Opinions on chiropractors.

DanB wrote:

Ok took me a while to find that JAMA article http://jama.ama-assn.org/content/289...

Having quickly skimmed it a) it is a fabulous example of appallingly conducted medical research b) as such you can't really use it as an argument against the usefulness (or not) of MRI for diagnosis. All it tells you a given group of people if only allowed access to 1 diagnostic test will perform about as well as another, and there is actually no other information there.

e2a: My point being; don't be so credulous about the latter part of that scienceblogs article.

Your point must then also be "don't be so credulous of JAMA" which...if you can't trust something as established as JAMA, who can you trust?

We have a great family GP. He thinks outside of the box and is not adverse to suggest complimentary therapy for a lot of medical issues we have.

After my motor cycle accident, when I broke both my arms, displaced my right clavicle and messed up the ligaments in my right knee, I was still having massive pain in my upper right shoulder and lower back 12 months after the incident. I went back to him, and he did some simple muscle manipulation. "If that hurts more in the morning, physiotherapy won't help, you'll need to go deeper, maybe even a chiropractor for results".

Odd, I didn't think they played nicely. Needless to say, my shoulder and back were screaming in agony before the morning even came around.

I searched out a chiropractor that came highly recommended, and as part of the assessment, you are given a spinal x-ray. The results from that were pretty shocking. Seems I had a perfect 's' curvature in my spine. The problem was, that was from the front view. That was meant to be from the side. The skull to shoulder part of my spine that was meant to be curved was also as straight as an arrow, apparently also conducive to head impact while wearing a helmet. I actually collided with the road at around 35km/h, rolled into the impact after taking the initial hit on my arms (better to snap them than my neck I thought) and then tumbled for a good 20 metres after that.

We set up a fairly extensive plan of three times a week, then twice, the weekly. I am now down to once every 3-4 weeks, my back pain is GREATLY reduced, and I have actually regained almost 2 inches to my height that I was unaware I had lost (181cm before the accident, when they took my height at the prelim scan, I was down to 175cm) and I have greater mobility as well. YMMV.

TLDR: It worked for me, but I had a significant structural issue from a motor vehicle accident that needed to be manipulated.

Certis wrote:

I've been going to a chiropractor for a few months now. I was having headaches and I hit the last straw when I threw my neck out drying my hair with a towel. They took an x-ray of my neck and back, went over the details of healthy curvature and based on my fairly basic issue recommended a couple weeks of three times a week, then a few weeks of twice a week and now once a week few for a few months. Then I'm done.

We took updated X-rays a couple weeks in and I could see for myself the difference in the spine.

I've been given exercises to do and some head weights to wear for a few minutes a day to strengthen the neck which also helps.

Regardless of how much of it is crap and how much of it has merit, the results speak for themselves. I do the work suggested, honor the process and I make sure I don't miss appointments. I haven't had any real headaches since about two weeks into the process and my neck feels mobile and clear in a way it hasn't for a long time. I won't be doing it for the rest of my life, but it's been great for getting me back to a healthy place I can maintain.

This is exactly what my chiropractor did. I had the same results.

I went to a chiropractor after I hurt my back from doing some improper lifting. After one session of realignment I felt 100 times better. He also recommended some back exercises, which might have helped as well. I was pretty satisfied, and I wasn't out too much money. I would keep an eye out for the quacks though.

DanB wrote:
CheezePavilion wrote:
.. the vast majority of people in both groups got better. ... Although these additional treatments were very expensive, they had no measurable benefit.

http://scienceblogs.com/cortex/2008/...

e2a: My point being; don't be so credulous about the latter part of that scienceblogs article.

I know crap about statistics, but it seemed to me that just those two statements were at odds with each other. Apparently getting better isn't a benefit if other people also got better?

Rezzy wrote:
DanB wrote:
CheezePavilion wrote:
.. the vast majority of people in both groups got better. ... Although these additional treatments were very expensive, they had no measurable benefit.

http://scienceblogs.com/cortex/2008/...

e2a: My point being; don't be so credulous about the latter part of that scienceblogs article.

I know crap about statistics, but it seemed to me that just those two statements were at odds with each other. Apparently getting better isn't a benefit if other people also got better?

Additional treatments cannot be cited as beneficial if the people who didn't get the additional treatments got better just the same. Like prayer therapy, Rezzy ; D

Tanglebones wrote:

Hmm, has MRI analysis improved at all in the last 17 years, though?

also found this following up on stuff written in that post:

http://www.annals.org/content/147/7/...

Watch the Penn & Teller Bullsh*t episode on Chiropractors. I know they're show is not a news source and often goes to the lunatic fringe but their opinion is one I had before the show came out and mirrors some of my own experiences. I have chronic neck stiffness and often as a result of a childhood accident. I went to a chiropractor when I was young who cracked it a bunch and told me to keep doing so. Since then, I've discovered that doing that could lead to severe arthritis in the future and I'm hoping at my next physical to get a referral to a specialist so I can get it treated properly. You couldn't pay me to see a chiropractor. Obviously, others have had different experiences and that's great. My biggest problem is that since chiropractors aren't really licensed like other medical professionals, they all claim different things and have different levels of expertise. For that reason alone, you couldn't pay me to go to one again.

CheezePavilion wrote:

Additional treatments cannot be cited as beneficial if the people who didn't get the additional treatments got better just the same.

There's a word for that: ineffective. They didn't use that word. Instead they used words that sound similar by drawing a conclusion that makes it sound like everyone would have gotten better equally if everyone had gotten only the limited treatment. Obviously making the expensive additional treatments the wrong option. If the data actually showed that then the doctors forcing these ineffective treatments should be sued for malpractice... but that isn't happening as far as I know, because that isn't what the data showed as far as I can tell. But again, I know nothing about statistics, but I do know a few things about misdirection and double-speak.

Parallax Abstraction wrote:

I went to a chiropractor when I was young who cracked it a bunch and told me to keep doing so. Since then, I've discovered that doing that could lead to severe arthritis in the future

To my knowledge, there's no evidence that suggests that cracking joints causes arthritis. That said, I don't trust bone cracking chiropractors either. A chiropractors goal should be to get you fixed up and give you exercises to do so you don't need to see them every week.

Oh, my girlfriend has it in her head that she'll be going to the chiropractor for the rest of her life. That's something I've been slowly chipping away at.

Edit: Work issues popped up so I had to cut before the second part:
I apparently strained or pulled something in my lower back a few months ago and discussed the Chiropractor option with my Doctor. She outlined the options she could provide ranging from muscle relaxers to physical therapy, and then asked some of her nurses if any of them knew of a reputable Chiropractic office in my area...
So far I haven't decided how to approach it because the issue comes and goes and is generally manageable if I take it easy, so I'm glad to see this thread.

I trust physical therapists and exercise/yoga much more than chiropractors. There is a lot written about the pseudo science behind the practice. Not to say it doesn't help some people, and when you are in pain, I say keep trying until you find a solution. If a chiropractor works, enjoy the relief, though I don't really trust the science behind it.

Personally, I would see an orthopedist, PT, try some new chairs/ways of sitting, and do yoga myself first if I were having issues and see a chiropractor as a last resort.

Also, I think they do realign, but without proper exercise and muscle support to maintain the new alignment, things will just go back to the way they were if you keep doing the same things you used to do.

If you're in the Malibu area, you might want to try this guy:

IMAGE(http://upload.wikimedia.org/wikipedia/en/thumb/1/1f/Alan_Harper.jpg/250px-Alan_Harper.jpg)

I started going to a chiropractor a few years ago, when I was experiencing repetitive stress pain in my shoulder (too much WoW!). They fixed me up, and have also helped with a few other problems like when I injured my shoulder moving garden wall stones, and when I knocked something in my foot out of alignment while running.

The thing to remember is that chiropractors work with bones and tendons and such. Because they do backs and lots of weird things can be caused by back issues, I've no doubt they've seen some interesting things - but they aren't miracle workers, and don't trust any chiropractor who peddles miracles (or any doctor who does, for that matter). For example, the reason I was having shoulder issues was because I had a problem in my right eye - one of the muscles that controls the eye was not working correctly, and thus I was tilting my head to compensate, especially when tired. So while the chiropractor dealt with my pain and helped me strengthen my back and shoulders to avoid it, they didn't - and couldn't - diagnose the root cause of that particular problem.

In other words, treat them like any other doctor - their opinion is worth something, but remember that they only know their own field and they're humans just like everyone else, so get more opinions and check out other possibilities. I've had medical doctors give repeatedly ineffective treatments because they didn't have a solid diagnosis, and too often the temptation to "do something" results in treatment that is unnecessary or even dangerous.

Tanglebones wrote:

Hmm, has MRI analysis improved at all in the last 17 years, though?

A 'written for the public' update from a more recent Medical Journal (Nov 2011) is found via the link below:
http://www.jospt.org/issues/perspectives.asp
The issue is filled with articles on the subject, but you might need a university or hospital subscription to read them...

"Physical therapy is safe and recommended for the treatment of low back pain. In most cases of low back pain, it is not necessary to have an MRI before starting treatment. Beginning physical therapy in a timely fashion can potentially speed up your healing as well as your return to full activity."

I can't weigh in on Chiropractors as I have no personal experience (though my gut says it's probably pseudoscience that happens to get it right once in a while). I can't understand what you're going through since I've never had a serious back problem, but I would try the simplest solution first - and that sounds like physical therapy to me.

As others have pointed out basically YMMV. Keep your wits about you, don't be afraid to ask questions and don't be afraid to walk away if they fail to answer those questions satisfactorily.

One of my issues with a local chiropractor here is that he never gives patients any defined treatment plan or expected timeline for improvement. Basically 'keep coming back as often as you can afford to / as often as your insurance will cover it and eventually you'll be better . . .really. . ."

Personally I'd invest in some physical therapy and maybe a good massage instead.

Rezzy wrote:
CheezePavilion wrote:

Additional treatments cannot be cited as beneficial if the people who didn't get the additional treatments got better just the same.

There's a word for that: ineffective. They didn't use that word. Instead they used words that sound similar by drawing a conclusion that makes it sound like everyone would have gotten better equally if everyone had gotten only the limited treatment. Obviously making the expensive additional treatments the wrong option. If the data actually showed that then the doctors forcing these ineffective treatments should be sued for malpractice... but that isn't happening as far as I know, because that isn't what the data showed as far as I can tell. But again, I know nothing about statistics, but I do know a few things about misdirection and double-speak.

Yeah that's not how I think medical malpractice suits work.

CheezePavilion wrote:
DanB wrote:

Ok took me a while to find that JAMA article http://jama.ama-assn.org/content/289...

Having quickly skimmed it a) it is a fabulous example of appallingly conducted medical research b) as such you can't really use it as an argument against the usefulness (or not) of MRI for diagnosis. All it tells you a given group of people if only allowed access to 1 diagnostic test will perform about as well as another, and there is actually no other information there.

e2a: My point being; don't be so credulous about the latter part of that scienceblogs article.

Your point must then also be "don't be so credulous of JAMA" which...if you can't trust something as established as JAMA, who can you trust?

Well yes indeed, appeals to veneration and/or authority are not what science is or rather should be about.

All that paper says is that if you give people access to only one diagnostic test then two separate groups will perform about as well as one another. There are likely innumerable reasons why this might be the case. Looking at table 2 you can see that there are obviously biases in the kinds of things that x-ray and MRI can diagnose so it's possible that all we're seeing is that MRI misses some people who fail to get better that x-ray would have caught and vice versa. Looking at bottom line on table 4, given the tone of the blog post, the difference in total cost seems surprisingly modest between either diagnostic path. The paper even points out that the difference in cost (approx 16%) was not statistically significant (given their methodology and sample size). Yet they continue draw conclusions about the measurable higher cost of MRI even though their method can't measure that; which is what 'not statistically significant means' (actually it can mean one of two things neither of which help the conclusion). The follow period is only 12 months yet joint problems often play out of years of someone's lifetime. For instance, is early surgical intervention for an otherwise painless or missable herniated disc a good thing? We simply can't tell from this paper.

Then there is a complete lack of any control group making it exceptionally hard to interpret whatever is going on anyway. Statistically a pretty poor paper but that is pretty common in medical research (it's pretty common in most research and even in venerable journals). Most medics are after all not statisticians (and I'm only tangentially one). It's not an uninteresting paper but it is mainly telling you is that there is probably something interesting here and a much bigger study is needed to work out what is going on. Nevertheless drawing definite conclusions from that paper strikes me as a case of interpreting something through the lens of confirmation bias.

DanB wrote:
CheezePavilion wrote:
DanB wrote:

Ok took me a while to find that JAMA article http://jama.ama-assn.org/content/289...

Having quickly skimmed it a) it is a fabulous example of appallingly conducted medical research b) as such you can't really use it as an argument against the usefulness (or not) of MRI for diagnosis. All it tells you a given group of people if only allowed access to 1 diagnostic test will perform about as well as another, and there is actually no other information there.

e2a: My point being; don't be so credulous about the latter part of that scienceblogs article.

Your point must then also be "don't be so credulous of JAMA" which...if you can't trust something as established as JAMA, who can you trust?

Well yes indeed, appeals to veneration and/or authority are not what science is or rather should be about.

If you're going with that radical a criticism, that applies to everyone in this thread who has given an opinion based on what doctors have told them--diplomas and board certifications are "veneration and/or authority" after all, at least as much as peer-reviewed and widely cited professional journals. Your criticism is equally applicable against anyone who has said "get and MRI" who has not done the review of the empirical research themselves, so.

CheezePavilion wrote:
DanB wrote:

Well yes indeed, appeals to veneration and/or authority are not what science is or rather should be about.

If you're going with that radical a criticism, that applies to everyone in this thread who has given an opinion based on what doctors have told them--diplomas and board certifications are "veneration and/or authority" after all, at least as much as peer-reviewed and widely cited professional journals. Your criticism is equally applicable against anyone who has said "get and MRI" who has not done the review of the empirical research themselves, so.

Well indeed, most of the time we do need to go on some manner of faith. But this is an example where I have exactly no reason to go on faith and trust the JAMA just because it is well established. In this case I can go straight to the paper and check if the paper is any good and then assess that blog post for myself. This is the actual benefit of the existence of the JAMA; I trust it because I can go back and check what was printed not because it is well established nor that it once printed some good stuff.

As an aside, peer-review is mostly a process that produces 'good enough' not 'should be trusted'.

CheezePavilion wrote:

Yeah that's not how I think medical malpractice suits work.

I am also not a doctor or a lawyer, but I'm pretty sure that performing a surgery that has been shown to be ineffective isn't good doctorin'.

krev82 wrote:

As others have pointed out basically YMMV. Keep your wits about you, don't be afraid to ask questions and don't be afraid to walk away if they fail to answer those questions satisfactorily.

One of my issues with a local chiropractor here is that he never gives patients any defined treatment plan or expected timeline for improvement. Basically 'keep coming back as often as you can afford to / as often as your insurance will cover it and eventually you'll be better . . .really. . ."

Personally I'd invest in some physical therapy and maybe a good massage instead.

I think that is why mine is so good. Her plan is to get you 'out' of seeing her as much as possible. Clearly defined treatment plan. Expectations on recovery/mobility targets. 6 monthly progress assessments linked to those. She does dabble in the pseudo science, but she understands her clients, and adjusts accordingly.

By dabble, I mean she has some fish oil and other supplements hanging around. If you're not into that, she dials it down. I figured that's her motivator for what she does, and what she does gets results, so why mess with it. I can see some merit to keeping the spine aligned, given all the nerve bundles etc. it houses.

Increased immunity properties through manipulation? Give me a bottle of antibiotics over a cup of chamomile tea any day

Interestingly, this was posted on the NY Times blog today (pdf of study report). To summarize, it appears that for neck pain, both chiropractors and physical therapy at home were effective.

I'm inclined to think there is a lot of bleed over in that area - a chiropractor may do adjustments but a good one will also give you a plan for exercising or avoidance of bad behaviors to prevent aggravating the problem, much like a physical therapist would do. It's just a matter of finding the right mix for you. If you have the means, try it and see if it works.

Rezzy wrote:
CheezePavilion wrote:

Yeah that's not how I think medical malpractice suits work.

I am also not a doctor or a lawyer, but I'm pretty sure that performing a surgery that has been shown to be ineffective isn't good doctorin'.

The issue is what it takes for something to be 'shown' conclusively enough that you'll get anywhere with a malpractice suit.

DanB wrote:
CheezePavilion wrote:
DanB wrote:

Well yes indeed, appeals to veneration and/or authority are not what science is or rather should be about.

If you're going with that radical a criticism, that applies to everyone in this thread who has given an opinion based on what doctors have told them--diplomas and board certifications are "veneration and/or authority" after all, at least as much as peer-reviewed and widely cited professional journals. Your criticism is equally applicable against anyone who has said "get and MRI" who has not done the review of the empirical research themselves, so.

Well indeed, most of the time we do need to go on some manner of faith. But this is an example where I have exactly no reason to go on faith and trust the JAMA just because it is well established. In this case I can go straight to the paper and check if the paper is any good and then assess that blog post for myself. This is the actual benefit of the existence of the JAMA; I trust it because I can go back and check what was printed not because it is well established nor that it once printed some good stuff.

As an aside, peer-review is mostly a process that produces 'good enough' not 'should be trusted'.

The question then is whether the proof for MRI effectiveness is any better. Like I said, you criticisms are so general they undercut both sides of the issue. Check this post for more info beyond that one study.

Grenn wrote:

My mother is a nurse and she believes that they are quacks, one and all. So, therefore, I believe they are quacks, one and all.

This, exactly. Except it's the MIL in my case, and you said it much more nicely than I would have.

Get the MRI.

CheezePavilion wrote:

The question then is whether the proof for MRI effectiveness is any better. Like I said, you criticisms are so general they undercut both sides of the issue. Check this post for more info beyond that one study.

Well my point is entirely that said JAMA paper can't be used to support either side of this issue.

I've never known anyone to stop *needing* to see their chiropractor once they started.
I've never known anyone say they *want* to go see one, they always *need* another hit visit.

Just my second hand opinion

duckilama wrote:

I've never known anyone to stop *needing* to see their chiropractor once they started.

/me raises hand. Saw a chiropractor for some stubborn low back pain back in 2007. Two sessions, good stable results.

Anecdote.pluralize != Data, of course.

duckilama wrote:

I've never known anyone to stop *needing* to see their chiropractor once they started.
I've never known anyone say they *want* to go see one, they always *need* another hit visit.

Just my second hand opinion

Same thing with MD's. It's the damndest thing, but every single person I know that has started with "traditional" doctors (usually some MD JR called a Pediatrician) ends up being told to make regular visits. At least some of them give you good pills.

My wife's doctor and insurance both supported her seeing one after a drunk driver hit her a decade ago. After several months of therapy she didn't "need" to go anymore, although she does occasional visits because some of her workout stuff makes her back hurt a bit again. That's on her "say so", though, and not the chiropractor's recommendation.

Although I generally have faith in doctors, I think that a few things stand out in my mind in this whole arena:

One is that "real" doctors aren't necessarily that great. Of the three guys at work I know who've had vasectomies, I'm the only one whose doctor used a very different method (no sutures), and I'm the only one with no complications. On the other end of that spectrum is the fact that I've had chronic sinus issues for 18 months now, and my GP has no idea how to treat it. When we get a bit of cash in hand, I'll have to go to a specialist and see what they say, because my "real" doctor has done nothing helpful. So attending and completing med school is not necessarily an indicator of future effectiveness as a healer.

Two is that everybody's body is so different that there are bound to be healing methods that work for some but not for others. So chiropractors may work great for some people but be totally ineffective for others.

Two turns into a problem with number three, which is the whole "unlicensed" thing. If you are a healthcare provider, you have to be able to either improve the health of your patient, or release them to another type of care provider. So in other words, if I had been continuously seeing my doctor for my lungs/sinus issues (as opposed to two or three times with no actual help) and I had no improvement, she has a moral requirement to find some kind of alternative treatment, not to keep taking $100 each time I see her and shrug when I don't get better. I therefore get very skeptical of many chiropractors who do set up these decades long sessions of "healing" where the patient is either still experiencing enough discomfort that they need to return, or the patient feels like some kind of maintenance is required.

If you don't have a chronic disease, once your initial injury/symptoms have been treated, I think the wheat and chaff get separated when one says something like, "Hey, now that you're feeling better, try yoga, ballet, or some other kind of core/flexibility workout. It should really help keep your back flexible and strong, and help prevent a recurrence of this." and the other says, "All right, now we can go 'down' to two treatments a month indefinitely."

@demonbox, your counter is nothing like my quote.
A Dr. Recommending regular checkups, every year, is a far cry from the junkie-like behavior I've seen from friends and family that feel good for a day, maybe 2, after an adjustment, then start jonesing until they can get back to the chiropractor to relieve the pain a few days later, ad infinitum.

My experience, my opinion, but I don't see the parallel.