ExRx.net

I noticed one of the threads gettiing a bit OT, and getting into the Chiro being good, bad, indifferent discussion. I have feelings on the subject and will start a new thread on it here. FWIW, I have a problem with one leg being shorter than the other ( I'm naturally a bit club footed, and over the years the overcompensation has caused my right hip to curve upward about 5/8 inch), and I can tell you, if it wasn't for orthopoedic shoes and an occasional visit to the chiro, I would be a hurting unit. I think KPJ and Pete have the right idea, find a good one before you make any judgement of the profession as a whole.
Tim

maybe my perspective is just tainted, but everyone I know that goes to a chiro is in terrible shape and never exercise.

I used to have back pain all the time till I started lifting and now its gone(except when I pass out on a floor drunk, that always kills my back). Im not gonna go so far as to say that everyone will be fine if they just exercise more/better (as is clearly not the case with you), thats just the trend I noticed.

I should say that i've never been to a Chiro. However, my physio does 'adjustments'. I see my physio every 3-4 months for a 'Service'.

It's worth noting that for a long time I was of the view that all physio's were a waste of space. That was after seeing 3 or 4 bad ones. Lack of a good physio is what got me into all the postural/corrective stuff. Point here is I feel i've been on the other side of the fence - the one that thinks all these guys are a waste of time.

I discovered my current physio through the recommendation from a Trainer friend of mine. He's been a trainer here for about 15 years. Funnily enough, Tim, he has a big structural discrepancy in femur length and also needs to see someone regularly and wears orthotics. He has some unique issues due to this and as a semi pro Rugby player in his day, too. He lets me use him as a guinea pig and I learn loads from it.

My point in this background report here is to show that a good physio was hard to find. Infact I had given up. The only reason I did find him was because I had a knee injury. I learned about some tests to check various things so went to Trainer friend in question and tried to get him to do them on me. He basically said, "um.. not my area at all - give this guy a call etc etc etc".

My physio comes from an athletic background too, formely a Cage fighter (runner up in the Battle of Britain). He still trains people for this butthe core of his business is physiotherapy. He's been in the industry for over 20 years and is qualified up to his neck. The kicker is, he doesn't advertise at all, and never has. Doesn't even have a sign on his building/gym. Yet, he's incredibly busy. He still learns. Half the time that I call him he's on his way to a course, most of which he says are a lot of rubbish. He lifts, too, obviously.

I think it's good just to clasify all types of specialsits as 'Manual Therapists'. From what i've read, a good Chiro can tell you about your muscular imbalances and a lot of them even do soft tissue work, too. Infact if I remember correctly Dr Cobb of Z-Health is from a chiro back ground.

To me this whole thing is obvious. We service our cars but not our bodies? That's bizarre, frankly. You only get one body but you go through loads of cars.

I'm wondering where it's the NEED for the service that get's questioned or the quality of the people in the industry?

KPj

To put it another way - most people that go to gyms are not in good shape but that doesn't mean gyms are useless.

I think it's the same with everything, from Chiro's, to Plumbers. You get good ones and bad ones - it's a part of life. Most physios over here are still stuck in the 80's with the treatment they use. They are still in the previous, symptom based era that was popular decades ago.

What you need to think about it most injuries are down to wear and tear. Impact based injuries are actually rare in comparison. Wear and tear is a result of overuse that occurs over a period of time. For some it will be decades before it surfaces and others it will be months. Everyone's different.

I think it's incredibly difficult, if not impossible to lift long term and avoid injuries. Infact, the only way i think it's possible is getting a regular 'service'. That way, the manual therapist (be it a chiro, physio, whatever) will discover any muscles that are tightening up or shutting down and you can get on top of things BEFORE it becomes an issue.


KPj

I have heel Spurs, so I have to wear orthotics for my feet or else my feet will hurt like crazy.

My foot doctor said that by wearing these my feet should mould into what they are supposed to be but they havent yet.

It sucks cause it really limits the types of shoes I can use.

i think as well that loads of folk don't bother going to see someone when they're hurting because of the massive amount of information people can access on the internet. How many queries regarding bad backs, elbows, knees etc are seen on this forum?

I was guilty of this too, one of my first ever posts on the forum was regarding my screwy posture, and I got some really good advice from all you helpful posters, but the advice is just general advice, and can no way substitute a proper one to one session with a qualified professional.

I too have never seen a chiro but have seen a bunch of physios, and the first few just gave me a stretch or two and sent me on my way, whereas the last one I saw (who is now incidentally probably the only one I will ever see) gave me a full MOT. She basically said a lot of stuff I had been doing on my own to correct my posture was good, but some of it was totally unneccessary.

Anyway the point I'm trying to make is that although the whole world seems to have a story about some crap chiro or physio or doctor or whatever they saw once, doesn't mean they're all bad. And internet sources are certainly no substitute. "A little learning is a dangerous thing" after all...

As i've mentioned before my girlfriend is currently doing an MSc in Physiotherapy, or Rehabilitation Science to give it it's full title. By her own admission there are only 5 people on her course who she would let perform any treatment on her, out of 20 on the course. Physio's are like any trade, some will be good, some won't be and some will be amazing. And it's such a specialist profession that you have to seek out the right one for what is wrong with you.

For instance someone who specialises in rehabing amputees isn't really the person you want to look at your dicky shoulder, but they will be a qualified physio. I would say always ask to see what extra qualifications they have and find one by recomendation.

Maybe physios and/or chiros are a lot different on the other side of the "pond", but PT and DC are so different, that I have trouble with the comparison, but like I say, maybe that's a difference between here and there.

Here's my take on chiropractic. It's primary modality is mobilization of joint capsules and muscles. There is no doubt in my mind that classic chiropractic spinal manipulation is beneficial for some people, at least temporarily. It's my experience that as chiropractic manipulation is applied further from the spine, it is of diminishing value. However, some DCs go beyond classic manipulation to soft tissue work, exercise prescription, etc. To the extent of their expertise in these areas these can also be helpful. Scientific studies have attempted to compare chiropractic with other modalities in certain situations. Most have shown that with acute strains (i.e. "whiplash" after an MVA) and in chronic back pain chiropractic is more or less equal to other approaches, including studied neglect. I'm including here what my profession typically does, recommending various rituals with heat and ice, splinting, wrapping, and drugs (which can and often do cause further harm).

The interview (in the "Expert Interviews" section) with Dr. Brian Nelson is interesting. Dr. Nelson treats chronic back pain with exercise. He makes the point that many modalities, including chiropractic, give short-term relief in this, but that only strength training provides long-term relief. I think he's probably right. Peter, think what would have happened if your chiros had manipulated you, and then you had not done anything differently in regard to your exercise. Do you think the results would have been as good or as long lasting? KPj, same question about your PT.

I think that chiros have a great opportunity to help people if they broaden their spectrum of expertise. Posture and strengthening in particular present great possibilities. If they just crunch people's spines and send them out without any tools to change their habits and strength, I doubt that they will do much long-term good. But the same could be said for my profession as well.

If a chiro sticks to the back that may or may not help. A lot of times just leaving it alone is just as good. It is possible that could help certain back issues.

But they claim to put people back into "alignment". Which is nonsense. Are they claiming they fix scoliosis or similar problem by just pushing things. That's insane. Then they go on to say these "adjustments" fix all sorts of ridiculous ailments. They condition people to feel they just aren't quite right and assume any problem they have must be a sign they need another "adjustment". It may have started out as a good profession, but now they are more like witchdoctors than anything else. If they want to be believed they can release a paper for peer review like everyone else.

My only experience of a chiropactor is in relation to my mother, who for many years suffered terrible back trouble. When i was a young child she once had to spend weeks lying on the floor due to a slipped disc. One morning she woke up in agony, couldn't get out of bed and was in considerable distress. On the advice of a friend she was driven to the local chiropactor and walked in literally bent over double.

After an examination the chiroc' found she had three discs that weren't where they should be. One was 'fixed' that day and my mum left the building upright and in hardly any discomfort. I think she went back for two more visits and had the other discs 'fixed' and to this day has never had any back trouble since, and that was nearly 20yrs ago.

The thing is, modern physical therapy is based on resistance training. The era of symptom based approaches in PT ended years ago, although many still practice it. However, a good 'manual therapist' will make you fully aware that the relief you feel is temporary, and the actual cause of the problem runs deeper - your lifestyle, be it your training, work, or whatever....

My PT is like that. He'll want to know what you do in the gym, what you do for a living, etc.

So, in short - if nothing altered in my training would it of lasted? No chance. Also, If nothing was altered in my day to day life, then I don't believe training and PT visits would be enough either. The day to day life thing is the biggest issue in my opinion, it even goes beyond the gym. The old 23/1 rule. 1 hour in the gym to make progress and another 23 to screw it all up. The best program in the world can't undo 23 hours of bad habbits.

If it's something of interest, you should read Shirley Sahrmann (Diagnosis and Treatment of Movement Impairment Syndrome). She's basically a pioneer in Physical Therapy. She gives a whole new meaning to what a Diagnosis is or does or tells us. I think the traditional way of dealing with Injuries (overuse) is not very good at all. Gray Cook is another great example of someone pioneering Physical Therapy into something more than 'rubbing it better'. Personally I think his movement screen should be enforced as a Law or something, for all Trainers.



Exactly. That's what I think these guys need to do. I wouldn't go to or recommend a PT or chiro that only knew how to ease the pain of the symptom, I would want one who got to the cause, and to do that, they need other skills. Also, it's probably his opinion but, my PT says getting 'crunched' itsn't good regularly. He says "every few months, maybe, but no more than that". He says it's no more than a pressure release. Whatever it is, it does help in the short term. I define 'help' in this case as - it makes you move either better or more pain free or both.

Also, in terms of 'alignment' - you can be out of aligmnent and not have conditions such as Scoliosis. That's quite an extreme example. It can also be structural or functional. Sure, many claim to work miracles but you can't tar them all with the same brush. Scoliosis can be quite extreme and a big problem, but, what looks like scoliosis isn't always scoliosis. I have a personal hate for most traditional diagnosis, such as Scoliosis (only when they're quick to tell you that), Impingement Syndrome, Patella Tracking Symdrome, ITBand Syndrome, runners knee, jumpers knee, whatevers-knee etc. I feel they mislead you. IN terms of Scoliosis, someone can be all screwd up on one hip or shoulder or both (which is common) and they 'look' like they have it. Someone can have more hypertrophy in one lumbar erector and get told they have it. A few tight muscles here and there can cause your alignment to screw up.

In general I feel the realm of just making a diagnosis is as screwed up as the realm of treating it. This is an area that things just aren't black and white at all.

KPj

Phil, I'm glad that this guy helped your mom. I don't know exactly what happened when he treated her, but I know that he didn't moved discs around. Discs don't move. They can tear, rupture, herniate, but they don't move. I've been there both in cadaver dissections and in the operating room (I'm not a surgeon, but I've done a lot of assisting), and believe me, discs aren't movable in an otherwise intact back. They are tenaciously anchored to the surrounding structures. To move them, you would have to break lots stuff that couldn't be fixed by pushing on your back.

The honest chiros I have known (and I went to one myself several times a few years ago) don't claim to move discs or vertebra. They acknowledge that they stretch and mobilize joint capsules and other connective tissues and muscles. They don't claim to change "alignment" except to the extent that they can by correcting uneven muscle tension, etc.

By the way, about scoliosis, there are several forms (I'm too tired to look it up now, this is from memory). Some may be amenable to manipulative treatment, but most are caused by birth defects that lead to abnormal growth of the spine, and are not something that chiropractors can help.

Andy, just read your posts, and have some interest in the disc thing, and although it's not chiro per se, this is the lounge, and it's related. What would you advise, or have seen advised for those with a herniated disc? I know the first step would be to go in and get it properly diagnosed. The reason I'm asking, is because I read Louie Simmons of Westside suffered from one, and used reverse hypers as part of his treatment, and atually designed a reverse hyper bench/machine for this purpose. Your thoughts?
Tim

Just to stir things a little. I had this saved, think I stole the reference from a Cressey article or newsletter.

http://www.ncbi.nlm.nih.gov/pubmed/8208267

"Study Title - Magnetic resonance imaging of the lumbar spine in people without back pain."

"RESULTS. Thirty-six percent of the 98 asymptomatic subjects had normal disks at all levels. With the results of the two readings averaged, 52 percent of the subjects had a bulge at at least one level, 27 percent had a protrusion, and 1 percent had an extrusion."

Interesting....Strange....and confusing.....

KPj