Doctor of Chiropractic Question

Off Topic
21

Maybe I missed the research but what is the connect on SMT and bronchitis?

Spinal manipulation (adjustment) isn’t about moving bones. It’s about restoring joint mobility and it can affect the nerve receptors and transmittors dealing with pain and feeling (a little diluted of an explanation). IMO, you adjust to great immediate change and follow up with physiotherapy to make lasting change.

My thoughts and feelings are that past and some current DCs aren’t worth anything and that is why I choose to treat neuromusculoskeletal issues and begin integration into the medical community. Chiropractic medicine if you will. Not practicing medicine, but a specialization dealing with neuromusculoskeletal issues. There’s no reason we can’t work hand in hand with MD, Do, Orthos, Neuros, etc. It requires some minor changes, such as the idea of subluxation.

22

Layman here, I understand what the medical definition of a subluxation is…why does it seem like a loaded term in this thread?

Also, can someone seek out a DC without the referal of an PCP? If so, is it on a state-by-state basis or do insurance companies require the referral?

23

[quote]mch60360 wrote:
Spinal manipulation (adjustment) isn’t about moving bones. It’s about restoring joint mobility and it can affect the nerve receptors and transmittors dealing with pain and feeling (a little diluted of an explanation). IMO, you adjust to great immediate change and follow up with physiotherapy to make lasting change.

[/quote]

Would this physiotherapy be performed by a chiro or physical therapist?

24

[quote]Dr. Pangloss wrote:
Layman here, I understand what the medical definition of a subluxation is…why does it seem like a loaded term in this thread?

Also, can someone seek out a DC without the referal of an PCP? If so, is it on a state-by-state basis or do insurance companies require the referral?

[/quote]

 Subluxation in chiropractic started as same idea in medicial terms. A vertebra out of placed (subluxated). Turns out that it's rarely the case. Since it wasn't valid the profession has distorted the definition into many different things, none of which matter.

You don’t need a referral for a DC because we are portal of entry providers (different from PCP). Basically you can come to us and we can refer you to others if need be.

25

Physiotherapy can be performed by both. I believe that in their purest forms DPTs and DCs are on the opposite spectrum of the same scale. By some distinction, not all modalities can be billed by DCs.

26

[quote]Theface wrote:
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[/quote]
I work in the physical therapy field(PT assistant), and have worked in chiro offices before. There are many good clinical chiro’s, and a few that I have serious questions about the billing practices. But, I am certain that the same can be said for many PT’s. Reality is, it can be a good marriage between the professions, as they can be complementary. The PT’s and MD’s are merely attempting to protect their turf, so it is not surprising that they would crap on DC’s.

27

[quote]BennyHayes wrote:

[quote]Theface wrote:
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[/quote]
I work in the physical therapy field(PT assistant), and have worked in chiro offices before. There are many good clinical chiro’s, and a few that I have serious questions about the billing practices. But, I am certain that the same can be said for many PT’s. Reality is, it can be a good marriage between the professions, as they can be complementary. The PT’s and MD’s are merely attempting to protect their turf, so it is not surprising that they would crap on DC’s.[/quote]

Interesting you bring that up. I’m in my last year of PT school and there can be a great deal of toe stepping. In my experience, chiros don’t really like PTs being able to do things like spinal manipulations and I’ve heard chiros say before they can do anything a physical therapist can.

I also do have a friend in chiro school and it seems we have the same goals, but approach things in a different manner. The focus of PT is mostly neuro/musculoskeletal/soft tissue while screening for different pathologies and treating what is covered in our practice act.

Just like in any field though there will be people that do excellent work and are committed to doing great work and there will be people that set horrible examples for their profession. The patient should always be the main focus, but turf battles for money will not likely go away anytime soon.

28

Do DCs only deal with the spine or will they perform manipulations on any joint?

I’ve read a bit more on the idea of vertebral subluxation as it applies to DCs. Is this paradigm falling by the wayside in DC school or is it an immutable part of the chiropractic education?

It seems that without the ability to diagnose vertebral subluxations, the professional turf that a DC occupies becomes succeptable to being overrun by DPTs, et al… Is this a valid concern?

30

[quote]TheBodyGuard wrote:

[quote]Theface wrote:

[quote]TheBodyGuard wrote:

[quote]Theface wrote:

Either way, there are going to be people like BG who discount the training, research and results. [/quote]

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”. [/quote]

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?[/quote]

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.[/quote]

The bronchitis didn’t set off the sarcasm detector there eh?

31

[quote]carlthescorp wrote:

[quote]BennyHayes wrote:

[quote]Theface wrote:
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[/quote]
I work in the physical therapy field(PT assistant), and have worked in chiro offices before. There are many good clinical chiro’s, and a few that I have serious questions about the billing practices. But, I am certain that the same can be said for many PT’s. Reality is, it can be a good marriage between the professions, as they can be complementary. The PT’s and MD’s are merely attempting to protect their turf, so it is not surprising that they would crap on DC’s.[/quote]

Interesting you bring that up. I’m in my last year of PT school and there can be a great deal of toe stepping. In my experience, chiros don’t really like PTs being able to do things like spinal manipulations and I’ve heard chiros say before they can do anything a physical therapist can.

I also do have a friend in chiro school and it seems we have the same goals, but approach things in a different manner. The focus of PT is mostly neuro/musculoskeletal/soft tissue while screening for different pathologies and treating what is covered in our practice act.

Just like in any field though there will be people that do excellent work and are committed to doing great work and there will be people that set horrible examples for their profession. The patient should always be the main focus, but turf battles for money will not likely go away anytime soon.
[/quote]

They can work together if the relationship is mutually beneficial. The manip skills of a chiro are going to be better than a PT in the vast majority of cases, but the rehab knowledge base of most PTs will exceed that of most chiros. I can stay busy simply focusing on adjusting, manual therapy and basic corrective exercise and postural training and refer out to a PT dept for more intensive rehab, and longer duration stabilization, then it behooves me to send those patients, and have them send patients to me for the adjusting and manual work.

Agreed on the toestepping though, but if both parties know what they do best and co-treat it can work well, but it takes the right kinds. From a scope of practice standpoint, in most states, DCs can do everything PTs do and a little bit more, again, correct me if I’m wrong, but PTs can’t officially diagnose (I know that may be changing in some states), whereas DCs can.

Funny you say that the focus of PT is neuromusculoskeletal…I’m not sure how that would differ from chiropractic.

Edit- Completely agree on the fact that the money factor will always play a part. The shitty part is when it affects patient care when an MD insults a patient who isn’t getting help for seeking out something else on their own such as chiropractic or even PT in some cases.

The fact of the matter is people have to take charge of their own health, ask questions and not treat MDs, DCs, PTs or any other letter grouping like they are God. Respect their professional opinions, but if it doesn’t make sense, or sounds off, get another opinion.

32

[quote]Dr. Pangloss wrote:
Do DCs only deal with the spine or will they perform manipulations on any joint?

I’ve read a bit more on the idea of vertebral subluxation as it applies to DCs. Is this paradigm falling by the wayside in DC school or is it an immutable part of the chiropractic education?

It seems that without the ability to diagnose vertebral subluxations, the professional turf that a DC occupies becomes succeptable to being overrun by DPTs, et al… Is this a valid concern?[/quote]

Some DCs are strictly spine only, some (those that should not be named) adjust only C1-C2, but most adjust extraspinal joints as well if there is a particular motion restriction.

The subluxation paradigm holds very fast in some schools, or in particular subsets, but for the majority of recent grads it has fallen by the wayside.

I think it might be a concern for some, but quality care is quality care, what it does is make professionals work harder to learn and provide quality care, or see their practice erode to the professionals who are actually getting people well.

33

I think subluxation should fall by the wayside, it’s complicated and confusing and misused often. Joint dysfunction or fixation works better and is the term I use in school and with professionals.

I do believe that DPT and DCs (DCs that treat neuromusculoskeletal issues-NOT ones who claim to treat other issues) do cover some of the same turf. I think it could go a multitude of ways. But seeing as I believe manipulation is very beneficial and DPTs only view it (depending on the DPT) as a minor tool, there will be a difference. A doctor can only focus on so many things during the time with a patient, So a good integrated model could be a DC examining, adjusting, and letting the DPT handle the modalities, corrective exercises, and education.

There is also the thought that somewhere in the future the professions will collide and be absorbed into each other.

On subluxation in the schools. It can be hard being around students still clinging to dogma and tradition rather than science. Just today I had a discussion with older students who all gave me different definitions of subluxation and how it causes disease. I couldn’t understand how with their superior understanding of neurology, anatomy, and physiology that they still clung to this beliefs about subluxation.

34

BBB did you go to chiropractic school?

36

Thats great BBB. It’s astounding how much I’ve learned about anatomy, physiology, neurology and more. And how much dogma and ignorance I have to shrug off at the end of the day.

Any particular reasoning for not maintaining your DC? I’d be interested to hear the way you operate your practice (I guess you’d call it that).

38

That’s quite the story!

I’m glad everything worked out for you and I can understand the frustration of being an employee. I feel as if there are alot of differences in the profession of Chiropractic between countries! Here it is a doctorate (I don’t know when you went to school so that may have changed on both sides of ocean).

It sounds very sad as to what your prior institution practices. Clinic can give people anxiety for sure, but it is seemingly due to unpreparedness on the students part (at my school anyway).

I’m not a fan of the idea of straight and mixer titles, but that’s semantics on the way I want to use chiropractic and the way I view it. I’m not in it to get rich (baby #4 on the way so no way I’ll be rich anytime soon!) but to help ppl improve their physical status.

PS your video with Z Khan was very informative.

39

[quote]mch60360 wrote:
I think subluxation should fall by the wayside, it’s complicated and confusing and misused often. Joint dysfunction or fixation works better and is the term I use in school and with professionals.

I do believe that DPT and DCs (DCs that treat neuromusculoskeletal issues-NOT ones who claim to treat other issues) do cover some of the same turf. I think it could go a multitude of ways. But seeing as I believe manipulation is very beneficial and DPTs only view it (depending on the DPT) as a minor tool, there will be a difference. A doctor can only focus on so many things during the time with a patient, So a good integrated model could be a DC examining, adjusting, and letting the DPT handle the modalities, corrective exercises, and education.

There is also the thought that somewhere in the future the professions will collide and be absorbed into each other.

On subluxation in the schools. It can be hard being around students still clinging to dogma and tradition rather than science. Just today I had a discussion with older students who all gave me different definitions of subluxation and how it causes disease. I couldn’t understand how with their superior understanding of neurology, anatomy, and physiology that they still clung to this beliefs about subluxation. [/quote]

If you are going through chiro school now and wondering where your place is in the professional world, I can’t recommend The Sensitive Nervous system enough.

Butler gives the pain practitioner a model for treating pain in light of advances in plasticity, EBM, blending roles between different professions, and more.

Butler considers sublaxation (and even many soft tissue techniques) to be an easy way to instigate pain relief via gate control mechanisms. This placebo effect can be quite powerful and he recommends using it when necessary. Butler also argues that the shift of focus on soft tissues is over-done and manual therapists are missing the big picture.

In light of advances in understanding the role of centralization and the pain process (the so-called neuromatrix), he believes that the pain practitioners job is to apply what we know about centralization in the clinic.

Additionally, the book goes on to say that one of the most important things you can do hands on is nerve manipulation (flossing, gliding, etc), which is something most professionals do not use. He gives instructions for palpating every nerve in the body and several tests to see if a nerve’s function is impeded by peripheral and physical factors or if symptoms are purely central.

After all, think about it this way: the modern belief is that you can’t fix joint alignment because joint alignment is controlled by soft tissue… so we need to work on soft tissues to fix the joint. Why do we stop there? Soft tissue is controlled by nervous tissue and central factors.

Joint alignment is controlled by the brain, not the muscles - so why do we continue to ignore this? A tight muscle might be the result of a local nerve misfiring, but it just as likely that the brain has decided to lock up that muscle because it actually wants to constrict movement at a joint.

At any rate, I digress… if you are interested in treating pain (regardless of profession) you should definitely grab that book. I would also recommend reading this blog on a weekly basis:

There are definitely people out there who are trying to revolutionize the way all manual (and even other professions) look at pain - you just have to find them!

edit: http://www.somasimple.com/forums/showpost.php?p=95298&postcount=1

another must read article (imo)

40

Challer, I agree, great post and I think you might agree with what is to follow but, unfortunately what I see in many devotees of Butler is that they treat the neuromatrix as the be all end all, and don’t focus on refining their diagnostic abilities to reduce peripheral dysfunction. Butler has some great stuff, and I have benefited from his information, I just think there are many occasions where peripheral dysfunction is skipped, and the practitioner goes immediately to centralization.

Does it happen in chronics- absolutely, but I’ve found a great amount of success keying in on peripheral dysfunction, fixing it and then allowing the body to stop its nociceptive redlighting of particular activities, and even though they’ve had the problem for years, the dysfunction is gone, so is the pain and so are the aberrant motor patterns. On the other hand, I’ve also reduced/eliminated peripheral dysfunction in patients and they are still in pain, so I’m glad I can approach it from some of the techniques Butler lays out.

I just don’t like the idea of jumping immediately to centralization, which seems to be what a lot of the people on somasimple do. I think the human body is way smarter than we give it credit for. Maybe I missed an article, but I don’t know that anyone has been able to cite an evolutionary benefit behind central sensitization, if there is info out there, by all means, please let me know I’d like to see it.