Sunday, April 20, 2008

How I really feel about chiro

In reference to What the ....?:

What is irritating about the chiro blogathon site mentioned previously (to which my own (PT!!!!) blog has been attached without my permission), is that there is no contact address provided so that I can protest directly about my blog being lumped in with chiro blogs.

There is, however, a little paypal thingy so that people may "donate" to help "maintain" the site... how chiropractic. Really.

I haven't been very outspoken on this blog about how I really feel about chiropractic. When I say anything much about manipulative therapy, I usually lump orthopaedic manual therapy in with chiro as being nearly indistinguishable on the surface, i.e., in that both groups love to manipulate, want to keep SMT (spinal manipulative therapy) alive as a treatment. I think this is still true; however, I may have been a bit myopic because of how I've been a PT for nearly 40 years and have never needed to use SMT on anyone. Upon digging deeper, and as a clarification, and to reassure ortho PTs that when I have to pick, I will always pick them over chiro any day, I offer this blog post.

Evidence in Motion

At Evidence in Motion, there is a nice thread about chiro in general and about cervical (neck) manipulation (which I have always, always been opposed to) in particular. The thread points out the video, Kinsinger Report on Chiropractic (about a half hour). It's worth talking about this very informative video for awhile, which I will do in a minute. But first, I want to say that I think this thread represents a good example of what "evidence" can be used for - i.e., it can be used to highlight chiro hubris, blow holes through chiro hegemony. A chiro came on the thread to attempt to dissuade readers away from the Kinsinger video, and a PT came on to say, au contraire, here is evidence to support the contentions made in the video about cervical manipulation risk. If you would like to examine this more closely, read the thread itself.

The Kinsinger video

So, I want to discuss the actual video now: In it, Bill Kinsinger, an MD, points out the public perception of chiropractic: i.e., an
"advanced form of physical therapy with a focus on treatment of low back pain."
He points out the perception chiropractic has of itself: i.e., an
"alternative comprehensive health care profession whose practitioners see patients on a primary care level treating everything from ear infections to PMS."
Then he points out the medical and physiotherapy view of chiro: i.e.,
"a philosophical belief system based on ideas that are not only unscientific, they are actually anti-scientific."
I agree. In fact, I couldn't agree more.
He says chiropractic has remained virtually unchanged since 1895. The ideas it is based on have not evolved, that the field more closely resembles a religion or a cult than a health care profession.

Kinsinger covers the main details on how chiropractic originated (a Canadian immigrant to the U.S., D.D. Palmer, founded it. As a Canadian, I apologize deeply for this..). By way of example for how non-evolved chiropractic is, he points out its superglue-like adherence to a concept called "vertebral subluxation complex" that has never been shown to exist, was something dreamed up by Palmer, and still rules chiro thinking. He goes on to outline what he terms "milestones to legitimacy", or how chiro has managed to crowbar its way into legitimacy through political ways and means. He discusses the fight (won by reason) in Florida a few years ago to keep a chiropractic program out of Florida State University. He talks about how PT has done most of the existing research on manipulative therapy. He points out:

1. the questionable benefits for musculoskeletal concerns and flat-out non-benefit for non-musculoskeletal concerns

2. the anti-vaccination statements emblazoned over doorways in chiro schools

3. risk of stroke associated statistically with over utilization of neck manipulation

He invites people to check out the grass-roots advocacy groups such as Neck 911. He ends his presentation by saying that PT provides the best hope for the future of manipulative therapy.

Other than my own personal dislike for manipulative therapy (i.e., the high-velocity kind) I agree entirely with this entire video.

Further links and resources

1. Neck 911

2. Petition: Legislate to Warn Public that Neck Manipulation can cause a Stroke (an Australian initiative)

3. The Kinsinger video, The Kinsinger Report on Chiropractic

4. The Evidence in Motion thread, Extra! Extra! The Kinsinger Report on Chiropractic

5. (read about the foiled plans to insert a chiropractic school at FSU, Jan/2005.)

6. Science-Based Medicine blogs in their chiro category

7. Chirotalk: The Skeptical Chiropractic Discussion Forum

8. Confessions of a Quackbuster (many many many more counter-chiro links at this blog)

9. Screwed4life ex-chiro blog

10. Chiropractic is Quackery squidoo page

11. Duplicitous Primates ex-chiro blog

12. (Added June 13/08) Alberta woman sues chiropractic after being made quadriplegic by a chiropractor, also this.



Anonymous said...

Yet another great post!

Question: what do you make of ortho PTs who are certified in manipulative therapy? I know a few PTs who have a diploma in manual and manipulative medicine who *on occasion* use cervical manips when they feel it's necessary. That said they make it clear that it is counterproductive for this to be a regular feature of any treatment plan.

Diane Jacobs said...

Hello Anonymous,
I don't think much about ortho PTs who are certified in manipulative therapy. To become certified in manipulative therapy has never been an ambition I've shared. (I've never had ambitions to become "certified" in anything within the broad scope of practice I enjoy, really...)

I look at it this way: I'm trained and licensed to be a generic human primate social groomer. Most pain has nothing to do with needing a very coercive, expensive-to-attain, archaic to the point of being practically dinosauric, manual skill set. I treat pain, which does not require a large amount of carefully contrived force designed to produce some dramatic noise, ostensibly to satisfy some perceived "need" of a patient to feel they have been "treated." It requires some careful attention, steady kinesthetic contact, teaching a patient how to realign themselves with the requirements of their own nervous system, small but mighty (only 2% of body mass, responsible for 100% of all body function, and requiring 20% of available oxygen/energy to do its job), which spans the organism from skin cell to construct of self.

If PTs feel they must go learn how to pop things, fine, but never my neck, thank you very much, and hopefully never as anything more than mere adjunct to what we are already trained to accomplish without clever audible human primate social grooming tricks such as manipulative therapy.