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Chiropractic: A Summary of Concerns

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Although obscured by controversy, there is evidence to indicate that spinal manipulation can be as effective as conventional treatment methods in relieving low-back pain.1,2,3,4 This grain of truth mixed with chiropractic vertebral subluxation theory that encompasses a broad scope of ailments makes it difficult for the average person to distinguish between appropriate and inappropriate use of manipulation by chiropractors. A person who is satisfied with chiropractic manipulative treatment for back pain might be led to believe that the same treatment can be used to treat a variety of organic ailments by correcting “vertebral subluxations.” Such treatment is usually described as a “chiropractic adjustment.”

A manual chiropractic adjustment

Although chiropractic care based on subluxation theory has been rejected by the scientific community, spinal manipulation used in the treatment of mechanical-type back pain has a plausible basis that makes it acceptable in mainstream healthcare. A good back-cracking back rub provided by a chiropractor or some other manual therapist can be a pleasurable, pain-relieving experience, and this can be a preferred method of treatment for some types of back pain. But you should be well-informed enough to know where to draw the line in separating subluxation-based chiropractic adjustments from appropriate use of generic spinal manipulation if you should consider treatment by a chiropractor. Otherwise, you might become the victim of the bait-and-switch tactics of chiropractors who offer you treatment for back pain and then attempt to indoctrinate you in subluxation theory.

Much of what follows in this article has been said before in other articles of mine posted on this site. An up-to-date summary of basic concerns about chiropractic care, however, might be useful for new readers and others, including professionals, who want a brief overview for quick reference in seeking answers to questions about the problematic aspects of chiropractic use of spinal manipulation.

Subluxations do not affect general health

The vertebral subluxation theory that gave birth to the chiropractic profession proposed that 95 per cent of diseases are caused by displaced vertebrae that place pressure on spinal nerves.5 Today, chiropractic is defined as a method of adjusting a “vertebral subluxation complex,” an asymptomatic and undetectable “joint dysfunction” (involving nerves, muscles, connective tissues, blood vessels, and other factors) alleged to influence organ system function and general health.6 There is no credible evidence to support the chiropractic theory that joint dysfunction or a vertebral subluxation in any form can affect general health or cause internal organs to become diseased. Spinal nerves are commonly compressed by bony spurs and herniated discs. Even the most severe compression of a spinal nerve, which may cripple the supplied musculoskeletal structures, does not cause organic disease. In the absence of fracture or pathology such as disc herniation or osteophyte formation, vertebral misalignments rarely affect spinal nerves.

Spinal nerves supply the sensory and motor (voluntary) functions of musculoskeletal structures. Involuntary function of the body’s organs is regulated by autonomic nerve ganglia and plexuses located outside the spinal column and by autonomic cranial and sacral nerves that pass through solid bony openings. The vagus nerves are autonomic (parasympathetic) cranial nerves that originate in the brain stem, traversing openings in the base of the skull to pass down through the neck, thorax, and abdomen to supply organs along their path. Preganglionic autonomic fibers, which emerge from the spinal cord and pass through spinal segments from the first thoracic vertebra to the second lumbar vertebra, terminate in sympathetic trunk and splanchnic ganglia located outside the spinal column. The vagus nerves along with autonomic ganglia and nerve plexuses provide overlapping sympathetic and parasympathetic nerve supply from many directions and sources (in concert with chemical, hormonal, and circulatory factors) to assure continued function of the body’s organs, independent of spinal nerves.7 This is why severance of the spinal cord in the neck area, shutting off brain impulses to spinal nerves, can cause paralysis of muscles from the neck down while the body’s organs continue to function. Transplanted organs function without reconnection of severed nerves.

A serious transverse spinal cord lesion above C5 (upper neck) can cause respiratory paralysis and often death. Since the spinal cord ends at the level of the 2nd lumbar vertebra, spinal nerves pass down from the spinal cord (like the hair on a horse’s tail) to exit openings between the lumbar vertebrae and from openings in the sacrum. The spinal nerves supplying bladder and bowel sphincter muscles pass through the solid bony openings of the sacrum (a pelvic bone at the bottom of the spine) and are not subject to compression by a subluxation. But they can be compressed by protrusion of a lower lumbar disc into the spinal canal, affecting voluntary control of sphincter muscles (cauda equina syndrome).

A chiropractic vertebral subluxation or “joint dysfunction” alleged to cause disease by interfering with nerve supply to organs cannot be demonstrated and cannot be equated with a real orthopedic subluxation, a partial dislocation that causes musculoskeletal symptoms. Spinal manipulation, massage, and other forms of manual therapy can have some temporary neurological and physiological effects that might be beneficial in relieving back pain symptoms. But there is no evidence to indicate that such effects have a significant affect on general health.

“One of the key ‘selling points’ for chiropractic care is the anatomically impossible premise that your spinal nerve roots are important to your general health.”8 An excellent, reader-friendly discussion of this subject can be found on the SaveYourself site via the reference for this quotation.

Despite the implausibility of chiropractic subluxation theory, which is more a belief than a theory, state laws and chiropractic publications in the United States continue to define chiropractic as a method of correcting vertebral subluxations to restore and maintain health.9

Alternative chiropractic care

Although the public generally thinks of chiropractors as back specialists, few chiropractors limit their care to treatment of back pain. The vague and all-inclusive chiropractic subluxation theory generates a hodgepodge of entrepreneurial techniques and treatment methods for a variety of ailments. Treatment methods vary from one chiropractor to another, and are often incompatible with interchange in mainstream health care. According to the Association of Chiropractic Colleges, chiropractic is associated with the field of complementary and alternative medicine as a method of improving and preserving health.10 The profession has chosen not to seek development as a scientifically acceptable musculoskeletal specialty, despite the fact that back pain and musculoskeletal conditions are the No. 1 and No. 2 causes of disability worldwide.11 Some chiropractic colleges offer decent instruction in the care of musculoskeletal problems but are tainted by subluxation theory that encompasses a broad scope of ailments. Physicians who refer patients to chiropractors for spinal manipulative therapy must be cautious in selection of a chiropractor, and they must take responsibility for the diagnosis, lest inappropriate treatment makes them vulnerable to liability for damages. Care must also be taken to make it clear that referral to a selected chiropractor who uses manipulation appropriately is not an endorsement of subluxation-based chiropractic.

Subluxation theory perpetuated as a belief system

There are no indications that subluxation theory, the foundation of chiropractic, will ever be discarded by all chiropractors. With no plausible or scientific rationale to support it, subluxation theory will be perpetuated as a belief system. Putative chiropractic subluxations that are not detectable by conventional methods are allegedly being located by such dubious procedures as thermography, applied kinesiology, and leg-length checks. Dozens of different techniques are used to correct such subluxations. Some chiropractors use a spring-loaded stylus in an attempt to tap vertebrae into alignment in order to “restore the integrity of the nervous system.” Upper cervical chiropractors believe that aligning the atlas (the vertebra at the top of the spine) will “influence the central nervous system and brain stem function” as well as realign vertebrae from the neck down.12

While there are some good chiropractors who offer a service of value in the care of back pain, combining appropriate use of spinal manipulation with other physical treatment methods, it would certainly seem advisable to avoid the services of any chiropractor who proposes to treat a health problem by adjusting vertebral subluxations. Physical therapists who use mobilization or generic spinal manipulation to relieve pain and restore mobility in an injured area of the spine are more likely to use manipulation appropriately than a chiropractor who adjusts every patient to remove “nerve interference” caused by an asymptomatic “vertebral subluxation complex.” A subluxation-based chiropractor may even manipulate the neck as a treatment for low-back pain.12 Since upper cervical manipulation has been associated with stroke caused by injury to vertebral arteries, neck manipulation should be reserved for a carefully selected, albeit rare, neck problem for which there is no other viable treatment option. Manipulative techniques that involve rotating the head to force rotation of upper cervical structures should not be used. Risk certainly outweighs benefit when neck manipulation is used routinely to correct chiropractic subluxations.13

Note: Mobilization moves joints through normal ranges of movement. Manipulation forces movement of a joint beyond a normal range, often into a paraphysiologic space where there may be slight separation of joint surfaces (cavitation) to produce a popping sound. Manipulation can produce popping sounds in normal joints. Such popping is not considered to be significant, but it can have a powerful placebo effect among those who believe that the popping sound signals correction of a disease-causing subluxation. Unfortunately, some chiropractors allow their patients to believe that a popping sound means that vertebral subluxations are present, producing a nocebo effect that lures chiropractic patients into a program of regular spinal adjustments in an attempt to maintain health by keeping their vertebrae aligned.

The bottom line

There is no credible evidence to support use of spinal manipulation for anything other than uncomplicated mechanical-type back pain and related neuromusculoskeletal problems. There is no evidence at all to support chiropractic subluxation theory. It has never been demonstrated that a real orthopedic subluxation or a pinched spinal nerve can affect general health or that an undetectable “vertebral subluxation complex” can cause organic problems.14 If you are looking for a chiropractor who offers spinal manipulation as an option in the treatment of back pain, look for one who does not subscribe to subluxation theory ─ one who is willing to exchange office notes with your family physician. Remember that most of the time, acute low-back pain is a self-limiting condition that will resolve in four to six weeks, with or without treatment. Appropriate treatment can, however, relieve symptoms and speed recovery. When back pain grows progressively worse, persists unrelieved for longer than a week, or is worsened by rest, there may be cause for alarm. Chiropractic care should not be continued for longer than two to four weeks if there is no measured improvement. A correct diagnosis is essential when considering treatment options. Treatment based on correction of an alleged chiropractic vertebral subluxation complex may result in unnecessary chiropractic adjustments for nonexistent or unrelated problems, delaying appropriate treatment based on a correct diagnosis. I don’t know of any reason to manipulate the immature, cartilaginous spine of a neonate or an infant as some pediatric chiropractors are doing.15

References

  1. Rubinstein, Sidney M., Marienke van Middelkoop, Willem J.J. Assendelft, et al. 2011. Spinal manipulative therapy for chronic low-back pain: an update of a Cochrane review. Spine. 36(13):E825-46. http://www.ncbi.nlm.nih.gov/pubmed/21593658 Accessed February 17, 2014.
  2. Rubinstein, Sidney M., Caroline B. Terwee, Willem J.J. Assendelft, et al. 2013. Spinal manipulative therapy for acute low-back pain: an update of the Cochrane review. Spine. 38(3):E158-77. http://www.ncbi.nlm.nih.gov/pubmed/23169072 Accessed February 17, 2014.
  3. National Center for Complementary and Alternative Medicine. 2012. Spinal manipulation for low-back pain: What the science says. NCCAM Clinical Digest. May. http://nccam.nih.gov/health/providers/digest/chronic-low-back-pain-science Accessed February 6, 2014.
  4. Agency for Healthcare Research and Quality. 2010. Complementary and Alternative Therapies for Back Pain. http://www.ahrq.gov/research/findings/evidence-based-reports/backcam2tp.html Accessed February 6, 2014.
  5. Palmer, Daniel David. 1910. The Chiropractor’s Adjuster: A Textbook of the Science, Art, and Philosophy of Chiropractic for Students and Practitioners. Portland, Oregon. Portland Printing House.
  6. Association of Chiropractic Colleges. Chiropractic Paradigm. http://www.chirocolleges.org/paradigm_scope_practice.html Accessed February 6, 2014.
  7. Homola, Samuel. 2006. Chiropractic: History and Overview of Theories and Methods. Clinical Orthopaedics and Related Research. 444:236-242. http://www.ncbi.nlm.nih.gov/pubmed/16446588 Accessed April 2, 2014.
  8. Ingraham, Paul. 2013. Spinal Nerve Roots Do Not Hook Up to Organs! http://saveyourself.ca/articles/spinal-nerves-and-organs.php Accessed February 6, 2014.
  9. Bellamy, J.J. 2010. Legislative alchemy: The U.S. state chiropractic practice acts. Focus on Complementary and Alternative Therapies. 15(3):214-222. http://onlinelibrary.wiley.com/doi/10.1111/j.2042-7166.2010.01032.x/abstract Accessed April 2, 2014.
  10. CCE. An open letter to the profession from the Council on Chiropractic Education. November 22, 2011. http://www.acatoday.org/pdf/CCE_Letter.pdf Accessed February 6, 2014.
  11. Vos, Theo, Abraham D. Flaxman, Mohsen Naghavi, et al. 2012. Years lived with disability (YLDs) for 1160 sequelae of 289 diseases and injuries 1990-2010: a systematic analysis of the Global Burden of Disease Study 2010. The Lancet. 380(9859):2163-2196. http://www.ncbi.nlm.nih.gov/pubmed/23245607 Accessed April 2, 2014.
  12. Homola, Samuel. 2009. The problem with chiropractic NUCCA. Science-Based Medicine. August 7. http://www.sciencebasedmedicine.org/index.php/the-problem-with-chiropractic-nucca/ Accessed February 6, 2014.
  13. Homola, Samuel. 2009. Neck Manipulation: Risk vs. Benefit. Science-Based Medicine. August 27. http://www.sciencebasedmedicine.org/neck-manipulation-risk-vs-benefit/ Accessed February 6, 2014.
  14. Mirtz, Timothy A., Lon Morgan, Lawrence H. Wyatt, et al. 2009. An epidemiological examination of the subluxation construct using Hill’s criteria of causation. Chiropractic and Manual Therapies. 17:13. http://www.ncbi.nlm.nih.gov/pubmed/19954544 Accessed April 2, 2014.
  15. Homola, Samuel. 2010. Pediatric Chiropractic Care: Scientifically Indefensible? Science-Based Medicine. http://www.sciencebasedmedicine.org/pediatric-chiropractic-care-scientifically-indefensible/ Accessed February 6, 2014.

______________________
Samuel Homola is a retired chiropractor who specialized in the care of back pain. He is the author of 15 books, including Bonesetting, Chiropractic, and Cultism (Critique Books, 1963), Inside Chiropractic (Prometheus Books, 1999), and The Chiropractor’s Self-Help Back and Body Book (Hunter House, 2002). He lives in Panama City, Florida, and is a co-host for the Chirobase.org web site. His email address is samhomola@comcast.net

Posted in: Chiropractic

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201 thoughts on “Chiropractic: A Summary of Concerns

  1. Windriven says:

    From time to time chiropractors have appeared in the comments pages and suggested a nascent movement to reform chiropractic to adhere to scientific principles and to bring it into the medical mainstream following a path similar to that taken by podiatry.

    Are there enough chiropractors willing to abandon subluxation theory and embrace a scientific approach to reshape chiropractic – or alternatively to form a sustainable breakaway group of evidence based chiropractic?

    Does chiropractic bring important insights and skills to the medical armamentarium that aren’t provided by physical therapists?

    1. Rx says:

      PT’s are trained in back manipulation (at least in states where chiropractors don’t have a legal monopoly).

      For chiro’s- its becoming a fight to stay relevant.

    2. Denise B says:

      As all but one of the chiropractors I’ve known are very dismissive of “allopathic” medicine, and see themselves as offering an alternative and not an adjunct, I’ve wondered if this is something they learn in chiropractic school.

      Do they enter their training harboring negative feelings about medicine, or do they start out just thinking they’re training for a good career helping people with back problems and then get taught that they can replace doctors?

    3. Damon says:

      This website is the most bias and bullshit filled “scientific” website I’ve ever come across. These “Doctors” are ignorant in subjects and therefore claim its “bait and switch”. Just because you dont understand why something works doesnt make it wrong or invalid. There is plenty of real scientific evidence supporting Chiropractic. I really hope people dont read the crap put out by the website and believe it. They are no better than Penn and Teller.

      This goes for other modalities as well. If acupuncture or something else helps you, who are these idiots to denounce it? If we waited for research to support our findings first we would be way behind and a lot of medicine wouldn’t be here either. Healthcare is ever changing and growing and in a few years everything on this website could look idiotic. What makes you think they know something that others dont? Chiropractors have more class room hours than med students. More in anatomy, diagnosis, Neurology, Orthopedics, and radiology to name a few. Medical doctors learn nothing on Spinal Manipulation and are terrible people to get an opinion of its benefits. It surprises me that a medical doctor doesnt know that nerves exit your spine and lead to organs, muscles, etc. and that if a nerve is interfered with (A Chiropractic subluxation) even by the weight of a hair, it can affect the transmission of the nerve to said organ, tissue, etc. You dont think that will have an effect on the human body, its nervous system and immune system? Well than youre an idiot. There have been plenty of studies showing this to be true.

      There is so much we dont know about the human body and it is not as cut and dry as these “doctors” would have you believe. Sorry to inform you but you can solve everything with a pill.

      1. Chris says:

        Just above these sets of comments is a paragraph that starts with: “Samuel Homola is a retired chiropractor who specialized in the care of back pain.”

        You might want to actually try reading the article. Or if you did, you are not giving us a good view of your reading comprehension.

      2. brewandferment says:

        Damon,

        Did you forget to read the information about the author at the end of the article? He is a retired chiropractor (and son of a chiropractor as well.)

      3. Windriven says:

        Damon,
        Before you humiliate yourself further, learn to construct a logically sound argument, write complete and coherent sentences, spell, and use punctuation more or less properly. Really, some of your nattering is over the top.

        “Well than youre an idiot.”

        Well then, you’re an idiot.”

        See, it works when I write it – not so much when you write it because the object (idiot) appears self-referential (it points back to you) in your, ahem, construct.

        See if you can trade in your DC license for a redo of 10th grade composition. It will be a worthy trade; good for you, good for humanity.

      4. WilliamLawrenceUtridge says:

        There is plenty of real scientific evidence supporting Chiropractic.

        Really? Can you provide any of it? And keep in mind what is required for a study to demonstrate causality:

        a) Control groups
        b) Randomization
        c) High n (at least 30 patients per group, more if you are doing multiple comparisons)
        d) Blinding (as much as possible, ideally at least double)
        e) Reporting in a high-quality journal
        f) Objective tests (or at least subjective tests that have high inter-rater reliability)

        If you lack any of these elements, the study could more properly be called “marketing” rather than “science”. See, chiropractors do a lot of “research”, but often it’s things like single patient case studies, or uncontrolled groups (so basically they can conclude “things change”, but can never conclude “because of chiropractic adjustments”).

        So please – show us how chiropractors heal, show us the science, but please exclude the shoddy nonsense that masquerades as science – that’s just the chiropractic profession pretending to do science so they can avoid the unfortunate reality that they lack proof for most of their claims.

        Sorry to inform you but you can solve everything with a pill.

        Of course not! Sometimes you need injections :P

        Or, you know, following conventional mainstream advice – don’t smoke, eat a healthy diet, sleep, exercise, reduce stress. You know, the stuff patients often avoid doing then end up in the hospital due to a heart attack and it’s too late to do anything but crack the chest open or put someone on drugs for the rest of their lives.

    4. jim says:

      RX and chiropractors are trained in PT so your point is??

      denise b – most chiros are very aware of the business side of big Med. Just as some here are aware of the business side of chiropractic. Most (not all) chiros are not dismissive of traditional med, just wary.

  2. tgobbi says:

    Sam states that the subluxation theory is nonfalsifiable. But didn’t Edmund Crelin falsify it over 40 years ago?

    Sam also mentions that chiropractors are assumed by the general public to be “back specialists.” I’ve met a number of people who take this assumption a step further, claiming the chiropractors are, in fact, MDs who have gone on to specialize in the study and treatment of “the back.”

    As for those MDs who may suggest that their patients consult DCs – I have the distinct impression that those doctors don’t really understand what chiropractic is all about – that DCs typically regard themselves as viable alternatives to what we know as science-based medicine as in a “separate-but-equal” status. Anecdotal example: at the moment I’m seeing a rheumatologist who is woefully ignorant about the pseudoscientific nature of the roots and practice of chiropractic. He seems unconcerned that patients with neck pain are subjecting themselves to the possibility of chiro-induced stroke.

    1. Sam Homola says:

      Perhaps I used the word “nonfalsifiable” incorrectly. Crelin clearly demonstrated that vertebrae could not be displaced enough to impinge upon spinal nerves without tearing ligaments. But vitalistic subluxation theory or a undetectable vertebral subluxation complex alleged to influence organ system function and general health does not have any substance that can be tested scientifically and continues to be classified as a belief system.

  3. tgobbi says:

    Windriven asks 2 questions:

    1. “Are there enough chiropractors willing to abandon subluxation theory and embrace a scientific approach to reshape chiropractic – or alternatively to form a sustainable breakaway group of evidence based chiropractic?”

    2. “Does chiropractic bring important insights and skills to the medical armamentarium that aren’t provided by physical therapists?”

    An emphatic NO is the answer to both questions. 25 or 30 years ago there was a short-lived movement called the National Association for Chiropractic Medicine (NCAM). At its peak it represented approximately 1%[!] of the practicing DCs and died a quick death while undergoing universal ridicule from the mainstream chiropractic community. And, according to Bill Jarvis (former National Council Against Health Fraud president): “The National Council Against Health Fraud (NCAHF) finds it remarkable that the chiropractic profession has existed for a century without having made a single notable contribution to the world’s body of knowledge in the health sciences.”

  4. DJ says:

    Within chiropractic, there are two camps: the “mixers” and the “straights”. The “straights” tend to believe in the “innate”, or the subluxation theory – that if you manipulate the spine – all can be cured! This is bogus and a shame! On the other hand – a modern, “mixed” chiropractor uses multiple modalities and can do EVERYTHING a physical therapist can do – PLUS diagnose and analyze joints. It’s horrible that this camp of intelligent, evidence based chiropractors gets lumped into the “straight” chiropractic group. These doctors are the ones who want to move the profession forward, into the realm of evidence based modern medicine.

    To explain further: if there is an issue at the joint, ligamentous structures and tissues will try to protect the joint and become hypertonic, or typically, shortened. This is why soft tissue techniques like Active Release technique and Post Isometric Relaxation are so vital. By working with soft tissue, and then addressing the joint, “mixer” chiropractors can get incredible results. Add on top of that nutrition, muscle activation techniques, and solid diagnostic skills to know when to refer out and it’s a 100% natural, cost-effective, drug free alternative. What is so bad about this??

    A fact: the adjustment works. That is why chiropractic is still around. Manipulation can be traced back to Hippocrates. There needs to be more research to understand exactly WHY the adjustment works. This is in progress, but big money in chiropractic is unheard of, with the lack of pharmaceuticals. What does great research require? Big money. Meanwhile – we have two camps in chiropractic, the mixers and the straights, who are hurting the profession by not agreeing on what direction to take the profession. I wouldn’t be surprised if within the next 10 years, there is a Doctor of Chiropractic Medicine degree (mixers) and a Doctor of Chiropractic subluxation degree (straights).

    There are awful lawyers, surgeons, and teachers. There are terrible chiropractors. Find yourself a good chiro, and it will change your life.

    1. Windriven says:

      “EVERYTHING a physical therapist can do – PLUS diagnose and analyze joints.”

      So why wouldn’t I go to an orthopod for diagnosis and a PT for treatment? My wife did that for an achille’s tendon issue with perfect results. I’m not trying to be a jerk but I am trying to understand if and what chiropractors bring to the table.

      “A fact: the adjustment works.”

      Citations please. The act of assertion doesn’t make it true. Neither does the appeal to popularity. Homeopathy has been around almost 100 years longer than chiropractic – would you argue that means homeopathy works?

      “big money in chiropractic is unheard of”

      Bullsh!t. Chiropractic management gurus shape million dollar a year practices. Ankle on over to ChiroWatch.org. Moreover, NCCAM spends north of $100 million annually studying all manner of quackery and nonsense. Chiropractic gets its share.

      “I wouldn’t be surprised if within the next 10 years, there is a Doctor of Chiropractic Medicine degree (mixers) and a Doctor of Chiropractic subluxation degree (straights).”

      Could be. But before it happens the ‘mixers’ need to demonstrate that they are bringing something valuable to the party.

      “Find yourself a good chiro, and it will change your life.”

      How? I don’t have any back trouble worth talking about. My internist and I monitor my diet and exercise regimens.

      Look, if chiropractic brings something unique and valuable to the medical armamentarium, great. But nobody here is going to accept that proposition without some proof.

      1. Sean Duggan says:

        Perhaps it would be more accurate to say that chiropractic adjustments by themselves may not be immensely profitable. Assuming that people get adjusted once per week (which seems horribly high to me), and you get $100 for each one, it seems like you’d have to have a pretty substantial patient list just to break even. Thus, you get the “movie concession stand” bits like selling supplements. The main line of business brings people in and the secondary one makes your money.

      2. DJ says:

        Why does a good chiropractor have to do something different than everyone else if they can do it better than your orthopod and PT? Under the same roof?

        In my opinion, a good chiro should focus mainly on musculoskeletal conditions.

        Let me clarify: when I say modalities, I mean soft tissue work (ART, PIR, ETC.), muscle activation technique, functional rehab based out of the Prague school of thought, Dynamic Neuromuscular stabilization, taping techniques like rocktape or kinesiotape, graston technique, etc.

        These are not pseudoscience – unless some of the best physical therapists, strength trainers in the world are practicing pseudoscience.

        A well trained “mixer” chiropractic physician is, in my opinion, the non-invasive musculoskeletal expert of medicine. They combine all of the above modalities, with yes, manipulation of the spine. Not even to mention nutrition and exercise.

        @Windriven:

        I’m talking about research, not people trying to make a buc. Do you understand the quantity of $$$ for these research endeavors? If you believe this is an equal playing field, without the help of big pharm, FOR research, then well that is quite naive. Of course people are going to be trying to make money, this is America, right?

        A little research for you: the Bronfort report is likely the most comprehensive report and lit search ever done looking at the effectiveness of manipulation and manual therapy on a wide array of musculoskeletal and non-musculoskeletal complaints and disorders. Some light reading:

        http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2841070/

        If you want to see an internist, go ahead, thats great! A chiro could help you maintain your diet and exercise as well. But maybe you’re not the type of person that would gravitate toward a more natural approach to healthcare. That’s fine. But this brigade against chiropractors – or at least the musculoskeletal based “mixer” chiros is nonsensical. It’s people trying to help people, which in my mind, is a noble deed.

        1. Scott says:

          The “mixers” are, in fact, even worse. What they tend to mix in are things like homeopathy, iridology, etc. that are even more profoundly useless quackery than chiropractic itself.

        2. Windriven says:

          “Why does a good chiropractor have to do something different than everyone else if they can do it better than your orthopod and PT?”

          They don’t. But where is the evidence that DCs do anything better than orthopods or PTs? I am not opposed to any medical specialty that delivers quality, science-based care cost effectively.

          “But maybe you’re not the type of person that would gravitate toward a more natural approach to healthcare.”

          More natural than what? My only interest is in quality, science based healthcare.

          I see my internist about my diet because she is my PCP and is educated to evaluate my diet as part of my overall health plan. We discuss exercise in terms of cardiovascular health and weight management. If I wanted to go beyond that I would consult a trainer – and have in the past. I’m not saying that a chiropractor would have no utility here but I am asking on what evidence a chiropractor would be the better choice.

          Thanks for linking the Bronfort. It has been discussed broadly here. Chiropractic has value in the treatment of low back pain. Everything else is more speculative. You are basing an entire clinical specialty on LBP?

        3. Calli Arcale says:

          “These are not pseudoscience – unless some of the best physical therapists, strength trainers in the world are practicing pseudoscience. ”

          Do you think PTs and strength trainers* are somehow immune to pseudoscience? Kinesiotape, which you mentioned, has become very popular but is lacking in evidence. Maybe it works. Maybe it doesn’t. What I’ve seen so far suggests more of a placebo effect, which has been true of an awful lot of athletic enhancement products. (It probably helps, from a marketing perspective, that elite athletes have a tendency towards superstition, probably driven by their extreme focus on performance that makes them willing to try just about anything that won’t get them banned during the drug screening.)

          Meanwhile, you talk about nutrition as if that’s part of chiropractic. I would not see a chiropractor for nutrition; I’d see a dietician. Nutrition advice is beyond the scope of chiropractic, and has nothing to do with subluxations. And you talk also about diagnosis — I definitely support chiros referring out, but the idea that they can *diagnose* conditions before referring out is dangerous hubris. They are not trained to diagnose much. Maybe some things with the back, but they’re not qualified to diagnose stroke or meningitis or gluten intolerance or low thyroid — this doesn’t stop them, of course. There are mixers out there who will happily prescribe thyroid medication for a person they believe has low thyroid. They may even order labs and things. But they don’t have the training to do this, and inappropriate thyroid medication can kill. They should absolutely be able to recognize when they’re in over their heads, but at that point they should also recognize they’re not equipped to diagnose either. Even if they suspect what it is, they can’t diagnose it.

          *Note: “strength trainer” is not a licensed profession. Anybody can call themselves one if they want. They’re not medical practitioners, unlike PTs; they’re athletic coaches, regulated about as well as yoga instructors or swimming teachers, which is to say not at all.

          1. pleigh says:

            Hi…just an fyi

            I understand that a license is not the same as certification, but I have a Certified Strength and Conditioning Specialist(CSCS) certification through the National Strength and Conditioning Association (NSCA) and that certification process is accredited through the National Commission for Certifying Agencies (NCCA)…I guess my point is there is one (or two?) strength training certification that has some accountability.

            I also have a high school teaching license for comparison…

            Again…no meaningful contributions to the topic of the post…just an fyi…

            1. Andrey Pavlov says:

              It would be interesting to know precisely what that entails and what the standards are. Sadly merely being certified or licensed doesn’t necessarily mean anything. Nor does being accredited. Obviously not being certified, licensed, or educated from an accredited place is pretty much always a bad thing and the converse is very usually a good indicator. But naturopaths are licensed, regulated, and graduate from accredited programs. As are chiropractors. And as are homeopaths in the UK. Heck, Bob Jones University is accredited under the same umbrella that legitimate universities like Harvard are, but the degree isn’t worth the paper it is printed on.

              Please bear in mind I am not saying that is what your cert is like. I genuinely have no idea. I am merely saying that one would need much more info to evaluate what that actually means.

              1. pleigh says:

                Points well taken

        4. Jay says:

          To DJ
          you posted:
          when I say modalities, I mean soft tissue work (ART, PIR, ETC.), muscle activation technique, functional rehab based out of the Prague school of thought, Dynamic Neuromuscular stabilization, taping techniques like rocktape or kinesiotape, graston technique, etc.

          However, most of what you listed there has little to no evidence to support its utilization. At best, it is Level 5 evidence which is either “guru” opinion or case reports. These “modalities” have not been scrutinized via RCTs.

          Unfortunately a variety of providers, not just use DCs, use these treatments. These treatments lack strong evidence and cost patients money. What would we think of MDs who say “lets try this little purple because it makes sense to use it”, even though little purple pill has yet to be tested for said condition (either efficacy or harm).

          All providers should strive to either practice evidence based OR conduct research to support their hypotheses.

          1. “MDs who say “lets try this little purple because it makes sense to use it”, even though little purple pill has yet to be tested for said condition (either efficacy or harm).”

            I am amazed at how people think that medicine is an exact science. Far from it!! We assess, assume and we try different pills(random chemicals that have gone thru a harm-benefit analysis then in clinical practice we take a pot-shot.

            Clinical practitioners are actively in the lab or office experimenting, the problem is that no one cares what we find that may be of benefit or that may do harm.

            1. Windriven says:

              “Far from it!! We assess, assume and we try different pills(random chemicals that have gone thru a harm-benefit analysis then in clinical practice we take a pot-shot.”

              Steve, Steve, Steve. Do you even think about what you write? How does : “chemicals that have gone thru a harm-benefit (sic) analysis” fit with “then in clinical practice we take a pot-shot?” If we have tested the drug and have a good second order approximation of its benefits and its risks, how is using it clinically a “pot shot?”

              1. “pot shots” with a little instruction from a guide.

                In the treatment of hypertension you begin with step 1. “potshot” with some degree of inaccurate but sanctioned by the AMA-dudes.

                If the BP is still not controlled add in “potshot” #2

                and so one until the bp is normalized.

              2. Windriven says:

                An alternative way of looking at what you call a ‘potshot’ is this:

                Patient presents with mild hypertension. Start with a review of BMI, diet, exercise and perhaps a diuretic and determine if we can control it with that. Chlorthalidone it is. Check for hypokalemia after a couple of weeks. If BP is well controlled, all is good. If not, fold in an ACE inhibitor. Etc.

                This is not ‘taking pot shots’, it is solid conservative primary medical care focused on managing hypertension with minimal intervention.

        5. “Let me clarify: when I say modalities, I mean soft tissue work (ART, PIR, ETC.), muscle activation technique, functional rehab based out of the Prague school of thought, Dynamic Neuromuscular stabilization, taping techniques like rocktape or kinesiotape, graston technique, etc.

          These are not pseudoscience – unless some of the best physical therapists, strength trainers in the world are practicing pseudoscience.”

          There is very little evidence to support the statements above (I also would not classify Strength Trainers with Physical Therapists. Most Physical Therapists hold a clinical doctoral degree while there is no standardization of education in “Strength Training”).

          While there is evidence to suggest manual interventions + exercise, are likely more beneficial than exercise alone, the manual intervention is likely no more than simply an “input” to an individualized neuromatrix . In some research I participated in a few years back (published in Manual Therapy), we found a within-session and between-session change was prognostic over outcomes. What didn’t appear to matter, was the manual intervention used (manipulation vs. lower grade mobilizations). Everything you described above simply delivers an “input” to the brain (some more harsher than others).

          1. Andrey Pavlov says:

            Well said Joseph. And precisely what I would have thought, but excellent to have someone in the field with more expert knowledge than I discuss it.

        6. WilliamLawrenceUtridge says:

          These are not pseudoscience – unless some of the best physical therapists, strength trainers in the world are practicing pseudoscience.

          Sadly some of them are – there is little evidence behind many of the practices you list. They might work (most have more likelihood than subluxations), but they’re not backed by good-quality trials.

          A well trained “mixer” chiropractic physician is, in my opinion, the non-invasive musculoskeletal expert of medicine. They combine all of the above modalities, with yes, manipulation of the spine. Not even to mention nutrition and exercise.

          Why a mixer chiro rather than a physio? Or even a massage therapist who sees their role as solely muscle-based? Why not a profession that starts from a scientific, empirical, reality-based grounding? Because even “mixers” who restrict themselves to musculoskeletal problems still base their reasoning on subluxations and will still try to adjust your spine, including cervical spine which runs the negligible but not zero risk of stroke.

          If you believe this is an equal playing field, without the help of big pharm, FOR research, then well that is quite naive.

          The fact that Big Pharma has lots of money does not prevent chiropractors from researching the effectiveness of their practices and does not prevent the profession from abandoning the fantasy-based parts of their practice that has no evidence to support it.

          Of course people are going to be trying to make money, this is America, right?

          So therefore all professional associations and government agencies for consumer protection should abdicate any responsiblity to protect the public? As long as anybody can make money, then it shouldn’t matter how, or how illegal, or how dishonest they are?

          What do you think about TARP and the bail-outs paid to major banks, or how the ratings agencies were explicitly gamed to give AAA ratings to sub-prime mortgage bonds and collateralized debt obligations?

          A chiro could help you maintain your diet and exercise as well. But maybe you’re not the type of person that would gravitate toward a more natural approach to healthcare.

          a) What is natural about taking a spine and twisting it until it pops?

          b) The science-based practitioners of nutrition require years of dedicated schooling to become registered. How much time do chiropractors spend on nutrition, and how much of it is science-based? And how many people don’t need help with nutritional or exercise advice so much as following the mainstream advice? Why on earth would you go to a chiropractor for this kind of advice (particularly when they’re likely to try to sell you supplements they just happen to stock) rather than say, a doctor, nutritionist or pharmacist? Or just read up on the NIH fact sheets, which generally recommend against supplements but for a healthy diet?

        7. Adam Rufa says:

          ” I mean soft tissue work (ART, PIR, ETC.), muscle activation technique, functional rehab based out of the Prague school of thought, Dynamic Neuromuscular stabilization, taping techniques like rocktape or kinesiotape, graston technique, etc. ”

          All of those techniques you just described have little to no evidence supporting them. I am not sure they classify as pseudoscience (can’t say I know where the line is) but they are far from well supported interventions. Regardless of how great you say the people are who use them.

      3. “EVERYTHING a physical therapist can do – PLUS diagnose and analyze joints”

        As a Physical Therapist, I want to make a clarification to the statement above. Physical Therapists do evaluate, make a clinical assessment and give a distinct diagnosis. This stated, our diagnosis is often made based upon one’s movement vs. simply focusing on joints.

        1. Andrey Pavlov says:

          When I had shoulder surgery (arthroscopic repair of a torn glenoid labrum) my orthopod sent me to PT. The PT did his own evaluation, and then made some minor modifications to the standard treatment protocols to fit both my specific limitations and desires. I was leaving the country and knew I would only be able to attend 4 PT sessions, so I had them teach me everything they knew. I left, and continued to PT on my own. In just under 5 months after my surgery I was surfing again.

    2. yogalady says:

      You have explained why there is so little research supporting the chiropractic subluxation theory — no money from the Big Drug companies.

      Chirorpactic theory is based on an understanding of nerves that is somewhat different from the mainstream understanding. While the inner nerves might not be impaired by subtle joint problems, the cells that cover the nerves (myelin) definitely can be.

      That is what M.D.s fail to understand, and why they dismiss chiropractic theory.

      Myelin is not well understood by mainstream medicine. That is not to say chiropractors understand it well either. But they do have a practical sense of how it works, and how disease can result from subluxations that are subtle and not recognized by mainstream medicine.

      And those of us who practice yoga understand also. Chiropractic theory and the philosophy of hatha yoga have a lot in common.

      1. Andrey Pavlov says:

        Myelin is not well understood by mainstream medicine. That is not to say chiropractors understand it well either.

        You are correct on the second part.

        The first, not so much. What, precisely, is it that we don’t understand about myelin? It is extremely well studied, characterized, and described.

        But your fundamental (implicit) premise is flawed.

        While the inner nerves might not be impaired by subtle joint problems, the cells that cover the nerves (myelin) definitely can be.

        This is not a reality-based description of nerves. There are not a whole bunch of “inner nerves” that are themselves surrounded by myelin, like a coaxial cable where the copper wire in the middle is the nerve and the black plastic coating on the outside is the myelin. Each and every single nerve axon is surrounded by myelin – from the very outer portion of the nerve to the inner portion. Here is a handy diagram of a cross section of the nerve.

        Each axon (of which there are millions) has itself millions of Schwann cells. These form the myelin sheath surrounding each and every single axon. Then, these axons are grouped into larger bundles, which are surrounded by a connective tissue layer called the endoneurium. It is not myelin, but merely some loose connective tissue to give a 3D structural support to the axons contained within. That entire bundle + endoneurium is then surrounded by a tougher tissue layer called the perineurium which acts like the fascia of muscle to hold these bundles, now called fascicles together. Multiple fascicles come together surround by more connective tissue but now with blood vessels running between them to form the whole nerve. All of this is then surrounded by another fascia-like tissue layer call the epineurium which bundles the whole of the nerve together in one unit.

        This is extremely well described on every level you can possibly imagine. So to claim that “Myelin is not well understood by mainstream medicine” is simply ridiculous. Also, the idea that there is somehow myelin on the “outside” of a nerve which can be impinged is simply wrong on every level. The myelin is distributed throughout the nerve bundle, around the axons, and in fact there is no myelin on the “outside” portion of a nerve. If you were to take a nerve and poke a needle through it, you would first pass through epineurium, then connective tissue (and maybe a blood vessel), then perineurium, then more connective tissue, and only then finally would you actually hit myelin.

        I’m sorry yogalady, but there is no conceivable way that “the cells that cover the nerves (myelin) definitely can be [impaired by subtle joint problems].”

        And this is why chiropractics is quackery.

        1. Windriven says:

          Nice description of the anatomy of a nerve bundle, Andrey. I didn’t know about the various layers of connective tissue and, like yogalady, thought it was all myelin.

          Unlike yogalady however, I did not believe myelin to be poorly understood. Given the effort put into the study of MS and other neurodegenrative diseases I would expect the medical understanding of myelin to be rather more insightful than ‘stuff around the nerves.’

          But wait for it… SSR will be around shortly to fascinate us with a disquisition on the utility of pointy objects in the treatment of nerve tissues which, I believe SSR technically refers to as ‘jacked up.’

          1. Andrey Pavlov says:

            Thanks windriven. The anatomy and histology of nerves is very interesting. The principles surrounding the actual structure of them exactly parallels the fundamental principles of conduction of electricity. Not surprisingly because nerves conduct electricity. You can actually do comparative neuroanatomy and see the different ways in which myelin is used and not used in different animals and within different structures, elucidating some of the evolutionary steps that led to myelinated nerves. Not all nerves are myelinated, by the way, and the detailed knowledge of multiple different types and classes of nerve fibers is more in depth than I needed to go, but is in fact tested on my board exams (shocking, I know).

            I do find it particularly gratifying when a CAM is justified by a claim that is so resoundingly refuted though. Often it is difficult to describe every single aspect that makes the putative CAM mechanism total crap. But not in this case. Just ask any medical student how much they love studying neuroanatomy for the boards!

            1. yogalady says:

              And I said that myelin covers the nerves, which is correct, and nothing in your long description denies that.

              There are important subtle energies which are completely ignored by mainstream medicine. It is a long tradition that you refuse to acknowledge them. It is part of your medical school indoctrination.

              Anyone who practices yoga seriously knows that correcting subluxations releases energy, and that this energy is somehow connected to the breath.

              This is an experience that we have every day and we know it is real.

              Hatha yoga has been practiced for thousands of years, and it is not some kind of illusion or mistake, it is a real physical experience that millions of people have.

              But I understand that you M.D.s completely deny the reality of anything that is in any way different from what you were indoctrinated to believe.

              1. Andrey Pavlov says:

                And I said that myelin covers the nerves, which is correct, and nothing in your long description denies that.

                No, that is actually exactly wrong. Myelin does not cover nerves. It covers axons. That is not a trivial distinction. And it is important for your argument, since you are claiming that “[w]hile the inner nerves might not be impaired by subtle joint problems, the cells that cover the nerves (myelin) definitely can be.”

                That is not possible. As I explained above, the myelin is actually 4 layers deep inside the nerve. And on top of that it is intimately wrapped around the nerve axon. It is simply impossible to have a force that can act on myelin but not the axon. That isn’t indoctrination – that is utterly straightforward physics. You can have a force that would act on the epineurium or even the perhaps the perineurium and endoneurium without also acting on the axon, but those are not myelin. And they would have no possible effect on the function of neural transmission.

                There are important subtle energies which are completely ignored by mainstream medicine.

                No… they were explored by medicine and found not to exist. If the energy is so subtle we can’t detect it using modern technology, it is too subtle to matter! We can detect the faint glow of cosmic background radiation from billions upon billions of lightyears away, yet this “subtle energy” in the human body is so subtle that it is undetectable? And yet still somehow has a profound affect on the body? That’s just silly.

                Anyone who practices yoga seriously knows that correcting subluxations releases energy, and that this energy is somehow connected to the breath.

                Look, I do yoga. I used to do it very regularly and found it to be an amazing workout, extremely healthful, and really made me more athletic, feel better, and even sleep better. But there is nothing magical about that. It is just a really good exercise that incorporates a lot of stretching, mindfulness, and relaxation. We know how that stuff works – and it is not through magical “subtle energies” or “breath energy.”

                This is an experience that we have every day and we know it is real.

                So yes! The experience is real! I’ve personally experienced! And when I have the time and get off my lazy a@@ and do it I experience it all over again. But it is not for the reasons you claim it to be. I recommend yoga to my patients (who can tolerate it). I do it with my fiance. Her mother does it and so does mine. But not because of magical energies. Those ideas were disproven ages ago.

                But I understand that you M.D.s completely deny the reality of anything that is in any way different from what you were indoctrinated to believe.

                No, we just like to know if something exists and if so how it works. And not based in pre-scientific, long disproven ideas.

              2. yogalady says:

                Subtle energies were NEVER disproven, were NEVER shown not to exist! That is mainstream indoctrination.

                You do not understand chiropractic subluxations, and how they are related to subtle energies, and to myelin.

              3. Harriet Hall says:

                Yoagalady is evidence that subtle energies DO exist: in the minds of believers. There is no evidence they exist elsewhere.

                “You do not understand chiropractic subluxations”
                No one does, since they are an imaginary concept. No one understands the Tooth Fairy, either.

                Yogalady has clearly drunk the Kool-Aid; one wonders why she bothers with a site that doesn’t serve Kool-Aid.

              4. Windriven says:

                @yogalady

                Do you know what an ultracrepidarian is? You should look it up.

                “Subtle energies were NEVER disproven, were NEVER shown not to exist! That is mainstream indoctrination.”

                It doesn’t work that way. Those who claim these energies need to demonstrate that they DO exist. I can’t prove that leprechauns don’t exist but that is not evidence of their existence.

                And sober up for a few moments and consider that scientists have spent untold man-years and jillions of dollars probing subatomic structures and the forces that shape them, they scan the human body using X-rays, magnetic resonance and positron beams – and yet none have ever found evidence of these magical forces?

                Really. Get serious.

              5. Andrey Pavlov says:

                @yogalady:

                As windriven said – and as I said – we can detect the energy of just a few degrees above absolute zero from billions of lightyears away, yet can’t seem to detect this subtle energy in a being that is 310ish Kelvin higher in temperature and inches away from us. That is just nonsensical.

                The absence of evidence is not the evidence of absence unless that evidence should be there. And it is simply inconceivable that there would be no evidence of these subtle energies at this point.

                But by your tack, I could argue equally validly that it is in fact tiny unicorns that spring into existence for femtoseconds that transmit neural impulses and that these subluxations annoy the unicorns so that they don’t do their job. Nobody has EVER disproven THAT either. Nobody has EVER shown quantum sized femtosecond unicorns NOT to exist!

                So YOU are totally wrong. Unicorns like yoga. THAT’S why you feel better after some Hatha or Bikram.

              6. yogalady says:

                “If the energy is so subtle we can’t detect it using modern technology, it is too subtle to matter!”

                Your statement is completely wrong, the usual materialist arrogance.

                Most substances, energies, fields, etc. ARE NOT DETECTED using modern technology! Most of what exists is considered “dark matter” because scientists don’t know what it is and can’t detect it with modern technology.

                But they know it must be there, and that it does matter.

                Dark matter is just an example — they happen to know it must exist. But what about things that mainstream science doesn’t happen to know must exist?

                According to alternative science, the fields known to physicists are not the only kind of fields in the universe. There are fields that structure higher levels of organization.

                Supposedly, the old philosophy of vitalism was disproven. Exactly HOW was it disproven? It wasn’t. Materialists perfer to think it was disproven, you are indoctrinated to think that.

                Vitalism is the basis of chiropractice, yoga, accupuncture, reiki — all the stuff you despise. Yet have never been disproven.

                If the Big Drug companies put one eight the funding into these things that they put into mainstream treatments, I am sure there would be plenty of convincing evidence.

              7. Windriven says:

                @yogalady

                “Most substances, energies, fields, etc. ARE NOT DETECTED using modern technology!”

                That is the silliest assertion I’ve read in some time. Do you have some evidence to support this? Love to see it.

                “Most of what exists is considered “dark matter” because scientists don’t know what it is and can’t detect it with modern technology.”

                Well actually we can detect it … or something that behaves like it. That is how we know it is there.

                ” they happen to know it must exist.”

                No, we don’t “happen” to know, we deduce it from the behavior of matter at a distance.

                Really, I’m tiring of talking with you because you offer nothing but your empty, pitiful beliefs backed by what may be the most purile (mis)understanding of science I’ve encountered in these pages – and that, lady, is quite an achievement.

                “Vitalism is the basis of chiropractice, yoga, accupuncture, reiki — all the stuff you despise. Yet have never been disproven.”

                It has been disproven – just not in a way that you recognize. It is an inanity lying prostrate in the dustbin of human knowledge.

                “If the Big Drug companies put one eight the funding into these things that they put into mainstream treatments, I am sure there would be plenty of convincing evidence.”

                Wrong again. At least you’re consistent. NCCAm spends more than $100 million a year trying to find some glimmer of utility in the various delusions you extol. And what they’ve come up with is … (drum roll, please) … bupkis.

                Why are you here? This is a site dedicated to medical science. You are like a kazoo player sitting down at a performance of the Cleveland Philharmonic Orchestra. You have neither the knowledge nor the skills nor even the instrument. The musicians laugh at you. The audience laughs at you. But your ears hear the glory of Mendlessohn bleating from your plastic horn. Is it really your mission in life to be comic relief?

              8. Dang Yoga lady has a better conceptual understanding of the neuromuscular system than most of you folks with high level degrees. My suspicion she is attempting to make sense out of all the data points with the least amount of technical jargon.

                How does one explain the “energy” that energizes our bodies??
                Guess what!!!! We do not have to explain this concept to help people feel better!

                We do have to explain it to the insurance companies who have made medicine into a checkbox series of names, codes, procedures to distribute cash to keep their profit margins high. Without that burden the paradigm would have different parameter and objectives.

              9. weing says:

                “According to alternative science, the fields known to physicists are not the only kind of fields in the universe. There are fields that structure higher levels of organization. ”

                Why don’t you start using your alternative science based computer powered by dark energy to communicate with us? You can read our replies on your alternative science based screen.

              10. MadisonMD says:

                I find it amusing that SSR showed up after windriven said:

                you offer nothing but your empty, pitiful beliefs backed by what may be the most purile (mis)understanding of science I’ve encountered in these pages – and that, lady, is quite an achievement.

                Come on, win. Let SSR compete for the prize. He’s trying.

              11. MadisonMD says:

                tiny unicorns that spring into existence for femtoseconds that transmit neural impulses and that these subluxations annoy the unicorns so that they don’t do their job. Nobody has EVER disproven THAT either. Nobody has EVER shown quantum sized femtosecond unicorns NOT to exist!

                Andrey, everyone knows subluxations are caused by invisible flying tiny monkeys who tap your noives with the weight of their hairs. You cannot prove me wrong.

              12. Andrey Pavlov says:

                This really is pure comedy. I have nothing left to say to yogalady. Honestly, yogalady, you genuinely honestly have absolutely no idea what you are talking about. You have a set of beliefs and ideas and absolutely nothing that contradicts it can ever be correct. No matter that we have sent a machine outside our solar system using precisely the same methods, science, and ideas. You don’t have an understanding, or a science – you have a religion. You’ll happily tack away at the keyboard on the computer over the internet given to you by the very things which prove your ridiculous ideas wrong, nattering away like a irate jabberwocky without ever realizing the irony of it all.

                As windriven said, keep playing your kazoo and living in your fantasy.

              13. WilliamLawrenceUtridge says:

                There are important subtle energies which are completely ignored by mainstream medicine.

                How do you know? Either piece by the way – how do you know subtle energy exists? How do you know it is ignored?

                I would also add “how do you know that it has an effect”? I mean, we can measure the fall of a single photon, or subatomic particles so tiny that they can pass through a light year of solid lead without hitting a single lead atom, yet these “subtle energies” have eluded us? And if they’re this “subtle”, how do you know they even have any effect? What you are saying is kind of akin to saying they are too subtle to measure but powerful enough to overcome the forces we do know about. Really? Isn’t that a bit like saying a fridge magnet’s magnetic field should be powerful enough to overwhelm the front-end loader used to move a ton of dirt per scoop?

                Hatha yoga has been practiced for thousands of years, and it is not some kind of illusion or mistake, it is a real physical experience that millions of people have.

                Bloodletting was practiced for thousands of years too, are you going to open up a vein? May I suggest you not do it during a hot yoga session?

                Also, the holy texts of Hinduism promote a color-based caste system in which dark people are less worthy than lighter-skinned people. I assume you also embrace this dogma? Racist.

                Your statement is completely wrong, the usual materialist arrogance.

                You may assert an error, but you have no proof that your antimaterialist arrogance is correct. Why should we believe you, or the ancients, merely because you claim to be right? Old ideas have a rather substantial tendency to be wrong, because they’re based on the assumptions of the person rather than any evidence independent of them.

                Most substances, energies, fields, etc. ARE NOT DETECTED using modern technology! Most of what exists is considered “dark matter” because scientists don’t know what it is and can’t detect it with modern technology.

                Most? What a startling claim! Also, we know “dark matter” exists because we can detect it – through its effects on light and other matter. There is quite strong evidence for its existence actually, so much so that it is considered overwhelming. And this evidence is totally independent of the individual observer, it is not based on the opinions of people in the absence of data.

                In contrast, your “subtle energies” are based solely on unverifiable assertions by gurus who cannot provide objective evidence for the existence of such “energies”, which behave nothing like any other energy we are aware of (meanwhile dark matter does behave like other types of matter, we merely can’t detect it directly). Further, their abilities evaporate upon efforts at objective testing.

                Merely because we don’t understand “dark matter” doesn’t mean you get to claim it as evidence that your “subtle energy” exists. People are convinced that dark matter exists because the evidence is so convincing, a claim you can’t make for your “subtle energies”.

                According to alternative science, the fields known to physicists are not the only kind of fields in the universe. There are fields that structure higher levels of organization.

                Yeah, but those “alternative scientists” are “alternative” because their claims are based solely on assertions that have no proof behind them. How do we know they are correct? Well, because they tell us they are correct. But can’t demonstrate their claims in any way beyond “trust me – oh, and please buy my book, and my supplements, and my free energy machine”.

                Supposedly, the old philosophy of vitalism was disproven. Exactly HOW was it disproven?

                By synthesizing, multiple times now, “living” compounds with nothing more than “dead” compounds, and the results being indistinguishable from those produced by living cells. Also, by viruses, which bridge living and dead.

                Vitalism is the basis of chiropractice, yoga, accupuncture, reiki — all the stuff you despise. Yet have never been disproven.

                Yeah, the thing is – all of those have had their startling, unlikely claims disproven. Sure, some of their claims are backed up – yoga is exercise, that’s good for you. Chiropractic can help with back pain. Everything else, nerve impingement causing cancer, the ability to manipulate life energy – all tested, all failed. We despise it because hucksters and quacks attempt to sell this nonsense with no proof, often to desperate patients.

                If the Big Drug companies put one eight the funding into these things that they put into mainstream treatments, I am sure there would be plenty of convincing evidence.

                If they found convincing evidence that could be independently replicated and converged on a set of findings that were in keeping with what we already know about the universe and biology – yeah, that would be convincing. That’s exactly what chiropractors, reiki masters and acupuncturists lack, yet still they charge you money for their time and efforts.

          2. If you ever have to treat someone how has been Traditional Medicine dismantled, your perspective would change.

            It is your choice to stay blind and ignorance.

            There are some here who will say, “pot calling the kettle black” and I have to agree but but but, I’m not as blinded.

          3. Dave says:

            Yogalady, it’s not wise to bring dark matter into a site populated by some physicists. I’m not a physicist but do know that the reason scientists believe in dark matter is that its effects HAVE been detected with modern technology. Two effects that I know about are the rotational speed of stars outside galaxies and the gravitational bending of light around galaxies. The Teaching company has courses for the lay public on Cosmology and Astronomy that go into this in some detail. The fact that exactly what dark matter consists of is not known does not allow one to posit energy fields from the imagination for which no evidence exists. Similarly, what “quantum” means to a physicist is totally different that when used by Deepak Chopra.

            1. @dave
              So humans are not matter, not elections/protons/atoms and are completely energy-less???

              Please … who are you?? Who is paying you to think so narrowly?

              We are energy, dark, light, invisible whatever but we are energy. Muscles function based on energy so any therapy aimed at muscles affect energy.

              Please point out my errors with a few links so I can educate myself. You do not have to prove your point just show me the way.

              1. Windriven says:

                “So humans are not matter…?”

                You’re a nut, IR. Dave never said that, never implied that, never remotely suggested that. You made that up all by yourself. Your mommy would be so proud.

                “Please point out my errors with a few links so I can educate myself. ”

                I am reminded of a Greg Larson Dark Side cartoon. A man is telling his dog Ginger at some length what she has done wrong. The next panel show what Ginger hears: “blah, blah, blah, Ginger, blah, blah.”

                I will leave you to struggle through the relevance of this anecdote to your request.

              2. weing says:

                Here is an animation you might find helpful dealing with energy in the body.
                http://www.wiley.com/college/boyer/0470003790/animations/tca/tca.htm

              3. Sawyer says:

                So humans are not matter, not elections/protons/atoms and are completely energy-less???

                Please point out my errors with a few links so I can educate myself.

                SSR, we are all at a complete loss at how to educate you without being incredibly insulting. We’ve tried everything under the sun and it’s failed every time. The above quote suggests that not only do you fail to understand science, but that you don’t even possess basic reading comprehension skills. How the hell are we supposed to respond to this gibberish? Is this some sort of joke, or do you really not think Dave knows humans are made of matter? It’s almost like you randomly insert/delete sentences from other people’s posts. I echo Madison’s sentiment that it looks like you are competing with the other trolls here to see who can make the most absurd strawman possible.

                I’m sorry I don’t know a polite way to explain this, but you need to just accept the fact that after hundreds of comments, you have added absolutely nothing to the discussions here. I’ve requested multiple times that you just stop posting and cut your losses, but I don’t have much hope you’ll ever follow that advice.

              4. Windriven says:

                @Sawyer
                “SSR, we are all at a complete loss at how to educate you without being incredibly insulting.”

                Several of us have tried it with being incredibly insulting. You can see, it didn’t help.

              5. Windriven says:

                @weing

                Damn iPad doesn’t support the plug-in to view the clip. If it is half as funny as your joke about a double blind study I feel really cheated.

              6. windriven says:

                @weing

                Finally got to a real computer and viewed the clip and found it really enlightening – though details of the biochemistry shown exceed my grasp.

              7. “Well actually we can detect it … or something that behaves like it. That is how we know it is there. … ” they happen to know it must exist.” … [[No, we don’t “happen” to know, we deduce it from the behavior of matter at a distance."]]

                Chi, Charka, Vitalism, life forces, dang just being alive=energy .. we don’t happen to know, we deduce it from the behavior of matter at a distance. So your argument is that your favorite word for energy is valid but the pre-science words are excluded?

                If someone is alive = vital and is not at equilibrium with the environment.
                If dead=no energy and is at equilibrium with the environment=dead as a door nail.

                Did you think we can not see the bias and errors in your statement ===> We Gotcha!

              8. Windriven says:

                @IR Rodrigues

                “We gotcha!”

                Yeah, huh? I’ve no idea what all of those Chopraesque equalities were intended to demonstrate. But you have heard of ATP and its role in intracellular energy transport, the Krebs cycle, and glycolysis, yes? We don’t have to infer what is going on there; we have a pretty complete inderstanding. And shock of shocks it doesn’t have a single goddam thing to do with qi, chakras, vitalism or any other pipe dreams and illusions.

                Isn’t it time to put away the childish toys and whimsical beliefs? There are children all over the world dying of curable diseases and surgically correctable conditions. There is an epidemic of obesity in this country and all the varied comorbidities that accompany it. There are mothers who lack decent perinatal care. You have an MD. Are you telling me that the best you can do is fantasize about life in some mythical dream world of spiritual forces and magic meridians. Seats in medical school are a rare and precious commodity. Don’t you feel any obligation to honor that opportunity by doing your level best to use the education you received to benefit mankind?

              9. WilliamLawrenceUtridge says:

                We are energy, dark, light, invisible whatever but we are energy. Muscles function based on energy so any therapy aimed at muscles affect energy.

                Yeah, if you try to resolve things on an energy level, rather than a chemical or anatomic level, you’re not going to get very far. It’s not like the body fails to function because of a dearth of electromagnetic energy (the ultimate reason why muscles contract at a molecular level). The body fails at a biochemical or structural level. Simply blasting the body with electricity or magnets or electromagnetic energy won’t do a damned thing for a mitochondrial disorder unless it has a chemical effect.

                The uncertainties of medicine are not addressed by simply picking the fairy tale that most appeals to you, or one that conveniently lines up with your pre-existing beliefs. Merely because you can come up with a pseudoexplanation or point out some medical uncertainty doesn’t translate into your assertion being right. You might be wrong. And in fact, based on your previous comments, you are wrong in most cases. If you believe that acupuncture (or anything else) works through manipulation of subtle energy, then you’re even more wrong than we have hitherto had reason to believe. And that’s pretty wrong.

            2. I’m at a loss to understand how to educate some of you, too??!!
              It is like some of you have an agenda against anyone who has alternate ideas and instead of learning you reject. This is not good for personal development.

              Granted, we all have different backgrounds and need to bring them to the table for discussions.

              My contributions have evolved into niche, a place difficult to comprehend by many even my AAMA colleagues. I’ll be patient hoping to leave a few ideas for further study. (That makes you envious and jealous and want me exiled. :)

              Here are a few disconnects:
              Acupuncture works by a different more scientific formula.
              Hands-on, Chiros, adjustments are valuable therapies.
              Trigger points, myofascial pain and dysfunction needs effective hands-on and needle therapy.
              Modern scientists are materialistic and think they can out think nature.
              Modern medicine is locked in a business like paradigm that wants to fix or medicate everything and when a therapy fails, well tough luck for that person who problem did not follow the instructions properly.

              1. WilliamLawrenceUtridge says:

                I’m at a loss to understand how to educate some of you, too??!!

                That’s because you don’t understand the rules of evidence. We don’t reject “alternative” ideas because they are “alternative”, it is because they inherently lack proof (if there were good proof, they would be adopted into mainstream medicine) and in many cases wildly contradict what we know about the universe (i.e. water doesn’t have a memory).

                The real problem is that we speak different languages. Science-based medicine is based on science, which discounts anecdote, individual experience and ideas that require substantial revisions of existing knowledge but lack commensurate amounts of proof. You base your statements and apparently customer decision-making primarily on your own experience and customer satisfaction. You do not embrace counter-factuals. You don’t really “study”, you merely look for confirming information. You actively avoid engaging with contradictory information. You embody and embrace the cognitive biases that produce poor decision-making. Evidence is not important to you.

                That’s why you are mocked for your posts and you haven’t convinced anybody here – you simply can’t see how you could be wrong, let alone why.

                That is arrogance. That is a paradigm that you have yet to escape. That is the disconnect.

                Oh, and you think that because you have some success with mechanical and manual therapies, that gives you the ability to parse the truth of all medicine.

        2. yogalady says:

          Describing and understanding are two different things.

          You think that giving a long detailed description makes you seem knowledgeable. However, you know nothing about yoga or chiropractic, and how that relates to myelin.

          1. Andrey Pavlov says:

            Sure, but you need to accurately describe something before you can even hope to understand it. And yes, my explaining the accurate description is being knowledgeable. I do happen to have knowledge of neuroanatomy. Not as good as some specialists, but vastly better than most people.

            It doesn’t matter if I know how yoga and chiro relate to myelin – the way in which you claimed it relates is based on a completely false understanding of it! I may not know how they relate (I do, actually, but for argument’s sake) but it is definitely not how you think it relates.

          2. Windriven says:

            “you know nothing about yoga or chiropractic, and how that relates to myelin.”

            Chiropractic is to myelin as a shade tree mechanic is to the vinyl insulator on a 12 gauge wire.

            Yoga is to myelin as modern dance is to grape jelly.

            Yogalady is to coherent thought as Moe Howard was to nuclear physics.

        3. Windriven says:

          @weing

          “the fields known to physicists are not the only kind of fields in the universe.”

          She’s right. Kevin Costner made a movie about the other kind.

          Annie Kinsella: “Hey, what if the Voice calls while you’re gone?”
          Ray Kinsella: “Take a message.”

  5. Cervantes says:

    “Although obscured by controversy, there is evidence to indicate that spinal manipulation can be as effective as conventional treatment methods in relieving low-back pain.1,2,3,4 ”

    That’s because “conventional” treatment doesn’t do anything either. Most low back pain is idiopathic and self-limiting. Aggressive treatment is generally counterproductive. Current guidelines call for watchful waiting in most cases.

    1. Sean Duggan says:

      I’d add to that the psychological benefit of doing something and feeling that you’re being served. I try to be as logical as possible in my life, but I’ll freely admit that I’m disappointed and more than a bit irked whenever I go to a doctor’s office and they don’t prescribe me anything because whatever I’m suffering will go away on its own. Rationally, I know that it’s good news, but irrationally, I feel like I spent $20 of co-pay for nothing. Silly as it may sound, I almost feel like the doctors need to introduce the equivalent of a lollipop at the end for adults. Let’s say that you go to your doctor and they tell you that you have lower-back pain that will resolve itself on its own with rest and adequate stretching. You leave not just with that advice, but a bottle of aspirin and a cheap back-brace. The doctor tells you that you have a cold and they can’t really fix it, but you leave with a complimentary bag of cough drops. It would be a small something that lets patients do something and feel like they got something tangible from the visit.

      With a chiropractor, you get about a half hour of attention and often a good stretch. I see it as the equivalent of how, in high school, anyone could take a visit to the school counselor without penalty. I know kids who were just stressed out and needed to talk for a bit and the counselor would let them do that. It’s doing something and feeling that you’ve had something done for you.

      1. Andrey Pavlov says:

        @SD:

        I’m not yet in a position to really comment, but I try and give the patients I have had so far some bit of information to part with. Something interesting, relevant, enlightening, and hopefully empowering to their condition. At a minimum I make it a point to convey clearly (sometimes in as many words) that it is perfectly reasonable and not a waste of time or money to have come in despite not getting “something” out of it. The “something” they got was information that will enable them to better handle similar situations in the past, comfort at having made the right choice to come in, and hopefully a smile if I can manage a joke along the way.

        Obviously not always possible to do, but I try and frame the encounter from the perspective when I can and make it a point to add more than the bare minimum of information to simply assuage their fears and tell them to go home. I’ve even been known to throw in “random trivia tidbit of the day” when it seems appropriate. Conversations have been known to happen. I’ve even occasionally hugged a patient.

        But what do I know? I’m the pedantic, materialist, CAM-hatin’ medical scientist who cares not for the “holistic well being” of my patients.

        1. Sean Duggan says:

          Hugs can be very helpful. :) And advice can definitely be helpful too. I think that, as much as anything, it rankles because a) it costs a fair amount for a doctor’s visit — the co-pay isn’t that bad usually, but time off from work, travel/parking costs, and general interruption of one’s day can add up — and b) it’s hard to go in with what you feel is a legitimate concern and then leave with an assurance that it is not. I’m always happy to know that I’m in good health, but there’s kind of a let-down to basically know that I put down all of that money to be told that I was wrong, that there’s nothing really wrong with me. I’m bad with metaphors, but it’s the psychological equivalent of bring your car in for a checkup because it’s making funny noises when you learn and getting charged for removing the bowling ball in your trunk.

          1. Andrey Pavlov says:

            I’m bad with metaphors, but it’s the psychological equivalent of bring your car in for a checkup because it’s making funny noises when you learn and getting charged for removing the bowling ball in your trunk.

            A good point and, to a degree, unavoidable. It is, as I imagine you well appreciate, largely on the part of the patient though. The expectations coupled with the individual costs (which you accurately lay out) combine to produce a differing level of satisfaction with the outcome. Part of what I actively do in all my social and professional encounters is manage expectations. This can range from trivial in meeting up with people for drinks to mortally serious in the ICU. That is one benefit of seeing the same physician consistently; I can better manage your expectations and help make the encounter more meaningful to you in doing so.

            And yes, that is a science based approach, not the “meaning” that Moerman overblows. But I digress. And bristle at how important concepts like these are co-opted by the CAMsters as somehow metaphysical.

        2. CHotel says:

          “I’ve even been known to throw in “random trivia tidbit of the day” when it seems appropriate. ”

          Soooo, where’s your practice located? Because I’m looking for a new doctor, and I love random trivia more than most things in life.

          1. Andrey Pavlov says:

            LOL. I don’t actually have a practice yet. I am still in training, though I suppose you could see me if you happened to be in New Orleans. I wouldn’t be able to act as your primary care provider though, particularly since most of my duties for the next 3 years will be inpatient work.

            That’s why I said I’m not really in a position to comment, since I am not an established physician (yet). This has been my experience and how I’ve learned to do things seeing patients in medical school. The only negative feedback I’ve ever gotten was a small one in that I occasionally take too much time with my patients. I’ve never had anything but positive remarks from patients (though I may not have heard negative comments, of course).

            1. CHotel says:

              That’s fine, I’m in very good health. More interested in the fun facts.

      2. Harriet Hall says:

        For most of my patients, my reassurance that they didn’t have a serious illness and that no medication was needed was all the “lollipop” they wanted. Many volunteered that they would rather not take anything unless it was really necessary.

  6. Andrew Pavlatos, MD says:

    I have been struggling with the issue of managed care referrals to chiropractic. Contracts demand that my managed care organization make chiropractic available to patients, and they require that I, as a Primary Care Provider, generate the referral. As a stout disbeliever, I am forced to become a participant in this folly and I assume that I have some liability risk if something goes badly. “Doctor, you are the one that passed on my care to this chiropractor”. Lawyers would love to add me to the defendants list.

    Does anyone have any suggestions on how I can deal with this? Can i have patients sign a waiver releasing me from any liability? can I insist that my managed care organization bypass my approval and processing of referrals?

    1. CHotel says:

      Surely it isn’t worded as such that you’d have to refer despite your own medical opinion? I would assume that no obligation to refer should be present without there being a sound medical reason to do so.

      I recall a loosely related situation from a jurisprudence class in pharmacy school. The hypothetical involved a patient approaching you requesting Plan B (which was kept behind the counter at the time) and you not wanting to fill it for personal religious reasons, but being duty bound to provide them with the medication in some way. The first solution was to have a colleague (either at your store or the one across the street) take your place in the interaction. Perhaps a referal to another physician within your organization who can then in turn send them to the chiro would be a possible solution if all else (education, efficacious alternatives, etc) fails? It absolves you of liability and provides some self-satisfaction in sticking to your guns, while retaining the patient’s autonomy in wanting the referral.

    2. WilliamLawrenceUtridge says:

      Can you refer to physiotherapists as an alternative?

      Another option is to call the chiropractors in the area and ask “do you think subluxations can cause cancer?” Anybody who says “no” gets asked if they think they can treat anything but mechanical back pain. Anybody who says “yes” doesn’t get a referral.

  7. tw says:

    All the benefit I have obtained from a chiropractor has been through the use of ART. I have a sort of complex back issue that I specifically avoid bone adjustments to.

    ART on the other hand vastly reduces or eliminates back pain and numbness which due to tightening muscles and pelvic torquing. Without ART treatments periodically I would not be training, skiing and mountain biking. This option has also been extremely effective on certain types of injuries.

    I personally dislike the joint manipulation aspects promoted by many chiropractors, but one experienced in sports with a strong background in ART is far better than any other method pursued including sadly, “physiotherapy”.

  8. tgobbi says:

    If I read DJs comments accurately, he claims that mixers, by and large, reject subluxation theory and that only straights continue to adhere to this chimera. This is simply not true. Mixers represent the majority of DCs and overwhelmingly believe in subluxations to at least some extent and incorporate diagnosing and treating them into their practices. But that’s only part of the problem. Straights treat only subluxations while the mixers, for whatever reason, continue to advertise and utilize a dazzling array of other pseudoscientific modalities, mostly co-opted from other fields (like naturopathy and health food store nutrition).

    I enjoy picking up brochures in chiropractic offices from time to time as well as frequently checking their websites and media advertisements. My conclusions are not based on a scientific poll but, judging from what I see in terms of pseudo- and quasi-scientific nonsense (what I believe DJ is referring to, perhaps unknowingly, when he cites “multiple modalities), there’s no question that the majority of the majority are practicing in the realm of mysticism and the occult.

    DJ claims as fact that adjustments “work.” Work for what? To help with minor musculoskeletal conditions or to treat diseases? If the former, I don’t think any of us are arguing with him. If the latter, then he’s right back in subluxation territory!

    1. Thor says:

      I agree with tgobbi. During the course of my career as a massage therapist, I worked with several chiropractors, all mixers. All subscribed completely to subluxation “theory”, and practiced joint manipulation as the core of their mo. Then they added on numerous other modalities to beef up treatment protocols. It was far more interesting for DC and patient to include an array of “healing elements” to the mix. I found that straights were rare indeed. Thus seen, mixers were perhaps even worse than straights because so much more bull was on display and promulgated. Straight = just joint manipulation; mixer = jm + _________(fill in the blank with any and every kind of pseudoscience imaginable).
      You come in for a muscle strain, say, and get inundated with all kinds of mumbo jumbo. Like acupuncture, most chiropractic is simply an elaborate placebo. Just the act of touching itself (and lying on a cushy table with a heat pack) has strong potential healing effects. “Works” must definitely be qualified.

  9. Sam Homola says:

    Perhaps I used the word “nonfalsifiable” incorrectly. Crelin clearly demonstrated that vertebrae could not be displaced enough to impinge upon spinal nerves without tearing ligaments. But vitalistic subluxation theory or an undetectable vertebral subluxation complex alleged to influence organ system function or general health does not have enough substance to be tested scientifically and continues to be classified as a belief system.

  10. Chiropractic care is very valuable, just as all of my favorite CAMs esp Needles.

    No matter how much anyone discourage, deny, disavow these CAMs, there is an inherent truth in all of these disciplines and as we all know “Truths” are forever.

    Some of the issues are a distinct names or diagnosis as needed by insurance companies and the business of medicine. Words like tension headache, subluxation, neuropathy, sciatica, myalgia are descriptions of a set of symptoms that we use to communicate. Some names providers use are arbitrary just because we have to check a box for billing purposes. Some people lock in or on the word and can not see the entire clinical picture. A simple term to use would be “spinal misalignment” because that is what is at the core of back pain issues.

    The why is lost too.
    Chiropractors are effective because they stretch muscles esp the rotators of the vertebra which stores “stress energy.” (please don’t say it)

    Chiropractors are not effective when the amount of stress energy reaches a point and the muscle will not budge with externally applied effort. These tight stubborn muscles will degrade and starve, become autonomous and set on a course of self-destruction by strangulation and starvation.

    At this point in the muscles you have to apply a different tool as Gunn noted this as per Cannon’s Law. (OH, Ingraham disregards this part of muscle dynamics for some reason which makes his theory incomplete.) At this point in the myofascial disease a metallic wire is needed to depolarize the muscle which will allow them to relax and let the spine or any other joint automatically realign.

    The end result of this auto destruct sequence of muscles is a painful, miserable life and the wish for death. This process usually doesn’t kill you but the wish for death is continuous. This is SSS that I mentioned and the treatment is to release the spinal muscles with Chiro adjustments, yoga and magnesium. I like needles which accelerates the healing and restoring of healthy muscles.

    Chiro as with other CAMs are a proactive way to save money, time and will keep patients out of ortho-neuro surgical suites.

    1. Andrew Pavlatos, MD says:

      there’s a whole bunch of nonsensical pseudoscience in this statement!

      1. PseudoScience if you wish to define it as such, is a dirty word on this blog. It is not a dirty word to a lot of us in the real world.

        These pseudosciences are vital to the health and wellness of us all, they help to cover a lot of people that do not fit into the narrow, material, mechanical scientific model of modern medicine. That is because these CAMs complement or can replace “vending machine medicine. ” CAMs will help keep this high-tech medicine from imploding on itself.

        So hoooray to CAMs!!!!!!

    2. Derek Freyberg says:

      To quote (or maybe misquote) a frequent author on this site: “The stupid, it burns”.

    3. AdamG says:

      The end result of this auto destruct sequence of muscles is a painful, miserable life and the wish for death. This process usually doesn’t kill you but the wish for death is continuous.

      wow, much science, such evidence

      1. Why are you laughing at people who suffer in myofascial pain and dysfunction + Trps, that will degrade into SSS?

        Have you lost your human side?

        1. Windriven says:

          No one has lost their human side and no one is laughing at people with chronic pain. But all of us are laughing at you because you just can’t muster the mental resources to understand the difference between wishes and reality.

          1. I WISH for a well balanced healthcare system based on what works.

            Since there are dogmatic mechanical material scientist who only see numbers and not people, the REALITY is those corruptors will slow the transition to this balanced system.

            1. Windriven says:

              Wow Steve – we finally agree on something! I want a well balanced health care system that works too. ‘ Works’ being the operative word.

              We spend a huge fraction of GDP on health care, far more than other industrialized western nations. I’d like to get a good return on that investment. But that means real medicine, not fantasies. Look, for what its worth I think adults should be able to choose sCAMs. But the decision needs to be irrevocable. I’m happy to irrevocably choose medicine in all its science based glory. Those who want acupuncture and homeopathy and antineoplastons should have that right. But no changies :-)

              1. “Wow Steve – we finally agree on something!”
                Yes we do except our views of how to get there is different, if we combine ideas we end up with a better system.
                If you reject my ideas all we have is the same broken system.

                “We spend a huge fraction of GDP on health care”
                Those other nations use a common sense patient centered approach.
                NOT our consumer driven, for-profit, high-technology, “science fixion” medicine that treats people like numbers and widgets.

                “But that means real medicine, not fantasies.”
                Duh, what we have is a fallacy what we need is reality.

                “irrevocable … no changies.”
                Dang so you are that hateful, sadistic and pessimistic that you would punish someone for attempting to find the best care for their illness. Why not figure out what really works and offer that to them.

                “Those who want acupuncture and homeopathy and antineoplastons”
                Hey do not group Acupuncture that has a 5000 yr vetted history which can be modernized for better outcomes!!! with the homeopathy and antiXs.

              2. Windriven says:

                “Why not figure out what really works and offer that to them.”

                We do. It is called science based medicine.

                “do not group Acupuncture that has a 5000 yr vetted history ”

                Appeal to antiquity. Fail.

                “Dang so you are that hateful, sadistic and pessimistic that you would punish someone …”

                Ideally they’ll perish before they breed. Eugenics in action. Hari kari by impaling oneself on a needle.

            2. WilliamLawrenceUtridge says:

              Steve, how would you assess whether something “works” or not?

              How would you determine whether your theory reflects “reality” versus erroneous beliefs?

    4. mouse says:

      SSR “Some names providers use are arbitrary just because we have to check a box for billing purposes. ”

      So – Yeah, It’s always hard to make out what you are saying, but that sounds kinda like fraud.

      1. You are what you tell us you portray which is a rodent, except I’m sure the rodent has much better instincts.

        1. WilliamLawrenceUtridge says:

          So…no reply to the observation that intentionally being deceptive on the submission of a form for reimbursement is in fact fraud? Just an insult? So…you have no justification for committing fraud?

    5. tatum says:

      “These tight stubborn muscles will degrade and starve, become autonomous and set on a course of self-destruction by strangulation and starvation…..The end result of this auto destruct sequence of muscles is a painful, miserable life and the wish for death. This process usually doesn’t kill you but the wish for death is continuous. This is SSS that I mentioned and the treatment is to release the spinal muscles with Chiro adjustments, yoga and magnesium. I like needles which accelerates the healing and restoring of healthy muscles.”

      What?! This statement is so bereft of basic physiology knowledge it is astounding. are you talking about apoptosis? Where the heck did you go to medical school? I would love to know because the faculty needs some feedback.

      “No matter how much anyone discourage, deny, disavow these CAMs, there is an inherent truth in all of these disciplines and as we all know “Truths” are forever.”

      wow. you have convinced yourself of things that are beyond your ability to understand. This statement alone makes it obvious that any scientific reasoning with you is a mute point.

      1. @tatum
        http://informahealthcare.com/doi/abs/10.1300/J094v06n01_02

        http://www.spinalsensitization.com/method.php

        You are showing your ignorance.

        If you are not a practicing physician who understand alternatives please ask appropriate questions. The links are for educational purposes which should add to your knowledge base. They should help you to fill in missing key data, more research is needed.

        1. WilliamLawrenceUtridge says:

          Steve, that’s an article on a 16-year-old effort to define a scale to evaluate painful points on the body. It has nothing to do with your efforts to describe what appears to be the biochemistry of muscular death, or tatum’s labeling that as apoptosis. It is irrelevant, and does not justify your claims about what is happening in the muscle. If you are going to attempt to cite the peer-reviewed literature to support your assertions, would it be too much to ask for relevant citations?

          Also, if there is “missing key data”, doesn’t that mean you are practicing purely on the basis of speculation? Do you consider this to be ethical?

    6. WilliamLawrenceUtridge says:

      No matter how much anyone discourage, deny, disavow these CAMs, there is an inherent truth in all of these disciplines and as we all know “Truths” are forever.

      Scientists recognize all truths as tentative, only dogmatic CAM practitioners and religious zealots claim to have “truths” that require no proof or for which any contrary evidence is automatically rejected.

      Regarding the rest of your post – can you link to the peer-reviewed evidence supporting your assertions? Or should we just believe you because you say it’s true.

      If the latter, I say it’s not true. We appear to be at a stalemate. How do we resolve it?

  11. BurnOut says:

    I agree with Andrew. Your post is a CAM word salad.

    1. Andrey Pavlov says:

      Stick around. SSR provides a veritable all-you-can eat salad bar daily.

      1. CHotel says:

        He’s like Olive Garden, but with accupuncture needles instead of breadsticks.

        1. Thor says:

          Darn, I thought he moved his salad bar somewhere else because business wasn’t so good here. Maybe he’s back with fresher offerings (more organics). Business is business, after all.

          1. Windriven says:

            More like tossed salad.

        2. Calli Arcale says:

          He even puts fresh cheese on the salad, and on occasion will offer a bottle of whine to go along.

          1. Chris says:

            Okay, I really did just laugh out loud!

      2. Frederick says:

        A blinded, closed minded, dogmatic and narcissistic salad :-) Imagined that, your salad arguing with you in with non-sense why not to eat her.

        was a buzz kill! :-)

        1. The bottom line — please read C. Chan Gunn, MD and Backache from Occiput to Coccyx Hardcover – January 1, 1964
          by Gerald L. Burke (Author)

          “There is no credible evidence to support use of spinal manipulation for anything other than uncomplicated mechanical-type back pain and related neuromusculoskeletal problems.”
          True statement and this therapy needs to be incorporated into the healthcare therapeutic options for ALL back pain that is not infectious, tumors or vascular deformation.

          “There is no evidence at all to support chiropractic subluxation theory.”
          True statement. The word is an incomplete concept. One reason for this word is so that the business of medicine can document records to monitors profits and losses.

          “undetectable “vertebral subluxation complex” can cause organic problems.”"
          TRUE!! This is actually a true statement related to myofascial pain syndromes that affect the paraspinal muscles which will lead to the SSS discussed earlier.

          “spinal manipulation as an option in the treatment of back pain, “look for one who does not subscribe to subluxation theory” ─ one who is willing to exchange office notes with your family physician.”
          IMO, look for one who is honest, efficient, reasonable and is actually getting you better, by 5-10% per visit that accumulated to wellness.

          “Remember that most of the time, acute low-back pain is a self-limiting condition that will resolve in four to six weeks, with or without treatment. … there may be cause for alarm.”
          True but incomplete. Acute back pain will improve just with time and some home care. If it does not in a few day, get some therapy via massage, chiro, acupuncture or needles. If pain still persist look for perpetuating factors and up the intensity of therapy.

          “A correct diagnosis is essential when considering treatment options.”
          Being too correct is dangerous and is where we are now. MF pain and dysfunction can not be detected by technology, only hands-on and with therapy.

          “I don’t know of … the immature, cartilaginous spine of a neonate or an infant”
          Agree.

  12. Damon says:

    This website is the most bias and bullshit filled “scientific” website I’ve ever come across. These “Doctors” are ignorant in subjects and therefore claim its “bait and switch”. Just because you dont understand why something works doesnt make it wrong or invalid. There is plenty of real scientific evidence supporting Chiropractic. I really hope people dont read the crap put out by the website and believe it. They are no better than Penn and Teller.

    This goes for other modalities as well. If acupuncture or something else helps you, who are these idiots to denounce it? If we waited for research to support our findings first we would be way behind and a lot of medicine wouldn’t be here either. Healthcare is ever changing and growing and in a few years everything on this website could look idiotic. What makes you think they know something that others dont? Chiropractors have more class room hours than med students. More in anatomy, diagnosis, Neurology, Orthopedics, and radiology to name a few. Medical doctors learn nothing on Spinal Manipulation and are terrible people to get an opinion of its benefits. It surprises me that a medical doctor doesnt know that nerves exit your spine and lead to organs, muscles, etc. and that if a nerve is interfered with (A Chiropractic subluxation) even by the weight of a hair, it can affect the transmission of the nerve to said organ, tissue, etc. You dont think that will have an effect on the human body, its nervous system and immune system? Well than youre an idiot. There have been plenty of studies showing this to be true.

    There is so much we dont know about the human body and it is not as cut and dry as these “doctors” would have you believe. Sorry to inform you but you can solve everything with a pill.

    1. Chris says:

      Did you notice that this article was written by a retired chiropractor?

    2. Andrey Pavlov says:

      What a ridiculous screed!

      Just because you dont understand why something works doesnt make it wrong or invalid

      Sorry bucko. We’ve worked very, very hard to understand. And found it completely lacking.

      There is plenty of real scientific evidence supporting Chiropractic.

      O Rly? Where is it hiding?

      What makes you think they know something that others dont?

      Hmmm…. what could it be? Perhaps decades of dedicated study, education, and research in the relevant fields? Same reason why I think particle physicists know a lot of things I don’t.

      Chiropractors have more class room hours than med students. More in anatomy, diagnosis, Neurology, Orthopedics, and radiology to name a few.

      Bull. Fracking. $hit.

      Go ahead and look at the officially stated hours. I did more in my 4th year of medical school than chiros do in all 4 years of their “education.” And there are still 6 more years ahead of me to train and learn. I’ll have 10 years of education and training (post undergrad), each year of which has more contact hours than any chiro, and somehow the chiro education in 4 years is more?

      What a joke.

      It surprises me that a medical doctor doesnt know that nerves exit your spine and lead to organs, muscles, etc

      Umm… it’s on our damned board exams. LOL.

      and that if a nerve is interfered with (A Chiropractic subluxation) even by the weight of a hair, it can affect the transmission of the nerve to said organ, tissue, etc

      Really? Really? The weight of a hair??? Are you a Poe or just truly a moron? Ever had a cat walk across your back? Or how about putting on a shirt? Ever done that? You somehow think that that wouldn’t transmit the force equal to the weight of a hair to your precious, precious nerves?

      There have been plenty of studies showing this to be true.

      Then please, provide them for us!

      Sorry to inform you but you can solve everything with a pill.

      Joke of a comment ends with joke of a hackneyed trope.

      Sorry to rain on your parade mate, but you’ve got some seriously bent ideas about reality. I’ve known people on serious recreational drugs that have a better grasp of reality than you do.

  13. Scubadoc says:

    Has anyone aver heard of a chiropractor telling a patient that they had a normal xray.
    I certainly haven’t in 40 years of general practice. Yet the radiologists I work with read lots of normal Xrays!.

  14. Marcel says:

    Good interpretation of chiro beliefs, cos that is what it is Belief.
    The whole manipulation treatment concept is actually Quackery.

    Selling placebo is quackery.

    1. Modern medicine is part true, almost true and pure quackery, so why jump on the Chiros.

      If Mod Med was perfect, we would not be having this conversation.

      1. Windriven says:

        “so why jump on the Chiros.”

        Because, so far as I can tell, beyond modest utility for LBP, chiropractic is ALL quackery.

        “If Mod Med was perfect, we would not be having this conversation.”

        Modern medicine isn’t perfect, just a little bit more perfect with each passing day. Compare and contrast with chiropractic or acupuncture.

      2. weing says:

        “If Mod Med was perfect, we would not be having this conversation.”
        Medicine was never perfect. We can’t claim cures for everything like the quacks.

  15. David Shmukler says:

    I am a practicing chiropractor. Chiropractors do not take pressure off of nerves. Chiropractors stimulate mechanorecpeptors. When somebody has a true pinched nerve you have loss of function. If it is a motor nerve you would have weakness and if it is a sensory nerve you would have loss of feeling. When somebody has a compressive neuropathy you have retrograde chromatoloysis and Wallerian degeneration. You can use spinal manipulation all you want you are not going to have any effect on a true pinched nerve. On average they regenerate an inch a month.
    Most of the effects of spinal manipulation are reflexogenic. Chiropractors are stimulating large diameter fibers that reflexively affect central neurons. Any manual technique practiced by any provider is stimulating mechanorecpeptors. That is the way information gets into the nervous system.
    Most of the stuff I was taught in school about subluxations is wrong. There is no mental impulses, innate intelligence or subluxations pinching nerves (garden hose theory).
    Pain is always a brain experience. It can be nocipeptive, neuropathic, or a combination of the two. The more chronic the pain the less likely it is to be tissue related and more likely to be central mechanisms. Obviously an organic cause of the pain has to be ruled out.
    Medically they use antidepressants and Neurontin on chronic pain. Where I may recommend in addition to the medications to try meditation, exercise, etc.
    It is often hard to convince patients that have chronic pain that even though they have disc pathology or arthritis that they may not be causing their pain.

    1. Joe Brence says:

      David,
      I am a Physical Therapist, who is also a Fellow of AAOMPT, and study the effects of pain and manual therapy. Your response is consistent with some of the current theories used to explain why manual therapy is effective. Two things I would like add:

      1. The mechanisms leading to a painful experience can also be due to central sensitivity (in addition to nociceptive and peripheral neuropathic). Thus, an “input” is not necessary nor sufficient to create an experience of pain (ex: phantom limb). Here is a recent guide I wrote for the APTA, to help Physical Therapists better understand pain: http://www.moveforwardpt.com/resources/detail.aspx?cid=e6dabed7-c6d5-4362-8260-9ce807427619#.Uz8R300nLIU

      2. The results of Manual Therapy, including Chiropractic, may be due to stimulation of mechanoreceptors, OR any other “input” we provide to a defensive nervous system. This may include the context of the clinic, the words we use, our mannerisms, etc. So a positive result may depend on a combination of variables, many of which may be placebo (if one would classify these variables as such). We don’t currently have enough evidence to suggest the results are solely due to the intervention (would a manipulation be equally effective if provided in a cold, damp, dirty basement? Something to consider.)

    2. —with the most respect— we are actually doing the “same” therapy, I with a needle.

      “true pinched nerve you have loss of function.”
      True, loss of both motor and sensory which is actually paralysis. Not much pain. The more pain the more myofascial pain and dysfunctions.

      “You can use spinal manipulation all you want you are not going to have any effect on a true pinched nerve.”
      True, but needs further research.

      “Any manual technique practiced by any provider is stimulating mechanorecpeptors.”
      Incomplete and needs further research. please read Gunn, he will add in a few concepts that will clarify your thoughts.

      “Pain is always a brain experience. It can be nocipeptive, neuropathic, or a combination of the two.”
      Pain is too complex to put in a short paragraph, but it is an “energy impulse” that is distressful and causes worry to the person. We do know that pain will destroy your will to live overtime.

      “The more chronic the pain the less likely it is to be tissue related and more likely to be central mechanisms.”
      Part false and part true, please see Travell/Simons, Rachlin, Gunn and Baldry. Muscle tear pain leads to trigger points, lead to more complex MF tissue disorganization, to spinal and central pain syndromes.

      “Obviously an organic cause of the pain has to be ruled out.”
      Yes.

      “Medically they use antidepressants and Neurontin on chronic pain.”
      “Where I may recommend in addition to the medications to try meditation, exercise, etc.”
      First rest, stretching, massage, wellness, yoga; then step up to needles and then Big Gunn’s and on to the Swords.

      “It is often hard to convince patients that have chronic pain that even though they have disc pathology or arthritis that they may not be causing their pain.”
      Very hard indeed!! This is due to the brainwashing of SBM and EBM communities who are actually by default in with the bed with the businesses of medicine and all of the radiologic evidence needed to justify bills.

      1. Windriven says:

        Unbelievable. I am formally rechristening you I R Rodrigues.

        If anyone here misses the joke recall the early years of Cow and Chicken.

  16. Oops my last few cents/sense was to go here. :)

    1. Windriven says:

      “Oops my last few cents/sense was to go here.”

      Steve, I sure hope you have more cents than you have sense ;-)

      1. Broke just like all primary care providers. The top earners are distracted earning.

        1. Windriven says:

          So Steve, put away your knitting needles and use the degree you earned to do some good. Open up, say, a diabetes care clinic where you can work with people on diet, exercise, managing dosages, minimizing and managing comorbidities. This is (I think) an under served community with real needs.

          1. “diet, exercise, managing dosages, minimizing and managing comorbidities.”

            Are you crazy! How do you expect a practitioner to help people when this society is making them into lazy, fat, uneducated, disenfranchised, fearful, paranoid and over stressed people who can not even afford health insurance.

            The ACA is just a drop in the bucket and in Texas will be corrupted by inaction.

            1. Windriven says:

              “this society is making them into lazy, fat, uneducated, disenfranchised, fearful, paranoid and over stressed people”

              We’re all part of this society Steve. There are those who make obesity and sloth, if not attractive, then at least easily achievable. The rest of us have an obligation to pull the rope in the other direction.

              If you aren’t going to be part of the solution then you are, be definition, part of the problem. You can be better than that Steve.

              1. Thank you Mr Judge of my fate! I must say the same for you too.

                I know a few key facts that are missing in your concepts that is all I’m attempting to convey.

                As long as I sense the presentation of my fav CAMs in a negative light, I have to post. Cuz yall are narrow, have a personal vendetta and unfair.

                Has anyone read the books yet??!! Or practiced any needling??

              2. Windriven says:

                “Cuz yall are narrow, have a personal vendetta and unfair.

                Has anyone read the books yet??!! Or practiced any needling??

                There is nothing personal about it. And the only narrowness is an insistence on facts and evidence.

                And no, we haven’t read the books. One objective of education is to understand fundamental concepts in part to avoid wasted time and effort. The world is brimming full of wonderful things to learn, and sadly life is short. There is no time for studying that which has been thoroughly debunked.

                There are books and believers in astrology and necromancy and alchemy and Voodoo. We don’t spend time studying those subjects either.

              3. Harriet Hall says:

                SSR said “Has anyone read the books yet??!! Or practiced any needling??”

                If we should read those books and practice needling, why shouldn’t we read Medieval textbooks of medicine and practice bloodletting to balance the humors? Oh, yes… we tested bloodletting and found out it didn’t work. Those Medieval doctors were every bit as convinced as SSR that they were helping patients. They had plenty of “experience,” and textbooks to support their beliefs. Anyone who can understand that they were wrong about bloodletting (and why) can understand why SSR might be wrong about his needling. There’s this thing called the scientific method… and there’s a reason we rely on it.

              4. So no one has told you all that science based medicine is incomplete.

                That bloodletting issues is incomplete too. We still blood let!

                You do not have to read medieval text to prescribe to medieval logic and ideas, here are yours.
                -An artificial joint is the best choice for pain (over MF therapy.)
                -Back fusion will treat pain.
                -A chemical will eliminate heart attacks and strokes.
                -Estrogens are safe so let give them all ladies over 50
                -Those Chinese were stupid for using needles for 5000 yrs.
                -How is yoga going to say money.

              5. WilliamLawrenceUtridge says:

                So no one has told you all that science based medicine is incomplete.

                It is known that medicine is incomplete, as is all of science. But merely because medicine is incomplete does not mean the gaps can be filled in through speculation, nor that merely because one can speculate, you are correct.

                You do not have to read medieval text to prescribe to medieval logic and ideas, here are yours.
                -An artificial joint is the best choice for pain (over MF therapy.)
                -Back fusion will treat pain.
                -A chemical will eliminate heart attacks and strokes.
                -Estrogens are safe so let give them all ladies over 50
                -Those Chinese were stupid for using needles for 5000 yrs.
                -How is yoga going to say money.

                An artificial joint is the best choice for pain when the pain is caused by joint damage. Myofascial therapy won’t do anything for pain caused by bone destroying bone through ongoing contact and wear.

                You pretend that back fusion is universally recommended. It is not.

                Estrogen is not universally recommended for women over 50, it is recognized to present risks and benefits and in most cases the risks outweigh the benefits. Estrogen is recommended for the shortest possible time, at the lowest possible dose, only for women whose menopausal symptoms are significant and significantly impair quality of life.

                The Chinese were not “stupid” for using needles for 5,000 years (more like 200 years since filiform needles were only possible with the development of higher-quality steel; previous acupuncture “needles” were quite large, often made of stone, and were more like fleams or bodkins for bloodletting – the modern “acupuncture needle” is very, very modern and bears no resemblance to what people used 5,000 years ago). The Chinese, like all prescientific people, had a medical theory that was based more on hypotheticals than reality, and didn’t test their ideas in a systematic, empirical manner. And like all prescientific people, they were wrong. Your error is in perpetuating their error in the face of contradictory evidence.

                Yoga is gentle exercise, and as such is recommended for all people, as it has been for years. The specific form of the exercise matters much, much less than the regularity with which it is performed.

                See, what you’re doing here is pretending medicine recommends things that it does not, then criticizing medicine for doing things it doesn’t do. It’s like me criticizing you for being a child molester when you don’t molest children.

                Also, criticizing real medicine for its failings is your effort to distract from the fact that the medicine you endorse has little to no evidence supporting it. Why not instead show us the evidence base for your practices?

          2. Low-tech pain therapy is very underserved and needs a few thousand providers at all levels from massage, wellness, cbt, acupuncturist, dry needle’ers to trp specialist. Pain will cause one to want to commit suicide and the majority of these patients are motivated to care for themselves.

            DM is a lifestyle choice illness and the one thing I’ve learned is you can not tell, ask or beg a grown-ass person what to do.

          3. MadisonMD says:

            Are you crazy! How do you expect a practitioner to help people when this society is making them into lazy, fat, uneducated, disenfranchised, fearful, paranoid and over stressed people who can not even afford health insurance.

            Let me guess. You think the solution is not to advise your patients against unhealthy lifestyles. It is not to find a way to deliver true medical care, including prevention, for the uninsured. Instead your solution is to use needles and either force your patients directly, or “check off the boxes” that allow you to get reimbursed even if these boxes don’t correspond to your actual diagnosis?

            Give it a rest, dude.

            1. Ass-u-me … why are you always assuming. Why not ask like a proper person.

              I know i know your tack … disparage the messenger, them you can ignore the message.

              You have NO idea who or what i’m thinking or my agenda. You take bits and pieces of my statements and juggle them around … is that all you are here to do.

              Gee you guys are worse the the Inquisition courts of the old Catholic church – stuck.

  17. Agashem says:

    @Scubadoc – as a PT I have told a few patients that there was nothing I could offer them – one went on to see a chiro – do you think this DC told her the same thing? I doubt it

    1. Andrey Pavlov says:

      do you think this DC told her the same thing? I doubt it/

      When you are not constrained by reality you can say whatever you want. Go talk to faith healers and they will tell you anything you want.

    2. I do know that each provider has different views, experiences and insights, so a patient can gain benefit by just changing providers within the same discipline.

      Another example, my ‘Acupuncture” is totally different from my colleagues and vastly different than a non-MD Acupuncturist. We all can offer care and it is up to us to refer the patient to the best or alternative provider.

      But this is the situation we are in — cost and restrictions place by an arbitrary group of business folks. The business of medicine is causing much misery and pain.

      1. Windriven says:

        “cost and restrictions place by an arbitrary group of business folks. ”

        In America we spend nearly 18% of GDP on healthcare. Shall we spend more? Shall we fund more diabetes care centers or shall we spend more on acupuncture? Shall we expand access to mental health services or shall we spend more on acupuncture? Shall we expand the range of social services support available to the chronically ill or shall we spend more on acupuncture?

        1. Yes, we need a new opps the OLD ideas based on the wealth of lo-tech medicine from the last 100 yrs without interference of bias or based on profiteers.

          I do know we waste a lot just on MRIs and replacement surgery.

          1. Windriven says:

            IR, we abandoned those “OLD ideas based on the wealth of lo-tech medicine from the last 100 yrs” because THEY DON’T WORK. They didn’t work 100 years ago and they don’t work today – regardless of your serial protestations to the contrary.

            1. Don’t work 100%? Does that include/exclude the placebo effects?

              By your narrow standards.

              You all have a lot to learn and consider from PCPs down stream from all you pseudo-academics.

              1. WilliamLawrenceUtridge says:

                Don’t work 100%? Does that include/exclude the placebo effects?

                By your narrow standards.

                You all have a lot to learn and consider from PCPs down stream from all you pseudo-academics.

                Your assumptions are in error, Windriven works in private industry (not Big Pharma), he’s not an academic.

                I consider it unethical to administer (and charge for) pure placebo treatments. I think if a patient has a problem that can be treated, it should be (and any placebo effects that accompany treatment are a bonus). I think that if a doctor thinks something can’t be treated, the ethical thing to do is to tell the patient, not patronize them with comforting lies.

                Clearly, we part ways here. I wouldn’t want a primary care physician who is consistently deceptive to his patients and wastes their time and money.

      2. WilliamLawrenceUtridge says:

        Another example, my ‘Acupuncture” is totally different from my colleagues and vastly different than a non-MD Acupuncturist. We all can offer care and it is up to us to refer the patient to the best or alternative provider.

        Great. Undertake a series of well-controlled tests which teases out the aspects of the practice that are necessary, and those that don’t, and publish the results. The results will be replicated and validated, then extended, and eventaully doctors the world-over will use your brilliant insights to help millions, if not billions of patients.

        Or just sit on it, claim your superiority, don’t test anything, and charge your customers for the privilege of being test subjects in a clinical trial that never reports out. Y’know, whatever. Who cares about anybody but the people you are in immediate contact with, right?

  18. GeneF says:

    I was glad to read this post; it has been a cause of frustration for me for nearly 20 years that I cannot find a ‘medical-model’ chiropractor since moving to Seattle (I’ve tried a couple and they both turned out to be subluxation quacks).

    When I lived in L.A., I had a wonderful chiropractor… I knew I had hit gold when I had VERY severe back spasms and he said, “I’m just going to do some gentle massage, no adjustment, until we can get the spasming to stop. If it doesn’t improve in a couple of days, it’s a medical issue and I’ll refer you to an orthopedist.” It was the ONLY time and the ONLY chiropractor who understood the limits of his practice/profession and the only positive mention of a physician ever heard from a chiropractor.

    There is a website (I forget what it is or if it continues to exist) with a list of medical-model chiropractors, but there were none listed in Seattle.

    As someone who suffers from intermittent recurring lower-back spasms (sometimes quite debilitating), I would welcome finding a chiropractor who understood that his profession should be limited to musculo-skeletal issues, but, for now, I must rely on physical therapy when my back acts up.

  19. windriven says:

    “but, for now, I must rely on physical therapy when my back acts up.”

    Have you found PT somehow insufficient? What did the chiropractor do that the PT misses?

  20. GeneF says:

    windriven — it’s not so much that the chiropractor did more than PT, actually, to the contrary: the PT does much more, including exercise guidance, etc. I have no complaints whatsoever about my wonderful PT; my comment about needing to rely solely on PT is if I just wanted manipulation without the other stuff, an occasional quick trip to a good, medical-model chiropractor would be appreciated. As Sam says and has said before, PTs now pretty much take the place of ‘good’ chiropractors. I’d just like to have the additional option to choose (not to mention putting an end to the chiroquack branch — which is now more of the trunk, actually — of the profession). Your questions are well-taken, however. Thanks.

    1. Windriven says:

      I have no problem with chiros who eschew subluxation. But I am trying to understand what a subluxation-free chiropractic model brings to health care that PT doesn’t already deliver. To ask the question slightly differently, what is the need that they would fill that is otherwise left wanting?

      Perhaps it doesn’t matter all that much. If manipulation for LBP is coded and reimbursed the same whether provided by a DC or a PT and assuming that the DC does not stray beyond the bounds of science based practice, there isn’t much reason to care. But if there is a cost differential without a demonstrable clinical benefit I would be opposed. If there is a cost differential there needs to be a deliverables differential.

      1. Any manipulation of the skeleton are the same; they only differ in the time, effort and intent. I would group all hands-on therapy together and train them all the same and put them all to work on the front lines.

        If you did your homework you would understand that most of the work done on the body is grouped into Myofascial Release Therapy with hands on and needles. (i know what you are thinking but Ingraham research is incomplete)

        The cost saving would be in the multiple 100 mill dollar areas. Why? the need to repair, replace or high-tech fix a joint or back pain problem could be eliminated.
        Saving hospital, radiological, surgical, error and blunder cost.

        1. Windriven says:

          “The cost saving would be in the multiple 100 mill dollar areas.”

          Yeah! It’s all there except for one timy little thing: evidence that it amounts to anything more than wishful thinking.

          We all know that you are a true believer, Steve. But belief is not the same as evidence.

        2. WilliamLawrenceUtridge says:

          the need to repair, replace or high-tech fix a joint or back pain problem could be eliminated.
          Saving hospital, radiological, surgical, error and blunder cost.

          Massage is quite cheap, low-tech, and doesn’t puncture the skin. Why don’t you use it instead of acupuncture needles?

          1. Because of how muscles will devolve when the proper treatment is delayed. Once they reach a critical point in the disease process, external applied energy will not release them.

            :) I thought I had explained that in past posts.

            1. WilliamLawrenceUtridge says:

              So massage will no longer “evolve” these muscles, but acupuncture needles will? And where is your evidence for this remarkable fact?

              Oh, of course, your own experience.

              You claim a lot of things Steve, explain few, and cite sources for essentially none. You consistently fail to grasp that your experience is of no use in this discussion, because your experience is not merely deceptive, it actively deceives you into believing that it is flawless. This is a basic human trait that you do not understand.

  21. jim says:

    Crelin clearly demonstrated that vertebrae could not be displaced enough to impinge upon spinal nerves without tearing ligaments.>>>>>> You are using the basic LAY explanation of chiropractic and the “subluxation complex” to discredit it. That is not what is taught in chiro school. The subluxation complex is more based on neurological reflexes from irritation at the joints and abnormal movement not a bone pinching a nerve. While I have seen some conditions involving “organs” miraculously improve with a chiropractic adjustment. I agree that advertising that chiro treatment can cure such miladies is misleading as its more an odd unexplained occurrence than anything reproducible.

    1. Yes it is but unconnected to any of the electro-mechanical reflexes of any of the list of my authors.

      I’m amazed that out of all of those studies, none cross reference with my MDs.

      Still must go deeper into the articles, looks like some good concepts.

      Thanks for posting.

    2. WilliamLawrenceUtridge says:

      That’s a 24-year-old paper, which was apparently sufficiently unconvincing at the time, or in the subsequent decades, to change doctors’ minds that chiropractors were onto something. Where are the primary studies showing that chiropractors can identify subluxations with high inter-rater agreement (rather than, say, using it as an excuse to adjust the entire spine from top to bottom)?

      The concept of subluxation has consistently had a superficial gloss of pseudoscientific babble applied to it without ever demonstrating that the knowledge of chiropractors aligns with the knowledge of other medical disciplines. See, a physiotherapist will agree on basic anatomy with a surgeon, and an internist, and a radiologist. But none will agree with the chiropractor about subluxations, because the concept lacks proof and independent confirmation.

      1. David Clemons says:

        I want you to research T4 syndrome on the PT sites. This may provide valuable information to you.

        1. WilliamLawrenceUtridge says:

          And I want CAM idiots to stop applying a double-standard where drug companies are seen as greedy and evil but quacks who justify their practices by pointing out Big Pharma’s greed and evil are not.

          But you can’t always get what you want.

          1. You get a research paper and then you negate the article. The age of an article is not so important as if the results reliable over time, reproducing the outcomes and if anyone is updating the findings.

            You should know that human studies are not like chemical reactions or mathematical models, variability and bias are human.

            Do you really know what YOU are looking for???
            Are you doing any outside independent study?
            Who do you believe?
            Is there a “perfect” human involvement study?

  22. David Clemons says:

    Ten years ago I developed a serious respiratory problem that was at times debilitating. The MDs were unable to help me. Ultimately I was adjusted at T4 by a Chiro and the issue was resolved though it has reappeared from time to time. I had no other indications of a problem with my thoracic spine. I was told by an MD that women who receive epidurals during childbirth sometimes complain of difficulty breathing. It validated to me the concept of a subluxation affecting my general health. It also proved to me that these can exist without pain. I later developed other issues in my mid and upper thoracic spine. Periodically a joint becomes fixed and painful. An adjustment usually provides immediate relief. My Chiro suggested I have T4 syndrome. Most of the information I received was from Physiopedia.com. It explains how the sympathetic nervous system is used to affect the cranial nerves, in contradiction of Dr. Homola. I have a lot of tension headaches. It also explains how cardiac like chest pain can develop as well as arm and hand pain. I have experienced all of these. I also have stomach issues I that I associate with this. Sometimes I have an irregular heartbeat that I suspect may be related to my back problem.Often I just feel bad when there is pain or tension in my mid back. When there is an absence of pain or stiffness I feel wonderful. Chiros waiting rooms are overflowing with patients. Where do you think these patients come from? They come from the offices of MDs and PTs who were unable to help them. You also must ask why most professional sports teams use Chiropractors.

    1. Windriven says:

      ” I was told by an MD that women who receive epidurals during childbirth sometimes complain of difficulty breathing. It validated to me the concept of a subluxation affecting my general health.”

      You are a nitwit. I hate to be blunt but you have taken a very real physiological response to an opiate moving higher than planned in the epidural space and mashed it up with the unscientific ravings of a religious nut. This betrays the scientific sophistication of a chipmunk and that betrayal echoes like a rifle shot through the rest of your comment.

      But you serve a valuable purpose, Mr. Clemons. Chiropractic is built on the backs of nitwits. Without those like you, chiropractors would have no patients and they would have to do other things for a living. And don’t you think it would be funny to see the grocery clerk or the guy changing the oil in your car wearing a lab coat and stethoscope and insisting that she be addressed as ‘doctor?’

      1. David Clemons says:

        You Chiro bashers are very intelligent but ignorant and you are bigots. What I said about the epidural was the response of an anesthesioligist when I told him about my respiratory problem and the adjustment that resolved it. He was the one that made the correlation. He believed what I stated to be true and it was. Until this experience I questioned the beliefs of Chiros but it really didn’t matter. I have a long history of back pain and spinal manipulation has help me. Chiros are the experts. I have seen 5 in 36 years and not one tried to sell me any snake oil. Medical people used to drill holes in people’s heads to let out evil spirits. You did not comment about the articles on T4 syndrome that state spinal dysfunction in the thoracic spine affects the autonomic nervous system ,contrary to what you believe. I do not wish to engage in argumentative rhetoric with people like you. You are fixed in your condemnation of a good profession and nothing I say is going to change your mind. I merely stated what i have experienced as a patient.

        1. weing says:

          “He believed what I stated to be true and it was.”
          Those are your criteria for verifying?

        2. Windriven says:

          “You Chiro bashers are very intelligent but ignorant and you are bigots.”

          When one dislikes an idea for the very good reasons that it is demonstrably untrue and that it is used to defraud others, is one still a bigot?

          “What I said about the epidural was the response of an anesthesioligist (sic) when I told him about my respiratory problem and the adjustment that resolved it.”

          Well as none of us were party to this alleged conversation, the questions of whether you and the anesthesiologist mis-communicated, the anesthesiologist was humoring you, or there was some unreported piece of the conversation that the anesthesiologist keyed on remain open. What I said about the likely cause of respiratory depression secondary to epidural anesthesia remains true.

          “Medical people used to drill holes in people’s heads to let out evil spirits.”

          Yes. And there you’ve hit as close to truth as you’re likely to get. Medical people once used treppaning, bleeding, and a variety of other ineffective maneuvers until medical science showed them to be ill-considered and ineffective. The difference between medical science and chiropractic nonsense is that medical science is constantly moving forward, learning more and in the process discarding the ineffective while chiropractic, homeopathy, acupuncture and their ilk cling like rats to the wreckage of their long discredited theories.

          “You did not comment about the articles on T4 syndrome that state spinal dysfunction in the thoracic spine affects the autonomic nervous system”

          You provided no citations. The only references to T4 syndrome that I easily found were not in scholarly journals indexed on Pubmed – other than a reference to a spinal chord injury secondary to chiropractic manipulation reported in the American Journal of Neuroradiology.

          ” I merely stated what i have experienced as a patient.”

          If you spent any time at this site or any of the others informed by logic and critical thinking you would understand that anecdotes are not evidence, that correlation does not equal causation. I’m glad your problem is more or less better. I’m saddened that you believe it owes to chiropractic.

        3. WilliamLawrenceUtridge says:

          You Chiro bashers are very intelligent but ignorant and you are bigots.

          Why? Because a careful parsing of the evidence indicates that much of the claims and literature for chiropractic is shown to be false or impossible? Because we point out that much of the care provided by chiropractic is not evidence-based? I would venture that many here know quite a bit about chiropractic care, as well as basic anatomy and physiology sufficient to demonstrate that chiropractic care can’t work.

          He believed what I stated to be true and it was.

          How do you know?

          I have a long history of back pain and spinal manipulation has help me.

          How do you know?

          Chiros are the experts.

          How do you know?

          I have seen 5 in 36 years and not one tried to sell me any snake oil.

          How do you know?

          Back pain is the most likely, in fact the only indication for chiropractic, provided they restrict themselves to mechanical dysfunction and don’t claim the ability to treat anything but.

          Medical people used to drill holes in people’s heads to let out evil spirits

          I don’t think doctors did this actually, and certainly not since the advent of science-based medicine in the late 19th/early 20th century. Meanwhile chiropractic currently and explicitly believes in vitalism (they call it “innate intelligence”) that can be manipulated through the bones of the spine.

          You did not comment about the articles on T4 syndrome that state spinal dysfunction in the thoracic spine affects the autonomic nervous system ,contrary to what you believe

          I will point out, as I did below, that T4 syndrome appears in the explicitly pro-chiropractic J Manip Physiol Ther. If you search on google scholar and remove “thyroid” from the results (T4 is a type of thyroid hormone), you get about 100 results, from either that journal or Manual Therapy. Please allow me to point to this 2009 article, which states “To date no controlled studies have investigated the effects of thoracic spinal manual therapy (SMT) applied to T4 on sympathetic activity in the hands.” I will also note that this particular study added very little to the body of “controlled research”. It appears that T4 syndrome is still quite speculative.

          May I suggest you decline when the chiropractor suggests adjusting your cervical spine? The greatest risk of the discipline is the rare, but real, riks of tearing the arteries of the cervical spine, which can be fatal.

          nothing I say is going to change your mind. I merely stated what i have experienced as a patient.

          Yes, nothing you can say will change our mind, just as nothing we can say will change yours. Your opinions are based on your experience as a patient, we are keenly aware of experience’s ability to deceive, and that is why we have strikingly different opinions on the matter, which cannot be reconciled.

      2. Chiropractic medicine is good medicine when it is practiced in a well established healthcare system. We do not have such a system and which is a huge problem.

        Biases and flaws in the definitions of pain, therapy, the scientific methods PLUS politics, personal interest, lazy researchers, stubborn scientist and disrespect are all getting in the way.

        Another issue is the need to have absolute certainty that what we know is forever correct, which is an impossible goal when dealing with people, emotions, feelings and the unique variations of human beings.

        1. Windriven says:

          “Another issue is the need to have absolute certainty that what we know is forever correct, which is an impossible goal when dealing with people, emotions, feelings and the unique variations of human beings.”

          Now you know that isn’t true, Steve. What we need is evidence that something works. It doesn’t have to be perfect or work flawlessly for everyone. But it should make sense and it must have evidence supporting its utility,

        2. WilliamLawrenceUtridge says:

          Chiropractic medicine is good medicine when it is practiced in a well established healthcare system. We do not have such a system and which is a huge problem.

          That’s funny, where I come from there is such a system and chiropractic doesn’t magically manifest proof for its assertions. Scientific medicine works or it doesn’t, the system it is embedded in can potentiate effective treatments but cannot make ineffective treatments magically better.

          Biases and flaws in the definitions of pain, therapy, the scientific methods PLUS politics, personal interest, lazy researchers, stubborn scientist and disrespect are all getting in the way.

          What about lazy practitioners who don’t bother to read and engage with the actual research or publish any of their own, despite asserting a nigh-unprecedented cure rate? It’s amazing that you have unbiased definitions of pain, therapy and science yet specialists who devote their entire careers to these topics just keep coming up short. Truly you are the Lamarck of pain research (except Lamarck published his incorrect ideas).

          Another issue is the need to have absolute certainty that what we know is forever correct, which is an impossible goal when dealing with people, emotions, feelings and the unique variations of human beings

          Uh, yeah, it’s known that this is an impossible goal, which is why scientific decision-making is based on the preponderance of the evidence, including explicit assessment of the quality of the studies that evidence is built from and the prior probability. That’s why chiropractic’s claims of treating systemic disease are considered nonsense, while their claims of treating mechanical back problems are taken more seriously, while simultaneously recognizing that it doesn’t seem to be a cure-all, merely slightly better than doing nothing.

          For someone who spends a lot of time pontificating about what science and medicine is and should be – you sure don’t know much about it.

    2. WilliamLawrenceUtridge says:

      Ultimately I was adjusted at T4 by a Chiro and the issue was resolved though it has reappeared from time to time.

      So…it wasn’t really resolved then?

      I was told by an MD that women who receive epidurals during childbirth sometimes complain of difficulty breathing. It validated to me the concept of a subluxation affecting my general health.

      How? Epidurals have an understood mechanism, while a subluxation does not. Your statement is akin to saying “because infants can experience plagiocephaly, craniosacral therapy works”. this is incorrect.

      You also must ask why most professional sports teams use Chiropractors.

      Sports teams also use Q-link bracelets and refuse to change their underwear. The question I would ask is – why is there so little good evidence supporting even the most justifiable claims of chiropractors (that they can ease back pain), and why is this translated into credibility and support for nonmechanical problems?

      It explains how the sympathetic nervous system is used to affect the cranial nerves, in contradiction of Dr. Homola.

      Dr. Homola has based his analysis on a study of the medical literature. A Web2.0 site like physiopedia is only as good as the contributors, and if they are explicitly pro-chiropractic, then their starting point renders their conclusions questionable. The T4 syndrome you allude to, for instance, is first published in J Manipulative Physiol Ther. 1995, and I that particular publication is explicitly pro-chiropractic. One wonders why it is not called “The Journal of Chiropractic ____”; I would suspect that it is because such a title would result in it being immediately discounted by many mainstream practitioners, because so much of chiropractic care is not evidence-based and frankly a lot of it is simply crazy. You can’t cure, or cause cancer through the spine.

      I don’t really have much of an issue with chiros manipulating backs to ease joint pain and stiffness (though I think they are totally redundant to physios in this regard). It’s all the other nonsense that accompanies this that is my larger issue with the profession.

      1. “How? Epidurals have an understood mechanism, while a subluxation does not. ”

        Your pants are on fire!!!

        There is no credible necessary for epidurals for pain or for any reason other than to put medication in that space for anesthesia.

        http://www.ncbi.nlm.nih.gov/pubmed/24353855

        1. Windriven says:

          WTF does your citation have to do with WLU’s assertion that you characterize as “pants on fire?”

          Epidurals have an understood mechanism, true or false?

          Chiropractic subluxations do not have an understood mechanism, true of false?

          So what the heck are you going on about, Steve?

        2. WilliamLawrenceUtridge says:

          Epidurals are understood to work at a chemical level, upon specific receptors within the body. It’s a mechanism wholly in keeping with our understanding of the body, even if the specifics are not known.

          As for your statement “There is no credible necessary for epidurals for pain or for any reason other than to put medication in that space for anesthesia”, assuming you mean there is no reason for epidurals period, I would ask why you think women should endure childbirth in unnecessary agony? Should we pull teeth without freezing? Are you a sadist? If you’re making any other claim, you’ll have to be clearer because I simply don’t understand what you’re trying to say.

          As for chiropractic, it is claimed it works by “freeing” the “innate intelligence” of the body to heal itself. There is no plausible mechanism through which impinging spinal nerves can cause the myriad diseases that chiropractic claims to heal – that very premise is lunacy, and any chiropractor who has abandoned it is simply a physiotherapist with delusions of grandeur and a propensity for unethical sales of supplements to boost their bank accounts (but not their customers’ immune systems). Further, specific analysis of anatomy and physiology suggests that the body generally cannot impinge upon the nerves sufficient to cause major dysfunction without considerable impairment that could be alleviated simply through a joint manipulation. And this point is even further eroded when you do specific tests of the abilities of different chiropractors to assess and agree upon how many, and which specific joints, are subluxated. Given the same patient, and five chiropractors, you will get five diagnoses. So even if they were correct about subluxations, which they do not have any evidence for, they still lose in their ability to properly diagnose which joint to adjust.

          And that is why the mechanism for epidurals makes sense, and the mechanism for chiropractic is false.

          1. Nope! We truly do not know the MOA of epidurals and the word subluxation!

            But that is OK that we don’t, epidurals should be banned!

            Chiropractic care should be studies, clarified and utilized as what it can offer patients.

            Yall are twisting words, deeds and definitions into a pile and burning the whole thing. NOT scientific.

            1. Windriven says:

              “Nope! We truly do not know the MOA of epidurals and the word subluxation!”

              What part of the MOA escapes you? Do you need an explanation of the pharmacokinetics and pharmacodynamics of, say, morphine or bupivocaine?

              And we do know the meaning of subluxation in the chiropractic sense. It means bull$hit.

              1. If you know beyond a doubt that steroids and epidurals are beneficial, YOU show me the data.

                Whatever you may read in RCT, pales in comparison to what we see downstream in the office. ESI are a waste of time, money and are fraught with dangers.

                Nice being upstream, everything looks and smells like roses.
                By the time the patients get to us downstream things stink!

                The horrendous part is that the rosy smell is so captivating upstreamers refuse to believe that we smell something far different.

                GOOD scientific methods. NOT to belief patients and providers. So we are the enemy of upstreamers because we experience the reality of the flaws.

              2. Windriven says:

                “If you know beyond a doubt that steroids and epidurals are beneficial, YOU show me the data.”

                No moving the goal posts, Steve. You said:

                “Nope! We truly do not know the MOA of epidurals and the word subluxation!”

                Well we actually do. The subject was mechanism of action of epidural anesthesia. Now you’re asking for something else entirely.

              3. This is a major issue and that is definitions and making assumptions.

                In the world of pain therapy ESI are the unfortunate standard which should be halted until we get to the bottom of what it is they are not doing and to what degree they are detrimental. IMO the positive outcomes have to be matched with the alternatives of my authors.

                Epidurals for anesthesia are not used to treat long term chronic pain except maybe to do some extraneous procedures. So this one was never entertained by me. And yes we have an “idea” as to how this works.

          2. “As for chiropractic, … “freeing” the “innate intelligence” of the body to heal itself. There is no plausible mechanism through which impinging spinal nerves can cause the myriad diseases that chiropractic claims to heal – that very premise is lunacy, and any chiropractor who has abandoned it is simply a physiotherapist with delusions of grandeur and a propensity for unethical sales …”
            “Further, specific analysis of … suggests that the body generally cannot impinge upon the nerves sufficient to cause major dysfunction without considerable impairment… be alleviated simply through a joint manipulation.”

            My response:
            This is a false assumption that is rampant in medicine. A spinal or distal nerve bundle that is compressed to a degree that is in being compromised will cause a sensory AND motor deficit! One or the other is a function of intracerebral lesions as in tumors or strokes.

            The questions that need to be answered are:
            Will a collapsed disc cause pain?
            Will a collapsed disc cause a neuromuscular deficit? If so why just a sensory or just a motor deficit?
            Why do disc collapse?

            Why will a massage relieve pain and why won’t it?
            Why will a chiropractic adjustment relieve pain?

            Why will Botox help relieve pain if Botox paralyses muscles? Can muscles be the source of the pain if Botox eliminates pain that originates in the muscle?
            Why are nerve “killing” procedures like a radiofrequency rhizotomy successful and why do they fail?
            Why will this radiofrequency “kill” only part of the nerve that produces pain and not the motor components?

            Why will a surgery designed to “fix” a pinched nerve not improve a patient’s well being and eliminate pain? What else can be contributing to that pain? Can the contributing factor be addressed prior to a major surgery to be compared to open surgery?
            Why are micro surgeries effective and why do they fail?
            Why are minimal invasive surgeries effective and why do they fail?

            The answers are found in Travell/Simons, Gunn, Cannon, Rachlin and Hackett! Complex Chronic Pain is in the muscles and connective tissues and NOT at the bone, disc or nerves.

  23. Andrey Pavlov says:

    Chiropractic is built on the backs of nitwits.

    I see what you did there. Though perhaps unintentional, twas funny.

    1. Windriven says:

      I’m hurt that you think that was unintentional!

  24. It’s interesting why people feel the need to be insulting to others.. We are all human.. sometimes we make mistakes.. I am not a religious man but surely what goes around comes around?

    W

    1. Windriven says:

      “surely what goes around comes around?”

      Yeah, I know more than a few real scumbags and only one of them is doing hard time. If what goes around comes around, it takes its good old time getting there.

      “It’s interesting why people feel the need to be insulting to others.”

      This is a site dedicated to clinical medicine informed by science. But we get every sort of belly-button gazer, dip$hit, snake oil salesman, and delusional that one might imagine. Those who come to contribute, those who come to learn, those who come to ask serious and meaningful questions, are invariably greeted warmly and treated with respect. Those who come to promote sCAMs, those who carefully culture their ignorance, those who confuse belief with knowledge, those are going to have a rough ride. I for one make no apologies.

  25. This article is tragically misleading and evokes controversy. It attempts to intertwine many issues and come to a conclusion which is unfair.

    Medicare wastes a lot of money and resources on high technology despite more economical and safe low-tech options. One of the most expensive is related to pain. You can simplify pain into 2 types of pain, structural pain and nonstructural pain. Structural pain is straightforward to treat, it can be repaired by the surgeon. Nonstructural pain is a lot more complex, and that it cannot be seen with any high-tech technology scanners or MRIs. Most importantly pain is a personal experience and cannot be witnessed by anyone except the person who is in pain. So because of this glitch in the thought process between structural and nonstructural pain, everyone wants to find something to fix. So a lot of time and effort goes into unnecessary MRIs, CT scans, x-rays, and questions the need and necessity of back surgeries, replacing natural joints with artificial man-made metal objects and placing patients on high-dose opiates which in themselves are detrimental.

    Chiropractic care works effectively if a problem is caught in the early stages. Just as Massage, acupuncture and active release are all highly effective at treating complex pain problems, also called myofascial pain problems or nonstructural pain problems. What bothers me the most is people will confuse and twist together that art of chiropractic care with the business of chiropractic care and realized that the business is getting in the way of the art. The solution to this is to separate the 2 out to evaluate the artistry of chiropractic care as a component of pain management.

    In terms of the mechanism of action of structural medicine it’s basically a one to one equation. In terms of nonstructural medicine it is a lot more complicated and can’t be simplified in such a manner. Since nonfunctional medicine is mostly safe, non-toxic, innocent, can be personalized, it should be use at the leading edge of all therapy.

    In terms of medicine and ethics, physicians, hospitals, emergency rooms, pharmaceutical companies, all do things that are not in the best interest of patient care and actually promote the business and profits of medicine. We all know them and should not marginalized or ignore all these aspects of the failures in the healthcare system.

    Call your lawmakers and make them accountable! We should ask them to discuss logical policy with all associated with health care at the decision making table from the AMA, FDA, scientists, businessmen and laypeople — ALL aspects of the entire community.

    http://www.forbes.com/sites/stevensalzberg/2014/04/20/new-medicare-data-reveal-startling-496-million-wasted-on-chiropractors/

  26. PMoran says:

    “So we are the enemy of upstreamers because we experience the reality of the flaws”

    Which flaws?

    I have often wondered about the cost/risk/effectiveness of currently very popular steroid injections, simply because it is the kind of intervention where there are likely to be few really high quality controlled clinical studies (if anyone knows otherwise I will retract that) and there are substantial incentives towards the acceptance of weaker data.

    The value of the injections may thus lie mainly in giving doctors and patients something credible to do for people with lingering pain conditions. Also, immediate relief of pain from local anaesthetic could help reset or adjust pain tolerance or provoke other kinds of placebo-related influence in some patients with the steroid adding little.

    Nevertheless, SS, your experiences are irrelevant to cost/risk/effectiveness considerations unless you can somehow document a very high rate of serious adverse outcomes from such procedures. Can you?

    If not, what else can you possibly have? No one is claiming that these procedures have uniformly good results, and these are common conditions, so that it would no surprise that you are encountering many patients who are not satisfied with the results ( steroid injections didn’t work for myself, for example ).

    Also a well-known characteristic of medical practice is that satisfied patients come back, the others go to “St Elsewhere’s” . Other practitioners are encountering your poor results. Their experience is no clear guide to your overall success rates either.

    1. “unless you can somehow document a very high rate of serious adverse outcomes from such procedures.”

      How many would satisfy your thirst before you notice? I notice each and every one who comes into my office. I know you guys are obsessed with numbers where as I am obsessed with people. One failure is enough for me to want to investigate.

      In my office where I see 100% failures, meaning all of these patients have failed! All have gone thru the gauntlet of modern mechanical medicine and had undergone; 1 to 3 Ablations, 1-5 open long incision or small 1 cm surgeries for upper or lower spinal; 1-3 ESI. They are still crippled and in pain after joint replacement surgery of the shoulder, hip or knee.

      Beside, I’m hoping a few who visit here will get out of here and read my references, none of these ideas are mind, I’m just the one who is vocal and stubborn enough to argue with fools who by now would have many pertinent questions related to the reading. I’m almost convinced that some are just misinformed, others can not imagine this concept and are locked in a flawed concept, some are dogmatic and just want a place to feel at home, some are intentionally instigating an illusion for fame or profits. The naysayers or instigators know what they are doing and find it very easy and rewarding to disparage a fellow practitioner just to feel good or gain financially.

      I reserve the word delusional, even though it can be applied, because I would have to talk face to face to that person and/or consult a Psychiatrist.

  27. MadisonMD says:

    Ugh, you can’t comprehend the difference between rate of SAEs and number of SAEs? And Peter clearly indicated how your sample was a biased– people self-selected after had bad outcomes from a common procedure.

    Hopeless. Just hopeless, Stephen. It is nice of Peter to try, but the task of educating you is Sisyphean.

  28. PMoran says:

    “In my office where I see 100% failures, meaning all of these patients have failed! ”
    All have gone thru the gauntlet of modern mechanical medicine and had undergone; 1 to 3 Ablations, 1-5 open long incision or small 1 cm surgeries for upper or lower spinal; 1-3 ESI. They are still crippled and in pain after joint replacement surgery of the shoulder, hip or knee.”

    I personally have had an excellent result from my joint replacement and everyone I spoke to beforehand had good results with theirs. I play golf with an old codger who has had both knees replaced.

    So it seems that your practice is unusually weighted with bad conventional results. If you believe these are routine outcomes with your local surgeons you should be documenting them and lodging a complaint with their medical board. It is your duty to do so.

    However , the patients you will be having most personal success with are almost certainly a different population to chronically disabled pain patients who end up undergoing major surgical procedures with not entirely predictable outcomes. In my experience of local orthopoedic surgeons the practices you are objecting to are mostly performed as a late resort, but perhaps your local surgeons are more aggressive.

    You seem to be claiming that you can save some patients having to have these procedures. I accept that that may occasionally be true, for a variety of different reasons.

    1. @MadisonMD
      In the office setting those terms are worthless!!! YOU seem to see people as data points and number, I feel for your patients. Do you see patient are just read articles?
      Who are you anyway? Since I can not readily find your bio or know your background … I will reserve the words “absolutely stupid” until I get more professional info. So “misinformed” is more appropriate.

      If you have any compassion you have to believe what the patient is saying and how they say it.

      The old therapy works very well and if used in the beginning of a pain syndrome will probably eliminate the need to have a joint replaced. So whether it’s soon, later or chronic, the “ALWAYS” inferior choice is to replace a joint. I use always because if a patient was not in pain, in the vast cases, 99.9% would not opt to have their natural joint replaced with a hunk of metal.

  29. T4, the name is an incomplete concept.
    Fortunate the treatments offered for T4 syndrome are correct.
    Spinal manipulations will treat many issues related to complex pain issues above and below the waist.

    You have to read Gunn, Rachlin and Hackett to connect the dots. If you do not have the textbooks and the experience it will be difficult to envision the links.

    Also see

    http://www.scribd.com/doc/51002931/UNDERSTANDING-SPINAL-SEGMENTAL-SENSITIZATION-AS-A-NEW-CONCEPT-OF-PAIN-AND-EMPLOY-ITS-TREATMENT-STRATEGIES

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