The Stephan trial and evidence-based healthcare

[TheSutterDynasty]

Originally Posted by Cali Panthers Fan

My point was that it’s not a common diagnosis to look at VAS first, so many clinicians of ANY discipline are likely to miss it in the absence of obvious clinical signs and symptoms, which is extremely common with VAS. Without tinnitus or vertigo there is nothing to distinguish it from normal neck pain and headaches.

I don’t think your assertion that MDs are better at recognizing VAS than chiropractors is accurate. It’s the highest risk condition that could walk into a chiropractic office other than obvious stroke or heart attack, so chiropractors have been expertly trained at looking for those specific signs and symptoms should they even slightly suspect it to be the case. In any profession there are better doctors than others, so it’s always possible for someone to not remember their training and miss something.

Physiotherapists also perform manipulation. The difference is we don't use aggressive rotational techniques that theoretically stress both the vascular and ligamentous systems and we do it far more specifically. We aren't just looking for a crack.

The other, probably more important difference is assessment. To be able to manipulate as a physiotherapist in Alberta you must obtain significant post graduate training that focuses not only on technique but screening. It is our responsibility to know when a patient is having a medical event, our responsibility to not treat it, and our responsibility to triage. When that patient walks in your door with red flags that their neck pain may be vascular in nature, YOU need to be the one that finds it.

There has never been a significant adverse event due to a manipulation by a physiotherapist in Canada. Every year there are a few events related to chiropractic manipulation.

I know a lot about the industry. The vast majority of chiropractors are extremely aggressive, maintenance focused, and have NO assessment techniques.

[Azure]

Originally Posted by peter12

After struggling through a year and a half of herniated discs and doing anything ANYTHING to alleviate the almost unbearable pain, I will say that the only treatment that worked was 6 months of physio followed by strength training 3 times a week. That's it.

Once you begin reading up on the subject you'll find that this is the most effective approach.

It is also an approach that takes the most amount of time, and is more involving than the 2x per week appointment approach.

All the people around me that have back problems have not ever done any kind of strength training or mobility exercises, ever. Instead they prescribe the solution to their 'pain' as simply going to the chiropractor as often as needed. If the solution lasts for a day, it simply means they should go more often.

Even worse they get to a point in their life where they just 'live with it.'

Yoga, foam rolling, soft tissue work, mobility exercises, strengthening exercises, core exercises, cardio....over the long term these all work better.

You will also not find many chiropractors that tell you to 'start doing mobility work 2x per week' because it directly affects their bottom line.

Shoddy industry to say the least.

[peter12]

Originally Posted by Azure

Once you begin reading up on the subject you'll find that this is the most effective approach.

It is also an approach that takes the most amount of time, and is more involving than the 2x per week appointment approach.

All the people around me that have back problems have not ever done any kind of strength training or mobility exercises, ever. Instead they prescribe the solution to their 'pain' as simply going to the chiropractor as often as needed. If the solution lasts for a day, it simply means they should go more often.

Even worse they get to a point in their life where they just 'live with it.'

Yoga, foam rolling, soft tissue work, mobility exercises, strengthening exercises, core exercises, cardio....over the long term these all work better.

You will also not find many chiropractors that tell you to 'start doing mobility work 2x per week' because it directly affects their bottom line.

Shoddy industry to say the least.

After two weeks of doing squats every other day - at first with no weight and then gradually moving on to the "Starting Strength" program - I experienced a 90% decrease in my pain.

The change was so rapid as to almost be miraculous.

[Cali Panthers Fan]

Originally Posted by TheSutterDynasty

Physiotherapists also perform manipulation. The difference is we don't use aggressive rotational techniques that theoretically stress both the vascular and ligamentous systems and we do it far more specifically. We aren't just looking for a crack.

The other, probably more important difference is assessment. To be able to manipulate as a physiotherapist in Alberta you must obtain significant post graduate training that focuses not only on technique but screening. It is our responsibility to know when a patient is having a medical event, our responsibility to not treat it, and our responsibility to triage. When that patient walks in your door with red flags that their neck pain may be vascular in nature, YOU need to be the one that finds it.

There has never been a significant adverse event due to a manipulation by a physiotherapist in Canada. Every year there are a few events related to chiropractic manipulation.

I know a lot about the industry. The vast majority of chiropractors are extremely aggressive, maintenance focused, and have NO assessment techniques.

I don’t entirely disagree. However, I will say that those who do high amounts of rotation are going to be older chiropractors. Those in the last two decades were trained to avoid any excessive rotation and focus almost entirely on lateral flexion to get into the proper position.

I think that in the next few generations chiropractic will be absorbed into either physiotherapy or osteopathy, as those are both evidence-based professions. It hurts me to say that, but chiropractors have done this to themselves. They were given an opportunity in the 80s to modernize and integrate but instead chose to isolate themselves even further.

[Cali Panthers Fan]

Originally Posted by Azure

Once you begin reading up on the subject you'll find that this is the most effective approach.

It is also an approach that takes the most amount of time, and is more involving than the 2x per week appointment approach.

All the people around me that have back problems have not ever done any kind of strength training or mobility exercises, ever. Instead they prescribe the solution to their 'pain' as simply going to the chiropractor as often as needed. If the solution lasts for a day, it simply means they should go more often.

Even worse they get to a point in their life where they just 'live with it.'

Yoga, foam rolling, soft tissue work, mobility exercises, strengthening exercises, core exercises, cardio....over the long term these all work better.

You will also not find many chiropractors that tell you to 'start doing mobility work 2x per week' because it directly affects their bottom line.

Shoddy industry to say the least.

So to be clear, I am/was a chiropractor that would focus entirely on exercises to strengthen and rehabilitate, as well as doing lots and lots of soft tissue work. I adjusted very infrequently, but again, I am probably not the norm in chiropractic. I would even cease to adjust patients if they didn’t complete their “homework” so to speak because I knew it was fruitless for me to continue adjusting them without any rehabilitative work. I felt it was unethical to continue care knowing that it wouldn’t reach a viable end point, because ALL medical care should strive to do that, not simply get you along to the next stop.

I have begged colleagues to reconsider their approach to care. Should a patient not have documented improvements within 6 weeks the chiropractor should dismiss the patient from their care. I can count on one hand the number of chiropractors who do that on a regular basis. Most just keep chugging along without any re-evaluation of the patient. Again, I consider that deeply unethical.

[Azure]

Originally Posted by Cali Panthers Fan

So to be clear, I am/was a chiropractor that would focus entirely on exercises to strengthen and rehabilitate, as well as doing lots and lots of soft tissue work. I adjusted very infrequently, but again, I am probably not the norm in chiropractic. I would even cease to adjust patients if they didn’t complete their “homework” so to speak because I knew it was fruitless for me to continue adjusting them without any rehabilitative work. I felt it was unethical to continue care knowing that it wouldn’t reach a viable end point, because ALL medical care should strive to do that, not simply get you along to the next stop.

I have begged colleagues to reconsider their approach to care. Should a patient not have documented improvements within 6 weeks the chiropractor should dismiss the patient from their care. I can count on one hand the number of chiropractors who do that on a regular basis. Most just keep chugging along without any re-evaluation of the patient. Again, I consider that deeply unethical.

Like you said, you are not the norm.

You are not the only one either. I know some chiropractors that have enhanced their practice to involve a different approach than simply adjust, repeat, adjust, repeat. But they tend to draw in patients that are skeptical of the practice to begin with, and as a result they are held more accountable in how they treat their patients.

A big reason the shoddy practice continues is because we as patients don't take the time to educate ourselves.

Spinal cord manipulation on infants? I mean really, does it take a PhD to see that it is sketchy as hell? But for some reason people fall for it, just like they fall for thinking vaccinations are bad.

[PsYcNeT]

Originally Posted by Azure

Spinal cord manipulation on infants? I mean really, does it take a PhD to see that it is sketchy as hell? But for some reason people fall for it, just like they fall for thinking vaccinations are bad.

The Venn Diagram is a circle.

https://nationalpost.com/news/colleg...o-anti-vaccine

Three senior members of the council that regulates Ontario chiropractors have made anti-vaccination statements
Presented with the information, Ontario's Ministry of Health said it will take no action because chiropractic is a self-regulated health profession

Amlinger, a former CCO president, has also been outspoken online about vaccination.

A 2015 post on the Amlinger Family Chiropractic Facebook page encouraged patients to get a chiropractic adjustment instead of a flu shot, claiming, mercury and aluminium in the shots may increase the chances of Alzheimer’s.

Not only are they anti-vaxx, they also believe visiting a chiropractor is a substitution for a flu shot.

[Azure]

Originally Posted by peter12

After two weeks of doing squats every other day - at first with no weight and then gradually moving on to the "Starting Strength" program - I experienced a 90% decrease in my pain.

The change was so rapid as to almost be miraculous.

Are you doing any kind of soft tissue work?

A proper foam rolling routine has helped me a lot.

I also follow MobilityWOD quite a bit. Kelly Starrett is one of the more foremost experts on physical therapy and I believe he has moved the injury prevention field away from 'get an appointment 2x per week' towards methods that people can do on their own.

Proper movement, joint mobilization, flexibility, etc are all things that have gotten lost in our sedentary lifestyle. Most people can't touch their toes, do a full air squat without having their heels elevate, raise their arms in the air and have proper shoulder rotation, proper hip rotation both external & internal, etc, etc. In years past because of the more active nature of how we lived, these simple movements didn't get lost and were maintained by people for many years. Nowadays because we all slouch at our computers all day, or bodies have become inflexible and weak.

We need to move everyone towards an approach where they are spending 15-20 min per day on improving these core movements with their bodies and most of the issues with chronic back pain, shoulder pain, ankle pain, etc, etc will go away.

[Azure]

Originally Posted by PsYcNeT

The Venn Diagram is a circle.

https://nationalpost.com/news/colleg...o-anti-vaccine

Not only are they anti-vaxx, they also believe visiting a chiropractor is a substitution for a flu shot.

A lot of the people I know who think taking their kids to the chiro for monthly or weekly treatments are anti-vaccination.

Not surprising at all.

[Knut]

Chiropractic is a gateway into Pseudoscience.

A good start would be for there to be a big crackdown on Chiropractors doing things outside of their scope of practice.

[Red Potato Standing By]

Originally Posted by Hes

Chiropractic is a gateway into Pseudoscience.

A good start would be for there to be a big crackdown on Chiropractors doing things outside of their scope of practice.

Not only that they are Oiler fans..it’s true..damn true

[TheSutterDynasty]

Originally Posted by Cali Panthers Fan

I don’t entirely disagree. However, I will say that those who do high amounts of rotation are going to be older chiropractors. Those in the last two decades were trained to avoid any excessive rotation and focus almost entirely on lateral flexion to get into the proper position.

Really? I personally know plenty of young and middle age chiros who primarily rotate the lumbar spine. Maybe there's a bit less of it in the cervical spine techniques but they seem to often have extension involved.

There are certainly some good practitioners out there but even my friend who is on the progressive edge of chiro is still pretty ignorant when it comes to screening and assessment. He was never taught it.

[PsYcNeT]

Might as well drop this here:

https://theness.com/neurologicablog/...ry-on-youtube/

Cancer Quackery on YouTube

Many outlets are covering the story of Mari Lopez, a YouTuber who claimed, along with her niece, Liz Johnson, that a raw vegan diet cured her breast cancer. Johnson recently updated the videos with a notice that Mari Lopez died of cancer in December 2017. She has refused, however, to take down the videos.

Good read.

[Cali Panthers Fan]

Originally Posted by TheSutterDynasty

Really? I personally know plenty of young and middle age chiros who primarily rotate the lumbar spine. Maybe there's a bit less of it in the cervical spine techniques but they seem to often have extension involved.

There are certainly some good practitioners out there but even my friend who is on the progressive edge of chiro is still pretty ignorant when it comes to screening and assessment. He was never taught it.

I'm sure your friend was taught some amount of screening or assessment. He was unlikely to pass a board exam without those skills. Is it just that he uses different methods or that he doesn't know about your particular assessment protocols?

I can't speak to how all schools teach technique, but it was hammered into us pretty well to avoid rotation wherever possible and to focus on the joint plane of drive instead. Rotation in the lumbar spine doesn't even make sense because it's not supposed to rotate all that much. Some side posture adjusting will have the thoracic spine rotated in order to create tension, but that's all I can think of. Extension while adjusting the cervical spine was also not the way I was taught, but again, technique seems to be the one thing about the profession that varies widely between practitioners. It's also why a decent study can't be done because there's no consensus on the proper technique, keeping chiropractic in the dark ages of scientific evidence.

[peter12]

Originally Posted by Azure

Are you doing any kind of soft tissue work?

A proper foam rolling routine has helped me a lot.

I also follow MobilityWOD quite a bit. Kelly Starrett is one of the more foremost experts on physical therapy and I believe he has moved the injury prevention field away from 'get an appointment 2x per week' towards methods that people can do on their own.

Proper movement, joint mobilization, flexibility, etc are all things that have gotten lost in our sedentary lifestyle. Most people can't touch their toes, do a full air squat without having their heels elevate, raise their arms in the air and have proper shoulder rotation, proper hip rotation both external & internal, etc, etc. In years past because of the more active nature of how we lived, these simple movements didn't get lost and were maintained by people for many years. Nowadays because we all slouch at our computers all day, or bodies have become inflexible and weak.

We need to move everyone towards an approach where they are spending 15-20 min per day on improving these core movements with their bodies and most of the issues with chronic back pain, shoulder pain, ankle pain, etc, etc will go away.

I just do squats, deadlifts, overhead and bench press, and sometimes snatches. I feel better than I did before I blasted my back.

[Cali Panthers Fan]

Originally Posted by peter12

I just do squats, deadlifts, overhead and bench press, and sometimes snatches. I feel better than I did before I blasted my back.

Do planks as well. Most bad backs are due to weak abdominal musculature.

[peter12]

Originally Posted by Cali Panthers Fan

Do planks as well. Most bad backs are due to weak abdominal musculature.

Squats and deadlifts done properly activate the abs like nothing else.

[TheSutterDynasty]

Originally Posted by Cali Panthers Fan

I'm sure your friend was taught some amount of screening or assessment. He was unlikely to pass a board exam without those skills. Is it just that he uses different methods or that he doesn't know about your particular assessment protocols?

I can't speak to how all schools teach technique, but it was hammered into us pretty well to avoid rotation wherever possible and to focus on the joint plane of drive instead. Rotation in the lumbar spine doesn't even make sense because it's not supposed to rotate all that much. Some side posture adjusting will have the thoracic spine rotated in order to create tension, but that's all I can think of. Extension while adjusting the cervical spine was also not the way I was taught, but again, technique seems to be the one thing about the profession that varies widely between practitioners. It's also why a decent study can't be done because there's no consensus on the proper technique, keeping chiropractic in the dark ages of scientific evidence.

Fair enough. I'm assuming by joint plane you're referring to superior anterior vs inferior posterior? Where did you do your schooling?

Originally Posted by peter12

Squats and deadlifts done properly activate the abs like nothing else.

Obviously a big aside but this simply isn't true. Also, the majority of back issues will not do well with heavy loading in their early stages.

[CaptainCrunch]

I think Calgary Puck should start a company selling old time miracle tonics. Mix a bunch of crap together, promise that it cures almost everything and sell it. There are lots of suckers out there that will believe that a bottle of CP Miracle tonic now with 10% more seaweed extract will cure constipation, watery bowels, kindney stones, brain affliction, heart palpitations and smelly after fish farts. Side effects may include a feeling of being bullet proof, an errection lasting an awesome amount of time and Brad Pitt hair.

[Cheese]

soooo...where does the Stephan trial sit? Judge pondering decision?