Chiropractic

ToneControl

Grunfeld said:

ToneControl said:

However, I have found the same with physios. Most just give you ultrasound and or heat and leave you on a machine while they have a cup of tea.

That's interesting.  Physiotherapy has changed massively in the last 25 years because of the requirement to use evidence-based treatments.  I subscribe to the view that the evidence base for ultrasound, heat, and massage is not strong.
Within the NHS the requirement for using only evidence-based treatments has become a culture in most places.  There will inevitably be some "traditionalists" but not many these days.  Basically, you're unlikely to get "heat" as a treatment in the NHS.

However, in private practice it's a different story.  It's very polarised.
There is still the professional requirement to only use evidence based treatments but at one extreme you will find a lot more "traditional" physio treatments in private practice because (a) you've got the last cohort of dinosaurs; (b) it's a business and I have worked in private practices where it's encouraged to have three patients lying in three separate rooms simultaneously, each of them wired up to electrotherapy or some other passive treatment.  So your physio, @ToneControl isn't having a cup of tea, he's seeing two other patients at the same time!  (I've never worked like that btw.)
At the other extreme in private practice you have physios who are really at the top of their game and choose private practice because of (a) economics, of course; (b) to be able to work without the admin demands of the NHS (which, while understandable in a stretched NHS, can really conflict with the best clinical practice; (c) to specialise. 

Lastly, all of this evidence which supports evidence-based practice is being produced overwhelmingly by the research community of doctors, scientists, physios, and others within the international science-based medicine community --- and rather tellingly not by chiropractors or even osteopaths. 

my physio is amazing in comparison to the others I have had, private and NHS
She does NHS and private, has amazing knowledge of anatomy, and can immediately visualise the likely problems  with wear/strain caused by deformities and previous injuries and operations

I did have a good NHS physio (in his 20s) last year for something, was quite impressed, not certain he could deal with non-standard stuff yet, but was on the right track

I once had an NHS physio patronising me for being lazy when I had muscle wastage in one arm (triceps). Turned out I had subacromial compression, for which I had surgery a year later. What a dickhead, I could not believe how incompetent you would need to be to not spot one of the most common conditions.

ToneControl

Snap said:

I would only ever go to a physio for anything like this.

As for scoliosis - someone in my family has it too, and the only person I trust with it, in the main, is the consultant who specialises in it.

If there is one thing that can make your life a misery if its not right: its your back.

I'd choose a physio every time over an osteopath or chiropractor. They cover all bases needed and IMO are far more safe and able.

until you can't stand up straight, are in constant pain and cannot work, and the chiropractor does a 5 second manipulation that has you completely back to normal - quite useful when self-employed. this was my experience.

ToneControl

digitalscream said:

You're right, I was typing in a hurry. I'll edit that "often" bit out.

However...I couldn't find any evidence of deaths due to physiotherapy (or osteopathy, which is probably borderline quackery itself). On that basis alone...physio, or a chiropractor? I'll go with the one that's less likely to result in death, thanks.

Happily, that's also the one that's evidence-based and actually has reliable results, and where the practitioners do accurately explain the risks of what they're about to do, rather than skip that part in case the customer leaves...

I didn't say I agree with the way most chiropractors are regulated, or their loopy ideas about toxins and illnesses being caused by things only they can fix. Someone needs to take the good bits from chiro and bring it into serious medicine, but at present it seems many are happy to throw the baby out with the bath water. Conventional medicine started with 75% bullshit ideas too, after all.

My points are:

• chiro does fix some stuff better than anything else I have tried. Lower back, neck 
• It also claims to fix stuff that few would believe.
• The public are used to accepting a risk for medical treatments
• There should be an acceptable risk/benefit ratio on any medical treatment. Even normal prescription drugs can kill, I have had various operations that can disable patients sometimes
• I now try to avoid chiro on my neck, unless I have been in pain for weeks, AFAIK there is no risk for lower back manipulation

btw Allanah Myles, the rather attractive woman who sang "Black velvet" has permanent injury from daily chiro on her neck
http://www.680news.com/2011/07/01/alannah-myles-shares-tragic-health-news-with-canada-day-crowd/
Personally, I align this with the over-use of treatments that can arise when the rich use compliant practitioners to over-use treatments (e.g. Michael Jackson)

Ideally, physios would be taught the most effective chiro manoeuvres, and then all will be well

ToneControl

Jalapeno said:

Snap said:

I'd choose a physio every time over an osteopath or chiropractor. They cover all bases needed and IMO are far more safe and able.

It's grossly unfair to co-label Osteopaths and Chripractors, Osteopaths have to do a degree, and join professional body to be able to operate.  My GP told me the physios and osteos use the same theory, but different treatments to achieve the same outcome.

Big fan of osteopathy for back, neck and shoulder ailments - always had a positive outcome.

chiropractors also do a degree and have to be in a professional body, you need to think of some other difference

Grunfeld

ToneControl said:

Ideally, physios would be taught the most effective chiro manoeuvres, and then all will be well

@ToneControl Here's why that idea contains a problem which means it can't work as you envision it:
The "chiro manoeuvres" are called spinal manipulations, or just manipulation.
The techniques of manipulation are pretty similar whether a Chiropractor, or an osteopath, or a physio does them.  There are some technical differences in some techniques but let's just say they're mostly identical.
The thing is manipulation is not without risk.  Really, you can ruin someone's day if you do it wrong.
Osteopaths and Chiros learn to manipulate from the get go.  Their training is all geared toward private practice and musculoskeletal (MSK) treatment.  By the time they're let loose on the public they should be able to manipulate safely. 
Physios have a very different career path. 
It is much broader at the base when you're training and newly qualified.  But you get to see and work in pretty much everything.  Later on, when you specialise, that long, broad training really pays off because you've got experience of lots of stuff that osteopaths and chiros have no first-hand knowledge about.
Here's the point:  a newly qualified physio isn't ready to do spinal manipulation.  But once we've specialised in MSK plenty of us do learn how to do it.  (I learnt from osteopaths as it happens.)  But it's all post-grad. 

Here's the thing:  consider all of the crappy problems that backs can have.  Really, they can have lots. 
Manipulation is really good at fixing a couple of them.  Sorted.  If I hear a certain history and the assessment checks out... click, crack, job done.  Very happy patient.
But... manipulation also has a fairly good short-term effect on a whole bunch of other back problems.  And here's where it's trickier, and I won't complicate it, but you can see where I'm going with this.  Do you give short term relief or work toward a long term solution? 
What are you gonna say if you're in pain and want the short-term relief?  How keen are you gonna be for the long-term solution which may well seem pointless (cos you're in pain and it's doing nothing) and is a lot of effort too?
Well, why can't you do both? 
You can.  If it's a straight-forward enough problem.
But there are a bunch of back problems which are anything but straight-forward. 
And that's absolutely where, for the long-term benefit of the patient, you don't want to be taking away their self-efficacy by having them rely on short-term treatment effects.  (And they do come to rely on manipulation, very quickly.)
And I think that's probably the area where you'll start to see the significant differences between physios and the other therapists.
That was probably way too long!

digitalscream

ToneControl said:

digitalscream said:

You're right, I was typing in a hurry. I'll edit that "often" bit out.

However...I couldn't find any evidence of deaths due to physiotherapy (or osteopathy, which is probably borderline quackery itself). On that basis alone...physio, or a chiropractor? I'll go with the one that's less likely to result in death, thanks.

Happily, that's also the one that's evidence-based and actually has reliable results, and where the practitioners do accurately explain the risks of what they're about to do, rather than skip that part in case the customer leaves...

I didn't say I agree with the way most chiropractors are regulated, or their loopy ideas about toxins and illnesses being caused by things only they can fix. Someone needs to take the good bits from chiro and bring it into serious medicine, but at present it seems many are happy to throw the baby out with the bath water. 

From the research I've done (and I did a lot when the wife had her accident), the "good bits" of chiro are generally accepted practice for sports physios all over the world - when chiro works, it's because of crossover rather than its inherent practices. Or, in other words, luck rather than judgement.

ToneControl said:

Conventional medicine started with 75% bullshit ideas too, after all.

The difference is that conventional medicine changed with the presentation of further evidence. Chiro doesn't and can't, because its core is based on the principles of subluxation, for which nobody has managed to find any evidence whatsoever in over a century of trying; equating that with conventional medicine is fundamentally broken logic.

ToneControl said:

• The public are used to accepting a risk for medical treatments

My point was actually that nobody should really have to accept a risk of death, strokes and other such unrelated damage for unnecessary manipulations performed due to the practitioner following dogma rather than actually having a clue how the body works.

I know I'm using quite strong language here - it's genuinely not directed at you, and I know you're trying to look at both sides

If, for example, I hadn't intervened with those wonks I referred to in my post above, they'd have convinced my wife to go for it - she was in huge amounts of pain, and that seriously affects the critical thought process. We talked it over with the consultant who performed the surgery on her, and his opinion - based on decades of surgical experience - was that any cervical manipulation of the sort they proposed would likely have left her paralysed from the waist down...and that's the best case scenario.

That makes me pretty angry. Idiots without the first clue what they're doing (or the damage they can cause) preying on the vulnerable and in pain, combined with a "regulatory body" who are similarly unqualified and turn a blind eye to the massive disparity in knowledge, capability and practices within the group they're supposed to regulate for the safety of the public.

west

digitalscream said:

west said:

well i suppose when i see 'that'  phrase used by medical professionals as irrefutable truth , it gets my back up a bit when ive been made aware of things like dr andrew marino's book going somewhere , where he discusses researchers personal bias, ego, money for future research their own career path plus flawed practices thus resulting in incorrect data ....  what good is evidence based medicince if the evidence is flawed ....

i shouldnt have posted in this thread its the phrase i hate it .... 

I honestly think you're misunderstanding what the phrase means. "Evidence-based" doesn't mean it's irrefutable truth at all - quite the opposite, in fact, in that it is refutable upon discovery of evidence to the contrary. Over many iterations, the method improves and yes, in many cases, that can mean it's irrefutable because it's completely proven.

Contrast that with other methodologies, which - in a dogma-like way - by definition never change despite evidence to the contrary. Homeopathy, for example.

https://www.vox.com/2015/3/23/8264355/research-study-hype

digitalscream

west said:

digitalscream said:

west said:

well i suppose when i see 'that'  phrase used by medical professionals as irrefutable truth , it gets my back up a bit when ive been made aware of things like dr andrew marino's book going somewhere , where he discusses researchers personal bias, ego, money for future research their own career path plus flawed practices thus resulting in incorrect data ....  what good is evidence based medicince if the evidence is flawed ....

i shouldnt have posted in this thread its the phrase i hate it .... 

I honestly think you're misunderstanding what the phrase means. "Evidence-based" doesn't mean it's irrefutable truth at all - quite the opposite, in fact, in that it is refutable upon discovery of evidence to the contrary. Over many iterations, the method improves and yes, in many cases, that can mean it's irrefutable because it's completely proven.

Contrast that with other methodologies, which - in a dogma-like way - by definition never change despite evidence to the contrary. Homeopathy, for example.

https://www.vox.com/2015/3/23/8264355/research-study-hype

Try communicating in actual words. You'll find it helps people understand your meaning enormously.

And, by the way, that article has absolutely zero to do with my post.

EDIT: Meant to say it has absolutely zero to do with refuting my post, which is what I presumed was the intention (in the absence of an explanation). @Grunfeld has a better analysis below...

Grunfeld

west said:

digitalscream said:

I honestly think you're misunderstanding what the phrase means. "Evidence-based" doesn't mean it's irrefutable truth at all - quite the opposite, in fact, in that it is refutable upon discovery of evidence to the contrary. Over many iterations, the method improves...

Contrast that with other methodologies, which - in a dogma-like way - by definition never change despite evidence to the contrary. Homeopathy, for example.

https://www.vox.com/2015/3/23/8264355/research-study-hype

The article in that link confirms what @digitalscream was referring to (way up yonder, in the bit I've quoted!). 
The article castigates the popular press for getting hyped up about a study.  But the opinions of the popular press don't really matter.
There is seldom a definitive study which is "the evidence".
Good evidence is more like a a collection of studies which start to stack up and all point in the same general direction.

There are problems with evidence based medicine.  But Ioannidis (who is also referenced in that recent link you've posted) is actually one of the guys who wants to examine how science relates to medicine.  His ideas are interesting.  The problem he had after he published his essay (your first link) is that lots of pseudoscientists and basically cranks used it as justification for their very non-evidence based theories.  That guy Dr Zamboni and his "liberation therapy" for MS -- he's a good example of what digitalscream said:  the original research was iffy (because it lacked prior plausibility) but it was worthy of investigation at least.  Well, it's been investigated and shown to be useless.  Has it stopped him touting his useless "cure" for MS?  I know he was still doing it a couple of years ago, (long after being disproved).

Ben Goldacre, who writes on this stuff, said about this:  "flaws in aircraft design do not prove the existence of flying carpets".  And it case it's not clear:   just cos scientific research is not perfect doesn't mean that claptrap is real.

ToneControl

Grunfeld said:

ToneControl said:

Ideally, physios would be taught the most effective chiro manoeuvres, and then all will be well

@ToneControl Here's why that idea contains a problem which means it can't work as you envision it:
The "chiro manoeuvres" are called spinal manipulations, or just manipulation.
The techniques of manipulation are pretty similar whether a Chiropractor, or an osteopath, or a physio does them.  There are some technical differences in some techniques but let's just say they're mostly identical.
The thing is manipulation is not without risk.  Really, you can ruin someone's day if you do it wrong.
Osteopaths and Chiros learn to manipulate from the get go.  Their training is all geared toward private practice and musculoskeletal (MSK) treatment.  By the time they're let loose on the public they should be able to manipulate safely. 
Physios have a very different career path. 
It is much broader at the base when you're training and newly qualified.  But you get to see and work in pretty much everything.  Later on, when you specialise, that long, broad training really pays off because you've got experience of lots of stuff that osteopaths and chiros have no first-hand knowledge about.
Here's the point:  a newly qualified physio isn't ready to do spinal manipulation.  But once we've specialised in MSK plenty of us do learn how to do it.  (I learnt from osteopaths as it happens.)  But it's all post-grad. 

Here's the thing:  consider all of the crappy problems that backs can have.  Really, they can have lots. 
Manipulation is really good at fixing a couple of them.  Sorted.  If I hear a certain history and the assessment checks out... click, crack, job done.  Very happy patient.
But... manipulation also has a fairly good short-term effect on a whole bunch of other back problems.  And here's where it's trickier, and I won't complicate it, but you can see where I'm going with this.  Do you give short term relief or work toward a long term solution? 
What are you gonna say if you're in pain and want the short-term relief?  How keen are you gonna be for the long-term solution which may well seem pointless (cos you're in pain and it's doing nothing) and is a lot of effort too?
Well, why can't you do both? 
You can.  If it's a straight-forward enough problem.
But there are a bunch of back problems which are anything but straight-forward. 
And that's absolutely where, for the long-term benefit of the patient, you don't want to be taking away their self-efficacy by having them rely on short-term treatment effects.  (And they do come to rely on manipulation, very quickly.)
And I think that's probably the area where you'll start to see the significant differences between physios and the other therapists.
That was probably way too long!

that's a great post thanks
and also highlights again the problem of people self-referring to any kind of practitioner (in my case chiros) - who is ensuring the combination of treatments is genuinely a good idea?

ThePrettyDamned

Sporky said:

They should not be allowed.

At least homeopathy does no direct harm.

I didn't give you a passive aggressive lol, but I do disagree. 

I worked with someone who treated themselves with a homeopathic medicine for a cold, which contained heavy metals and neurotoxins. I can't remember the specifics, but I'll never forget them fighting to not have medical treatment because drugs and surgery are dangerous.

However, ordinarily the harm comes from not treating something but believing you are, so in that sense you are right. 

Grunfeld

ToneControl said:

that's a great post thanks
and also highlights again the problem of people self-referring to any kind of practitioner (in my case chiros) - who is ensuring the combination of treatments is genuinely a good idea?  [emphasis added]

Cheers.  That's an important question.  It goes straight to a theme in this thread:
The answer is that the therapist, the doctor, the professional, should be giving you treatments in a way informed by evidence. 

It's difficult to do sometimes.  Because you get experience with "what works".  Experience is invaluable.
Evidence based research sometimes goes against what you've learnt by experience. 
But the whole point of evidence based research is that it's "bigger" than our individual experience and the cognitive biases that we can't escape.  And that, @west , is why on the whole evidence based medicine is so useful. 
It does not mean jumping on the latest study and doing a U-turn; it means evaluating the research, looking at the quality of the meta-analyses, and then using that and clinical reasoning with the individual patient in front of you.

It's actually quite humbling because it makes you evaluate what you think you know.  E.g. there are treatments I no longer give and it's the same for the doctors -- they've now got patients going, "Why aren't you going to inject my facet joints? [for the umpteenth time]" and the answer is "Cos the evidence says it doesn't work."
And for me, with neck manipulation, "Why won't you crack my neck? [for the umpteenth time]" -- Cos the evidence says it doesn't work!  And Allanah Myles would probably agree.

Jalapeno

scrumhalf said:

Donkey's years a go I did my back in taking a throw-in during a football game and it wasn't pleasant. My GP told me he wasn't allowed to refer me to an osteopath, and gave me the details of the osteopath he couldn't refer me to. It worked..

The GP cannot refer you for NHS funded treatment, but can advise you.

After my broken elbow, I got good NHS physio for my elbow and wrist from the hospital. But they wouldn't look at the soft tissue damage in my shoulder as it wasn't on their chart - which in the end was more painful than the fracture.  Fracture is all better (thanks ), GP referred me for "urgent" physio treatment at the end of October - wait time allegedly 2-3 weeks, non-urgent 3-4 months. After a 3 month wait without a peep from local physio dept, GP told me the service was in chaos and if I could, go and see a private Physio or Osteo, which I did yesterday (Osteo) - instant relief.

ToneControl

Sporky said:

They should not be allowed.

At least homeopathy does no direct harm.

"Direct harm" does that include killing people by inducing them to refuse normal treatment. I think so, since that is a direct consequence of following homeopathic guidance

 http://www.iflscience.com/health-and-medicine/cancer-patients-who-turn-to-alternative-medicine-are-25-times-more-likely-to-die/

https://www.ncbi.nlm.nih.gov/pubmedhealth/behindtheheadlines/news/2017-08-16-alternative-cancer-therapies-may-increase-your-risk-of-death/

Overall, 78% of people having conventional treatment for cancer survived at least five years, compared to only 55% of people having alternative treatment alone. The difference was biggest for breast cancer, where people who chose alternative therapies were more than five times as likely to die within five years as those who chose conventional treatments.

https://sciencebasedpharmacy.wordpress.com/2013/11/23/use-of-homeopathy-kills-child/

http://whatstheharm.net/homeopathy.html


http://www.telegraph.co.uk/technology/apple/8841347/Steve-Jobs-regretted-trying-to-beat-cancer-with-alternative-medicine-for-so-long.html



http://www.telegraph.co.uk/technology/apple/8841347/Steve-Jobs-regretted-trying-to-beat-cancer-with-alternative-medicine-for-so-long.html

The Apple chief executive, who died this month after a pancreatic tumour spread elsewhere, delayed having operations and chemotherapy for nine months after the disease was discovered in October 2003.
In spite of pleas from family and friends, he tried to cure himself through acupuncture sessions, drinking special fruit juices, visiting "spiritualists" and using other treatments he found on the internet.
Some cancer experts have said that Mr Jobs may have extended his life or even survived if he had promptly tackled his cancer aggressively with scientifically proven medical treatments.

https://www.theguardian.com/uk-news/2014/jan/31/neon-roberts-cancer-treatment-recovering



there are hundreds of stories like this 

digitalscream

ToneControl said:

Sporky said:

They should not be allowed.

At least homeopathy does no direct harm.

"Direct harm" does that include killing people by inducing them to refuse normal treatment. I think so, since that is a direct consequence of following homeopathic guidance

Yes - when the guidance is to avoid conventional treatment. I know of one woman who was explicitly told by a homeopath that "...conventional medicine kills people - look at these statistics showing how many people die after having chemotherapy". Fortunately, that woman wasn't an idiot and suggested that the homeopath go back to GCSE Maths.

ToneControl

fandango said:

As i understand it, chiropractors work on the bones/joints, whilst oesteopaths work on the muscles. Not exclusively, but thats the gist.

Since chiropractic is alternative/complementary ‘medicine’ it’s not normally available via the NHS. Oestopathy is naturally available vua the NHS.

Best start with one’s GP, and quiz him about osteopathy treatment.

check again, looks like the NHS disagree:

 https://www.nhs.uk/conditions/osteopathy/

In the UK, osteopathy is a complementary or alternative medicine (CAM) and is different from conventional western medicine.
Although osteopaths may use some conventional medical techniques, the use of osteopathy isn't always based on scientific evidence.

https://www.nhs.uk/conditions/chiropractic/#uses-of-chiropractic

it's considered a type of complementary and alternative medicine (CAM), which means it's not a conventional medical treatment.
....
Chiropractic isn't widely available on the NHS, but is provided in some areas.

ToneControl

digitalscream said:

However...I couldn't find any evidence of deaths due to physiotherapy (or osteopathy, which is probably borderline quackery itself). On that basis alone...physio, or a chiropractor? I'll go with the one that's less likely to result in death, thanks.

Happily, that's also the one that's evidence-based and actually has reliable results, and where the practitioners do accurately explain the risks of what they're about to do, rather than skip that part in case the customer leaves...

The osteopaths have some general figures here (not specific to osteopathy, just manipulation):
https://www.ncor.org.uk/practitioners/practitioner-information-communicating-benefit-and-risk-in-osteopathy/risk-and-patient-incidents/#question4


Bit more info:
http://www.sportsinjuriesspecialist.co.uk/info/75-how-safe-is-osteopathy

ToneControl

RaymondLin said:

Rather than going to chiropractor, see an osteopath.  

based on what?

ToneControl

ToneControl said:

Jalapeno said:

Snap said:

I'd choose a physio every time over an osteopath or chiropractor. They cover all bases needed and IMO are far more safe and able.

It's grossly unfair to co-label Osteopaths and Chripractors, Osteopaths have to do a degree, and join professional body to be able to operate.  My GP told me the physios and osteos use the same theory, but different treatments to achieve the same outcome.

Big fan of osteopathy for back, neck and shoulder ailments - always had a positive outcome.

chiropractors also do a degree and have to be in a professional body, you need to think of some other difference

@Jalapeno ;

I just had a quick look
both subjects are available at a few UK universities, the grades required for chiropractic are slightly higher:
https://www.whatuni.com/degree-courses/search?subject=chiropractic

ToneControl

fwiw I recognise that chiropractors are nowhere near on a par with medical doctors for training or ability 
My dilemma is " what do I do when I am in great pain, and my SI joint or neck has seized up?"

Perhaps I should try an osteopath one day too
I am very impressed with my physio though, and the chiro I have is the best I have used