Chiropractic Care: Is this too much?

I was chatting with my wife (specialist neuro physio) about this recently as I’m presently recovering from a back injury. She explained how the mobilisations performed by chiro are often very extreme/aggressive and often lead to long-term damage, without actually addressing the real problem (normally poor fitness and posture).

She reckons she’s witnessed some permanent and horrific back conditions/spine degeneration most likely caused by long-term chiropraction.

I’d probably give it a miss.

Glupton, doesn’t what you’ve quoted state that SMT is as effective as seeing a GP or a Physio?

Glupton, doesn’t what you’ve quoted state that SMT is as effective as seeing a GP or a Physio?

No, it says it ‘appears’ to be, before going on to question the reliability / lack of studies showing this.

Interesting thread.

I recently read this:

Suckers

Unsuprisingly there is a (little) bit about chiropract in it. Only thing I would add having read this ^^ is never to let a Chriroparcator near your neck: in the book Rose Shapiro writes about people who have had arteries damaged by neck ‘cracking’ and in direct consequence suffered strokes either during or shortly after treatment. 😯

ten min appointments? treatment curses of hundreds of pounds? They sound like a money making machine.

Dangerous voodoo, from at least 1 in 4:
http://www.newscientist.com/article/dn18780-simon-singh-wins-libel-battle-against-chiropractors.html
Should tell you all you need to know about the ‘profession’

Ten min appointments?!

I had a private Physio session where the woman wasn’t strong enough. Crackers.

Crackers

No, they’re chiropractors.

She reckons she’s witnessed some permanent and horrific back conditions/spine degeneration most likely caused by long-term chiropraction.

I think one of the chiros at the practice my wife works at has injured someone recently.

I thought osteopaths generally use more indirect manipulations than a chiro – like putting you in a recovery position, moving a few limbs and then leaning across you to get the ‘crack’.

The chiro I went to directly pushed on the vertebra – felt scary.

Also. If you’re gonna post on a forum about back pain, try one like this:
http://www.rebuildyourback.com/forum/index.php
Come back here when your rear mech has fungilated its spodgules and needs re-doobry-ing.

(Seem to remember there were quite a lot of folks on RBYB *because* they’d visited a chiro-quack-ter, back when I was looking at it.)

Thanks:)

Some of the comments and sentiments expressed on this thread make for very depressing reading.
I’m a chiro so I’m clearly biased but if you look at all the research dispassionately as, for example, the Kings Fund did, then chiropractic, osteopathy and manipulative physio all come out as both safe and effective for musculoskeletal conditions like uncomplicated low back pain and neck pain.
When the Kings Fund looked at cost effectiveness the case for chiro/osteo/physio becomes more compelling.
Just because some people behave unprofessionally you need not tar us all with the same brush. Would you dismiss the entire legal profession because some lawyers are less than ethical? Perhaps you consider all medics like to murder their patients based on Harold Shipman’s behaviour?
Anyone who’d care to really find out what chiropractic is about is welcome to come to my practice, have a chat, talk to patients etc with no obligation and no fee whatsoever. I’m located near Reading.
My contact details are in my profile.
Incidentally I last xrayed someone in 1994 so I don’t find it an essential part of the diagnostic process…….

marmottefarcie

sorry but look at the post a few above with your national association trying to silence a man who pointed out the flawed claims chiropractors were making.

That is not what the kings fund found.

Sure. Next time I have the flu I’ll swing by for some subluxation to improve my body’s innate intelligence.

if you look at all the research dispassionately as, for example, the Kings Fund did, then chiropractic, osteopathy and manipulative physio all come out as both safe and effective for musculoskeletal conditions like uncomplicated low back pain

The King’s Fund also incorporated homeopathy into the NHS. You’ll forgive me if I don’t take that as a glowing endorsement.

I’d be interested to hear what other complaints “like” lower back pain you’d recommend chiropractic for, given that IIRC pain relief for nonspecific LBP is about the only thing chiropractic has shown any efficacy for beyond placebo.

I’d also question why you need to bundle your profession in with others when discussing efficacy. If we’re going to discuss chiropractic, it seems somewhat disingenuous to be adding “and physio” every time you mention it. They’re not the same thing.

When the Kings Fund looked at cost effectiveness the case for chiro/osteo/physio becomes more compelling.

I wonder how cost effective a nice cup of tea and a sit down would be. Safe and effective too.

Just because some people behave unprofessionally you need not tar us all with the same brush.

Er, no. I’d expect a medical profession to be regulated in such a way that behaving unprofessionally wasn’t possible.

With respect to the points raised by Cougar:
I am not for a moment suggesting that you should see me if you had flu.
Nor am I trying to defend homeopathy – I’ll leave that to the homeopaths!

I made reference to the King’s Fund as a think tank that examines all sorts of healthcare approaches and since they deliberately bundled together all of those offering spinal manipulative therapy at the time that they reached their conclusions, I tried to convey their opinion as they expressed it.
It’s not really an attempt to be disingenuous – there are plenty of studies that demonstrate the benefits of chiropractic care as a separate entity.

I am aware that there are differences of approach between chiros and physios and there are differences of approach between standard physios and those who are skilled in manipulation.

With respect to your sit down and a cup of tea point, I would have to agree – lots of people benefit from being listened to/taken seriously/supported. I wouldn’t be surprised if there was an element of that in lots of therapeutic encounters. Does acknowledging that element imply that a therapeutic approach is worthless?

I would also concur with you about regulation – with the General Chiropractic Council the regulation of the profession is deliberately kept out of the hands of the chiropractors (like the HPC for the physios and the GOsC for the osteopaths). I would love to see Groupon type offers banned for Chiros – it just makes us all look bad.

Finally, the range of conditions that we’re allowed to refer to is strictly limited according to the best available evidence (currently low back pain, neck pain, certain types of headache, migraine, shoulder girdle pain/dysfunction, adhesive capsulitis, tennis elbow, hip and knee pain, plantar fasciitis).
We all use a variety of methods and joint manipulation is just one of many. Focussing on joint noises is fairly unproductive in my experience.

With respect to TJ’s point about Singh and the BCA:
The BCA is not my ‘national association’ and I am not a member because of the way that they behaved when faced with critiscism.

Where people (of any profession) make claims that can’t be substantiated, then its reasonable to expect them to retract those claims. Evidence informed practice and all that…

marmottefarcie > thank you for replying.

there are plenty of studies that demonstrate the benefits of chiropractic care as a separate entity.

Are there? Could you suggest some? Only I’ve not found anything reliable and unbiased that proves efficacy for anything above other comparable treatments or placebo. The most recent high quality studies I’ve found are the Cochrane reviews from a couple of years back showing no advantage to chiro for LBP (to keep with your example) over other treatments.

lots of people benefit from being listened to/taken seriously/supported. I wouldn’t be surprised if there was an element of that in lots of therapeutic encounters

100% agreement here.

Does acknowledging that element imply that a therapeutic approach is worthless?

Heh. Can open, worms everywhere.

I don’t believe that it’s worthless, no. But what you’re effectively asking here is, is it ok to lie to people if it makes them feel better? That’s a long discussion right there.

As an aside, it’d appear that mainstream medicine would say that it isn’t. Anecdotally, my mum used to be a pharmacist. Years ago, she’d get prescriptions to complete for (IIRC) ‘red asprin’. People swore by them, recommended them to friends. In reality they were placebo pills given to people who wanted the doctor to ‘just give them something’, basically chalk with no active ingredients. These days it’s not an option. The NHS has decided that lying to patients is inappropriate.

So, worthless, no. But how about ethical? Is it ok to peddle any old nonsense as ‘therapy’, parting people from large amounts of cash in the process, so long as they feel better afterwards?

I would also concur with you about regulation

I’m aware of the GCC as a regulatory body and your requirements to be authorised by them. I’m less clear on what, as a regulatory body, their code of conduct requirements are. I’d like to read that if you’ve got a link?

the range of conditions that we’re allowed to refer to is strictly limited

I’ve got work to do tonight so I might have to get back to you on some of this, but I was really enquiring as to what you would recommend rather than what you’re allowed to do. Would you stand by that list personally?

We all use a variety of methods and joint manipulation is just one of many. Focussing on joint noises is fairly unproductive in my experience.

Well, that’s not really straight chiro then is it, it’s chiro in tandem with Other Things. If you’re using other methods, such as physio for example, why would I be better off seeing a chiropractor over a proper physio?

This is the big sticking point for me. Mixer chiros are the majority these days as far as I’ve been able to ascertain from talking to people, and I’m sure that some of the more evidence-based techniques borrowed from other disciplines have a degree of effectiveness. I think I’d just have a lot more time for the profession overall if it billed itself as a multi-technique approach and dropped all the metaphysical pseudo-science that is straight chiropractic once and for all. It all just seems very dishonest otherwise.

Where people (of any profession) make claims that can’t be substantiated, then its reasonable to expect them to retract those claims. Evidence informed practice and all that…

*strokes beard*

Cougar:
Apologies that this is brief but I’ll try to respond in a more comprehensive way once the children have gone to bed.
I am nonplussed by the inference that listening to someone’s concerns/acknowledging their situation/supporting their choices and decisions equates to ‘lying to them’. The psychosocial aspect of pain and dysfunction is part of the mainstream model and is hardly a contentious issue?
I am not suggesting that one ‘peddles any old nonsense’, nor am I attempting to ‘part people from large amounts of cash in the process’.
Time and again people remark that they come to our practice because they get information about their condition that enables them to make informed decisions about their health. They state that they value our honesty/ clear explanations.
A recurrent theme is that frequently, they are not treated as an individual/equal partner in the decision making process regarding their health within allopathic medicine.
Being told to “expect it at your age” or “live with it” in a medical interaction is frequently cited as a reason for dissatisfaction with conventional medical care.
The link for the GCC is http://www.gcc-uk.org
The straight/mixer distinction harks back to an historical division within chiropractic in the US from the 1920’s-1950’s. For my generation of chiropractors it’s about as relevant as pre-antibiotic era medical practice is to todays level of allopathic medicine.
Chiropractic care covers a wide range of therapeutic interventions as does Osteopathy and Physiotherapy. There is enormous overlap in what each profession will do – and within each profession some will specialise in certain aspects rather than others.
For example, the evidence at present suggests that laser therapy is at least as effective as steroid medication when dealing with joint inflammation and laser doesn’t have the undesireable side effects that can accompany steroid use. From an evidence informed approach, it is reasonable to use laser therapy to reduce joint inflammation. Unsurprisingly you will find evidence based chiros, osteos and physios may all choose to use laser to reduce joint inflammation.
This doesn’t mean that the chiro isn’t “doing chiropractic”, it just means that they have chosen to incorporate laser therapy when its appropriate to help that patient with joint inflammation.
Nor does it mean that the patient is being fleeced by an unscrupulous practitioner – they are applying the best evidence at the time to provide the best care.
If in 5 years time research suggests a better alternative to laser, then practice will change accordingly.

Mine’s going to be briefer as I start work in ten minutes. Couple of quick points,

I am nonplussed by the inference that listening to someone’s concerns/acknowledging their situation/supporting their choices and decisions equates to ‘lying to them’. The psychosocial aspect of pain and dysfunction is part of the mainstream model and is hardly a contentious issue?

No, but the subsequent treatment may be.

allopathic medicine.

Are you aware that this is widely regarded as a pejorative term? Just wondered if your usage was accidental or intentional.

There’s no such thing as “allopathic medicine”, either it’s evidence-based medicine or it’s a nice warm drink and a pat on the head.

For my generation of chiropractors it’s about as relevant as pre-antibiotic era medical practice is to todays level of allopathic medicine.

I’ll take that on faith as I wasn’t aware of that, and appreciate the clarification. So what defines a chiropractor in modern day as opposed to similar practices?

the evidence at present suggests that laser therapy is at least as effective as steroid medication when dealing with joint inflammation

I think perhaps you and I differ on how we define this ‘evidence’ business and also what you mean by “effective.” LLLT is still controversial and there’s (being generous) little evidence to support any efficacy for joint inflammation other than anecdotally for short-term pain relief.

If chiros are using this technique as you suggest, they’re not applying the best evidence, they’re applying the best guess. Whilst I’m all for trying new techniques, using the public as unaware guinea pigs seems somewhat irresponsible at best, no?

Got to dash, sorry. Will check back later if the job doesn’t drag on all night.

Apologies if being referred to as an allopath is offensive – it certainly wasn’t intended as such.
You are absolutely right that our understanding of ‘evidence’ is at odds when you state that “there’s (being generous) little evidence to support any efficacy for joint inflammation other than anecdotally for short-term pain relief” – to my mind the animal studies alone provide very good evidence at an intracellular level for LLLT’s anti inflammatory effect.
Our ‘best guess’ with respect to the clinical use of LLLT in neck pain has good backing if you consider that Roberta Chow’s Lancet paper was amongst the 20 most downloaded from that journal in 2010 http://www.ncbi.nlm.nih.gov/pubmed?term=19913903&cmd=DetailsSearch.
To avoid bunging up this thread with a list of references, I’ll try to send them to your email.
We’ll have to agree to differ.

Sorry, back now.

I’ve received your email, thanks for that. For the benefit of other readers, it’s a six page .pdf listing papers submitted to PubMed regarding LLLT, the sort of thing you’d find in the appendix of a text book.

Unfortunately I don’t have the weeks spare, nor the qualifications, that would be required to review each paper in order to find out what their conclusions were and to analyse whether they were conducting fair trials etc. (assuming I even have access to them). So all the impressive-looking list actually tells me is that some people have written papers. Sorry if that sounds like a cop-out, but interesting though it is I really don’t care that much about point scoring in an Internet debate.

to my mind the animal studies alone provide very good evidence at an intracellular level for LLLT’s anti inflammatory effect.

Assuming these animal studies are of sufficient quality, it provides evidence in those animals. It proves nothing in humans until it’s properly tested and, even then, critically, in isolation it still won’t prove that it’s any better than other established treatments.

Our ‘best guess’ with respect to the clinical use of LLLT in neck pain has good backing if you consider that Roberta Chow’s Lancet paper was amongst the 20 most downloaded

You seem to be using “most downloaded” as a badge of approval here. Did everyone who read it automatically support it and agree with it?

Like I said at the start, I don’t have the resources to evaluate the paper in full; but going off the synopsis she makes no mention of any efforts to validate the quality of the previous trials performed, she just searched a database and collated the results. This should immediately raise a question here; her paper might be otherwise perfect, but if it’s based on biased trial data then it’s ultimately worthless.

Her interpretation, rightly or wrongly, is that LLLT provides short term pain relief for neck pain. Assuming this to be a valid conclusion, there’s no data provided to say whether it’s any better or worse than other treatment (to wit, it may work, but does it work any better than a warm towel or a back rub?)

Also, there’s no regard whatsoever for treating the cause of the pain. Which, sure, is beyond the scope of the paper, but I find that a little ironic when masking symptoms rather than curing ailments is the slur implied by the term “allopathy”.

So where does that leave us? Potentially, with a posh torch that’ll warm your neck up a bit and might well provide the same overall level of treatment as a can of Ralgex and a nice scarf. How much is a session?

I’m with Cougar on the ‘most downloaded’ thing (and most of the other observations too). Maybe they’re all dowloading it so they can point and laugh?

Just sending someone pages and pages of links as ‘evidence’ is obfuscation, not clarification.

This got lost in the discussion.

what defines a chiropractor in modern day as opposed to similar practices?

I’m still hazy on this, because you seem to by suggesting that chiropractors don’t practice much actual chiro these days, focusing more on other alternative therapies. Which is fine, but seems as though the the job title is inaccurate at best.

Just sending someone pages and pages of links as ‘evidence’ is obfuscation, not clarification.

Oh, they weren’t links, just a list of titles and authors.

even betterer for avoiding actually answering the point 🙂

Apologies for sending too many references.
I was attempting to answer your point about a lack of evidence supporting the use of laser to reduce inflammation.
The animal studies were included because they detail which chemical messengers involved in the inflammatory cascade are influenced by laser.
Animal studies are used to evaluate pharma despite the obvious differences between us and rodents.
In the past the criticism of not providing research of sufficient quality has been levelled at those using CAM.
The purpose of providing the pdf with references was to enable you to find some of the studies that I referred to earlier.
With respect to being published in journals such as the Lancet and Pain, you generally need to be presenting good quality research if you want it to even reach the editorial board level.
As I said before, we’ll have to differ.
I asked an oncology consultant about the allopathy term and she didn’t share your opinion regarding it being either a slur nor offensive but since you find it so, may I apologise again?

I was attempting to answer your point about a lack of evidence supporting the use of laser to reduce inflammation.

And it’s appreciated. That’s a failure on my part, I should have been clearer. What I meant was there’s a lack of conclusive, reliable evidence. I’m sure there’s plenty of papers.

With respect to being published in journals such as the Lancet and Pain, you generally need to be presenting good quality research if you want it to even reach the editorial board level.

Sure, but I doubt that analysing the methods of every highly specialist paper published is within either the remit or the capability of those journals. That’s the job of the authors’ peers. It tells me all I need to know about their acceptance criteria that Andrew Wakefield was published in the Lancet.

Animal studies are used to evaluate pharma despite the obvious differences between us and rodents.

Sure. But “hey, it works in rats” isn’t sufficient ‘proof’ for you to then run out and buy your own laser machine and start using it on the unsuspecting public who take advice in good faith. It is at best experimental.

Now, if you’re telling people “well, we’ve got this experimental technique, it’s not proven but it’s relatively safe, it won’t fix anything but it might help the pain for a little while, would you like to try it?” then that seems fair enough to me. Hey, you could document your findings and send them to the Lancet. But if you’re selling the treatment as an actual cure for, well, anything frankly, I’d suggest that that is dishonest if not fraudulent.

I asked an oncology consultant about the allopathy term and she didn’t share your opinion regarding it being either a slur nor offensive but since you find it so, may I apologise again?

No apology necessary, I don’t offend easily. I only mentioned it to see if you were aware of its possible connotations. It means something along the lines of ‘other than the disease’ (paraphrasing, I forget exactly), in comparison to the ‘like cures like’ mantra of homeopathy. And to be honest, the homeopathy connection should be reason enough to avoid using the term if you’re at all concerned about credibility.

Would it be churlish of me to suggest that your sample group needs to be a little larger than ‘one’ before you form an opinion as to the term’s intent? (-:

Here’s a little light reading for you re: “allopathy”, might help clarify what I meant.

http://www.ncahf.org/articles/a-b/allopathy.html

Btw, you also seem to have missed my question again.

what defines a chiropractor in modern day as opposed to similar practices?
…
I’m still hazy on this, because you seem to by suggesting that chiropractors don’t practice much actual chiro these days, focusing more on other alternative therapies. Which is fine, but seems as though the the job title is inaccurate at best.

I went to my GP today to ask him what he thinks about it and managed to get a referral to a physio. My GP said that he was going to have to sit on the fence about it and stated that there’s no evidence to say chiro works although it may help some individuals. It surprises me a little that there’s no evidence having seen people benefit from chiropractic treatment. He also quickly inspected my back and said he couldn’t feel that anything was wrong and that I should expect to have discomfort in it from time to time. Well discomfort I was getting and big time and I don’t believe I should have to live with it to that degree.

Like my doctor I am also on the fence about it at the moment until I see what the physio is like. Apparently the waiting list is VERY long and I don’t know if I’ll get more than one appointment. I never would have considered going to the chiro if it hadn’t been for the deal and the 4 appointments have definitely made me feel better. What’s the problem with putting it on Group On and like I said to my friends it’s possibly the best £40 I ever spent? There’s no obligation to continue treatment if you don’t want to. If I was well off I might consider further treatment but I don’t have the money.

I can see how chiropractors get a bad reputation but I like to think I’m a good judge of character and the one I went to seemed genuinely concerned for my welfare. I know you’ll all say ‘he just wants your money’ but when was private health care ever cheap? It may be seen as ‘alternative medicine’ but isn’t this how advancements are made? I expect many of the techniques used by the NHS were once seen as Ju Ju magic.

Like I said I’m still on the fence but it seems like the chiro’s are getting a bit of a hard time.

most back pain of the type you have will get better in a couple of weeks anyway

Really? Well it’s been going on for a couple of years now. It goes away for a while then comes back even worse and for longer. I used to ignore it but it became unbearable. Since treatment I can now breath better and no longer get the horrible aching, cramping sensation up my neck and into my head. I have much more mobility in my whole back and no longer feel that my left leg is shorter than my right. I’m just hoping the physio, exercises, changes to posture etc will keep it like this.

Did we scare him off? Guess I’ll never get my definition of modern chiropractic.

Three appointments for me – total price £120, about the same as 2-3 tires – pain gone, pins and needles gone. Money well spent. All in two weeks, without delay and prompt service. Still not sure about the whole thing but the results have been very good. Placebo (doubt it) or wonders of chiropractice (not sure)? But nice to be over the pain and back on the bike.