Does anyone use chiropractic services even with no back/leg whatever issues?

Triathlon Forum
21

Tri hack,

As you are anonymous on ST, I must make inferences based on the information that you communicate.

I’m going to simply state that you have just enough information to be dangerous, but not enough information to actually understand the scenario surrounding medical research.

physical medicine from any provider fits poorly into the double-blind randomized clinical trial approach of supporting healthcare related interventions. I could use your own argument to state that over half of all procedures carried out by medical providers have zero research demonstrating any clinical effectiveness over placebo. I can also use your own argument to state that vaccines are completely worthless because there has never been a double blinded randomized clinical trial on a single vaccine. Yet I’m willing to bet that yourself Addition to the majority of the people in this country believe that vaccines provide an effective medical service.

You cannot blind a patient who is receiving spinal manipulation effectively, you simply cannot. The patient knows if they are receiving therapy, the provider knows whether or not they are manipulating the patient or not. Therefore all research conducted has to fall underneath studies that are deemed to be inferior in quality compared to the gold standard.I will provide a massive list of links demonstrating the positive benefits of chiropractic and spinal manipulation when I return to my computer. In the meantime feel free to demonstrate any qualifications you have that would justify any credibility to your own argument.

22

Well, if you’ve been on here for awhile you’ll know that I have many opinions and with a Masters Degree (MBA) I suspect that I’d be classified as “educated”. So, seeing as I’m both educated and have many opinions, I did comment. But then perhaps your statement was more general and didn’t apply directly to me. By the way, as part of the “education” part, you may want to learn the difference between “there” and “their” (and there is also they’re but that didn’t apply in your paragraph). Now that the “personal aspect” of this is out of the way we can continue with the conversation.

Your post, along with some others has had me reflecting on my beliefs. Now, as we all know, “beliefs” are hard to change, they are like “faith” and it is hard to challenge the faith and / or beliefs of others. I could go on about all sorts of others beliefs but that isn’t what this is about. My belief has also been (based upon what I’ve learned, what my extended families have believed) is that Chiropractors are nonsense. I’ve also put this in the same category as touch healing and similar groups. I would classify ART as a massage technique and wouldn’t have grouped that with Chiro. Similarly, Graston can be done by many people who are not Chiros and I think that works about as well as a copper bracelet but again that’s my belief. Now, having said all that, I remain confused. In order to become a Chiro, a person must spend a lot of time in school. One of these days I’ll look at it in more detail and who knows, may change my beliefs but in the meantime I have no plans to go to a Chiro. Now, as I originally stated, if I were in distress and nothing else would work, yes I would seek out a Chiro but then I’d also seek out anything else that I hoped would work.

My apologies for not double checking my post on my iPhone…

Having an MBA doesn’t have much to do with an understanding of different therapy options and different specialties of doctors and therapists. I’d also expect an educated person not to use a term like quackapractors. Would be like saying a person with an MBA just paid 50k+ for three letters behind their name.

You clearly have very limited experience with chiropractors and seem to base everything on opinions and quite outdated info. You obviously have no idea how Graston is used as part of a treatment plan. Did you also know that ART was developed by a chiro?

23

Zev,

I have a reasonably extensive medical and scientific background, including studying molecular biology at CU and being a former paramedic. I know how to read the literature, and I know the limits of studies. Here is what it comes down to:

  1. There is no scientific basis for subluxation theory, which is accepted by the vast majority of chiropractors according to their own literature.
  2. This is further not backed with research showing much overall effectiveness. A few potential use cases stand out and should be studied more.
  3. This is in contrast to your examples. There is actually quite a lot of good science behind vaccinations, and in those cases we can use epidemiological studies and basic math to see effectiveness. The model behind vaccines is testable, and epidemiology can test it in the field without a double blind study. The science behind vaccines is ridiculously clear (hopefully you believe that, I’m not going to assume you are anti-vax based on you picking that example). There is no equivalent for most chiropractic use.

What I would expect to see from chiro to change my beliefs is a model that passes basic science, some way to test it, and results. The field hasn’t provided that, and the model behind it is provably, fundamentally, flawed.

Now, I have met chiropractors that are closer to physical therapists. They don’t believe in subluxation theory, they do believe in germ theory, and they limit themselves to SMT techniques that show the most promise based on the scientific evidence. Techniques also used by some doctors and PTs. But that basically makes them chiropractors in name only, since they no longer follow the primary teachings of the field they learn in school.

Look, this is the Internet. We can battle references all day. For people that haven’t made up their mind, they should look at the links I provided and what you will provide later and make up their own mind. If you find a chiropractor that doesn’t follow subluxation theory then the odds are better they know the limits of manipulation and won’t sell you on garbage. The OP was clearly talking to someone else.

And if something makes you feel good, and doesn’t hurt you, and you believe in it… crack on. I probably spent more on bike gear that won’t affect my race results (because I’m too slow for it to matter) than you would spend on treatments, whether they work or not.

24

There is very little scientific evidence for any treatments of injuries. I’ve heard PT’s say that 60% of patients will recover without any treatments, so a 60% success rate means you didn’t help or hurt anyone.

Now, in my experience over the last 15 years working with 30+ practitioners in all fields, I have found chiros to be the most effective. I find they aim to make structural changes that allow proper movement patterns to resume. I find PTs tend to try and slowly influence change by stretching and strengthening. When you find a chiro that does both, you’ve hit the jackpot.

The teams I’ve worked with and sports I’ve consulted with, mostly talk about ‘therapy’ in a general sense and typically mean physio, massage or AT. Chiro gets the same response as our MBA above who insults them by saying quackapractors.

25

Zev,

I have a reasonably extensive medical and scientific background, including studying molecular biology at CU and being a former paramedic. I know how to read the literature, and I know the limits of studies. Here is what it comes down to:

  1. There is no scientific basis for subluxation theory, which is accepted by the vast majority of chiropractors according to their own literature.
  2. This is further not backed with research showing much overall effectiveness. A few potential use cases stand out and should be studied more.
  3. This is in contrast to your examples. There is actually quite a lot of good science behind vaccinations, and in those cases we can use epidemiological studies and basic math to see effectiveness. The model behind vaccines is testable, and epidemiology can test it in the field without a double blind study. The science behind vaccines is ridiculously clear (hopefully you believe that, I’m not going to assume you are anti-vax based on you picking that example). There is no equivalent for most chiropractic use.

What I would expect to see from chiro to change my beliefs is a model that passes basic science, some way to test it, and results. The field hasn’t provided that, and the model behind it is provably, fundamentally, flawed.

Now, I have met chiropractors that are closer to physical therapists. They don’t believe in subluxation theory, they do believe in germ theory, and they limit themselves to SMT techniques that show the most promise based on the scientific evidence. Techniques also used by some doctors and PTs. But that basically makes them chiropractors in name only, since they no longer follow the primary teachings of the field they learn in school.

Look, this is the Internet. We can battle references all day. For people that haven’t made up their mind, they should look at the links I provided and what you will provide later and make up their own mind. If you find a chiropractor that doesn’t follow subluxation theory then the odds are better they know the limits of manipulation and won’t sell you on garbage. The OP was clearly talking to someone else.

And if something makes you feel good, and doesn’t hurt you, and you believe in it… crack on. I probably spent more on bike gear that won’t affect my race results (because I’m too slow for it to matter) than you would spend on treatments, whether they work or not.

Thank you for your honesty:

You are exactly what I was referring to: Someone with enough medical background (paramedic) to think they understand clinical case management at the physician level (as defined by Medicare and the Joint Commission). Please don’t be insulted, thats just a fact.

  1. Subluxation theory evolved from a static model somewhere around when I was born to a motion based model. All modern research supports this. All it takes is some basic research into mechanoreceptor inhibition of nociception in vivo studies to understand why a restricted or fixated joint can cause all kinds of problems, and getting it to move generally is beneficial, no matter who does it.

  2. Here are a collection of the most recent studies of 2013 and 2014. As stated previously

  3. Just an example for the sake or argument on your end about the lack of research, we can move on :slight_smile:

The big picture is that you are assuming that manipulation differs dramatically when a DC performs vs a PT/DO. For HVLV (thrusting) there isn’t, and within the scope of manual care, we use the same tools. I’ve read the textbooks for all professions regarding manipulation, there is no major difference. So your argument is really that manipulation in your opinion isn’t documented well by research. But assuming manipulation is all I do is like assuming all a physical therapist does is give you exercises. It’s not even close.

I think you would accept that being able to choose: It’s generally its better to permanently fix a problem without surgical intervention or prescription medication than with if given the choice. Chiropractors, by intentionally taking the prescription of medications out of the equation, force themselves to be as accomplished as possible at helping the human body with a plethora of non-surgical tools. PT’s are the same, DO’s who do not prescribe are the same. This again is common sense. Manipulation is a tool, and not the only tool. But if you are trying to tell me manipulation doesn’t work when I treat a patient with an acute rib fixation who can’t take a deep breath without sharp severe pain,and I remove 75% of that pain in one adjustment. I’m going to politely laugh at your close mindedness, but fell truly sad that your uninformed voice could really hurt someone else’s ability to get help.

The largest single group of my patient base are physicians, nurses, NP’s, DO’s, neurologists, and other medical providers. When they come in for a problem and I explain to them exactly what is going on on a science based background, they understand and, 95% of the time, we accomplish their goals. When I don’t think my tools can help someone, I refer out: Standard of care. There is zero of this nonsense amongst my medical peers.

I would say this: For people that haven’t made up their mind, they should remember that they are a consumer. Choose a provider based on excellent referrals and reputation!. If you aren’t moving in the right direction in 3-6 treatments, consider a different provider or a different approach. With very little exception, thats the standard I hold myself to.

Tridana NAILS it: It is not the profession, it is the practitioner.

26

Perfectly stated!

27

I never commented on the OP’s question!

  1. I live and practice in the northeast. The roads are very crowned here to promote drainage.
  2. Runners run against traffic, on a surface that is consistently uneven. This leads to a relative rotation on the pelvis.
  3. It is medically unnecessary (that terms means an insurance company doesn’t want to pay for it) to treat a patient with a pelvic rotation without pain (my practice is primarily insurance driven). But if that rotation is causing biomechanical problems that result in injury, then it becomes medically necessary and treatment is justified. This same rationale applies to skeletal changes such as loss/reversal of the cervical lordosis: It probably should be fixed, but there is no insurance-justification as you have no symptoms. In a pain based model of healthcare there is no justification, but as insurance companies are accepting preventative/screening models this is rapidly changing. Insurance companies are now finding preventative treatment is actually a lot cheaper to pay for than waiting until something is really bad.
  4. Athletes tend to be very in touch with their bodies, and can notice functional improvement well beyond basic measures of pain or injury. They also value their time, and lost weeks can destroy a training build.
  5. Therefore you may find intrinsic value in preventative or maintenance care, as many do. I personally have soft teeth (bad genes!). Additionally I eat a lot of gels and chews while training, so I go for dental cleanings every 4 months instead of every 6 per my providers recommendations. I like my teeth and want to keep them. I run my body like a high performance machine and treat it as such. It doesn’t make a lot of sense to buy a car and drive it until something breaks, so why would you do that with your body?
  6. Ultimately its up to you! If manipulation is a service you find valuable go for it. This is same for massage, PT, acupuncture, or any other healthcare intervention. If you TRULY know you obviously feel better, particularly during heavy training volume, thats your answer. I would recommend you find a provider that incorporates many tools such as therapeutic exercise, Active Release Technique, or other modalities into their plan for you. That will enable you to self-manage as much as possible.

Best,

Zev

28

I am an MD with a PhD in biomedical research. All the time, we see patients with strokes caused by chiro manipulation. e.g. http://www.ncbi.nlm.nih.gov/...articles/PMC2564146/. There are two in our neuro ICU right now. However, anecdotes do not an argument make.

The main difference between medicine and pseudo-medicine is that it is evidence-based. Not ALL of it is evidence-based, but the field is distinguished by an attempt to conduct clinical trials to determine if treatments actually work, or not. Clearly, many commonly accepted medical treatments are not evidence-based, and when that is the case one must use things like “expert opinion” to decide whether a treatment should be pursued. The reason that most doctors and many laypeople oppose chiropractic is that the evidence is weak or nonexistent, and there are known harms. The Cochrane Foundation is the most trusted organization for evaluating evidence-based interventions. Here is their take on the chiro bread and butter: http://www.ncbi.nlm.nih.gov/pubmed/21248591.

If it were proven to help people, I’d be delighted. Then we could balance the benefits and risks. Now, patients are not clinical trials, they are patients, and the placebo effect is one of the best interventions known to man. So if YOU think it works for you, do it. Just realize that Icyhot or a hot tub bath or a million other things might be equally effective, or not. In the end, if you’re not doing anything for your injury, you are probably worse off than doing something, because our brains are flawed and think that doing something must be helping, which makes us feel helped. Post hoc, ergo propter hoc.

p.s. there is a lot of misinformation in this thread. e.g. http://www.ncbi.nlm.nih.gov/pubmed/10493337

29

I am not dismissing all forms of manipulation. Adjusting a rib can make perfect sense, just like reducing a disclocation… However, if you tell me that you can prevent non-structural disease, as subluxation theory still claims, there is no basis to support that.

I’m not asking anyone to believe me based on my personal credentials or education. That’s why I provided sources from the medical community. You don’t need to refute me or my background, you need to address that widespread criticism. As for your patient base, not all doctors follow scientific principles. I once had a doctor who was also an acupuncturist, which is another form of treatment that doesn’t pass scientific muster.

As I said, if someone finds a DC that applies science-based adjustments as would a PT or DO, that’s fine. It is often the exception. If the DC recommends ongoing treatment for random wellness, walk away. If it makes you feel good, spend your money on whatever you would like.

Let’s go back to the OP. No current injuries or issues, so need need for any sort of medical care. People should look at your sources, then the ones I listed, and make their own decision. They should also look at the source of the studies.

We don’t need ad-hominem attacks. I’m not presenting my own evidence or interpretation, but that of people that do have the credentials you want.

30

TriHack,

I make zero claims about manipulation fixing internal disease, nor do I believe adjusting a foot helps your cancer or Crohn’s. So it sounds like we are in agreement? Besides the comment about credentials, I’m quite happy. Perhaps you meant yourself?

Re: VBA dissection: Its an absolute risk, and very sad, but statistically less than 1 per 1 million. Near zero risks of course do not matter when its you. The evidence shows its irrefutably safer than medication or surgery. If given two choices that can both help my pain, but one is over 100x more dangerous? The consumer can always make their own choice, so long as they can choose.

That being said, everything has risk, lets put manipulation induced VBA into perspective:

**Neck Pain Treatment Risks: **
Risk of death from spine surgery: 1,800 per 1 million
Risk of serious side effects/death from cervical spine (neck) surgery: 500 in 1 million
Risk of death from combined use of NSAIDS/aspirin: 153 per 1 million
Risk of death from prescription opioid pain medications: 53.6 per 1 million
Association between neck manipulation and stroke: about 1 in 5.85 million adjustments5 (or <1 in 1 million).
Its all about risk vs reward

Re: The RCT on the influenza vaccine: (Please keep in mind this is not a vaccine debate, but rather my previous comment on the lack of RCT’s showing they work:

  1. The quoted study showed zero effect in reduction of infection rate.
  2. The quoted study actually showed an increased amount of days actually sick, could one extrapolate the vaccine makes your immune system weaker?
  3. The quoted study showed a .4 day reduction in lost work days due to being sick. (I have no idea how this has any value in demonstrating immune function when they were sick just as often and for longer)
  4. The quoted study showed patients who received vaccines felt they could return to work sooner. (Again, zero response in primary goals of desired reduction of infection rate and sickness duration. This is even more worrisome as people are returning to work sooner even though they are still sick, increasing the likelihood of viral shedding and additional infection).

My misinformation was in error, I should have been more specific: To my knowledge, there has never been a double blinded RCT demonstrating a vaccine actually does what it claims to do: Prevent the intended disease. Of course the placebo effect is one of the best interventions known to man. Please keep in mind I plan on vaccinating my children.

While we are now outrageously off topic, it illuminates the problem in the research!

31

I have only ever gone for soft tissue work (ART) from my chiro. I go monthly for maintenance work, or more frequently if there is an issue. Mine also helps develop a good series of physio style exercises to work on strength and flexibility.

As usual, the service you get and the benefit of the service will likely depend on the person you are dealing with.

32

tkos,

Great you are finding help and respond to this kind of care.

Therapeutic exercise is standard education for most chiropractors, and many choose to specialize in it (many don’t). When you say “physio-style” it implies DC’s do not normally receive that in their training, or that we are using another professions techniques which is not the case :slight_smile:

x2: As usual, the service you get and the benefit of the service will likely depend on the person you are dealing with!

Zev

33

Zev,

You are a DC. I’m not going to try and convince you to give up on your chosen profession on a triathlon forum. As long as you vaccinate your kids like you say, I won’t address that issue either.

There is enough information in this thread for people to do their own research and make their own decision. I prefer evidence based medicine.

34

Trick,

I respect your opinion.

Of course there is no swaying either one of us. This topic comes up almost as often as a lance thread. I’ve saved the links to most of them and I have a moral obligation to make sure the facts are presented. Every time.

While its unlikely you will be one of them, I go to bed every night knowing my efforts help hundreds of people. Just google/facebook some of the reviews on my office or on ART. You may not consider it, but others will.

The point is, as you said, to provide enough information to those who truly are looking for advice. If one more person sees a colleague of mine and it saves their race or keeps them moving then my efforts are worth it. I see all of our professions continuously merge. Its highly likely the whole MD/DC argument will fade away during my lifetime just like the MD/DO did last generation.

Best,

Zev

35

What is a reasonable amount of ART treatments to expect results from?

36

What is a reasonable amount of ART treatments to expect results from?

I initially went in for some IT band work. I was not able to run much more than 1-2 km without a flare up. I did twice a week session for 1 month (after the initial visit to look for the causes). At each visit we added a new exercise, and by the end of the month I was in a spot where we switched to an as needed basis. Over the next year I would go occasionally, as minor flare ups would occur and I pushed harder in training.

I treat my visits now as I would a massage therapist or other secondary care provider. I go on a regular basis (usually during my heaviest training loads) to help prevent issues from reoccuring.

37

For the majority of cases you see obvious improvement in 3-6 treatments, 6-12 for the majority (80-100%) of symptoms to disappear. Intermittent maintenance can be required if you have an activity that causes the problem ie cumulative tissue injury from pounding pavement but as mentioned on an as needed basis.

I would add, as Ian can probably vouch for, that there is a tremendous amount of transparency between the treatment and the problem area. The patient knows that the treatment is clearly affecting the problem. Follow-up visits after symptoms are initially abated provide obvious relief, so long as the pain isn’t from an inflammatory process such as a irritated joint or inflamed nerve, that can typically require a few hours to calm down.

A day of “I went to the gym” type soreness in the areas treated strongly is typical. Strenuous activity i.e. intervals are discouraged after treatment, however recovery sessions are encouraged. It’s typically a goal to increase blood flow to the affected area to help expedite muscular recovery, just like we all typically do.

38

You are referring to the “rule of 10”.

Out of every 10 patients you’ll have:

  • 3 who were going to get better WITHOUT ANY treatment
  • 3 who will get better WITH ANY treatment
  • 3 who will only get better if you educate and/or treat correctly based on their signs and symptoms
  • 1 who is just not going to get better no matter what you do.

So yea, 60% success rate = you’re simply not hurting people. The probable truth behind this saying is in my opinion why poor practices that are simply good at marketing are able to easily stay in business in both the PT and DC industries… among others

39

http://www.foundationtraining.com/ for strength, better posture, proper movement.