There is no question that bad things happen in the practice of medicine, and stats about iatrogenic problems can seem alarming. However, to simply state that medicine kills and hurts people is misleading fear-mongering. Cars kill and hurt people, too, for pretty much the same reason: it’s risky, but the benefits are worth it, and large numbers of people take the gamble.

The medical system deals with vastly greater numbers of much more serious cases than manual therapists do, many of them no-win, rarely-win, or sometimes-lose situations with high stakes. It’s just not an apples-to-apples comparison. You should should a little more respect, criticizing that from the outside. Try working in a hospital for a while, try to be perfect, try to never have anything go wrong that matters.

I assume that you are a chiropractor. If you routinely had to treat huge numbers of people with life-threatening injuries and dire illness, your profession would have scary error rates, too.

And most medical interventions are subjected to vastly more scrutiny — orders of magnitude more — than Graston has been subjected to here or anywhere.

What do you mean “this much scrutiny”? Every drug that is approved for marketing is subjected to far more scrutiny than this. Can you name a single medical treatment that is “killing and hurting people” that is based only on two mouse studies, one of which suggests the treatment doesn’t work?

Perhaps this one treatment is not all that is in need of examining, but the entire theoretical construct on which it is based. Especially, since many other treatment techniques that are becoming mainstream are based upon it.

The article you cited refers to one specific condition, tendinitis. The Graston technique is used for many other diagnoses, including ankle sprain, fasciitis, neck pain, low back pain, epicondylitis, adhesive capsulitis, carpal tunnel syndrome, and scar pain.

If the “original insult” didn’t cause inflammation, why not? And how can you be sure a new insult will? Also, there is no way to judge the amount of microtrauma you are causing – how much is necessary and how could you be sure not to overdo it?

I don’t like the idea of deliberately causing trauma, but I would accept it if there were clear evidence that it works. There isn’t.

Thank you for turning your attention to this. This idea of creating microtrauma to facilitate healing or promote redeposition of scar is one that is taking root in physical therapy. I’m curious if you could expand your thoughts a bit more on this. The background theory for this type of method, at least as I’m familiar with it, is that most conditions that traditionally have been labeled as -itis conditions are actually -osis conditions in which the tissue is degrading due to a lack of initiation of the inflammatory response with insult. The theory goes that creating “microtrauma” (which in my mind its trauma or its not) re-initiates the inflammatory process and the aim of therapy is to provide an environment in which the process can proceed to resolution. So, by this theory they are not claiming to further inflame and inflamed tissue, but rather initiate inflammation in a tissue that is failing to inflame.

Here is an editorial by an author who is driving this thinking and it may be worthwhile to examine his/her claims.
http://www.ncbi.nlm.nih.gov/pubmed/11895810?itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum&ordinalpos=2

I think it is important to address this as there are other therapies popping up in the mainstream of PT that also are claiming to act on this theory with and without tools. Another example are exercises focusing on the eccentric phase of motion. There are some studies showing promise in regards to some traditionally stubborn conditions including patellar and achilles tendon area pain. The idea being that eccentrics create more load and initiate process throught this form of “microtrauma.” At least that is my understanding.

Curious of your thoughts.

Helpful? Possibly your (and others’) brain(s) has/have been induced, at both conscious and non-conscious levels, to ‘believe’ (and self-reinforce) that this kind, type, intensity of sensory-discriminatory input is repeatedly necessary to enhance self-regulation.

Re: massage causing pain –

Sometimes the only thing that will relieve painful muscle spasms in my mid-to-upper back is massage to the point of bruising. Drugs don’t work, exercises don’t work, heat/ice helps temporarily. It is slightly sore afterwards but better than the cramping pain, and sometimes will last for a few weeks. Usually though to stay comfortable I need to get brutalized at least once a week. Just an anecdote.

I can see that the science behind this method is not there but why would deep tissue massage be so helpful for some people?

The device is called a ‘Molecular Enhancer” and sells for $2500.

This is from the website under the heading ‘Supporting Science:’

“Dan Dial’s Molecular Enhancer™ falls under the category of Pulsed Electromagnetic Feild (sic) Therapy and a multiple-wave oscillator. It saturates the cells of the body with the appropriate resonate (sic) energies on which the cells’ electro-chemical systems depend (feed) on (sic).

This, in turn, maximizes the chemical processes of the cells, which are brought into balance through mutual resonance, allowing proper repair and operation.

When one uses the Enhancer regularly, it maintains the electrical health of the body on the cellular level by bringing the electrical level in each cell to the same potential, i.e. working in harmony. All chemical processes in the body require energy to take place and the Enhancer feeds the cells’ energy need at the molecular level, energetically assisting the cell in its chemical processes.

This is accomplished by setting up a high-energy field in and around the body through multiple-wave resonance.

The Enhancer does not pass current through the body. The transfer of energy is accomplished through induction. All that is used is the oscillating-field voltage and not the current. A person is insulated from the high voltage at either connection by glass. This prevents excess current from getting into the body.

The resonance process is similar to gently shaking a box of marbles. After a while, the marbles organize themselves into the natural order their shapes dictate. The cells molecular structure (encoded by the persons DNA) has the same way of organizing themselves IF provided sufficient energy. When this is achieved, the cells work at maximum efficiency without causing cellular stress.

The Enhancer is the vehicle providing the movement in the molecular structure of the cells to their optimum interactive arrangement for normal operations within each cell. And it does this, not by passing current but by providing a resonant state that the bodies cells try and match.

One scientist explains it this way: A normal cell has an electrical potential of 70 millivolts (mV), an aged cell has 50 mV and the cancer or ill cell has 15 mV. When the cell is in electrical difficulty, the mV and sodium-potassium levels are out of balance causing cellular distress.

The high-resonate potential provided by the Enhancer brings all of the cells to an equal level, basically natures way of resetting them to their normal state. This provides the potential for healing to occur at an accelerated pace without stressing the cell.

The additional energy restores cell integrity by reorienting its molecular structure to allow for easier potential movement and interaction. Basically, it bolsters the field of each cell individually, so the cells support each other more easily, thereby helping to create a balanced system. ”

WTF???

There are cleverly worded disclaimers scattered about the site noting that the device doesn’t cure anything – though I was told by my trainer that it “breaks up scar tissue.”

If you want a good laugh: http://www.dansenhancerweb.com

Klaatu barada nikto. Dude.

Unfortunately, there seem to be no good modalities for treating back pain, in formal medical practice, or outside of it. This is why back pain is so often treated by personable quacks, and well-meaning doctors who produce indifferent results. Almost everyone has back pain, and it is often self-limiting, which is why many so-called “treatments” seem to work. But there is a subset of those patients who end up with chronic pain, go from doctor to quack again and again without relief, or with only temporary relief. At least that’s my own anecdotal experience in trying to get help for my mother’s back pain, mostly from real medical doctors who say they can help, but after a few weeks of trying their own favorite treatment, give up and blame her for the pain, or even refer to her to quacks (like acupuncturists.) I even met a real M.D. at Cedars Sinai Hospital in Los Angeles–usually considered a top-flight institution–who wanted to inject my mother with a homeopathic substance–another example of how quackery is becoming a part of today’s medical practices. No–we didn’t do it, but I was outraged at the “Doctor” for suggesting it. When Doctors become quacks, how are any of us going to get real medical care?

Chiros are especially inventive, patenting their “tools” and copyrighting their ‘new and improved’ dubious kinds of human primate social grooming, calling ’same old’ by a new name and altering a tiny detail here or there in the conceptual hallucination and perceptual fantasy packaging of the treatment construct, usually targeted to some mesodermal derivative or other. They long ago figured out how to work the “cont ed” circuit to make better $. By attaching their own name to the construct and method, they can become a famous manual therapy guru. Many PTs are no better. MTs are the usual targets.

To clone a new income, conceptually take acupuncture needles, make them a lot bigger and blunter, lay them sideways to scrape instead of poke/pierce. Call this by your last name, then teach other practitioners for big bucks, the Newest Best True Way of Getting Fantastic! Results With Your Patients.

An interesting point that almost never gets discussed is the way that these workshops are the nearly universal source of “continuing education” credits for most manual therapists, especially massage therapists and chiropractors. To be eligible for CE credits, workshop sellers basically just submit a curriculum. Thus the concept of continuing education is rendered almost meaningless.

Maybe you could suggest making sure this story DOES get put in the paper, exposing it for the quackery it is. It could be an example of the ever-so-rare responsible skeptical mainstream article.

Although it’s pretty obscure, I think Graston is one of the most egregious of the modality empires (http://SaveYourself.ca/modality_empires). It’s not only implausible, unproven, and expensive, but also so painful that it may be the best example of a physical therapy with a placebo powered by the it-hurts-so-it-must-be-good factor. There are many other good candidates in that category as well, but there’s something special about an intervention that uses gleaming steel tools to inflict agony!

My trainer is a true believer in a weird device that is apparently made somewhere here in the Pacific Northwest. It is said to break up scar tissue and to promote healing of damaged muscle and connective tissue. I’ve forgotten just what they call the contraption – magnetic oscillator, or something – but it is in fact a high voltage power supply – like a van de Graff generator – coupled with a large clear glass ball. The ball crackles with electrical discharges and I suppose looks very impressive to the average rube. The surface of the ball is placed in contact with the ‘afflicted areas.’ When I pressed on the supposed mechanism of action I was treated to something about how the inventor is a really smart guy.

Oh my, I’ll start treatments immediately!

Magical thinking again, similar to “like causes like”: Fibrous tissue is “bad” and caused by inflammation, so causing “controlled” inflammation in “small amounts” will magically fix the original problem.

Diane’s comment on “Dubious kinds of human primate social grooming” is perfect.

tim

Their device doesn’t use electricity yet, the next version will.

Diane