T Nation

Doctor of Chiropractic Question


#1

This is an idea posed to Doctors of Chiropractic and other healthcare professionals.

DCs: Have you heard of the National Assoc. of Chiropractic Medicine? What do you think of the idea of removing the word and IDEA of subluxation from the DC profession and instead focusing on LBP, neck pain, and headaches.

Healthcare professionals:

What are your current views of healthcare? If Chiropractors took a role as spinal healthcare experts and worked in that context how would you view them?

This is not meant to provoke controversy, but to share ideas. I am currently working on my DC and want to begin working on the future of healthcare with chiropractic as the main players treating LBP, neck pain, and headaches (not subluxations). If this is in the wrong section, MODs please move it)


#2

The MODs have yet to answer. Where are you going to school?


#3

Cleveland Chiropractic College in Kansas.


#4

I don't know how much of a response you'll get in regards to this in a weightlifting forum, but since I'm on here and in practice, I'll throw in my .02

I have heard of them, and to me it's a bit of a trivial argument. We should focus on these things (HA, NP, LBP), because in reality medicine as a whole just plain sucks at it. Mainly because the biopsychosocial model of practice is just now finally being embraced. These 3 complaints have huge psychosocial implications, which in the past have been approached and solved more efficiently through taking a whole patient approach (ie chiropractic).

Part of the big problem in chiropractic are the idiots who want to cling to BJ & DD's philosophy, and not make any progress, add to research, etc. It's nonsense, ignorant and simply dangerous, not only to the profession, but to the patients they encounter.

Although more recent grads are equipped with the knowledge base, experience and education to be the leaders in these areas, many MDs, PTs, etc view the profession as frauds and charlatains, and will therefore not refer their patients until you prove yourself time and again, and maybe not even then. Is it professional bigotry, in some cases yes, but in the case of many chiropractors, they're dead on. In the town I practice in, the community would be better served if 1/2-3/4 of the chiros here were not in practice. There is a HUGE difference in practice styles between chiropractors, which the majority of the populations doesn't know about. A dentist is a dentist is a dentist for the most part, a nephrologist is a nephrologist, etc etc, but the gap between the Haves and the Have Not's when it comes to chiropractic isn't so much a gap as it is the Grand Canyon. Unfortunately two things suffer, when it comes to that, the profession, and the patient. The only reason some people in my town are in practice is because the old saying is true- Sometimes even a blind squirrel finds a nut once in awhile. They get a few people well here and there, the others they treat until they eat their insurance and then they cut them loose with little to no improvement. It disgusts me that it happens, but it does far too often.

I could go on for days, so I'll end now, feel free to PM me and we can have a chat. What school if you don't mind me asking?

Edit: Disregard, saw that you're at Cleveland


#5

Well, I can comment from a litigation perspective as far as "experts" are concerned. There is nothing a chiropractor can write in a report that is worth the paper it's written on in terms of the weight it's given in court or in evaluating any type of litigation. From the Social Security Administration to Disability carriers, to courtrooms, to other physicians, chiropractors are not highly regarded and that includes treatment for LBP, neck pain and headache. Orthopedic, neurosurgeons and neurologists are the respected professions for the spine and headaches. And if you go to a DC for a chronic headache problem before seeing a neurologist, you're fucking stupid. In fact, I wouldn't treat with a DC for any condition until whatever my condition is was properly diagnosed by a qualified physician.

So I ask you, what difference does "subluxation" make? DC's do what they do, believe what they believe and there will be people that treat with them and find relief, and there will be those that will not. You will not win any new hearts and minds by losing "subluxation".

I think I probably just started "controversy".


#6

Question - I recently read an article that said a good portion of chiropractors do not believe in the germ theory of disease. Is this true?


#7

Many headaches are caused by simple mechanical tension in suboccipital muscles. I would say you're fucking stupid if you run off and get cat scans and MRIs for every ache and pain. There's nothing wrong about these tests, but I've helped many people with such things for much less the cost.

And before we get into the OMG how deadly this stuff can be be if you don't get a thorough medical makeover, check into malpractice rates. I pay 2000$ a year for 1 million/3million coverage. Chiproactors aren't killing 50,000 people a year with medicine. We don't take off the wrong leg. we don't botch plastic surgery.

As a litigation expert you should know these things. there is a reason why my insurance is so cheap. It comes down to risk. What I do is less risky. Yes, mistakes can be made. yes, people have been hurt by chiropractors.

But you seem somehow shell shocked in regards to risk. not everything is a potential disaster. Even with the kids and lifting thing. Mark Rippetoe disagrees with you on that. And has sited some good studies in regards to it.

As for not taking reports etc. seriously, that's more prejudice than actual reality. I have the same training as a Medical doctor in what I do. I have received minimal pharmacology training , since I don't prescribe. If I get a drug question I refer back to the doctor or pharmacist.

But the thing that cracks me up is the ole ask your doctor about exercise etc. When they have no training in it. That's the best.

Litigation is not the total world, I've been sued one time in 20 years by a drunk welfare case who was working on my cousin's farm under the table. we settled it after 13 years when the attorney begged us to offer something so he could drop the case. It would have cost me more to take off work than settle it.

Deal with people well, be thorough, listen to them. you'll do a good job with them then.


#8

"And if you go to a DC for a chronic headache problem before seeing a neurologist, you're fucking stupid. In fact, I wouldn't treat with a DC for any condition until whatever my condition is was properly diagnosed by a qualified physician."

--DC's are qualified and are able to differentiate and refer out to a neurologist if warranted. The difference with subluxation is that it has been the basis in the past and should no longer continue to be. It was a major point of contention btw professions. If it changes, and with a change in chiropractc, then things should move in a better direction.

As far as the germ theory? Germs (viruses, bacteria, pathogens) can and do infect the human body. How your body deals with it is up to you.


#9

Tom had an excellent and accurate assessment. A tangent from his point-When it comes to musculoskeletal diagnosis, regardless of your letters, you should know your anatomy well enough that you can make a reasonably accurate diagnosis without CT, MR, etc. The imaging/testing should be to confirm, but more and more it's being used to diagnose.

I don't think much would change in the general public with the loss of subluxation. It might change a lot within the medical community. When DO's dropped their philosophy in the 50s/60s they were integrated into the medical community, and are now seen as equals. The tenets of the DO was that they were affecting bodily "humors" or fluids, so they really didn't have a leg to stand on.

The chiropractic "subluxation" deals with nerve impulse alteration. There is growing data to suggest that from a neurological standpoint the "adjustment" or "manipulation" does affect the nervous system both peripherally and possibly even centrally, causing neuroplastic changes to take place within the CNS. More research is needed in this regard. More sensitive NCV, EMG would also help in this regard. That is if chiropractic wants to stand by the subluxation theory.

Either way, there are going to be people like BG who discount the training, research and results. On the other hand there are going to be people who don't want to shell out 3 grand for an MRI and no treatment, when they get the same diagnosis, treatment and resolution for less than a grand in my office. (Yes I use imaging, yes I refer when I'm thinking something needs additional assessment/pain management so I can open a window to get treatment in, etc etc)

And to Tmay...Where did you find your interesting reading about the germ theory? If we're going to start mentioning fictional pieces, I'm going to refer to my article in Men's Health about how upside down single leg bosu ball curls get the best bicep activation of any bicep exercise. In other words...

No, most chiropractors do not discount the germ theory of disease, there are some out there, but there are also people out there who still believe the moon is made out of green cheese, the earth is flat, Sarah Jessica Parker doesn't have a horseface, etc, etc

Sidebar to Tom- A couple guys that were a few tri's behind me at Logan just published an article in Jan 27 Spine regarding the attachments to the dura from the rectus cap post maj that Leahy has been talking about for years. They found 11/13 cadaveric specimens had a direct connection. "Anatomical Connection Between the Rectus Capitis Posterior Major and the Dura Mater" by Scali, Marsili and Pontell if you want to check out the abstract on pubmed


#10

My brother and my mom see a Chirpractor, and one thing I don't get (if I'm correct) is manipulating bones instead of the soft tissues. Like when they crack the spine, and send you on your way. That makes no sense to me b/c bones don't decide where they lie, soft tissues pull bones in certain directions, and if you're only manipulating the bones instead of the soft tissues, you're just dealing with the symptom.
Again, I may be mistaken, but this is what I've been told by my family.


#11

I used to have sinus problems and headaches constantly, I have been going to the chiropractor for over 10 years now and I experience little to no symptoms. I do have some seasonal allergy issues also and I did see a doctor for that.

So call me fucking stupid if you want but my problem is resolved and has been for 10 years now. Also there have been times where I procrastinated on visiting my chiropractor and my symptoms flared up again. Its almost like my sinuses dont drain properly when my neck is not aligned.


#12

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#13

Matty- BBB is right as usual, one caveat though, you can't really adjust bones, you adjust joints, but that's really just getting nitpicky. The soft tissue component is huge, and that's why I tend to tell people I'm a doctor of chiropractor and soft tissue specialist, because we have to advertise that we are DCs in Ohio.

One guy in town had a sign outside his office saying "Have you been checked for VSC" for a long time, sounded too close to some type of VD to me, of course this is also a guy who refers to himself as "Captain Chiropractic" when he advertises. When you don't know how the body works, then you just revert to a less specific diagnosis, like "subluxation" or "shoulder strain/sprain" rather than "AC sprain" or "Infraspinatus strain" It's a bit of a disservice to the patient to just slap "Subluxation" down as the only diagnosis IMO


#14

I've seen several chiropractors over the years as a result of injuries and simply moving around the country.

My wife's aunt is a now retired DC (Palmer), but fixed a headache problem I had where my family MD failed.

I was in college and for a couple months had been getting headaches which I never really got before. One day I couldn't get out of bed because it was so bad. I took some pain killers to get by but the next day I was literally in tears.

Went to MD. He said "muscle spasms" and promptly put me on Fioricet and Motrin. By the way, Fioricet is one HELL of a drug...... (but it didn't fix my headache).

So, after a week, my 'aunt-in-law' tells me come in the office. Does some poking, prodding, some tissue manipulation, cricky-cracky on neck, and..... within the hour the pain was gone. Some pain came back next day (not nearly what it was before). Took XRays and it turns out the curvature of my neck was straight, in fact, almost 'back bowed'. Neck curve should be convex to the front. I don't know what I ever did traumatically or otherwise, but the "fix" was obvious. After a couple months she had gotten my neck back to normal curvature.

No neurologist, physician, or MD is qualified to put the joints back where they're supposed to go and no prescription fixes structural issues.

My rule-of-thumb is: Structural/Muscular--> Chiro (first), Buggy/Fluey--> MD/DO (first.. my "regular" doc is a D.O.).

When I injured my back a few years ago now, I went to a D.O. who sent me to a (useless) P/T but I ended up at the D.C. for "the fix". My DC is a regular part of my weightlifting routine.


#15

I've tip toed around you before, perhaps in some effort to not attack you, even after your very troubling post about how you allowed an obviously neurologically challenged man to bench press at your office which almost resulted in an accident. Any questions? But I will respond to the above. Point. By. Point.

  1. No PCP would send you off for an MRI or CT Scan for the occasional headache. But chronic headaches can be a sign of something serious. As for the causes you listed, nothing wrong with getting chiropractic relief for that once serious issues have been ruled out;

  2. Your comment about malpractice rates is really misleading and irresponsible. Your malpractice rates are low because YOU ARE NOT A DOCTOR! You do not prescribe medication and you aren't screening prostrates, doing breast exams, examining lesions, coughs, infections, etc. You are NOT "practicing medicine" as an insurance company defines it. To an insurance company, you're little more than a physical therapy office;

  3. Yes, it is a matter of "risk". See the above. And yes, after 20 + years managing litigation I am an expert. If the perception of chiro's offends you, your argument is not with me;

  4. Nowhere did I express an opinion about being "shellshocked". Huh?;

  5. No one said "everything is a potential disaster", although it is true I'm conditioned to see and appreciate "risk";

  6. I'll politely disagree with your opinions on lifting - you thought it was a good idea to allow a neurologically impaired (by your direct observation) man to "bench press" in your office, narrowly avoiding an accident. You apparently believed this was sound judgment;

  7. You are misrepresenting my comment about "reports". I stated that a report from a chiro, in a litigation setting, is not worth the paper it's written on. Chiro's are not regarded as "experts";

  8. I expressed no opinion about "asking your doctor about exercise". I pretty much stated that for a medical problem, I'll have it screened by a physician before I seek chiropractic care; and,

  9. Your personal experience with litigation is unrelated to my comments, and certainly does not rebut my point expressed earlier.

Were you being "thorough" and "doing a good job" when you allowed the neurologically challenged man to bench press? Bench press?! Really?


#16

I did no such thing. My post was factual. I told you exactly how DCs are perceived.

If you want to win your case, you better be showing up with a neuro or ortho - a "physician".


#17

Before you DCs get all subluxated, I use chiropractic care too, when appropriate.


#18

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#19

Sorry, I might be misunderstanding, do you mean it's a fact that DCs are perceived as less or the perception that litigators hold of DCs is fact?

I agree, to win some type of litigation, it's rare that a case has only one "expert" and typically in most cases a DC would be involved in, there is going to be another neuromusculoskeletal expert with a similar opinion.

Glad to hear you use chiro sometimes, when appropriate- I'm guessing that means you'll be scheduling an appointment with your chiro the next time you have bronchitis?


#20

It's a fact that DC testimony carries very little weight in the legal world. Very very little.

I've never seen a case turn on the testimony of a chiro. Ever. And I've seen 10's of thousands of cases and results. A disability insurer will not even consider them and you will NEVER get Social Security disability with a chiro alone. That should tell you all you need to know about the perception.

No, I will not be seeing a chiro for bronchitis. Ever.