I Got 99 Problems and Chiropractors are One

[sas5814]

I so over calling "BS" and will move on the end of the year. This is LAST job I will take working along side a Chiro. The post on this thread have confirmed my suspicion. I personally would love to hear your Chiro rant. 

Its a long one. I remember a news shows about 3 or 4 years ago where a reporter snuck a camera into a Chiro "CME". The entire conference was about buzz words to use to keep insurance payments coming in and making more money selling vitamins and supplements than by being a Chiro.

From Wiki: The American Medical Association called chiropractic an "unscientific cult" and boycotted it until losing a 1987 antitrust case. For most of its existence, chiropractic has battled withmainstream medicine, sustained by antiscientific and pseudoscientific ideas such as subluxation.

Here in Texas several years back some genius decided we all needed 12 hours of live in-person training for the privilege of seeing workers comp patients and about 90% of all the providers in the state bowed out. The Chiro's stepped in and are now doing the overwhelming majority of worker's comp. I could tell a few dozen stories I am personally aware of of them mismanaging patients and keeping the coming back over and over for different adjustments while doing no useful diagnostic imaging past in-office x-rays and sending them to me for "medicine". 

[UpRegulated]

Too much tip-toeing by some in this thread.  Chiro's are quacks that practice pseudoscience at best.  Why are so many medical professionals afraid to say that?

[UpRegulated]

I don't know if there is any (actual) science in OMM, but I don't think anyone disputes that it can be effective. 

 

I don't understand.  How can something not a science be effective beyond placebo?  And if you don't know of anyone that disputes its effectiveness, now you do.

[delco714]

I don't understand. How can something not a science be effective beyond placebo? And if you don't know of anyone that disputes its effectiveness, now you do.

My personal anecdotes... Slight realignment to my neck and back feel better..than I can ease the spasm, heat and ice. Then there's the whole omm thing that's not manipulations.. I omm my wife's sacroiliac joint all the time which helps her..essentially it's stretching and loosening her. I am not a proponent of most chiropractic stuff or using omm for constipation

[Boatswain2PA]

I don't understand. How can something not a science be effective beyond placebo? And if you don't know of anyone that disputes its effectiveness, now you do.

Lots of science we don't understand yet. Why doesn't lowering your cholesterol with lipitor reduce your risk of MI? We don't know....yet.

[Guest Paula]

Lots of science we don't understand yet. Why doesn't lowering your cholesterol with lipitor reduce your risk of MI? We don't know....yet.

 

WHAT????  Lowering cholesterol with lipitor doesn't reduce your risk of MI???  Huh?  I thought statin drugs were the only drugs that reduce the risk of MI.   OR is it that they only  reduce the risk of heart disease?   How have I gone so wrong on my thinking?  Ezetimbe does nothing for MI risk reduction and I don't understand why it is even on the market?  It can still lower the "numbers" to make them look pretty to value based reimbursement folks. 

 

Jeesh, I better study up for PANRE!

[2234leej]

I don't know if there is any (actual) science in OMM, but I don't think anyone disputes that it can be effective.  

 

So the question is who do you refer your patients to for OMM?  I try to send my patients to a DO who does OMM because they are the best of both worlds (ie: they practice medicine AND they do OMM).  I go to a DO who does a good job on my wrecked back and neck and I get better results than I can get on my with with stretching, exercises, mobic or ibuprofen, ice, and lidocaine patches.

 

Here's my Chiropractor rant:  

 

There are some good Chiropractors.  They are the one who may put a heat pack on you, then they come in, feel up and down your spine/joints, and then do a manipulation.  They also know their limits; they know they can't fix your "sinus infection" by manipulating your facial lymph nodes, or your infertility by adjusting your little toe.  

 

But if you walk into a chiropractor office and see the "wall of shame" in the lobby....the entire wall of overpriced supplements, vitamins, and minerals, then run out the door because the same things are 1/10th the price at wal-mart, and the chiropractor is a quack.

 

If you walk in and the first thing the chiropractor wants to do is take an x-ray of your back, then run out the door because the chiropractor doesn't have a clue how to read an X-ray. 

 

 

 

 

 

Agree 100% 

 

I'd like to weigh in on this as well. Hah I am very bias in regards to recommending a physical therapist (I am one) for musculoskeletal conditions. I truly believe the education is way more consistent across the board compared to chiropractic school. The fact that chiros even using radiographic imaging (and exposing adults and children) to radiation for joint manipulation/mobilization is ridiculous. I use manual therapy in my practice and that is not required for a successful manual intervention.

 

While I do believe chiros are better than many PT's at joint manipulation, their philosophy, diagnosis, and criteria for the intervention is absolutely horrendous. Their guidelines and lack of clinical prediction rules to determine who would benefit from manipulation/adjustment is terrible. 

 

My advice is to send your patients to physical therapists who are orthopedic specialists and well trained in manual therapy. Their line of thinking and medical train of thought will be much more in alignment with what you know.

[2234leej]

Too much tip-toeing by some in this thread.  Chiro's are quacks that practice pseudoscience at best.  Why are so many medical professionals afraid to say that?

 

I don't know of any healthcare profession that is more paradoxical than chiropractic. You have the straight shooters who believe in the pseudoscience and you have the other ones who are trying to change their profession for the better (i.e. using evidenced based medicine/practice).

 

There are good chiropractors out there (in my opinion, more bad ones than good ones). Though, if you're looking for someone to help your patients with orthopedic and MSK conditions, you're better off sending them to a PT.

[GeminiPA34]

Since creating this post, I find myself really paying closer attention to Chiros in our office.

 

Example, we had a patient who was very upset she was told by our front desk she must keep her appointment for the day even though she was having flu (contagious) symptoms. I was unaware of this and was told this information by the patient once seen for their E&M. 

 

I had no idea who informed the Front Desk to give the information and brought this up in a meeting. Seriously who wants a sick patient in the office spreading their germs on other patients and possibly spreading it to the Provider ( me). We are a Physical Medicine office not a Urgent Care or Family practice office. I explained the patient felt they were forced to come in and were upset about it.

 

One of the Chiros says, "Oh I told the front desk to give the patient that information". Then my eyes became really big ( O_O ) as the "senior" Chiro says, "yes we want our patient to come in even if they are sick because Chiropractic treatment has been known to cure the Flu.   IT'S A VIRUS HOW CAN AN ADJUSTMENT CURE THAT???????  I could do nothing but die of laughter on the inside as I thought about the comments on this thread. THANKS GUYS!!"

[NLRP3]

Since creating this post, I find myself really paying closer attention to Chiros in our office.

 

Example, we had a patient who was very upset she was told by our front desk she must keep her appointment for the day even though she was having flu (contagious) symptoms. I was unaware of this and was told this information by the patient once seen for their E&M. 

 

I had no idea who informed the Front Desk to give the information and brought this up in a meeting. Seriously who wants a sick patient in the office spreading their germs on other patients and possibly spreading it to the Provider ( me). We are a Physical Medicine office not a Urgent Care or Family practice office. I explained the patient felt they were forced to come in and were upset about it.

 

One of the Chiros says, "Oh I told the front desk to give the patient that information". Then my eyes became really big ( O_O ) as the "senior" Chiro says, "yes we want our patient to come in even if they are sick because Chiropractic treatment has been known to cure the Flu.   IT'S A VIRUS HOW CAN AN ADJUSTMENT CURE THAT???????  I could do nothing but die of laughter on the inside as I thought about the comments on this thread. THANKS GUYS!!"

Why didn't you call them out? I mean it is funny and all amongst people who know that what they are saying is nonsense, but patients don't know that, and silence is tantamount to condonation (if that is even a word...)

[GeminiPA34]

Why didn't you call them out? I mean it is funny and all amongst people who know that what they are saying is nonsense, but patients don't know that, and silence is tantamount to condonation (if that is even a word...)

 

It's pointless. These guys believe what they believe. When we start losing patients due to this type of thinking then maybe the lights in their heads will go off. FYI, I've questioned this type of thinking before and always get an an answer that makes me ask more questions. It becomes the debating to debating with brick wall game. I'm not a politician and I do not get paid enough for that. With these guys money speaks and if patients continue to not show up maybe then they will get it. 

[CAAdmission]

In any profession, there are some good ones and then there are some shady ones. 

 

 

I don't know. It is theoretically possible that some entire professions are shady.

 

[whoRyou]

I don't know. It is theoretically possible that some entire professions are shady.

 

Anything is possible these days with the help of the WWW

[cbrsmurf]

WHAT????  Lowering cholesterol with lipitor doesn't reduce your risk of MI???  Huh?  I thought statin drugs were the only drugs that reduce the risk of MI.   OR is it that they only  reduce the risk of heart disease?   How have I gone so wrong on my thinking?  Ezetimbe does nothing for MI risk reduction and I don't understand why it is even on the market?  It can still lower the "numbers" to make them look pretty to value based reimbursement folks. 

 

Jeesh, I better study up for PANRE!

 

Statins have proven benefit in secondary prevention of cardiovascular disease, including MI's. - see JUPITER trial

Pretty good evidence they work well in primary prevention in patients who have some cardiovascular risks: http://www.ncbi.nlm.nih.gov/pubmed/23440795

[GetMeOuttaThisMess]

WHAT???? Lowering cholesterol with lipitor doesn't reduce your risk of MI??? Huh? I thought statin drugs were the only drugs that reduce the risk of MI. OR is it that they only reduce the risk of heart disease? How have I gone so wrong on my thinking? Ezetimbe does nothing for MI risk reduction and I don't understand why it is even on the market? It can still lower the "numbers" to make them look pretty to value based reimbursement folks.

 

Jeesh, I better study up for PANRE!

It's promoted by the funeral home industry.

 

 

Sent from my iPad using Tapatalk

[FBIDoc]

I have taken care of several patients that had either quadriplegia from chiro cervical manipulation following MVC (unrecognized cervical fracture) as well as devastating and debilitating strikes from vertebral artery dissection, again from cervical manipulation...I suppose I'm ok with letting them mess around in the lumbar/hip and maybe thoracic areas, but never, ever cervical...good luck running from that barn fire

[ventana]

Chiropractors are physicians, we are merely assistance, how dare we question them?

[sas5814]

OK, that bothers me ... I am not sure how others feel, but to me that is just weird and someone needs to stop this type of abuse! 

Report it to who? This is what they learn in school along with treating diabetes and asthma and everything else through spinal manipulation. Manipulations for Life! Manipulations for health! Since this kind of quackery has been given legit status by the PC police and the insurance companies they are practicing to their standard of care.

[GeminiPA34]

Report it to who? This is what they learn in school along with treating diabetes and asthma and everything else through spinal manipulation. Manipulations for Life! Manipulations for health! Since this kind of quackery has been given legit status by the PC police and the insurance companies they are practicing to their standard of care.

Preach Brother!!!

[2234leej]

I have taken care of several patients that had either quadriplegia from chiro cervical manipulation following MVC (unrecognized cervical fracture) as well as devastating and debilitating strikes from vertebral artery dissection, again from cervical manipulation...I suppose I'm ok with letting them mess around in the lumbar/hip and maybe thoracic areas, but never, ever cervical...good luck running from that barn fire

 

How did that all pan out? Was there a lawsuit against the Chiro or what?

[2234leej]

I have taken care of several patients that had either quadriplegia from chiro cervical manipulation following MVC (unrecognized cervical fracture) as well as devastating and debilitating strikes from vertebral artery dissection, again from cervical manipulation...I suppose I'm ok with letting them mess around in the lumbar/hip and maybe thoracic areas, but never, ever cervical...good luck running from that barn fire

 

The American Heart Association released their stance on cervical manipulation as it relates to cervical artery dissection in 2014. Definitely a good read (rather long though).

 

I perform cervical manipulation...but again...careful consideration has to be done for each individual patient (clinical diagnosis, co-morbidities, other suitable interventions, etc.). I actually have the patients fill out a medical questionnaire and check off any medical conditions (relative contraindications, red flags, etc.) that relate to cervical manipulative therapy. If anything is checked off, I resort to other interventions that the patient would likely benefit from.

 

Cervical manipulation (thrust) is relatively safe; the risk for an ulcer with an NSAID is something like 1/1000 (I forgot the particular study but I'll cite it) whereas the risk for a real adverse event with manipulation is way higher (different studies say different things). 

 

 

 

[Boatswain2PA]

.....I perform cervical manipulation...but again...careful consideration has to be done for each individual patient (clinical diagnosis, co-morbidities, other suitable interventions, etc.). I actually have the patients fill out a medical questionnaire and check off any medical conditions (relative contraindications, red flags, etc.) that relate to cervical manipulative therapy. If anything is checked off, I resort to other interventions that the patient would likely benefit from.......

 

 JML- DPT, OCS, CSCS

Board-Certified Orthopedic Specialist | Residency-trained at UCMC

Are you a PHYSICIAN (ie: MD or DO) who is a"Board-Certified Orthopedic Specialist" who "Residency-trained at UCMC"?  Or are you...something else??

 

Boatsw2ain2PA- PA-C, MPAS, MPH, BMCS, USCG (ret), OIC(AA), OIC(AS), HW, DWO, MLB47, MLB44, UTB, RBS, (and a bunch of other useless certifications that nobody here cares about).

[2234leej]

Are you a "Board-Certified Orthopedic Specialist" who "Residency-trained at UCMC"?  Or are you...something else??

 

 

 

Yup! Just an orthopedic physical therapist. Completed my orthopedic residency at the University of Chicago and took my board exam for orthopedics (you need it if you want to teach at PT residencies and universities). 

 

The pay wasn't the greatest (~46k), but it was definitely one of the best/most challenging experiences I've had. Learned a lot from the board certified PT's, orthopedists, radiologists and other physicians. PA's were great there too. 

 

[Boatswain2PA]

Okay, not knocking you.  PT's are great.  But this is just another example of how the explosion of "Doctor type credentials" are getting more and more confusing.  A "Board Certified Orthopedic Specialist" who is "residency trained" could easily lead someone to believe that you are a physician, like an Orthopedic Surgeon.  Add to the "Doctorate" in your degree, if you refer to yourself as "Doctor JML, a Board-Certified Orthopedic Specialist" who did your "residency at UCMC", many people (including many who are much smarter than I am) will think you are a physician.  

[2234leej]

Okay, not knocking you.  PT's are great.  But this is just another example of how the explosion of "Doctor type credentials" are getting more and more confusing.  A "Board Certified Orthopedic Specialist" who is "residency trained" could easily lead someone to believe that you are a physician, like an Orthopedic Surgeon.  Add to the "Doctorate" in your degree, if you refer to yourself as "Doctor JML, a Board-Certified Orthopedic Specialist" who did your "residency at UCMC", many people (including many who are much smarter than I am) will think you are a physician.  

 

Ah gotcha. Nah not a physician by any means; and although I have a 'doctorate' I never refer to myself as such. 

 

You are right though. MD. DO. Optometrist (OD). Podiatrist (PDM). Pharmacist (PharmD). etc.

 

I use it because many orthopedic physicians like to know who they're referring to for PT. It helps to separate us who went through more training and specialization.