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Opinion of chiropractic and acupuncture?


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If I were going for spine manipulation, I would go to a DO who does OMM, not a chiropractor.

 

 

honestly I would go to a great PT

 

much more directed at getting you better and discharging you..... not every PT can do this, but there are a few out there that are truly amazing......

 

ask around....

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In ortho I'm not opposed to sending patients to a chiro for spine related issues, but rarely do. I've had countless patients come to my office with non-standard (aka terrible) x-rays with diagnoses from chiros that are completely inaccurate. I've also talked to a few chiros on the phone that have no idea what they are talking about. Conversations that have gone something like this-- "does the patient's ____ show up as black or white on their MRI? ... well that depends on if we are looking at T1 vs. T2 weighted images, which are you interested in? ... silence..." My mother-in-law has seen chiros that have treated her hypothyroidism, diagnosed her with a milk allergy, put her on a gluten free diet without basis, etc. She's essentially become an enemy of evidence-based medicine. Scary stuff.

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In ortho I'm not opposed to sending patients to a chiro for spine related issues, but rarely do. I've had countless patients come to my office with non-standard (aka terrible) x-rays with diagnoses from chiros that are completely inaccurate. I've also talked to a few chiros on the phone that have no idea what they are talking about. Conversations that have gone something like this-- "does the patient's ____ show up as black or white on their MRI? ... well that depends on if we are looking at T1 vs. T2 weighted images, which are you interested in? ... silence..." My mother-in-law has seen chiros that have treated her hypothyroidism, diagnosed her with a milk allergy, put her on a gluten free diet without basis, etc. She's essentially become an enemy of evidence-based medicine. Scary stuff.

More examples of "good chiropractors" and "bad chiropractors".  Good ones limit themselves to manipulations.  Bad ones will do ANYTHING that lines their pockets, including x-rays and costly supplements, neither of which do a damn thing.

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In ortho I'm not opposed to sending patients to a chiro for spine related issues, but rarely do. I've had countless patients come to my office with non-standard (aka terrible) x-rays with diagnoses from chiros that are completely inaccurate. I've also talked to a few chiros on the phone that have no idea what they are talking about. Conversations that have gone something like this-- "does the patient's ____ show up as black or white on their MRI? ... well that depends on if we are looking at T1 vs. T2 weighted images, which are you interested in? ... silence..." My mother-in-law has seen chiros that have treated her hypothyroidism, diagnosed her with a milk allergy, put her on a gluten free diet without basis, etc. She's essentially become an enemy of evidence-based medicine. Scary stuff.

 

The T1/T2 issue isn't very convincing.  I'd venture to say that many medical folks out there couldn't answer your question either.  Years ago I shared office space with a PT and the guy couldn't even read xrays.  Did I think any less of him as a PT?  Of course not.  And for the vast majority of cases, does T1/T2 really matter?  No.

 

Is there no role for nutrition in hypothyroidism?  I guess it's Synthroid or nothing.  There are some chiros out there who are very well versed in nutrition and, yes, they know more than you do about some things.

 

Some people don't do well with dairy products.  That's common knowledge.  Perhaps that's what the 'milk allergy' was about.

 

And what is your basis for a gluten-free diet? Is it just full-blown celiacs that do better on a GF diet?

 

My point is that it's true there are some weird chiros out there, but my experience has been that most do a pretty good job.  And as I just said, some take nutrition pretty seriously and if you aren't into that sort of thing, some of the recommendations may sound foreign.  Being overly critical (e.g., T1 vs T2...c'mon) seems a bit much. 

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The T1/T2 issue isn't very convincing.  I'd venture to say that many medical folks out there couldn't answer your question either.  Years ago I shared office space with a PT and the guy couldn't even read xrays.  Did I think any less of him as a PT?  Of course not.  And for the vast majority of cases, does T1/T2 really matter?  No.

 

Is there no role for nutrition in hypothyroidism?  I guess it's Synthroid or nothing.  There are some chiros out there who are very well versed in nutrition and, yes, they know more than you do about some things.

 

Some people don't do well with dairy products.  That's common knowledge.  Perhaps that's what the 'milk allergy' was about.

 

And what is your basis for a gluten-free diet? Is it just full-blown celiacs that do better on a GF diet?

 

My point is that it's true there are some weird chiros out there, but my experience has been that most do a pretty good job.  And as I just said, some take nutrition pretty seriously and if you aren't into that sort of thing, some of the recommendations may sound foreign.  Being overly critical (e.g., T1 vs T2...c'mon) seems a bit much. 

 

 

many medical folks could not answer this

 

but I bet every ortho could

 

and since chiro tries to pass themselves off as musculoskelatal experts they darn well should know this....

 

all the local chiros I know of wont even order and xray - they don't know what to order, how to order or want to order....  I have gotten MANY MANY requests for xrays on patients from a chiro who is treating a patient for chronic low back pain....  almost exclusively I decline, explaining to the patient that it is the treating providers responsibility to order the correct test, and they use it for the treatment - if they want the test, they have to order it....

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...and since chiro tries to pass themselves off as musculoskelatal experts they darn well should know this....

 

 

Worse yet, many chiros try to pass themselves off as IM guys as well when they utterly lack the education and training to do so.  Why would a chiro try to treat an abdominal issue?  Or supposed hypothyroidism?  Because they can push their expensive supplements.

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The T1/T2 issue isn't very convincing.  I'd venture to say that many medical folks out there couldn't answer your question either.  Years ago I shared office space with a PT and the guy couldn't even read xrays.  Did I think any less of him as a PT?  Of course not.  And for the vast majority of cases, does T1/T2 really matter?  No.

 

Is there no role for nutrition in hypothyroidism?  I guess it's Synthroid or nothing.  There are some chiros out there who are very well versed in nutrition and, yes, they know more than you do about some things.

 

Some people don't do well with dairy products.  That's common knowledge.  Perhaps that's what the 'milk allergy' was about.

 

And what is your basis for a gluten-free diet? Is it just full-blown celiacs that do better on a GF diet?

 

My point is that it's true there are some weird chiros out there, but my experience has been that most do a pretty good job.  And as I just said, some take nutrition pretty seriously and if you aren't into that sort of thing, some of the recommendations may sound foreign.  Being overly critical (e.g., T1 vs T2...c'mon) seems a bit much. 

if a chiropracter calls to specifically discuss the results of the MRI and asks the question (aka what color is the tendon/ligament/whatever) to use for their own treatment purposes, then I'd hope they know what they are talking about. If you just want the results, that's fine. But if you try to come off as if you know how to interpret an MRI, that's another. And the color of the anatomy in question was different on T1 and T2 weighted images, so it is very relevant.

 

As for the hypothyroidism, the chiro took her off of synthroid and promoted a "herbal supplement" that would boost natural production of thyroid hormone. I told her that her own natural TSH couldn't do it, how could this "supplement" do it? I encouraged her to get follow up labs and sure as **** her TSH was through the roof and thyroid hormone nonexistent. What would have happened had she not listened to me?

 

The "milk allergy" was basically some hocus pocus wave something over you and if your hip flexes you are allergic? She cut it out of her diet and there was no change in her "symptoms." I told her to get more info on it from the chirco and she was told that based on the degree of hip flexion, maybe it was just a "sensitivity..." mmk.

 

She was also diagnosed with Lyme's disease because of some vague symptoms. I recommended lyme titers, etc. to confirm and she wouldn't have anything to do with it. I told her that to effectively manage this if it were indeed lymes disease, it would required antibiotics but instead she just needed chiro treatments...

 

The gluten free diet coincided with the hypothyroid. On synthroid her TSH and thyroid hormone levels were fine. Not sure why a change in diet is indicated there.

 

This isn't all 1 chiro either, this is many.

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I believe that chiropractic is quackery with no scientific value.  It was "discovered" by a guy who first thought it would be a religion.  If you show two chiros the same xray, they won't even agree with what's wrong.  I could go on and on...  Check out the website http://www.chirobase.org/.  It is part of the Quack Watch system.  Very interesting.

 

No, I'm not closed minded to all "complimentary" treatments, but I am a scientist and insist on honest proof, not anecdotes.  Only God gets by with my faith alone, everyone else must prove themselves!

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I believe that chiropractic is quackery with no scientific value.  It was "discovered" by a guy who first thought it would be a religion.  If you show two chiros the same xray, they won't even agree with what's wrong.  I could go on and on...  Check out the website http://www.chirobase.org/.  It is part of the Quack Watch system.  Very interesting.

 

No, I'm not closed minded to all "complimentary" treatments, but I am a scientist and insist on honest proof, not anecdotes.  Only God gets by with my faith alone, everyone else must prove themselves!

 

 

I would suggest that some good chiros function as effectively as a PT (but the bad ones are horrible)

They do have the same value as a PT if they are good

 

BUT in general they are only interested in having more treatments and collecting more money - placebo effect keeps them going....

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There is a great episode on Quackcast about this topic. Medical physicians tried to get rid of chiros years ago but went about it the wrong way. The argument from docs came across as a smear campaign which they ended up being sued for by the chiropractors and losing. Now they don't want to deal with the legality of it. Which sucks because chiros are, for the most part, are a complete joke. I had a chiro tell me once that they have the ability to extend people's lives to 120-130 years with a high quality of life. Funny she couldn't present me the data backing that up. 

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My take on this:  Disclosure first:  I am the daughter of a chiropractor who did a great job and in my mind functioned like a PT.  He was our town "sports medicine" Dr. and treated all the wrestlers and football players for their injuries, etc.  He had a thriving practice and the 3 MDs in town (all GPs) referred MSK cases to him.  He referred patients to them that were beyond his expertise.   This was back in the 70s - 90s.  He is now retired for many years.  He did not sell supplements or any of that sort of thing.  Just good spinal and MSK adjustments and patients did not come back weekly for the rest of their lives.

 

My clinic: Hired a chiropractor several months ago.  Full spinal xrays done on every patient.  He reads them and interprets.  It has stunned me how EVERY single patient has a twisted spine or hip.  One of our patients has already used up all of her insurance limits for chiropractor/PT/OT and all of it has gone to the chiro.  So, I think she needs PT and now won't go 'cuz her insurance is all used up for the year.  She is not better. I see the parade of people week after week traipsed down the hall to the section he is in.  I think it is a scam.  I had xrays done on a patient for a legit reason of the lumbar spine and radiologist read as  normal except for arthritic changes.  She went to chiro and had the full spinal xrays (something like 8-9 different views) and he read them all as abnormal and she has a twisted spine and hip misalignment. 

 

I cannot discuss this with the MD medical director because he goes to the chiro and they are friends.  It is telling when the chiro will readily give up one and 1/2 days a week at his local practice to travel 30 miles to our clinic to practice and then no one is seeing patients at his clinic.  He must have gotten a sweet deal for a salary.

 

Next experience:  one of our employees came to me to ask it I would order a panel of tests that her chiro brother wanted done on her (not the same one hired here).  I made her register as a patient, got her history (long standing hypothyroidism not treated since she was a teen) and I ordered some of the tests the chiro wanted.  NOt the weird ones tho.  Of course, she was hypothyroid and I wanted to treat with levothyroxine, she refused and insisted her chiro brother's recommendation of Armour Thyroid or Nature-throid were the ones to use.  I really didn;t have a problem and gave her Armour.  She is doing well, but of course he tells her to go on a gluten free diet and that the thyroid issues are from gluten.  I finally looked him up and he has a supplement/natural/chiro business.  She is feeling good...maybe a combination of better diet and certainly the Armour is the key.

 

But, she came back later to ask if I would order again a long list of labs....some weird ones....lyme, etc. and I said no since I cannot practice medicine under the guise of a chiropractor.  I did re-order the TSH, T3, T4 as they were due anyway and she needed f/u.

 

Ultimately,  there are a few good chiros out there, maybe a dying breed from the type my Dad was.  I don't know.  I am aware of several PAs who were formerly Chiro's. 

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I am conflicted about chiros as well, although I don't know much about their education or practical training. A friend of mine recently consulted a chiropractor for some back pain and upon examination of several xrays, she was found to have a reverse cervical curve. The chrio office wanted her on a six month plan to reverse this curve to normal using various devices and manipulation such as head weights, laser therapies, processes that would expand and relax the disc, etc.

 

Here are some red flags, but please let me know your opinion.

 

1. The cost was close to 7k; most of this cost came from optional therapies outside of what insurance would pay, that "would help you heal faster and more appropriately, and we cannot be held responsible for your progress should it not go as plan if you skip these therapies." Does insurance not pay for this because they think it's not necessary? 

 

2. At the close of the consultation, the rep, not actual chiropractor, said that he would give her a 15% discount if she was willing to commit to their original pricing of 7K for the treatment plan. If she took time to think about this, then the discount will not be applicable; I'm thinking this guy is full of it at this point.

 

3.The rep told her that her lumbar region was compressed one minute, hence she needs those additional therapies to expand and relax her spine, and then the next minute the chiro (different from the original one who saw her) walks in w/o the rep, and told her that her lumbar region is fine. We asked why she needs those therapies then if the chiro just said it was fine, and he (the rep)  said he's sure there's a good reason why the original chiro place the recommendations on there, and looks confused.

 

As we left, I told her chiros reminds of car mechanics, so we're seeing someone who is trained in medicine for a second opinion. But as I said, I don't know much about this profession, so I don't want to disparage them on this one incident, but I felt like we were bargaining with a salesmen and the practice that he represents. I don't feel this way when I go see my doctors or PA, they assess me, give me treatment options, show my research and data, and allow me to make an informed decision. But like car mechanics, there are probably one good one for every 10 bad ones.

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Saw a chiro once for a car accident. My injury attorney sent me there. Prescribed 6 weeks of 2 times a week manipulations and "treatments." My LBP went away around the 5th and 6th week...You know the typical time frame for simple acute axial back pain. I wonder if they prescribe "6 weeks" so it will coincide with this phenomena and then claim it was all the bone cracking doing it.  And if their specialty is truly subluxed vertebrae then why cant they fix a spondy? I have pt's who are being "treated" for asthma and HTN and when I was in Peds, AOMs with adjustments.

 

 A pt recently came to me because she has been having a chronic dry cough for several months and has been seeing an accupunturist and a chiro. The cough was recalcitrant and the two "Doctors" prescribed herbs and homeopathic treatments as well as SMT. Needless to say it didnt work. I examined her, and took down her HNP and diagnosed her with GERD. Put her on Prilosec and cough resolved, as well as a low level nausea she was also having. SHe asked me "why didnt the other two doctors not figure it out?" I answered: " I dunno, I practice medicine not magic." She got a good laugh out of it and she was one of those CAM proponents that now respects my opinion above theirs.

 

 Its all quackery to me methinks.

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