Archeologists have found a document with Richard III’s body confirming his last words were A chiropractor! A chiropractor! My kingdom for a chiropractor. Reply
I noticed you made the point “Interestingly, Steve Gilbert, National Lead Clinician for Chronic Pain in Scotland, mentioned that any treatment will help a patient where time and attention is enhanced by touch” Why are physio’s discouraged on the NHS from touching patients in the NHS, don’t the want them to get better? As a Chiropractor in Scotland I would suggest to any patient if you are asked to block book a program of treatment in advance, are given a myoscan (roll a sensor up your back and have lovely green and red bars off either side of a image of the spine), given X-rays with no history of trauma, serious pathology (malignancy) or anything else that would result in change to bone, it is nothing more than marketing. Nod politely and go elsewhere. There are good Chiropractors in Scotland who are good at getting you out of pain (and we dont only do manipulation or cracking the spine, but we do do some of that), Blue Wode is absolutely correct Holistic, Vitalistic, Optimal Health are buzz words (which have in my opinion have come across from the States with Chiropractors trained outside the UK system) for which patients should be rightly wary. The scary thing is there is a mission by the SCA to create a Vitalistic Chiropractic College in Scotland. I sincerely hope the model follows that of what the AECC and WIOC teach, the more Vitalistic Chiropractic Colleges in the USA have struggled to retain accreditation, where a a full wallet and a pulse get you an education. I think it only fair to point out that whilst it is easy to write Chiropractic only good evidence for acute and subacute Lower Back Pain, by inference slating how little evidence supports Chiropractic, a similar poor level of evidence exist for Physiotherapy for treatment of other areas of the body, Facet Joint injections have been shown to be less effective than manipulation, decompression surgery about the same as doing nothing if you take a 5-10 year prognosis. No private healthcare system is perfect especially when the clinician stands to have a financial advantage if he gives more care. Back surgery rates 5-10 times higher in the US than the UK. I know they are fatter does that make their back that much worse. Bottom line you pay your money and take your choice, but if you are not improving after 3-5 treatments for Acute or subacute pain (up to 7 weeks) its not helping, 7-8 treatments for chronic pain, ask about other treatment options or referral its a GCC requirement there is research to back this up but I cant find it right now. 1. Peterson CK, Leeman S, Lechmann M, et al. Symptomatic magnetic resonance imaging-confirmed lumbar disk herniation patients: a comparative effectiveness prospective observational study of 2 age- and sex-matched cohorts treated with either high-velocity, low-amplitude spinal manipulative therapy or imaging-guided lumbar nerve root injections. J Manipulative Physiol Ther 2013; 36(4): 218-225). Reply
E.P. wrote: “Why are physios discouraged on the NHS from touching patients in the NHS, don’t they want them to get better?” NHS physios do touch patients, but they don’t want to create patient dependency. IOW, they encourage self-help and coping tactics in their patients (usually by prescribing exercises). When they do use touch, in the form of manipulation, they are normally far more judicious in their use of it than chiropractors because their approach is mechanical rather than vitalistic. E.P. wrote: “As a Chiropractor in Scotland I would suggest to any patient if you are asked to block book a program of treatment in advance, are given a myoscan (roll a sensor up your back and have lovely green and red bars off either side of a image of the spine), given X-rays with no history of trauma…nod politely and go elsewhere.” How would a patient know to do that? The General Chiropractic Council does not publish advice to help patients know when they are being scammed. E.P. wrote: “There are good Chiropractors in Scotland who are good at getting you out of pain.” That may be so, but with no directory to which patients can refer to locate one, it’s currently a lucky dip. E.P. wrote: “Holistic, Vitalistic, Optimal Health are buzz words (which have in my opinion have come across from the States with Chiropractors trained outside the UK system) for which patients should be rightly wary.” With scarce, unambiguous information available about chiropractic, it’s likely that the vast majority of patients won’t know to be wary of these buzzwords. E.P. wrote: “The scary thing is there is a mission by the SCA to create a Vitalistic Chiropractic College in Scotland.” That’s not surprising when you consider that the current president of the SCA, Ross McDonald, was Chair and co-author of the dossier, ‘The Vertebral Subluxation Complex – The History, Science, Evolution and Current Quantum Thinking on a Chiropractic Tenet’: http://bcc.biblioteques.info/en/detall_simple.php?biblionumber=371 That dossier saw the GCC revise its guidance note on the Vertebral Subluxation Complex in 2010: http://www.zenosblog.com/wp-content/uploads/2010/11/AUKC_Oct_Newsletter.pdf Basically, where it had previously not allowed chiropractic ‘subluxations’ to be linked to ‘health concerns’, it did a U-turn and decided that they could be: https://skepticbarista.files.wordpress.com/2010/08/subluxrevltr1.jpg E.P. wrote: “Bottom line you pay your money and take your choice” With regard to chiropractic, that is rarely an informed choice. Reply
Sounds as though you need some recent research to help you belief in something like chiropractic! http://chiropracticresearch.ac.nz/publications/publications-2015/ Have a look at some of the great research that’s being done recently. In the past there has been a lack of decent research proving the benefits of chiropractic but now there is plenty. Reply
Yet the National Institute for Health and Care Excellence now no longer recommends chiropractic (or osteopathy) even for low back pain and sciatica… Reply
@ James White It is not a matter of ‘belief’, it’s about what the robust science tells us. The hodge-podge of studies that you cite are far from convincing. With regard to the one area of chiropractic that has shown to be of some use in the past (i.e. spinal manipulation for the relief of low back pain), it increasingly looks like it is a placebo. See here http://edzardernst.com/2015/08/chiropractic-spinal-manipulation-placebo/ and here http://www.ebm-first.com/chiropractic/research-and-efficacy.html Reply
So yet again Zeno economical with the truth. So the 2016 Nice Guidelines state “Consider manual therapy (spinal manipulation, mobilisation or soft tissue techniques such as massage) for managing low back pain with or without sciatica, but only as part of a treatment package including exercise, with or without psychological therapy”. Interesting the truth is they no longer recommend Chiropractic or Osteopathy, but has anyone noticed they don’t recommend Physiotherapists provide manual therapies either. What is more NICE states “Do not offer acupuncture for managing low back pain with or without sciatica”. And yet, “Physiotherapists are the largest group of medical professionals in the UK practising acupuncture. The vast majority of acupuncture treatments in the UK is for musculoskeletal (physiotherapy requiring) conditions”. https://www.aacp.org.uk/page/16/why-an-acupuncture-physiotherapist Is it just me that finds it somewhat odd how selective Zeno is being with the research he cites and the references he quotes, could there be some bias? In my humble opinion there appears to be some intellectual bullying or “shooting fish in a barrel” that in no way serves patients at all. If you have low back pain NICE’s omission of recommending named Statutorily Registered Professionals will mean a number of people will have a delayed diagnosis of potentially serious medical conditions which present as back pain. If you have back pain find a registered professional who is trained to assess and deal with the condition. Reply
Eugene wrote: “Interesting the truth is they [2016 NICE Guidelines] no longer recommend Chiropractic or Osteopathy, but has anyone noticed they don’t recommend Physiotherapists provide manual therapies either.” According to Neil O’Connell, an academic physiotherapist who was a member of the NICE Guideline Development Group, the evidence was assessed for interventions rather than professions. That said, the new guidelines should not be misinterpreted by chiropractors or osteopaths: QUOTE “It’s important to understand that the wording from the guideline above makes it clear that exercise is a mandatory part of a treatment package. Manual therapy and psychological therapy are optional add-ons but exercise is compulsory. That means that the treatment options are: exercise alone, exercise plus manual therapy, exercise plus psychological therapy, exercise plus manual therapy and psychological therapy. Using a treatment package that consists of manual therapy alone, psychological therapy alone or manual therapy plus psychological therapy does not comply with the guidance. It’s also important to understand that there is no requirement to provide a multimodal treatment package and in some cases exercise alone will be the most appropriate treatment. You certainly can’t “select just the bits you like” as exercise is not an optional component. Now let’s look at what the NICE guidelines say about exercise: “Consider a group exercise programme (biomechanical, aerobic, mind–body or a combination of approaches) within the NHS for people with a specific episode or flare-up of low back pain with or without sciatica. Take people’s specific needs, preferences and capabilities into account when choosing the type of exercise.” One important point from this guidance is that NICE recommends a “group exercise programme”. This presents something of a problem for pure manual therapists such as osteopaths and chiropractors as they don’t normally have access to a group exercise programme for their patients. I have already highlighted the fact that osteopathy and chiropractic are no longer first line treatment choices for low back pain and sciatica. NICE have made it clear in their own press release that exercise is the “first step in managing the condition”. The right person to deliver an exercise programme is of course a physiotherapist. Ultimately, the purpose behind these guidelines is to bring about improvement in care for patients. Views such as “Osteopathy or manual therapy continues to be the treatment of choice for low back pain with the proviso that it is provided with exercise” give an interesting insight into the goals of the osteopathic profession. This statement is far too obviously in conflict with the guidelines to be a mere “misunderstanding”. These kinds of statements appear to be more focused on promoting the businesses of the osteopaths. In so doing, osteopaths seem to have forgotten the most important thing of all: looking after the best interest of their patients. The new NICE guidelines are something of a problem for osteopaths and chiropractors as their treatments are no longer first line choices and they are not well placed to offer a suitable exercise programme. Some of them may opt to continue treating patients the way the always have and not take the NICE guidelines into account. However, that is a potentially risky strategy for two reasons: 1. It doesn’t seem to be in the best interest of their patients 2. They risk being found in breach of their “Practice Standards” which could result in formal complaints to either the GOsC or GCC. ” Reference: https://complementaryandalternative.wordpress.com/2016/12/06/nice-guidelines-for-low-back-pain-and-sciatica-a-clarification/ Eugene wrote: “What is more NICE states “Do not offer acupuncture for managing low back pain with or without sciatica”. And yet, “Physiotherapists are the largest group of medical professionals in the UK practising acupuncture. The vast majority of acupuncture treatments in the UK is for musculoskeletal (physiotherapy requiring) conditions”. I should imagine that physiotherapists will start to drop acupuncture for LBP and sciatica. Further, I understand that the membership of the UK Acupuncture Association of Chartered Physiotherapists is 6,000+ strong. As there are around 49,000 registered physiotherapists in the UK, that would mean that approximately 12 % practice acupuncture (which, of course, is 12% too many). However, according to the latest data on the scope of chiropractic practices in the UK, traditional chiropractic beliefs (chiropractic philosophy) were deemed important by 76% of the respondents, and 63% considered subluxation to be central to chiropractic intervention: http://www.ebm-first.com/chiropractic/uk-chiropractic-issues/1188-the-scope-of-chiropractic-practice-a-survey-of-chiropractors-in-the-uk.html Those figures indicate to me that physiotherapists are vastly more evidence-based than chiropractors (unless, of course, you have any better data). Further, let’s not forget that a new vitalistic chiropractic college is set to open in Scotland within the next two years: http://www.zenosblog.com/2016/02/the-scotland-college-of-chiropractic-out-of-kilter-with-science/ How does that reassure Scottish patients suffering from low back pain or sciatica? Eugene wrote: “Is it just me that finds it somewhat odd how selective Zeno is being with the research he cites and the references he quotes, could there be some bias? In my humble opinion there appears to be some intellectual bullying or “shooting fish in a barrel” that in no way serves patients at all. If you have low back pain NICE’s omission of recommending named Statutorily Registered Professionals will mean a number of people will have a delayed diagnosis of potentially serious medical conditions which present as back pain. If you have back pain find a registered professional who is trained to assess and deal with the condition.” Eugene, I think the above illustrates that it *is* just you who finds bias in Zeno’s comments. Reply