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Thread: Back Pain

  1. #1

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    Default Back Pain

    Usually I try not to let myself be drawn in to these discussions but I feel compelled-for better or worse-to comment here because of tonyb’s thread. I am a chiropractor. I was a mechanical engineer before so I take an analytical approach to most things that I do. I had a private practice for eight years, several of which were spent working in a pain management clinic. The last 10 years I have worked for the Department of Defense taking care of the men and women who take care of us. It does not pay as well as private practice but has its own rewards and, especially working for the Army, one tends to learn a thing or two about back pain.

    The best things you can do to prevent or self-treat back pain are to develop/maintain good core strength, pay attention to posture and ergonomics, and maintain range of motion. Of these, posture and ergonomics are the most important and effective things you can do to avoid needing treatment by any health care practitioner.

    MRIs and X-rays, which and when? Despite what your neighbor, co-worker, grocery bagger, audiophile posting buddy, or relative told you, there is actually reasoning behind ordering imaging. X-rays are the standard for evaluating initial injury but even those are not always necessary. Obtaining an MRI without cause does not improve outcomes and adds to the cost of health care. Additionally, just because there is evidence of a disc bulge or herniation on the MRI does not mean that this is the cause of your pain. I cannot stress this strongly enough. About 50% of people off the street, who do not have any back pain whatsoever, will have a demonstrable lesion on MRI so just because it exists does not mean it matters!

    What to do if you have back pain?

    Study after study supports manipulation (chiropractic adjustments) for back and neck pain – especially on an acute basis. So don’t be a typical male and pretend it is going to go away. If caught early, spinal pain is usually easy to treat. If you have chronic pain things get more complicated, not only because of bad biomechanical habits but because there may be physical and structural changes. This is sometimes where surgery comes in. But…and this is a big but…there is no guarantee that surgery will cure your pain (and of course it comes with its own risks) and even if it does, “fixes” like fusion just means that stress is transferred from one vertebral level to another and you will be in the OR for another fix several years later.

    Sometimes this is the only option but studies show that after two years, people who pursue surgery or treat conservatively are in about the same place as far as pain level and function. Those who delay surgery, and end up getting it later, have the same chance of a successful outcome; so there is no downside to delaying surgery to see if you can manage it on your own!

    Disclosure:
    As stated before, I am a chiropractor. I believe in what I do. My patients believe in what I do. The PCMs here believe in what I do. I exist solely on referrals from MDs and PAs (and physical therapists) and I am backed up several weeks, so I have to be doing something right. And I am not unique in this. Also, as I alluded to before, there is a lot of research to support chiropractic treatment of back pain, neck pain, and headaches. Chiropractic treatment is one of the preferred interventions in virtually all back pain treatment protocols. That being said, I am painfully aware of the warts in my profession. Those types are present in any profession: Chiro: come back every day until your insurance runs out. PT: same thing - but no one ever questions them. Plus just do the exercises on this sheet, you’ll be fine. MD: Blah, blah, blah “back pain” take these pills.

    Obviously, these are just easy stereotypes and though they are true in some situations, they are not indicative of everybody. Judging by stereotypes is easy and lazy, evaluate people on their merit. Find a provider who THINKS and cares about what he/she does; there is nothing more important than that regardless of degree. If you have specific questions, PM me but there is no substitute for face-to-face evaluation.

    This has been a Bavarian Beer sponsored PSA...
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    I went to a chiropractor for neck pain. She used X-rays for diagnosis, which as you should know, don't really show anything, except broken bones. She ended up doing more damage to my bulging discs, and one of them burst. I ended up going in for emergency fusion surgery on two levels, because I was pretty much paralyzed on one side.

    If only I had gone for an MRI, which you seem to advise against rushing into. Of course she had no idea I had damaged discs, and in hindsight, why should she, chiropractors have no real medical training. Just a bunch of quacks.

    My advice, if you have serious back or neck pain, go see an orthopedic surgeon, or better yet a nuerosurgeon. Don't waste time with quacks who "believe" in what they are doing.

    http://en.wikipedia.org/wiki/Chiropr..._and_criticism

    http://www.quackwatch.com/01Quackery...ics/chiro.html

    Edit: And if you do decide to try spinal manipulation, find an Osteopath, they have been trained in spinal manipulation AND have a real medical degree. They can even write prescriptions, unlike those who are not really in the medical field, but just pretending.
    Last edited by WilliamM2; 10-27-2013 at 11:17 AM.

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    Wow, just wow. Just proves my point "Despite what your ... audiophile posting buddy, ... told you" Yeah, your ever so educated adivice is worth what exactly ? Wikipedia?? OMFG

    Clinicians should not routinely obtain imaging or other diagnostic tests in patients with nonspecific low back pain
    For patients who do not improve with self-care options, clinicians should consider the addition of nonpharmacologic therapy with proven benefits—for acute low back pain, spinal manipulation; for chronic or subacute low back pain, intensive interdisciplinary rehabilitation, exercise therapy, acupuncture, massage therapy, spinal manipulation, yoga, cognitive-behavioral therapy, or progressive relaxation

    http://www.acponline.org/mobile/clin...pain_1007.html
    "The secret of happiness is freedom. The secret of freedom is courage." Thucydides

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    And Stephen Barrett?.

    Who Is Steven Barrett, What Are Quackbusters?

    Steven Barrett is an unlicensed Pennsylvania psychiatrist, who,
    though he failed his psychiatric boards and has been criticized for
    his lack of expertise by several courts, still claims to often advise
    the Federal Trade Commission (FTC), the Food and Drug Administration
    (FDA), the FBI, State Attorneys General, HMOs, Consumer Reports,
    medical journals and state medical, chiropractic and dental boards.

    The insurance industry cites Barretts highly opinionated Quackbuster
    attacks to deny paying claims for chiropractic and other natural healthcare.

    Barrett and the Quackbusters, a vigilante group of self proclaimed
    skeptics of any medical or health modality that avoids drugs, surgery
    or radiation, attack almost all non-conventional healthcare practices
    as quackery. Ignoring all scientific research to the contrary, they
    dismiss Gulf War Syndrome, Post Traumatic Stress Disorder, Chemical
    Sensitivity, Chronic Fatigue Syndrome, and dietary supplements as
    rubbish. Double Nobel Prize winner Linus Pauling is on their quack
    hit list along with many well known and respected doctors and
    scientists, including Deepak Chopra, Andrew Weil, and dozens of others.

    Barrett claims to give over 500 interviews a year to newspapers,
    magazines, and television shows, including CNN and the Today
    Show. He claims to have been a peer reviewer for seven medical
    journals, including the Journal of the American Medical Association,
    even though he had no license to practice medicine when he did the reviewing.

    The Quackbusters run over 70 websites. Millions of people go to them
    every year. Look up chiropractic, acupuncture, homeopathy or even
    vitamin C, as well as almost every other natural health topic, on the
    Internet and you (and the public) will be led to Quackbuster sites
    advising you of natural health dangers. In all these forums Barrett
    and the Quackbusters relentlessly attack the consumer right to
    informed choice. These activities continue the AMAs anti-quackery
    committees activities that were struck down by federal courts as an
    illegal restraint of trade in a landmark lawsuit brought by Illinois
    chiropractor Chester Wilk. They also help insurance companies deny
    consumer reimbursement claims.

    At the same time, Barrett flacks for products like aspartame
    (NutraSweet), which is the subject of tens of thousands of consumer
    complaints. Question (asked on Barretts web site): An email message
    is being circulated with many statements to the effect that aspartame
    is dangerous. How worried should I be? Answer (from Barrett): Not at
    all. The message is pure rubbish.
    Last edited by Disc Jockey; 10-27-2013 at 11:27 AM.
    "The secret of happiness is freedom. The secret of freedom is courage." Thucydides

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    Apparently chiropractors can't read either. I didn't have lower back pain, but neck pain.

    http://www.quackwatch.com/01Quackery...chiroeval.html

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    Neck pain is not your problem.
    "The secret of happiness is freedom. The secret of freedom is courage." Thucydides

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    Last edited by Disc Jockey; 10-27-2013 at 11:35 AM.
    "The secret of happiness is freedom. The secret of freedom is courage." Thucydides

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    Neck Pain

    As with back pain, despite the widespread use of chiropractic spinal manipulation for neck pain, there is as yet no reliable evidence that it works any better than other therapies, particularly over the long-term . 30,31,65,82 Of the limited number of studies performed, most have failed to find manipulation (with or without mobilization or massage) convincingly more effective than placebo or no treatment. One large study (almost 200 participants) found that a special exercise program (MedX) was more effective than manipulation. 32

    http://www.med.nyu.edu/content?ChunkIID=37431


    http://www.webmd.com/stroke/news/200...es-stroke-risk

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    Quote Originally Posted by Disc Jockey View Post
    Neck pain is not your problem.
    Not anymore. After a chiropractor made it much worse, a real doctor fixed it.

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    Ahh yes, the stroke myth, was waiting for that. For the people that can't differentiate between causality and correlation. http://journals.lww.com/spinejournal...&type=abstract

    One can find pretty much any research to support neck pain treatment, here's another one for you. http://annals.org/article.aspx?articleid=1033256 At this point, I am done. Do what you want, get the treatment you want. Believe it or not, there are no absolutes in MS treatment. My patient list includes primary care docs, physical therapists, occupational therapists, and surgeons of all stripes. I am sure all of them are hoodwinked by my quackery. Thank God for you. Stay vigilant
    .
    "The secret of happiness is freedom. The secret of freedom is courage." Thucydides

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    A chiropractor claiming something is a myth. Now that's funny.

    I remember mine claiming she was going to cure my high blood pressure as well. Good times...

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    One should be careful with what one says if one is NOT familiar with the history of Medicine and the AMA in the U.S.A. Legitimacy is something that was "denied" to just about "every" form of alternative medicine throughout our past. Even Osteopathic Doctors did not have, nor perhaps do they still have the SAME legitimacy as an M.D. by AMA standards. The AMA protects its own, manipulates the number of M.D.s that can be approved within our boundaries in order to keep incomes above a certain ceiling. They are the first to cry "quack"! But it is also true that in recent times many "legitimate" chiropractors and the field itself has been accepted by the Medical establishment and many M.D.s even recommend chiropractic manipulation for some? The war between these two fields and a number of others is pretty much over. And no credible member of the AMA would call all chiropractors "quacks" anymore. That's at least a decade out of date!

    I am merely relating the "history" here boys and girls as I have never seen a chiropractor in my life but have friends and family who have. I am also a social scientist who understands something about POWER, LEGITIMACY, PRESTIGE and WEALTH. And how these function to produce and reproduce something called "legitimacy". I am reminded of when psychologists came together in the first part of the 20th century to form the APA and "license" therapists (or prevent quacks from practicing). The famous clinician, Carl Rogers and a number of others "opposed" some of the licensing criteria with the argument that that very licensing would allow some cold, heartless, uncaring, profit seeking only, individuals to be licensed, while many "good", "capable", compassionate and caring individuals would be excluded, shut out of a "healing" profession.

    All I am saying is be careful with blanket statements about an entire profession since this is no longer the mid-twentieth century. And times HAVE CHANGED!

    That said. Bad chiropractors as well as ASININE M.D.s do exist. In fact, one of those M.D.s helped to knock off my mother! There was a QUACK who was, on the surface, LEGITIMATE! Incompetence and callousness abounds in many professions, my own included. And having a Ph.D. or M.D. from an top ten University in the U.S. doesn't mean much if your entire "being" is in question or you're just an "idiot"!

    cnh
    Last edited by cnh; 10-27-2013 at 12:59 PM.
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    Dang it cnh, I said I was done and I meant it but you decided to insert rationality in to this discussion. Stop it!
    "The secret of happiness is freedom. The secret of freedom is courage." Thucydides

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    I had a similar experience as William when it came to a "heavily recommended" chiropractor. Same issue as William, neck pain and upper back pain. The chiropractor didn't even want to see my MRI's, only x-rays, walked out of there in agony and felt worse than ever. A couple of weeks with a pair of competent physical therapists and I felt 95% better.

    I'll just leave this here: http://en.wikipedia.org/wiki/Wilk_v....al_Association
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    Two back surgerys here, wish i had tried chiropractic, although the later surgery proved i have a deterioration issue, maybe could have delayed the problems.

    Decades of constant back pain, the disability and its asociated thievery of many of the things you loved to do in life are pretty tough to deal with.

    Add the prevailing wisdom of critical people with xray vision and opinions on people with "back problems", and the effects of narcotic pain meds as a daily regime of treatment, well all i can say is do everything you can to stay out of the operating room, and if that includes a chiro, research them just as you would any other person you are trusting with your health.
    humpty dumpty was pushed

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    Plenty of good chiropractors and plenty bad ones. Same with physicians, surgeons, PT's and every other profession in the world.

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    I work in the medical field and the way physicians protect their "turf" is unbelievable. There are competent people in all of these fields the key is to get good referrals.
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    While I believe the OP's profession has it's place, and regular medicine has it's obvious problems, it's still not a valid replacement for good medicine practices. You can't treat something you can't see or even know exactly what the problem is without a MRI. An MRI will give you a good picture of all the tissue,bone and most importantly the nerves which look like a bowl of spaghetti around the spinal cord. Spinal cords can shift, even twist under certain conditions just enough to trap a nerve or apply pressure up against it causing pain. Granted, there are many different scenarios involved with back pain and some I agree are easily treatable. I want a definitive answer as to whats wrong, not a guess, so the path forward isn't wasted in the wrong direction. Make sense ?

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    Quote Originally Posted by tonyb View Post
    While I believe the OP's profession has it's place, and regular medicine has it's obvious problems, it's still not a valid replacement for good medicine practices. You can't treat something you can't see or even know exactly what the problem is without a MRI. An MRI will give you a good picture of all the tissue,bone and most importantly the nerves which look like a bowl of spaghetti around the spinal cord. Spinal cords can shift, even twist under certain conditions just enough to trap a nerve or apply pressure up against it causing pain. Granted, there are many different scenarios involved with back pain and some I agree are easily treatable. I want a definitive answer as to whats wrong, not a guess, so the path forward isn't wasted in the wrong direction. Make sense ?
    Tony, I know how to cure your ailments... its from lifting your heavy equipment. In the interest of making you healthier I will gladly come and collect it all from you and leave you with a BOSE stereo which you can operate with a remote and is very easy to move around.

    Thats how much of a friend I am ...

    the above is my attempt at humor as I have no dog in this fight.

    I will say this: regardless of what method of treatment you use and from whom, the root issue needs to be addressed and to do that the right tests/images need to be done in order to properly determine what issues are there.
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    Funny guy you are Dan, but I too do have a Bose system that I was going to offer to you for the kid.....after she's potty trained of course.

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    Quote Originally Posted by tonyb View Post
    Funny guy you are Dan, but I too do have a Bose system that I was going to offer to you for the kid.....after she's potty trained of course.
    LOL...

    What can I say, its late, I've been jamming to music for about 6 hours straight, and all is right with the world.... till I wake up tomorrow....
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    While I agree with Disc Jockey's well wrote help guide. I am one of those "extreme" cases. I did something stupid in my mid 30s'. partial crush/tear to L7? (The lowest disc) After about 6 months of toughing it out, I went through all the paces and eventually had micro-surgery to trim the torn cartilage poking into my cyatic nerve. Lasted 10? ten years... Toughed it out another 5... Went to the best Orthopedic Surgeon in the states and, guess what? With a simple x-ray, it was obvious I was "bone to bone". No disc left...

    Point being x-rays can show problems, MRI's can clarify some things and spinal taps/cats are needed also for fusion. Do I feel great now? No...But I feel 10x better and can walk now, with complete control of my legs.

    As chn said nowadays there are good and bad doctors. Health insurance companies ALWAYS verify and make new things work, BEFORE just jumping in on it. My adive is to get trusted info on back care, keep your weight down and keep some muscle mass around your ab area and you should be okay. as you get older don't try to be superman...ever.

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    Quote Originally Posted by tonyb View Post
    While I believe the OP's profession has it's place, and regular medicine has it's obvious problems, it's still not a valid replacement for good medicine practices. You can't treat something you can't see or even know exactly what the problem is without a MRI. An MRI will give you a good picture of all the tissue,bone and most importantly the nerves which look like a bowl of spaghetti around the spinal cord. Spinal cords can shift, even twist under certain conditions just enough to trap a nerve or apply pressure up against it causing pain. Granted, there are many different scenarios involved with back pain and some I agree are easily treatable. I want a definitive answer as to whats wrong, not a guess, so the path forward isn't wasted in the wrong direction. Make sense ?
    It does make sense but it is not the complete picture. Study after study shows that early MRI does not improve outcomes and does not predict the need for surgery. That doesn’t mean there aren’t times when early MRI is warranted because there are. Obviously, any time there is a presence of “red flag” indicating serious pathology that would warrant a referral to a surgeon an MRI should be obtained. If the need is more immediate, then off to the ER and have them obtain it. In your example above of the spinal cord shifting (it is actually more likely that things shift into the spinal cord rather than the other way around), there are going to be red flags present and this would absolutely warrant an MRI.

    The other time one should be ordered and this is one that most people don’t think about, is that an MRI (or any test) should only be obtained if there is a reasonable suspicion that it will change your treatment approach. And that’s the kicker because in the vast majority of cases, it won’t. If you get referred to a physical therapist or a chiropractor you will receive the same basic framework of services, tailored to your particular needs based on exam and history. During your initial visit, it should be able to be determined if a treatment plan modification is a possibility and then appropriate tests should be ordered but otherwise, no.

    If there is no suspicion of severe pathology, and it will not affect treatment, why get one? For most people it is nice to be able to point to something and say “That’s my problem, it’s a bulging disc!” but the presence of a bulging or herniated disc on MRI does NOT mean that it is your problem, even if it is shown to be pressing on a nerve. It may be and it may not be; there are other things that can mimic radiculopathy and many, many things that can cause similar types of back pain, and they are not all visible on MRI or any other modality. It’s often not that easy to get a definitive answer to what’s causing your back pain and that is part of why there is such a high failure rate in back pain treatment. This tendency to see it and blame it is what leads to unnecessary surgeries. An unnecessary surgery is one that did nothing to affect the original complaint because the accurate cause of pain was not determined.

    I am not against surgery; there are many good surgeons out there and thousands of successful surgeries. Sometimes it is the only option and can make all the difference in your life. It is a decision you have to make in an informed fashion. How much is my current pain and dysfunction influencing my life? What have I tried/not tried? How much are my habits and lifestyle influencing my pain and what have I done to change them? What are the risks/benefits and the odds of success? If you are going to have surgery, ask for additional functional testing. An MRI is a great tool, but it is only a picture. Tests such as NCV or needle EMG can help assess the function of nerves and help nail down exactly where the problem is and will improve your odds of a good outcome. They really work well when combined with MRI.

    Couple final notes. 1)The poor X-ray got kicked to the curb in the 80’s when MRI came around but, as Pork&Beans pointed out it is still a very useful test and provides a lot of information. You will almost always get one before an MRI, even if just an MRI is ordered. Usually it’s just for a quick screen and to make sure there are no surprises inside. Patients have an annoying habit of forgetting that there are pieces of metal inside them and it’s really not good if those pieces start migrating in the presence of a magnetic field. 2) Literature is a great tool but health care is practiced in a clinical setting. Every patient is unique and should be treated as such, and sometimes decisions are made in spite of what the literature tells you. 3) Prevention is better than any treatment.
    "The secret of happiness is freedom. The secret of freedom is courage." Thucydides

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    Quote Originally Posted by Disc Jockey View Post
    It does make sense but it is not the complete picture. Study after study shows that early MRI does not improve outcomes and does not predict the need for surgery. That doesn’t mean there aren’t times when early MRI is warranted because there are. Obviously, any time there is a presence of “red flag” indicating serious pathology that would warrant a referral to a surgeon an MRI should be obtained. If the need is more immediate, then off to the ER and have them obtain it. In your example above of the spinal cord shifting (it is actually more likely that things shift into the spinal cord rather than the other way around), there are going to be red flags present and this would absolutely warrant an MRI.

    The other time one should be ordered and this is one that most people don’t think about, is that an MRI (or any test) should only be obtained if there is a reasonable suspicion that it will change your treatment approach. And that’s the kicker because in the vast majority of cases, it won’t. If you get referred to a physical therapist or a chiropractor you will receive the same basic framework of services, tailored to your particular needs based on exam and history. During your initial visit, it should be able to be determined if a treatment plan modification is a possibility and then appropriate tests should be ordered but otherwise, no.

    If there is no suspicion of severe pathology, and it will not affect treatment, why get one? For most people it is nice to be able to point to something and say “That’s my problem, it’s a bulging disc!” but the presence of a bulging or herniated disc on MRI does NOT mean that it is your problem, even if it is shown to be pressing on a nerve. It may be and it may not be; there are other things that can mimic radiculopathy and many, many things that can cause similar types of back pain, and they are not all visible on MRI or any other modality. It’s often not that easy to get a definitive answer to what’s causing your back pain and that is part of why there is such a high failure rate in back pain treatment. This tendency to see it and blame it is what leads to unnecessary surgeries. An unnecessary surgery is one that did nothing to affect the original complaint because the accurate cause of pain was not determined.

    I am not against surgery; there are many good surgeons out there and thousands of successful surgeries. Sometimes it is the only option and can make all the difference in your life. It is a decision you have to make in an informed fashion. How much is my current pain and dysfunction influencing my life? What have I tried/not tried? How much are my habits and lifestyle influencing my pain and what have I done to change them? What are the risks/benefits and the odds of success? If you are going to have surgery, ask for additional functional testing. An MRI is a great tool, but it is only a picture. Tests such as NCV or needle EMG can help assess the function of nerves and help nail down exactly where the problem is and will improve your odds of a good outcome. They really work well when combined with MRI.

    Couple final notes. 1)The poor X-ray got kicked to the curb in the 80’s when MRI came around but, as Pork&Beans pointed out it is still a very useful test and provides a lot of information. You will almost always get one before an MRI, even if just an MRI is ordered. Usually it’s just for a quick screen and to make sure there are no surprises inside. Patients have an annoying habit of forgetting that there are pieces of metal inside them and it’s really not good if those pieces start migrating in the presence of a magnetic field. 2) Literature is a great tool but health care is practiced in a clinical setting. Every patient is unique and should be treated as such, and sometimes decisions are made in spite of what the literature tells you. 3) Prevention is better than any treatment.
    And all that being said, for the hundreds of patients (collegiate athletes mostly) that I see on a weekly basis, their first referral will always be to orthopedic surgeon and physical therapist. Chiropractors, no matter which way you cut it and this is strictly my own opinion, should never be the first line of treatment for treatment. Additionally, there is a prevalence of "quack" chiro's. Those who claim to do anything besides what they're clinically qualified to do give you all a bad name in the eyes of people who know medicine. We have chiro's come in all the time offering their services ranging from curing menstrual cramps to treating cancer. Its laughable and irresponsible. This unfortunately tarnishes the profession that those like you (who seem to be reasonable and competent) work so hard to preserve.

    Your 3rd point "Prevention is better than treatment" is correct, but unfortunately not subscribed to by insurance companies. You know as well as I do that unless there is a problem, insurance will not pay. And there's the rub. Insurance companies will usually pay for a limited number of visits to a chiropractor and then the clinic can "negotiate" a fee schedule, which can vary greatly from clinic to clinic.

    Also, an MRI will show just about anything and more than an xray. If we are talking back issues, I would much rather get an MRI and skip the xray. Gives a basic all in one, one stop information gathering that covers a hell of a lot more than an xray. Its one of the only areas where we skip the xray if insurance allows it (almost never) and we are sure it is not a bony issue.

    Like I said, I think you are correct in almost all of your points and you seem and sound like an incredible clinician and chiro. The phrase one bad apple spoils the bunch has unfortunately infiltrated into this setting and it's sad that the perception is out there. But in my opinion a lot of the skepticism about chiropractors (and many other fields of healthcare - Physical Therapy included) is self inflicted and the result of greed.
    Last edited by shawn474; 10-29-2013 at 12:46 PM.

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    I like the first exercise here for low back pain. Also managing it with Tai Chi.
    +1 for massage therapy in general.
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    The problem with chiropractic methods/therapy is assessing their efficacy. When you interact with patients and tell them you're helping them, they almost always show a response. This is partially due to the placebo effect.

    You'll notice that plenty of controlled trials show absolutely no effects of chiropractic care, especially when properly compared to "sham" treatments. For example:http://www.ncbi.nlm.nih.gov/pubmed/23169072
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    Quote Originally Posted by Disc Jockey View Post
    It does make sense but it is not the complete picture. Study after study shows that early MRI does not improve outcomes and does not predict the need for surgery. That doesn’t mean there aren’t times when early MRI is warranted because there are. Obviously, any time there is a presence of “red flag” indicating serious pathology that would warrant a referral to a surgeon an MRI should be obtained. If the need is more immediate, then off to the ER and have them obtain it. In your example above of the spinal cord shifting (it is actually more likely that things shift into the spinal cord rather than the other way around), there are going to be red flags present and this would absolutely warrant an MRI.

    .
    A few things here. One....usually an insurance company will require you to get an x-ray before an MRI, that's not doctor requested, that's simply going by the rules of the road in the insurance industry. Second, you do not just waltz into an emergency room for an MRI....unless it's truly an emergency. If it's not, again, an insurance company is going to have a hard time with that. Thirdly, an MRI in the hospital costs roughly 4 grand in my neck of the woods. If you go to the independents outside the hospital, it's roughly 1000 bucks. That's a 3g swing there my friend. Even between the outside facilities prices differ as much as 500 bucks. Same machines in all of them. So in cases such as mine, non-emergency, it's a valid option. The doctor informed me of the right ones to go too, gave me a list, told me to shop it. Told me never to go to an emergency room for non-emergency tests, prices are too outrageous unless you have buckets of money to waste.

    Fourth, an MRI isn't wasted if a determination of the cause comes of it. Find the cause, adjust the treatment accordingly. Without a definitive cause, you could be treating the wrong thing too and wasting money in the process. NO ? Possibly even making the situation worse. Chiropractic care certainly has a place in medicine, even physical therapy, but it's no replacement for certain diagnosis.

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    Quote Originally Posted by tonyb View Post
    Thirdly, an MRI in the hospital costs roughly 4 grand in my neck of the woods. If you go to the independents outside the hospital, it's roughly 1000 bucks. That's a 3g swing there my friend. Even between the outside facilities prices differ as much as 500 bucks. Same machines in all of them. So in cases such as mine, non-emergency, it's a valid option. The doctor informed me of the right ones to go too, gave me a list, told me to shop it. Told me never to go to an emergency room for non-emergency tests, prices are too outrageous unless you have buckets of money to waste.
    .
    \
    Tony we even found a price difference an MRI facility charges depending on the day you got the MRI. They didn't offer that up initially had to ask a few more question to tell us it was couple hundred cheaper to do it early Saturday morning.

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    tonyb, You're free to do what you want, of course, but I'm not just going off my personal opinion. This is all taken from the American College of Physicians and the American Pain Society clinical practice guidelines. These are very similar to the Australian back pain guidelines and the European guidelines. I did not mean to imply that you would just waltz in to an ER for an MRI. That example was for true emergencies. You should never go to the ER for anything other than an actual emergency - couldn't agree with you more. We will just have to disagree on when MRI comes in to the picture, no biggie.

    badchad, for every one of those you find, I can find another that shows superiority, then you can find another, etc. That is why clinical practice guidelines can be helpful. You have experts review the data and studies for good quality design, stregth of evidence, etc and provide a synthesis of what's out there.
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    Shawn, thank you for the kind words. I would think that with your population you are dealing with a lot of acute injury, Ortho/PT referral is going to be indicated more often anyway. Although my PT here hates acute patients, go figure. I take issue with your one bad apple comment though, it's more like a whole bushel. I think standards need to be raised and there are two schools that need to be shut down altogether. I said in my first post that I am painfully aware of the warts in my profession and I am. It is still a good profession and a good treatment option, if you have the right provider. If someone doesn't want to go to a chiro, don't. It's that easy. If you are convinced it is not going to help then chances are it won't anyway. The psycho-social aspects are another huge aspect of low back pain. In the end, it shouldn't be Intervention A, B, or C is the best and only thing you can do. There are aspects of different care approaches that are better suited to particular conditions and people.
    Last edited by Disc Jockey; 10-29-2013 at 02:31 PM.
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