systems. Pain states affect immune/autonomic systems; therefore relief of pain also affects the systems. That is physiology at work. But we haven't the evidence at our disposal, so it cannot be stated as fact.
I appreciate fig's comment that very little of what we do is "proven". Research is getting better, but the fact that most of what we do is simply 'more effective' than telling the patient to lie down with a hot pack, does not hold much for a vote of confidence.
Nari
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