Quote:
Originally Posted by photon
My only problem with placebo is a) charging for it feels immoral, at least if the practitioner is aware of it and isn't up front about it and moreso b) if there's risk involved (especially if it's undisclosed).
My understanding is that there is some risk of stroke with neck manipulation, but I haven't read anything about that in a long time, do you have any info or comment on that?
Thanks for your super informative posts on this!
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Well you’re talking about informed consent, and it’s a legal requirement for a physician to discuss it with patients and document it. Failure to do so may result in losing your license. The risk needs to be stated as about 1 in one million (although it may have changed since last I practiced) which is a ridiculously low risk overall. So while there is some risk, it’s so low as to be negligible and you’re a thousand times more likely to be hurt in a car accident on the way to the appointment.
I should mention that there are other observed benefits to maintenance care, but they would be deemed subclinical, meaning they aren’t immediately obvious in terms of symptoms of physiology. Maintenance care ensures that joints are moving through the full range of motion on a regular basis. We know that joints that don’t move completely also don’t activate mechanoreceptors in those joints properly or effectively. This creates aberrant neural input, and therefore, inappropriate activation of musculature, sometimes resulting in spasm. Over longer periods of time, it can result in the brain learning a new incorrect motor activation pattern, resulting in dysfunction of the musculoskeletal system. It doesn’t always lead to pain, but it can create small issues in balance, muscle over or under activation to stimulus, and degenerative joint disease if left untreated. I liken it to getting your teeth cleaned every 6 months. You don’t always have a problem that requires dental surgery or cavities being filled, but if left unchecked it could become a problem long term.
Now again, I would always present this as a recommendation for follow up after resolving the main issue, but never presented it as required. I also made sure they understood that the benefits would be minimal, but it would also possibly prevent future flare ups, and it would not guarantee the absence of a flare up.
I myself still get maintenance care, and I find that by 8 weeks I usually have a few things that need some attention. My wife on the other hand can go 3 or 4 months between adjustments and be just fine. It depends on the person, which is why some people believe in chiropractic so much, and others don’t seem to notice any benefit.