I had gone to a chiropractor several times and felt conflicted that the up to date research suggested it was a sham but that it felt, in my experience, to be quite relieving. It's unexpectedly affirming to see the research reconcile with my life experience. Thanks for keeping us up to date!
This has to be the worst review of medical literature ever. First: ONLY 2 TRIALS of chiropractic adjustment out of the all the articles they reviewed had statistical difference and they were split. One fore and one against. as for the over all review of chiropractic in the study of non traditional medicine. I am going to quote the article you are referencing, "The systematic review found no differences in pain relief at 1 week between spinal manipulation and treatments considered inactive (an educational booklet, detuned ultrasound, detuned or actual short-wave diathermy, antiedema gel, or bed rest)" Whats worse lets look at the ONE study that showed a benefit, "although 1 trial found an association between manipulation and greater pain relief at 3 months (mean difference, −1.20 [CI, 2.11 to −0.29]); no differences in function were seen at 1 week (2 trials) or 3 months (1 trial) (86). In addition, no differences were observed in pain relief between patients receiving spinal manipulation and those receiving interventions considered active (primarily exercise, physical therapy, and back school) at 1 week (3 trials: WMD, 0.06 on a 0- to 10-point scale [CI, −0.53 to 0.65]) through 1 year (1 trial: mean difference, 0.40 [CI, −0.08 to 0.88]), nor were any effects on function noted." Second: To the cost effectiveness of complementary and alternative medicine or CAM from the second study you listed I will let it speak for itself "After excluding inpatient expenditures, there was no difference in spine-specific or overall medical expenditures between CAM and non-CAM users." IT IS RIGHT THERE.
Why because you want to become addicted to that medication, or perhaps you love the side effects of putting those poisons in your body. Yeah, make perfect sense, mor on.
What they should do is tell you to tell your MD to recheck your medications. Sometimes Chiros can find a conflict of medications that the MD might of missed.
I do believe in Chiropractic care, however, this past year I went to one of the most crazy chiropractors ever. She believed that going to the chiropractor could cure everything from period pain to cancer. She also tried to convince me not to get vaccines and to stop taking my birth control and anti anxiety medication and also believed that babies should be getting chiropractic care as young as a week old. And icing on the cake, she wanted me to come in 3 times a week for 3 years. Luckily my insurance covered me for a year so i figured why not, but dang. I see why some doctors don't trust some chiropractors.
Pretty sure she was just crazy, she seemed very sincere and to really believe it herself, I think she was just wrongly educated. I needed to go for corrective work on my hips thanks to breaking my tailbone in a car crash and her place was the only one that offered a discount to students in my college and it was the only office near me, not having a car really limited my options. The point of my original comment was just that some chiropractors think that their work does more than it actually does and take it a bit too far.
Very fair, she helped me with what I needed, but I would definitely never go back and would never tell people to go to her. I don't really know the laws about where I live but it would be nice for there to be more regulation about what chiropractors can claim to do or not.
the baby manipulation is very scary as the bones are in little cartilage pieces for a few years. Occasionally there is help with an organ pain if you take pressure off the nerve that operates that organ, but usually it only needs to be tried once, and it doesn't usually work that great, but if it's going to, it will do so in one session (usually).
This sounds way to familiar im willing to bet that the brand of chiro you went to is called cbp or chiropractic bio physics. 3 times a week for 6 months
Chiropractors might be able to help with minor back issues, but their other claims are very off-putting. I had a friend who went to a chiropractor, not for spine issues, but to treat her upset stomach because she was told that it helped. It never did, but she justified that because they told her that she had a really bad case. (A really bad case of what?) I've personally been told that they can cure diabetes, ulcers, cancer, asthma, ADHD, autism, lupus, and period pain. The last one actually used tuning forks to diagnose people. My back surgeries have been extensive, and based on those tuning forks, they were all unnecessary. If you had seen all of the MRIs, you wouldn't hesitate at doing those surgeries, though. I can't imagine how much damage is being done by people like that.
Oh you picked a real kook to be treated by. A more careful selection of a legitimate chiro practitioner would have kept you away from those claims and tuning forks.
My chiropractor claimed to cure cancer. No, seriously. He did. Literally took credit for one of his patient’s cancer remission. He also had a poster telling the story of an 1800s chiropractor who cured deafness, and told me that vaccines were made out of aborted fetuses. As you might expect, they also caused autism. But that’s nothing compared to the crowning glory, “If God intended for us to need aspirin then he would have made aspirin trees.” At this point I trust chiropractors like I trust MLMs.
someone offended your brainwashed perspectives on what chiropractic is and isn't about. with no proof to the contrary you rejected their statements. it can be a chore to root out the truth from the garbage but it is better than continuing to suffer with health problems and keep seeing doctors who keep failing to identify the real cause or correct it.
I like the term "spinal manipulation" because it allows for a separation from the fantastical claims that chiropractic makes. Yes, we already know that the quack claims are false, we don't need to continue to prove that to ourselves. But I believe that spinal manipulation can be used to treat a limited number of conditions and rigorous scientific study is required to determine what those are and what degree of effectiveness they have compared to other methods to determine when it is an adequate alternative.
This has to be the worst review of medical literature ever. First: ONLY 2 TRIALS of chiropractic adjustment out of the all the articles they reviewed had statistical difference and they were split. One fore and one against. as for the over all review of chiropractic in the study of non traditional medicine. I am going to quote the article you are referencing, "The systematic review found no differences in pain relief at 1 week between spinal manipulation and treatments considered inactive (an educational booklet, detuned ultrasound, detuned or actual short-wave diathermy, antiedema gel, or bed rest)" Whats worse lets look at the ONE study that showed a benefit, "although 1 trial found an association between manipulation and greater pain relief at 3 months (mean difference, −1.20 [CI, 2.11 to −0.29]); no differences in function were seen at 1 week (2 trials) or 3 months (1 trial) (86). In addition, no differences were observed in pain relief between patients receiving spinal manipulation and those receiving interventions considered active (primarily exercise, physical therapy, and back school) at 1 week (3 trials: WMD, 0.06 on a 0- to 10-point scale [CI, −0.53 to 0.65]) through 1 year (1 trial: mean difference, 0.40 [CI, −0.08 to 0.88]), nor were any effects on function noted." Second: To the cost effectiveness of complementary and alternative medicine or CAM from the second study you listed I will let it speak for itself "After excluding inpatient expenditures, there was no difference in spine-specific or overall medical expenditures between CAM and non-CAM users." IT IS RIGHT THERE.
It's odd to hear physical therapy isn't a go to for lower back pain relief. I just assumed from my own experience that that was the standard first step in treatment.
gleep1984 In my experience a good PT has more expertise, is more likely to help, and less likely to have bizarre pseudoscientific beliefs than the average chiro.
Are you Canadian? I know that here in Canada physiotherapy is well integrated with the medical system. Otherwise I dunno, perhaps it's different across State lines as well.
gleep1984 State licensed physical therapists go through the same first year as future medical students in my country. I started working with them in my first internship in ortho surgery patients in second year. It might be a US thing.
I used to go to a chiropractor for neck pain and because he also employed massage therapists. It was great for the neck pain, but it was annoying when he claimed he could fix other things for me like my sinusitis and a heart condition by cracking my spine. . .
My chiropractor lowered my HBP over the course of a couple months of adjustments. Think about the anatomy. Behind the lower cervicals and upper thoracic you have the stellate ganglion. If an adjustment could fix the positioning of the bones to reduce pressure in the intervertebral foramina to this ganglia, wouldn't it be less activated due to less inflammatory pressure around it? Inflammation basically occludes the IVF, making the nerve potentiall hypo or hyperactive. Who is to say the same can't be held true for the nerves associated with the heart lower in the thoracic spine (though I'd agree it would be interesting to see how an adjustment would help CN X).
I have very bad sinus problems. Do not know how a chiropractor would fix it. But a hot stone massage on your face (sinus area) is really helpful. The relief only lasts a day or two. It is expensive so I only get them occasionally usually when the decongestants are not working well and I want a break.
To be fair, chiropractic helped my sinuses actually. Helped my chronic nausea too which really threw me for a loop! There will always be quacks but sometimes it can surprise you! It took me 6 chiropractors to find one who could help, but when I did it was a miracle.
Apparently a lot of places are not required to have medical licenses before becoming a chiropractor. In my state it is required to be a doctor before you can be a chiropractor. They just go through a chiropractic Fellowship. However I have seen misguided approaches to Chiropractic seems but I believe many of it is based off of an autopsy of winds door back in 1927 he autopsy a ton of people and showed how Chiropractic Health increase the health of many organs and other things in the body. The Windsor Autopsies | Chiropractic | Organ (Anatomy) Chiropractic work can help a lot of things don't get me wrong however I don't think they're necessarily a cure but a complementary medicine that we should try first to see if it can allow the body to fix itself or if we need to progress to Medicine.
@@kateajurors8640 This has to be the worst review of medical literature ever. First: ONLY 2 TRIALS of chiropractic adjustment out of the all the articles they reviewed had statistical difference and they were split. One fore and one against. as for the over all review of chiropractic in the study of non traditional medicine. I am going to quote the article you are referencing, "The systematic review found no differences in pain relief at 1 week between spinal manipulation and treatments considered inactive (an educational booklet, detuned ultrasound, detuned or actual short-wave diathermy, antiedema gel, or bed rest)" Whats worse lets look at the ONE study that showed a benefit, "although 1 trial found an association between manipulation and greater pain relief at 3 months (mean difference, −1.20 [CI, 2.11 to −0.29]); no differences in function were seen at 1 week (2 trials) or 3 months (1 trial) (86). In addition, no differences were observed in pain relief between patients receiving spinal manipulation and those receiving interventions considered active (primarily exercise, physical therapy, and back school) at 1 week (3 trials: WMD, 0.06 on a 0- to 10-point scale [CI, −0.53 to 0.65]) through 1 year (1 trial: mean difference, 0.40 [CI, −0.08 to 0.88]), nor were any effects on function noted." Second: To the cost effectiveness of complementary and alternative medicine or CAM from the second study you listed I will let it speak for itself "After excluding inpatient expenditures, there was no difference in spine-specific or overall medical expenditures between CAM and non-CAM users." IT IS RIGHT THERE.
This video likely isn’t up to date anymore, but it’s exactly what I was looking for. I’ve long wondered about chiropractic care as a whole so learning that it’s shown to work in at least one specific situation answers a lot of my questions. It’s hard to do this kind of digging on my own because studies are often very difficult to understand for non researchers.
I'm pretty alarmed at the inclusion of acupuncture and other things in that list of recommendations, without any additional evidence for it specifically (that you cited at least). There's a huge body of evidence showing that it is just placebo, and its inclusion in this list should be a huge red flag. Glossing over that seems like a giant oversight for such a usually well reasoned and researched show.
James Jurack The video said "first line therapy", so here's the thing...obviously if someone has a broken arm you won't send them to get acupuncture right? But if it's a minor lower back problem, you don't want the patient to just sit at home on opioids either. So why not give one of the non invasive treatment a try? If the patient believes it works and that person feels better then what difference does it make if it's a placebo or not?
SNBoomer although he didn't state it explicitly, I would assume the sort of systematic reviews cited in the video for spinal manipulation actually found results better than placebo. Otherwise why recommend expensive, potentially risky procedures over just sugar pill?
I'd like to add that while I'm very upset at the ACP for shoddy work on their new recommendation, I'm only mildly annoyed at HCT for not including a better disclaimer about the other things in ACT's list. The overall conclusion of the video is still good.
@SNBoomer I'm not sure sticking needles into the skin is sufficiently "non-invasive" to include it in a list of non-invasive procedures. There's a genuine risk of infection that none of the other treatments have. OTOH you could get "placebo" acupuncture which is basically just poking with toothpicks (no penetration of the skin) which appears to be just as effective in trials; (BMJ 2009;338:a3115) (Arch Intern Med. 2009;169(9):858-866)
Good on you Dr. Carroll for acknowledging your own biases and updating your views and practice to reflect new evidence. Sometimes that can be hard to do (especially the acknowledging you were wrong bit).
I've always wondered why people got so bent out of shape about chiropractors. I went to one for six months to help straighten out my spine, and it helped immensely. No more back pain, no more walking funny because my back looked like a convulsing snake. Chiropractors can be great, just make sure they're not wooo ones.
So much of the talk about chiropractic treatment mentions only spinal manipulation. As a 30 year practicing chiropractor I, and many others, have learned that spinal manipulation is often a small part of our treatment of low back pain. Spending the time investigating why the patient has back pain is almost always more important than the treatment. Giving advice as to how to keep from having issues in the future is a major focus. Does the patient sleep on their stomachs, do they bend and twist when they could squat, do they sit with their knees below or above their greater trochanters, etc.? We agree most back pain is limited to a few weeks. Yes, spinal manipulation may help the patient heal a bit faster with a bit less pain but the real success will be if they take my (our) advice as to how to change why they have the pain in the first place and perform the stretches/exercises we give them. Thank you for a fair evaluation of what we are known for--but a truly effective chiropractor does much more than spinal manipulation.
Thank you so much for the update on this. I have been so conflicted about my chiropractic care given the studies I assumed my improvement of symptoms of back pain from chiropractic care were a placebo and really struggles with my decision to continue with the few chiropractor appointments I have through out the year... but at the same time I do find that they helped very much with my back pain symptoms. I feel I have a good quality professional and I only expect him to treat my back pain.
This has to be the worst review of medical literature ever. First: ONLY 2 TRIALS of chiropractic adjustment out of the all the articles they reviewed had statistical difference and they were split. One fore and one against. as for the over all review of chiropractic in the study of non traditional medicine. I am going to quote the article you are referencing, "The systematic review found no differences in pain relief at 1 week between spinal manipulation and treatments considered inactive (an educational booklet, detuned ultrasound, detuned or actual short-wave diathermy, antiedema gel, or bed rest)" Whats worse lets look at the ONE study that showed a benefit, "although 1 trial found an association between manipulation and greater pain relief at 3 months (mean difference, −1.20 [CI, 2.11 to −0.29]); no differences in function were seen at 1 week (2 trials) or 3 months (1 trial) (86). In addition, no differences were observed in pain relief between patients receiving spinal manipulation and those receiving interventions considered active (primarily exercise, physical therapy, and back school) at 1 week (3 trials: WMD, 0.06 on a 0- to 10-point scale [CI, −0.53 to 0.65]) through 1 year (1 trial: mean difference, 0.40 [CI, −0.08 to 0.88]), nor were any effects on function noted." Second: To the cost effectiveness of complementary and alternative medicine or CAM from the second study you listed I will let it speak for itself "After excluding inpatient expenditures, there was no difference in spine-specific or overall medical expenditures between CAM and non-CAM users." IT IS RIGHT THERE.
Great video. And happy to be contributing to the ongoing investigation of the sound origin. It works for many, but not all. We have to continue to understand who is the best fit for manipulation.
Reassurance and advice to resume activity as able should be sufficient for most cases of acute low back pain. Non pharma at home strategies such as local cold or heat are low risk options. OTC NSAIDS if needed for limited time. 10point pain relief on 100 point scale hardly worth the trip and cost!
Honestly, if you want your back cracked see a physio, not a chiro. Every single physio I've ever been to has been significantly more comprehensive regarding determining the causes of the issue, treating it and providing advice on follow-up symptom relief that can be done at home without further appointments. A physio can do all of the same manipulations a chiro can, and they're usually about the same price.
They are a lot more expensive where I live, but that is because THEY HAVE DEGREES IN PHYSIOTHERAPY. I'd rather someone qualified MANIPULATE MY SPINE. This is so clear... so so clear...
As someone who suffers from a small scoliosis, I've always been referred to an NHS physiotherapist when pain flares, but it's never a permanent solution, so I'm open to anything that may help
I had a discussion with my brother, because he didn't belives on quiropractic care, but thaks for showing this evidence, I'm a quiropractor, greetings from Mexico, you've got a new subscriber
Do you think most physicians know that physical therapists have doctorates? Also chiropractors and physical therapists have different methodologies and typically don't get along.
@@therabbithat BS the Chiropractor's education is the same as the MD's minus pharmacology. The colleges are accredited and in fact the DC get more anatomy than MD's. PT's with a doctorate are not Physicians and never will be. Get your inof straight before you just try to BS people here
As a chiropractor I'm happy to see him post a video about chiropractic care. However he is not aware that chiropractors are physicians. Our scope of practice is includes writing prescriptions for MRIs, CT Scans, blood work and any other test that helps us diagnose our patients. Also almost every insurance company not only pays for our treatment. They pay us well. That's because of how effective the treatment usually is. We pay the lowest malpractice rates when compared to any other specialist. Also has this man noticed chiropractors are seemingly on every other street? Our rate of growth is well above average. Not sure if he has good intentions or bad. If he didn't know were physicians that not only can prescribe an MRI. We're trained extensively on reading them as well as CT Scan and radiographs. Lastly, every discipline has poor or bad physicians but having to pay significantly less for malpractice insurance when compared to other specialists should show we are not hurting our patients. He should add a video on the effectiveness of treating just symptoms with medication. Pain..here's a pill. Swelling here's a pill. High blood pressure here's a pill . We have some wonderful medications. I'm talking treatment of just symptoms. That alone is why this country has so many unhealthy people. Continuing following big pharma seems to be his final thoughts. Very sad videos like this are allowed on RUclips. So many facts wrong. Lastly, he should watch the docu- series Dope Sick and see how pain medication worked out for the country. He's so lost inside bad information.
I've used the same chiropractor for 15 years, and he's been of great help every time I've hurt myself. I see him maybe once every 4-5 years or so, and each time he just puts everything back where it's supposed to be, gives me some tips on better posture, and how to avoid doing whatever I did to myself to cause me to need to go see him in the first place. Definitely an effective alternative to popping pills.
As a new DO med student, I'm excited to hear that OMT/manipulations are becoming more commonplace and accepted by the medical community. I expect studies supporting manipulative therapies to become more abundant as Osteopaths become more prevalent in the public.
The public doesn't understand what you guys are. You prescribe drugs, therefore you are a doctor. They call you medical doctors even though you're doctors of osteopathic medicine. Further, DOs tell patients often they do 'both' or 'let's do some chiropractic' and end up hurting the patient and the patient goes out and starts bad mouthing chiropractic when the patient never saw one to begin with- they saw a DO who is a jack of all trades and master of none. Your profession sold out to allopathy and big pharma decades ago. Embrace your sold out profession
There've actually been a ton of cities into the placebo effects of alternative or holistic medicines. However the issue comes into effect as with acupuncture how do they make a control or do a placebo version of acupuncture. People know if they're being stuck with a needle or not or getting deep massage therapy. And that's usually the issue many of these studies run into they're also usually very small studies hosted by colleges and people that are getting ready to graduate their PHD or master's program. So a few hundred people each time but there are a whole bunch of small little studies about this topic primarily focusing on acupuncture Chiropractic measures that aren't quite proven. They tend to also focus on some studies with reflexology and seeing how much of a placebo it has with the reflexology what they did is they told people that certain areas were certain things but mixed up the areas to see if people were still feeling a positive effect with a different area being treated through reflexology. Kind of the same as like if you told someone that poking needles in their left foot would help their heart when you know it's scientifically known poking needles in the right foot help the heart. By the way that needle thing was a total made up fabrication. Just an example to see how people relate even similar Placebo effects. I think doctors or certain practitioner should be allowed to use Placebo effects to heal people. Why people don't realize how powerful their own mind is and if we could tap into the placebo effect imagine how little medicine we would actually need. Like as a country we would need a lot less medicine. then again there's convincing people that they're getting treatment. so that have to take some kind of pill
This sounds like a throughly unreseached opinion. There are all sorts of “alternative” medicines and things like crystal healing shouldn’t be lumped in acupuncture, which has a lot of evidence to be highly effective with some conditions.
My father slipped a disk in his lower back in 1982. After five days of terrible pain, he opted for surgery, which solved the problem. BUT for his recovery, he was sent to a Chiropractor. There was no manipulation, but rather he was given exercises to help his lower back recover. This was the only instance I know of where a chiropractor gave the kind of treatment that was actually helpful.
Glad to hear it. I've experienced both sides with chiropractic care. Several years ago I injured my back lifting weights and the pain got worse and worse over a few months until I went to a chiropractor. I had two adjustments a week for 6 weeks, seeing a lot of improvement between each visit. At the end my back only hurt when my posture was bad all day, or when I twisted or lifted something in a bad way. But I've also had other experiences where repeated visits didn't improve my symptoms at all (notably with different chiropractors). I think it varies a lot from chiropractor to chiropractic, but it also depends on what is actually wrong with your back.
Hi Dr. Carroll, I don’t think you made a clear enough distinction between upper and lower back, stroke risk, and what exactly is legitimate. Maybe try to break it down more in a future video
Thanks for this video Dr. Carroll! As a chiropractor I can understand the hesitation of the medical community to get behind spinal manipulation because it has not been as well studied up to recently as well as some ugly history (that I won't get into) between MDs and DCs. I also understand why doctors and patients are skeptical of chiropractors that claim they can deliver the moon to their patients with only very low quality or no evidence to back it up. This of course is not best practice and I think lies in deficiencies in chiropractic education. It is widely known among the profession that there is a deep split between those chiropractors with a philosophical approach and those with an evidence based approach. The choice of school a student makes will make a huge difference as to where along this spectrum a chiropractor will fall, which is a failing of the profession. This is the complete opposite of medical and osteopathic schools where education looks about the same no matter where you end up. As a side note, more chiropractic schools should be more rigorous in their admission of students, including requiring a science background, completed bachelor's degree and graduate school entrance exam testing. We will never be taken seriously until the profession as a whole can slough off the old straight philosophical chiropractic model. As much as do not want to put down my colleagues this old model is unproven and unhelpful towards the greater picture of patient-centered, multi-disciplinary healthcare. I believe that we will see an even deeper split in the profession if this is not corrected, there will be straight philosophy based chiropractors and science based chiropractic physicians. There are thousands of good chiropractors that believe in and practice evidence-based chiropractic care that can partner with MDs to treat back pain, instead of relying on addictive opioids or ulcer causing NSAIDs. Patients seem to be trending towards a holistic approach to health, putting emphasis on nutrition, non invasive treatments and drug free therapies, and many insurance companies have chiropractic care as an option in their plans, even Medicare nationwide and Medicaid in some states. Gone are the days of the solo practitioner, integrated healthcare is definitely the future. This is an awesome opportunity to cross the divide and have MDs, DOs, DCs, LAcs, LMT, and PTs work together towards what is best for the patient.
Thanks Mike! I appreciate the compliment. I've always tried to see both sides of an issue even when I may disagree with the other side. How else can we grow and learn? I'm a solo practitioner in Philadelphia, trying to help patients and build a few bridges.
A osteopath helpped me once i almost tore my foot off, after the doctors set it, weeks later my foot was still purple so she somehow see unpinched my blood vessels.
Seeing John Green as the producer here makes me sad. Did he even read the study. The conclusion said that they were not sure how much the placebo effect had on those results.
I love my chiropractor. I find my posture improves and I find tremendous relief of back pain, both lower and mid back. Combined with excercises to strengthen my back to both strengthen a muscle damaged in an accident years ago and to generally improve my posture I've seen tremendous improvement.
I have never met a chiropractor that was a quack and claimed he could do anything outside the skeletal/nervous/ muscular systems. Perhaps it is because in Canada we require they have they have standardised testing and government regulated licensing? It really is too bad to hear there are some making wild claims like that. I personally have had a good experience with chiropractors for sciatic nerve pain and once when I stretched my arms wrong and messed up my entire right shoulder blade area. I had been icing my shoulder and taking an ibuprofen + methocarbamol combo for a week and it didn't help so much but I tell you when the chiropractor did her thing it was sweet sweet relief. I walked out of there feeling giddy and the swelling finally subsided over two days. BUT do take this with a grain of salt, it worked for me but might not work for you, it is an anecdote after all. The only thing Chiropractors ever talked to me about was having good posture and that my backpack was too heavy. The episode did feel a tad short today, seemingly glossing a lot of content and specifications. I'll read the Upshot article perhaps it's more through.
Chiropractic itself emerged as a pseudoscience and still is. Check this out: bigthink.com/surprising-science/chiropractic-pseudoscience?rebelltitem=1#rebelltitem1
you are lucky, a quick glance around youtube will show that there are a lot of quack chiros,especially in america.Even the ones that stick to the musculoskeletal system are quacks,theres no rationale for their treatments or diagnosis.The vast majority of lower back pain resolves with no treatment so that is what is happenening when you go to a chiro for adjustment,the treatment had no effect..From what ive seen and I trained in physiotherapy many yrs ago but work as a physician assistant now, quacks are the rule rather than the exception in chiros.
It isn't 10%, it is a rating of 10 on a 100 point scale. This "rating" is a number people give and is subjective. Saying 10% implies some non-subjective measurement that can be put into a formula. This really can't be as it is a number people give for how they feel. That being said, sure it sounds small but as Maddy said, you need a comparison group.
In chronic low back pain treatment, open-label placebo scores an improvement of 1.5 on a scale of 10. This is a better result than the physical treatments given by these pseudo-doctors. Yes, both are the result of the brain's reward mechanisms, but that doesn't condone the risks attached to the manipulation of such a critical structure as is the spine.
Have you done an episode on upper spine chiropractic care? I used to go to a guy but stopped because of a lack of noticeable results and spurious claims of what it could do.
Alan Gebhardt There is absolutely no evidence that manipulation to the cervical spine has any benefits for pain, or any other issue for that matter, and it even comes with risks (stroke, fracture). if you have any type of back pain, go to a physical therapist, not a chiropractor. PTs practice evidence-based treatments, most chiropractors do not.
depending on which segmental region of the spine you are looking at, there are around a dozen joints on one vertebrae. these joints can become misaligned for various reasons and cause a change in tissue behavior or non optimal nerve function etc. if a muscle isn't receiving it's proper impulse from the nerves which innervate it, it won't have optimal function. manipulation or corrective tissue work can realign the segments and return optimal function, same to be said with all innervations.
I've got a bulging disk in my neck, and I was in agony for about 3 months. Physical therapy (including traction and electronic stimulation) did wonders for it!!!! I don't recommend a chiropractor for though, because when I went to a chiropractor, it seemed like he did more harm than good.
I love how this channel broadens my medical knowledge. I wouldn't have considered spinal manipulation until very recently. Good to hear more about it though
a 10 point drop on a 100 point scale is still better than most medical interventions will fewer, if any side effects. so... yeah it is a little worth it.
Actually it is a very good video of an MD that changed his mind by looking at the available evidence. Today in the U.S. lower back pain is the number one reason to be prescribed an opioid for non cancer pain, it is the most disabling disease in the US (and the fastest growing disabling condition according to the social security administration) and according to the AMA in an article in December it is the third most expensive condition to treat in the US behind diabetes and heart disease (these costs are attributed to advanced imaging and referral to specialists like pain management and orthopedic surgeons). We have got to change how we treat this common problem. The current way of prescribing NSAID and pain killers has not helped and the condition is getting worse.
The problem is that nearly half of the chiropractic community are christian fundamentalists that think Chiropractic gives you the healing powers of Jesus. My father spent his entire life battling these quacks, sitting on the national board of Chiropractic, helping set rational standards for the profession. I'm really glad to hear his work was not in vain.
Yoru, what should we do then? Not treat anything? Sometimes things don't work. Sometimes they do. So many variables to account for in studies. But at least we are trying to research practices that may offer help but if they don't, the side effects are low or relatively harmless. We all wish we had better options for everything, many times we don't though
I went for 6 months twice a week and my symptoms worsened. I dropped 40 lbs and continued to hit the gym and focused on physical therapy, yoga, and mobility at home. My symptoms worsened. I got a cervical spine steroid injection that offered no relief and followed up with an epidural that offered some relief for about 5 days. They want to remove a rib and several muscles and do an Arthroscopy surgery in the joint space to clean up scar tissue. I asked for another month of supervised physical therapy on top of hitting the gym. I have 5 days until I go back to the surgeon to decide if I am making positive progress. All of the specialists are recommending surgery at this point. It's looking more and more like that is going to happen. I will be referred to Felix H. "Buddy" Savoie III at Tulane Medical to look over everything before getting a final recommendation.
Placebos work very well with pain. Raise your hand if you didn't already know that. My mother was told by doctors she wouldn't walk again without spinal surgery, thanks to an injury caused to her by a chiropractor, who said she had scoliosis. She walked into the chriopractor with minor lower back pain. She wasn't able to walk out. When a doctor and later physical therapist looked at the x-rays the chiropractor had drawn on, they said the markings she had made were nonsensical, and that there was no way my mother had scoliosis. Don't let unqualified people near your spine. Physical therapists (=phisiotherapists) know what they are doing. Chiropractors are not qualified, it's guess work.They don't have to do proper courses, they believe everyone has scoliosis because they don't know what scoliosis means. They might help you, like a massage therapist can help you, but they do not know how or why. In the end my mom recovered, thanks to physiotherapy. Physiotherapists have at least 4 years of university education in Europe, and many more in the US. Chiropractors and osteopaths do not have any similar qualifications. To throw all spinal manipulation in together is ridiculous, not every person who manhandles your spine for a living has any idea what they are doing.
Dear rabbitthat,I would like to clarify a few things, your assumptions are in fact incorrect, physios have 3 years training in the UK and Europe,Whereas Osteopaths and Chiros have 4 or 5 years training with a minimum of 1200 clinical hours before qualifying after rigorous clinical competency examinations.I am an Osteopath, with a Masters degree, and also have a physiotherapy degree.Now there are many overlaps between the professions,however,the philosophies and treatment approaches are completely different.Now I do not disregard Chiropractors but in my experience very rarely does manipulation resolve a MSK issue by itself, Osteopaths implore a large variety of gentle techniques ,like articulation , muscle energy technique,soft tissue massage and stretches amongst many more etc.,manipulating joints solely can't physiologically change muscle mechanics and improve posture,therefore an entire holistic approach needs to be incorporated looking at all the biomechanics,whilst taking into consideration predisposing and maintaining factors, if those aren't adressed, its a waste of money; patients need an exercise or rehab program to create long term change,not only does it improve their postures etc. but hands some responsibility back to the patient, and their exercise compliance is vital for medium and long term rehabilitation .Next time try an osteopath the treatment approach is definitely a lot more hands on and gentle,then you can make an informed comment.
interesting, but I do still worry as chiropractor isn't a protected title (in the UK), so results could be very variable. As the training isn't standardised like it is for physiotherapists. Physio, and heat would still be my gut first recommendations for my patients, but this does open up options for further treatment.
So would another way to evaluate the data be that we still don’t have an effective treatment for low back pain? The data may provide some guidance on new studies but none of this sounds all that impressive. Have there been any studies on how a long term strength training program improves back pain? Is there a specific type of spinal manipulation that is more effective according to the studies?
I prefer OMM practicing DOs. They're board certified doctors, and don't claim OMM can cure your cancer. My experience there was identical to my experience with my physical therapist (they just use different jargon to explain the same concept). I'll stay as far away from chiropractors as possible.
Chiropractors are also board certified doctors. They are experts in spinal manipulation and also use physical therapy as well. I’m sorry that you had a bad experience with a chiropractor previously, but like with any doctor, if you don’t like that one try another. You wouldn’t just give up on all MD’s from not liking one, you would find a different one. I hope you can give it another chance.
@@imGerry123456 I'm not sure where you are located but in the United states it is required for chiropractors to be board certified in order to get licensed.
Lots of people bashing anecdotal stories in the comments here, but I'mma go ahead anyways. I've been seeing a chiropractor since my teenage years for back pain, mostly caused by sitting at the computer too much. I've seen a few different ones, and there are absolutely chiropractors that do it better, and chiropractors that are quacks, and chiropractors that just suck. My absolute favorite is Dr. Mark Akers in Golden, Colorado, as he is also trained as a kinesiologist and has helped me with minor tissue manipulation as well, such as moving my stomach out of my diaphragm when I was experiencing depression accompanied by an upset stomach. However, Dr. Akers never gave me much advice for how to keep my body from needing chiropractic adjustment. Separately, I also saw Pelvic Therapy Specialists in Boulder, Colorado to treat dyspareunia or painful sexual intercourse, and they also worked within my spine and hips to provide lower back pain relief and relaxation. Unlike Dr. Akers, the PTs gave me a lot of exercises to do to help keep my lower spine and hips in better shape, and relieve the tightness that causes much of the pain. Of course, it doesn't matter what your medical issue is, having a doctor that understands your issue and also understands the treatment is the key, from family doctors to chiropractors to physical therapists. Be a thoughtful doctor shopper! Best to anyone with back pain, Kayla
Sure, and if chiropractors would just focus on the lumbar spine for LBP, that _might_ be okay. But they tend to insist on treating patients "holistically", which means they'll probably treat the cervical spine anyway--sometimes even when the patient tells them repeatedly not to.
Well done. Patients have been finding relief with spinal manipulation for decades. Thanks for thinking outside the the box. You're right though, there are lots of practitioners who make overblown claims about the applications of spinal manipulation.
Yeah, as a OMS 3, Osteopathic Manipulation is essentially massage/physical therapy with some extra techniques added in. Specific techniques can be very effective (subjectively) for specific things, generally musculoskeletal problems. Most DO students remain skeptical about it's application beyond MSK problems, so don't adopt it as a panacea.
Was gravity valuable before or after science proved it worked? If science proves gravity does not work can we still use it? Is it wrong to believe in gravity if we don’t have science to back it up?
1) There are clinical prediction rules for the use of spinal mobilization that physical therapists use, I cannot say if DC's do or not. This helps us to determine when it's truly safe to apply a Grade V joint mobilization or if it's contraindicated. 2) Most Physical Therapists (DPT) and Chiropractors (DC) ARE doctors. Correct, we are not medical doctors, but, we are doctors nonetheless. Physicians must start to honor and respect that title the same as you would honor a PhD, DDS, etc. We won't typically refer to ourselves or introduce ourselves as doctors, but to say we aren't is a difficult thing to hear. 3) PT and Chiro was talked about together, or at least I interpreted that way. To be clear, Physical Therapists do not believe spinal manipulation helps anything systemic or non-mechanical. We also believe that you must reinforce spinal mobilization with corrective exercises to make a joint mobilization truly effective. Bones don't move unless muscles move them. Fix the muscle imbalance and you often fix the problem. Give the patient a home exercise program and show them how to treat symptoms so their back pain is self managed just like you know to take OTC meds for the common cold. That's how you save the healthcare system money. Patient education. 4) Expensive? You should do your next video on the money that PT saves the healthcare system. Most insurance plans cover PT. The copays can be ridiculous, I won't disagree with that. We are billed as a specialist copay. Well, you see a specialist once every now and then but usually you're in PT 3x/week. Tough for the middle class to get the care they deserve with copays like that. I hope policy reform can help to reduce PT copays.
I'd go to a chiropractor if I could, but just for the relief/relaxation it can offer, rather than as any sort of physiological treatment. If I had a chronic issue, I'd look to see if there was a lifestyle change or physical training I could undergo to before anything more drastic. My job left me with standard back stiffness/soreness, so I looked up some professional training advice and worked out the right parts of my body instead of going to my doctor and getting any prescription.
yourfullofsheite Yes. But there are many modalities used in both physical therapy and in chiropractic. Lots of overlap. In general, spinal manipulation is great, and spinal manipulation with exercise is even better. But it all depends on how the patient presents.
a well done manual assessment and treatment would fix up a lot of pressure and reactive muscles in a quick time. Rarely does a well done treatment need to be repeated unless scar has dragged the tissues back to the old place.
Chiro needs to know its roll and focus on chief complaint. Acute LBP should not involve a cervical manipulation. Risks and Benefits and Consent need to be verbalize before adjustment. DDx needs to also be considered BEFORE treatment (seen too many UTIs with CC of back pain after many Chiro visits).
Drs in the the hospital cant fix my scoliosis... They recommended me to do surgery, wear the super uncomfortable brace or wait until i gt older, so that it would straightened out itself... I waited for 11 yrs all i gt was daily headaches, nausea, stiffness and short of breathe.... For someone who feels shes doom, chiro has helped me..
most get better with or without chiro,by placebo,regression to the mean or spontaneous healing.If chiro helps its by exercise therapy or plain recognised physio treatments.Its the bogus diagnoses,irrelevant xray findings and manipulations that real doctors have trouble with.
I'm glad more and more research is pointing to the benefits of drugfree care for back pain. I hope in the future people will seek an MD to determine there is no red flags and safety of care for low back pain. They seek the chiropractor for proper alignment of their spine and joints and they seek the physiotherapist for their muscles and soft tissue related disorders. Hopefully this competition between professions can end and each profession can work in harmony with the other for the benefit of the patient.
It just depends on your Chriopractor I take physical therapy thank god my wife is a physical therapist she said going 2 times a year is ok but not all the time that’s when you get injured well for some people who are delicate I’ve gone to two times a year plus therapy for my bulging disk and sciatica
are we talking about slowly reshaping the spine or forcibly realigning the spine by pushing on it "the right way"? Every part of the spine is meant to shield the delicate command center of your body within. Forcing it to move unnaturally... how is that a good idea in the slightest? Doesn't that tear up stuff between the segments that is there to cushion the spinal cord as much as possible while retaining some flexibility?
I think its also very important to look at the literature into physical exercise for chronic non-specific low back pain (which is also recommended by the American College of Physicians). A core concept of modern physiotherapy is to empower individuals to be physically active and not reliant on passive treatment modalities, such as manipulations, massage or acupuncture. I fear that this article and the recommendations discussed will only further encourage passive treatment approach which leaves patients feeling they are fragile and will fall apart if they don't get their weekly "alignment".
well, an accurate assessment of joint motion and muscle tone with hands-on treatment for same is more specific than exercise. Exercise can be inhibited if the muscles are refusing to go into a painful range, so these perk up when you correct the joint motion. THEN exercise works so much better. it's not either/or.
But are you using hands-on muscle and joint palpation as a form assessment or treatment? I have no issues with palpation assessment or with some use of passive treatment modalities, particularly in the acute stages. I'm just suggesting that the current literature would indicate that exclusive use of passive treatment modalities, such as spinal manipulations, is not recommended.
I only saw a chiropractor once. They fixed my sciatica. Would i ever go for any other reason? No. Upkeep? No. My mom needed a level 4 spinal fusion surgery. She saw a chiropractor once. He did a few manipulations and did some traction exercises and told her to see a neurologist because she needed spinal fusion, he was right. Has she been back for any other purpose? Nope. Just that one time. There is a time & place for chiropractic, but is it as needed as people make it out to be? Probably not. Is it a cure all? Also nope.
I will say timing is everything. Three weeks ago doing intervals on my bike I did something to my lower back. The pain was so intense I nearly blacked out got a regimen of steroids from my PCP -- helped. Saw him said it was inflammation gave me some exercises but it is S L O W heal. I am going to send him this, thank you. Hope he is not above internet evidence based videos.
Nothing stated here is new. Chiropractors, physiotherapists, massage therapists, acupuncture, tai chi, herbal tea, reiki, smooth jazz. Choose whatever treatment you like. 90% of lower back pain resolves by itself, regardless of which ineffective treatment you use. Saying that spinal manipulation is as effective as other ineffective therapies is not saying anything. I'm disappointed in this offering from healthcare triage.
physiotherapists do not belong in that list. They study at university for an absolute minimum of 4 years (depending on the country) and do evidence based exercises and give people evidence based advice for home exercises they can do to relieve their pain. None of the other stuff has any basis in science or anatomy.
Another alternative form of treatment for lower back pain which you don't mention is Yoga. I have suffered with lower back pain on and off for several years. I really did not have much success with chiro so went on to Ortho doc, PT, R/F ablation, etc..... along my path. Now learning from a Yoga specialist who focuses on lower back pain. No big breakthrough yet, but it is really not all that different from PT , and pretty cost effective. Aaron, love hearing you on Sirius XM when you are on!! -T
I would be interested to have seen more mentioned of osteopathic physicians (D.O.'s) who practice OMM/OMT. Many don't know that this treatment is available. EDIT: osteopaths are not osteopathic physicians. I edited this for clarification.
Ryan Stevens It's my understanding that the vast majority of DOs do not use OMT in the field. I've worked with a dozen DO ER docs and none of them use it.
I've studied this - many of it shares similarities with chiropractors. They both branched from the same ideas back in the late 1880s or so. The difference is, with the D.O.'s interconnection with the AMA in the mid 20th century they more or less stopped emphasizing on OMT. Thus it never really developed. Chiropractic, on the other hand, continues to research new forms of manipulation, and is perhaps more advanced in performing it. If not only to help with the problem, new forms of manipulation focus more on doctor and patient care. Gone are the days of potentially harmful cervical rotations which can cause adventitious tear of the vertebrobasilar artery - new manipulation protocol doesn't twist the head around its crazy path behind C1 (and takes into consideration a posterior ponticus should the patient have one). While a manipulation from an OMT and chiropractor might objectively have the same result, the latter is used more commonly now and thus has a higher level of care behind it. After all, it's an optional part of D.O. training in some schools, and only briefly touched on at that. It's the entire focus of a D.C.'s 4 year degree.
here, the chiro school still teaches the rotatary manips. Not a degree either. More than half their focus is marketing and human resources and accounting, poor anatomical reasoning. Any manipulations I have had from a DO were super accurate and wonderful.
The money issue aside because I feel this is a problem with the medical industry as a whole. I don’t like how the go to is often to just use pain medication (narcotic or not). Not to say medication doesn’t have its place but I do think if there’s a way to fix something without medication that’s preferable, even if this route requires more work on the part of the patient. I do think most if not all medication isn’t good for us, or at the minimum not responsible for some kind of adverse effect. And sometimes the benefit outweighs the risk, but if avoidable I think this is better
I swear by my chiropractor's! My spondolo in the L5 has been improved along with upper-back pain. I seldom have any spondolo pain nowadays and mainly visit for an overall adjustment every 6-8 weeks.
Personally I'm very nervous of chiropractors, because of the possibility of breaking the neck or spine, or causing stroke. Therapeutic massage on the other hand, has helped me a great deal. I *always* have lots of knots in my back, so getting someone to loosen them up every so often helps reduce neck/shoulder/back pain and headaches. And sometimes I tweak a muscle that then doesn't let me move my head in a certain direction, and a professional massage helps clear that up quite a bit too. Acupuncture sounds too much like pseudo-science to me, so it seems like if it works, it's probably a placebo effect. (I obviously have nothing to back this up, though.)
It's really interesting and somehow funny to realize the difference between America and Germany on this topic. I am from Germany and chiropractic here is mostly used and done by medical doctors (mostly general practioners). You don't have to go somewhere else and pay a lot of money, you just go to your doctor. And no one would even think of using chiropractic for anything else than back pain/orthopedic problems...
I have to say that I think HCT seriously dropped the ball here. IN THEORY, this all sounds good. In practice, I have major concerns that were not addressed. First, is there evidence that what a chiropractor does is substantially different from and better than what a physiotherapist could do without adding in a bunch of pseudoscience? Second, by mentioning acupuncture in the same breath as chiropractic, you implied tacit support for acupuncture without offering any supporting evidence. I am not aware of any studies showing that acupuncture works better than placebo for anything, and many that show that it doesn't. These are two completely unrelated practices and should have been separated more completely. Finally, I cannot ignore the fact that many chiropractors overstep their bounds and claim to treat conditions they have no business treating, something you gave only the briefest of mentions. Furthermore, many chiropractors espouse harmful pseudoscientific beliefs and recommend other pseudoscience treatments to their patients. For just one example, some even recommend against vaccines. How can you, the primary care physician, be confident that your patient won't find one of these practitioners when you suggest chiropractic care? Do you accept that risk? Do you comb through chiropractors in your area to find one that doesn't, and then recommend him or her in particular? In good conscience, can you ever recommend chiropractic care even knowing how deeply this problem is embedded in the field? I would love to have my mind changed about chiropractic, but this video hasn't done it yet. Sometimes the focus needs to be a little broader than the singular question "does it work?".
weird. these things are the first thing you get prescribed when you complain about back pain to an austrian GP. more people over 25years old i know have had massages, heat, or electric therapy prescribed than have not. you can even get 3 week long treatments at a health resort paid by your regular insurance (part from a small part you have to pay yourself depending on your income). we've been doing this for dozens of years. i am sure insurances wouldn't pay for all this if it didn't help
do you think this could be because of psychosomatic factors? pain is rather subjective. Chiropractic work is not physical therapy. just because patients are reporting better mitigation of symptoms does not prove that the treatment is actually doing anything.
Just think: heat and going to chiropractor is WAY BETTER than prescribing opioids. I think more doctors should be recommending less harmful methods (although I'm not advocating homeopathy)
this can be solved pretty simply, do a very public case study on something they promise like regenerating the disc heights by proper adjustments and giving specific exercises for rehydrating the spine proper sleep nutrition etc.. do one with every thing but adjustments and compare the two. find the best know chiropractor who gets the best results for this too. lets get this shit settled so there are no more agruements
I have chronic pain from degenerative disc disease in my cervical spine and I would never consider seeing a chiropractor. I have seen physiotherapists extensively, I have more trust in a therapy backed by a university degree. Australia does cover chiro through private health insurance and even chronic disease treatment plans through Medicare, but I don't think they should without chiropractors at least requiring a biology degree and only being licensed for treating pain associated with the spine. Licenses should be revoked for anyone purshing anti vaccination or other quack treatments
The vast majority of studies have found chiropractic to do more harm than good. It's alarming to see it promoted. ...and acupuncture? It's a placebo effect.
Love the show. Seems odd that Aaron is going through some pretty weird lengths lately to remind everyone he's a doctor. He literally mentions it twice in the first minute of the show.
Duloxotine is a newer medicine that provides incredible relief for my chronic lower back pain. It is primarily an antidepressant with a miraculous side effect!
It's got to be quite hard to do a blind study with spinal manipulation though. You can't exactly do a placebo massage, it would be pretty obvious that someone was giving you a pretend spinal manipulation.
The problem is that nearly half of the chiropractic community are christian fundamentalists that think Chiropractic gives you the healing powers of Jesus. My father spent his entire life battling these quacks, sitting on the national board of Chiropractic, helping set rational standards for the profession. I'm really glad to hear his work was not in vain.
So Dr. Carroll changed shirts at the end why? I mean that just comes across to me as really really really weird. Is he going to start changing his shirts and clothes through the show from now on? "I'm Dr. Carroll and I like changing shirts. This is Health Care Triage."
The theory why spine manipulation helps with all kinds of things, is that the spine is putting pressure on nerves altering the information transmitted from one part of the body to another.
A chiropractor I use to go to had a sign on his entrance door that claimed manipulation made vaccination unnecessary. The fact that so many DCs tend to snake oil is a caution. Just go for the spine care and avoid the silly stuff
![How Chiropractic Adjustments Really Work [Evidence based explanation]](http://i.ytimg.com/vi/ZoKGkBfbiSY/mqdefault.jpg)
I had gone to a chiropractor several times and felt conflicted that the up to date research suggested it was a sham but that it felt, in my experience, to be quite relieving. It's unexpectedly affirming to see the research reconcile with my life experience. Thanks for keeping us up to date!
This has to be the worst review of medical literature ever.
First: ONLY 2 TRIALS of chiropractic adjustment out of the all the articles they reviewed had statistical difference and they were split. One fore and one against. as for the over all review of chiropractic in the study of non traditional medicine. I am going to quote the article you are referencing, "The systematic review found no differences in pain relief at 1 week between spinal manipulation and treatments considered inactive (an educational booklet, detuned ultrasound, detuned or actual short-wave diathermy, antiedema gel, or bed rest)" Whats worse lets look at the ONE study that showed a benefit, "although 1 trial found an association between manipulation and greater pain relief at 3 months (mean difference, −1.20 [CI, 2.11 to −0.29]); no differences in function were seen at 1 week (2 trials) or 3 months (1 trial) (86). In addition, no differences were observed in pain relief between patients receiving spinal manipulation and those receiving interventions considered active (primarily exercise, physical therapy, and back school) at 1 week (3 trials: WMD, 0.06 on a 0- to 10-point scale [CI, −0.53 to 0.65]) through 1 year (1 trial: mean difference, 0.40 [CI, −0.08 to 0.88]), nor were any effects on function noted."
Second: To the cost effectiveness of complementary and alternative medicine or CAM from the second study you listed I will let it speak for itself "After excluding inpatient expenditures, there was no difference in spine-specific or overall medical expenditures between CAM and non-CAM users." IT IS RIGHT THERE.
Why because you want to become addicted to that medication, or perhaps you love the side effects of putting those poisons in your body. Yeah, make perfect sense, mor on.
And don't let a chiropractor tell you to stop taking medicine your doctor prescribed! Happened to someone I know not long ago.
What happened to him/her then
@@Xdianaandini I have to assume I don't know that person anymore, because I definitely don't recall this comment!
@@TakeWalker at least you're honest
What they should do is tell you to tell your MD to recheck your medications. Sometimes Chiros can find a conflict of medications that the MD might of missed.
I do believe in Chiropractic care, however, this past year I went to one of the most crazy chiropractors ever. She believed that going to the chiropractor could cure everything from period pain to cancer. She also tried to convince me not to get vaccines and to stop taking my birth control and anti anxiety medication and also believed that babies should be getting chiropractic care as young as a week old. And icing on the cake, she wanted me to come in 3 times a week for 3 years. Luckily my insurance covered me for a year so i figured why not, but dang. I see why some doctors don't trust some chiropractors.
She wasn't a scam just, very optimistic about what chiropractic care could do
Pretty sure she was just crazy, she seemed very sincere and to really believe it herself, I think she was just wrongly educated. I needed to go for corrective work on my hips thanks to breaking my tailbone in a car crash and her place was the only one that offered a discount to students in my college and it was the only office near me, not having a car really limited my options. The point of my original comment was just that some chiropractors think that their work does more than it actually does and take it a bit too far.
Very fair, she helped me with what I needed, but I would definitely never go back and would never tell people to go to her. I don't really know the laws about where I live but it would be nice for there to be more regulation about what chiropractors can claim to do or not.
the baby manipulation is very scary as the bones are in little cartilage pieces for a few years. Occasionally there is help with an organ pain if you take pressure off the nerve that operates that organ, but usually it only needs to be tried once, and it doesn't usually work that great, but if it's going to, it will do so in one session (usually).
This sounds way to familiar im willing to bet that the brand of chiro you went to is called cbp or chiropractic bio physics. 3 times a week for 6 months
Chiropractors might be able to help with minor back issues, but their other claims are very off-putting. I had a friend who went to a chiropractor, not for spine issues, but to treat her upset stomach because she was told that it helped. It never did, but she justified that because they told her that she had a really bad case. (A really bad case of what?) I've personally been told that they can cure diabetes, ulcers, cancer, asthma, ADHD, autism, lupus, and period pain. The last one actually used tuning forks to diagnose people. My back surgeries have been extensive, and based on those tuning forks, they were all unnecessary. If you had seen all of the MRIs, you wouldn't hesitate at doing those surgeries, though. I can't imagine how much damage is being done by people like that.
Oh you picked a real kook to be treated by. A more careful selection of a legitimate chiro practitioner would have kept you away from those claims and tuning forks.
walkonking That is basic Chiropractor care. The ones that don't do shit like that are considered kooks by the rest.
Chiropractors are conmen, the only reason these studies showed positive effects is because they included physical therapists!
My chiropractor claimed to cure cancer. No, seriously. He did. Literally took credit for one of his patient’s cancer remission. He also had a poster telling the story of an 1800s chiropractor who cured deafness, and told me that vaccines were made out of aborted fetuses. As you might expect, they also caused autism. But that’s nothing compared to the crowning glory, “If God intended for us to need aspirin then he would have made aspirin trees.” At this point I trust chiropractors like I trust MLMs.
someone offended your brainwashed perspectives on what chiropractic is and isn't about. with no proof to the contrary you rejected their statements. it can be a chore to root out the truth from the garbage but it is better than continuing to suffer with health problems and keep seeing doctors who keep failing to identify the real cause or correct it.
I like the term "spinal manipulation" because it allows for a separation from the fantastical claims that chiropractic makes. Yes, we already know that the quack claims are false, we don't need to continue to prove that to ourselves. But I believe that spinal manipulation can be used to treat a limited number of conditions and rigorous scientific study is required to determine what those are and what degree of effectiveness they have compared to other methods to determine when it is an adequate alternative.
This has to be the worst review of medical literature ever.
First: ONLY 2 TRIALS of chiropractic adjustment out of the all the articles they reviewed had statistical difference and they were split. One fore and one against. as for the over all review of chiropractic in the study of non traditional medicine. I am going to quote the article you are referencing, "The systematic review found no differences in pain relief at 1 week between spinal manipulation and treatments considered inactive (an educational booklet, detuned ultrasound, detuned or actual short-wave diathermy, antiedema gel, or bed rest)" Whats worse lets look at the ONE study that showed a benefit, "although 1 trial found an association between manipulation and greater pain relief at 3 months (mean difference, −1.20 [CI, 2.11 to −0.29]); no differences in function were seen at 1 week (2 trials) or 3 months (1 trial) (86). In addition, no differences were observed in pain relief between patients receiving spinal manipulation and those receiving interventions considered active (primarily exercise, physical therapy, and back school) at 1 week (3 trials: WMD, 0.06 on a 0- to 10-point scale [CI, −0.53 to 0.65]) through 1 year (1 trial: mean difference, 0.40 [CI, −0.08 to 0.88]), nor were any effects on function noted."
Second: To the cost effectiveness of complementary and alternative medicine or CAM from the second study you listed I will let it speak for itself "After excluding inpatient expenditures, there was no difference in spine-specific or overall medical expenditures between CAM and non-CAM users." IT IS RIGHT THERE.
It's odd to hear physical therapy isn't a go to for lower back pain relief. I just assumed from my own experience that that was the standard first step in treatment.
gleep1984 In my experience a good PT has more expertise, is more likely to help, and less likely to have bizarre pseudoscientific beliefs than the average chiro.
Chris F- I concur.
Maybe because it often costs a fortune? IDK, but I was surprised too.
Are you Canadian? I know that here in Canada physiotherapy is well integrated with the medical system. Otherwise I dunno, perhaps it's different across State lines as well.
gleep1984 State licensed physical therapists go through the same first year as future medical students in my country. I started working with them in my first internship in ortho surgery patients in second year. It might be a US thing.
If no one knows what a bad chiropractor looks like, then what's the control? This could be a placebo effect.
I used to go to a chiropractor for neck pain and because he also employed massage therapists. It was great for the neck pain, but it was annoying when he claimed he could fix other things for me like my sinusitis and a heart condition by cracking my spine. . .
My chiropractor lowered my HBP over the course of a couple months of adjustments. Think about the anatomy. Behind the lower cervicals and upper thoracic you have the stellate ganglion. If an adjustment could fix the positioning of the bones to reduce pressure in the intervertebral foramina to this ganglia, wouldn't it be less activated due to less inflammatory pressure around it? Inflammation basically occludes the IVF, making the nerve potentiall hypo or hyperactive. Who is to say the same can't be held true for the nerves associated with the heart lower in the thoracic spine (though I'd agree it would be interesting to see how an adjustment would help CN X).
I have very bad sinus problems. Do not know how a chiropractor would fix it. But a hot stone massage on your face (sinus area) is really helpful. The relief only lasts a day or two. It is expensive so I only get them occasionally usually when the decongestants are not working well and I want a break.
To be fair, chiropractic helped my sinuses actually. Helped my chronic nausea too which really threw me for a loop! There will always be quacks but sometimes it can surprise you! It took me 6 chiropractors to find one who could help, but when I did it was a miracle.
Apparently a lot of places are not required to have medical licenses before becoming a chiropractor. In my state it is required to be a doctor before you can be a chiropractor. They just go through a chiropractic Fellowship. However I have seen misguided approaches to Chiropractic seems but I believe many of it is based off of an autopsy of winds door back in 1927 he autopsy a ton of people and showed how Chiropractic Health increase the health of many organs and other things in the body.
The Windsor Autopsies | Chiropractic | Organ (Anatomy)
Chiropractic work can help a lot of things don't get me wrong however I don't think they're necessarily a cure but a complementary medicine that we should try first to see if it can allow the body to fix itself or if we need to progress to Medicine.
@@kateajurors8640 This has to be the worst review of medical literature ever.
First: ONLY 2 TRIALS of chiropractic adjustment out of the all the articles they reviewed had statistical difference and they were split. One fore and one against. as for the over all review of chiropractic in the study of non traditional medicine. I am going to quote the article you are referencing, "The systematic review found no differences in pain relief at 1 week between spinal manipulation and treatments considered inactive (an educational booklet, detuned ultrasound, detuned or actual short-wave diathermy, antiedema gel, or bed rest)" Whats worse lets look at the ONE study that showed a benefit, "although 1 trial found an association between manipulation and greater pain relief at 3 months (mean difference, −1.20 [CI, 2.11 to −0.29]); no differences in function were seen at 1 week (2 trials) or 3 months (1 trial) (86). In addition, no differences were observed in pain relief between patients receiving spinal manipulation and those receiving interventions considered active (primarily exercise, physical therapy, and back school) at 1 week (3 trials: WMD, 0.06 on a 0- to 10-point scale [CI, −0.53 to 0.65]) through 1 year (1 trial: mean difference, 0.40 [CI, −0.08 to 0.88]), nor were any effects on function noted."
Second: To the cost effectiveness of complementary and alternative medicine or CAM from the second study you listed I will let it speak for itself "After excluding inpatient expenditures, there was no difference in spine-specific or overall medical expenditures between CAM and non-CAM users." IT IS RIGHT THERE.
This video likely isn’t up to date anymore, but it’s exactly what I was looking for. I’ve long wondered about chiropractic care as a whole so learning that it’s shown to work in at least one specific situation answers a lot of my questions. It’s hard to do this kind of digging on my own because studies are often very difficult to understand for non researchers.
I'm pretty alarmed at the inclusion of acupuncture and other things in that list of recommendations, without any additional evidence for it specifically (that you cited at least). There's a huge body of evidence showing that it is just placebo, and its inclusion in this list should be a huge red flag. Glossing over that seems like a giant oversight for such a usually well reasoned and researched show.
James Jurack The video said "first line therapy", so here's the thing...obviously if someone has a broken arm you won't send them to get acupuncture right? But if it's a minor lower back problem, you don't want the patient to just sit at home on opioids either. So why not give one of the non invasive treatment a try? If the patient believes it works and that person feels better then what difference does it make if it's a placebo or not?
James Jurack I'm tempted to unsubscribe over this video.
SNBoomer although he didn't state it explicitly, I would assume the sort of systematic reviews cited in the video for spinal manipulation actually found results better than placebo. Otherwise why recommend expensive, potentially risky procedures over just sugar pill?
I'd like to add that while I'm very upset at the ACP for shoddy work on their new recommendation, I'm only mildly annoyed at HCT for not including a better disclaimer about the other things in ACT's list. The overall conclusion of the video is still good.
@SNBoomer I'm not sure sticking needles into the skin is sufficiently "non-invasive" to include it in a list of non-invasive procedures. There's a genuine risk of infection that none of the other treatments have.
OTOH you could get "placebo" acupuncture which is basically just poking with toothpicks (no penetration of the skin) which appears to be just as effective in trials; (BMJ 2009;338:a3115) (Arch Intern Med. 2009;169(9):858-866)
Good on you Dr. Carroll for acknowledging your own biases and updating your views and practice to reflect new evidence. Sometimes that can be hard to do (especially the acknowledging you were wrong bit).
I've always wondered why people got so bent out of shape about chiropractors.
I went to one for six months to help straighten out my spine, and it helped immensely. No more back pain, no more walking funny because my back looked like a convulsing snake. Chiropractors can be great, just make sure they're not wooo ones.
So much of the talk about chiropractic treatment mentions only spinal manipulation. As a 30 year practicing chiropractor I, and many others, have learned that spinal manipulation is often a small part of our treatment of low back pain. Spending the time investigating why the patient has back pain is almost always more important than the treatment. Giving advice as to how to keep from having issues in the future is a major focus. Does the patient sleep on their stomachs, do they bend and twist when they could squat, do they sit with their knees below or above their greater trochanters, etc.? We agree most back pain is limited to a few weeks. Yes, spinal manipulation may help the patient heal a bit faster with a bit less pain but the real success will be if they take my (our) advice as to how to change why they have the pain in the first place and perform the stretches/exercises we give them. Thank you for a fair evaluation of what we are known for--but a truly effective chiropractor does much more than spinal manipulation.
yes, a truly effective chiropractor does something called adjustment.
It's good of you to be willing to change your stance on a subject based on newer evidence. That's the sign of a good scientist.
Thank you so much for the update on this. I have been so conflicted about my chiropractic care given the studies I assumed my improvement of symptoms of back pain from chiropractic care were a placebo and really struggles with my decision to continue with the few chiropractor appointments I have through out the year... but at the same time I do find that they helped very much with my back pain symptoms. I feel I have a good quality professional and I only expect him to treat my back pain.
This has to be the worst review of medical literature ever.
First: ONLY 2 TRIALS of chiropractic adjustment out of the all the articles they reviewed had statistical difference and they were split. One fore and one against. as for the over all review of chiropractic in the study of non traditional medicine. I am going to quote the article you are referencing, "The systematic review found no differences in pain relief at 1 week between spinal manipulation and treatments considered inactive (an educational booklet, detuned ultrasound, detuned or actual short-wave diathermy, antiedema gel, or bed rest)" Whats worse lets look at the ONE study that showed a benefit, "although 1 trial found an association between manipulation and greater pain relief at 3 months (mean difference, −1.20 [CI, 2.11 to −0.29]); no differences in function were seen at 1 week (2 trials) or 3 months (1 trial) (86). In addition, no differences were observed in pain relief between patients receiving spinal manipulation and those receiving interventions considered active (primarily exercise, physical therapy, and back school) at 1 week (3 trials: WMD, 0.06 on a 0- to 10-point scale [CI, −0.53 to 0.65]) through 1 year (1 trial: mean difference, 0.40 [CI, −0.08 to 0.88]), nor were any effects on function noted."
Second: To the cost effectiveness of complementary and alternative medicine or CAM from the second study you listed I will let it speak for itself "After excluding inpatient expenditures, there was no difference in spine-specific or overall medical expenditures between CAM and non-CAM users." IT IS RIGHT THERE.
Great video. And happy to be contributing to the ongoing investigation of the sound origin. It works for many, but not all. We have to continue to understand who is the best fit for manipulation.
Reassurance and advice to resume activity as able should be sufficient for most cases of acute low back pain. Non pharma at home strategies such as local cold or heat are low risk options. OTC NSAIDS if needed for limited time. 10point pain relief on 100 point scale hardly worth the trip and cost!
Honestly, if you want your back cracked see a physio, not a chiro. Every single physio I've ever been to has been significantly more comprehensive regarding determining the causes of the issue, treating it and providing advice on follow-up symptom relief that can be done at home without further appointments. A physio can do all of the same manipulations a chiro can, and they're usually about the same price.
They are a lot more expensive where I live, but that is because THEY HAVE DEGREES IN PHYSIOTHERAPY.
I'd rather someone qualified MANIPULATE MY SPINE.
This is so clear... so so clear...
As someone who suffers from a small scoliosis, I've always been referred to an NHS physiotherapist when pain flares, but it's never a permanent solution, so I'm open to anything that may help
I had a discussion with my brother, because he didn't belives on quiropractic care, but thaks for showing this evidence, I'm a quiropractor, greetings from Mexico, you've got a new subscriber
Do you think most physicians know that physical therapists have doctorates? Also chiropractors and physical therapists have different methodologies and typically don't get along.
chiropractors don't have doctorates or real qualifications
@@therabbithat BS the Chiropractor's education is the same as the MD's minus pharmacology. The colleges are accredited and in fact the DC get more anatomy than MD's. PT's with a doctorate are not Physicians and never will be. Get your inof straight before you just try to BS people here
I love how clear and concise this video is
As a chiropractor I'm happy to see him post a video about chiropractic care. However he is not aware that chiropractors are physicians. Our scope of practice is includes writing prescriptions for MRIs, CT Scans, blood work and any other test that helps us diagnose our patients. Also almost every insurance company not only pays for our treatment. They pay us well. That's because of how effective the treatment usually is. We pay the lowest malpractice rates when compared to any other specialist. Also has this man noticed chiropractors are seemingly on every other street? Our rate of growth is well above average. Not sure if he has good intentions or bad. If he didn't know were physicians that not only can prescribe an MRI. We're trained extensively on reading them as well as CT Scan and radiographs. Lastly, every discipline has poor or bad physicians but having to pay significantly less for malpractice insurance when compared to other specialists should show we are not hurting our patients.
He should add a video on the effectiveness of treating just symptoms with medication. Pain..here's a pill. Swelling here's a pill. High blood pressure here's a pill . We have some wonderful medications. I'm talking treatment of just symptoms. That alone is why this country has so many unhealthy people. Continuing following big pharma seems to be his final thoughts. Very sad videos like this are allowed on RUclips. So many facts wrong. Lastly, he should watch the docu- series Dope Sick and see how pain medication worked out for the country. He's so lost inside bad information.
Dude! Citations in the description please! That is why I came to your video.
I've used the same chiropractor for 15 years, and he's been of great help every time I've hurt myself. I see him maybe once every 4-5 years or so, and each time he just puts everything back where it's supposed to be, gives me some tips on better posture, and how to avoid doing whatever I did to myself to cause me to need to go see him in the first place. Definitely an effective alternative to popping pills.
As a new DO med student, I'm excited to hear that OMT/manipulations are becoming more commonplace and accepted by the medical community. I expect studies supporting manipulative therapies to become more abundant as Osteopaths become more prevalent in the public.
The public doesn't understand what you guys are. You prescribe drugs, therefore you are a doctor. They call you medical doctors even though you're doctors of osteopathic medicine. Further, DOs tell patients often they do 'both' or 'let's do some chiropractic' and end up hurting the patient and the patient goes out and starts bad mouthing chiropractic when the patient never saw one to begin with- they saw a DO who is a jack of all trades and master of none.
Your profession sold out to allopathy and big pharma decades ago. Embrace your sold out profession
Why didn't he mention placebo effects. Most alternative medicine, like acupuncture and chiropractic use it to achieve results
Jonathon Bialas. He doesn't have to. He's quoting peer reviewed journals that take that sort of thing into question.
There've actually been a ton of cities into the placebo effects of alternative or holistic medicines. However the issue comes into effect as with acupuncture how do they make a control or do a placebo version of acupuncture. People know if they're being stuck with a needle or not or getting deep massage therapy. And that's usually the issue many of these studies run into they're also usually very small studies hosted by colleges and people that are getting ready to graduate their PHD or master's program. So a few hundred people each time but there are a whole bunch of small little studies about this topic primarily focusing on acupuncture Chiropractic measures that aren't quite proven. They tend to also focus on some studies with reflexology and seeing how much of a placebo it has with the reflexology what they did is they told people that certain areas were certain things but mixed up the areas to see if people were still feeling a positive effect with a different area being treated through reflexology. Kind of the same as like if you told someone that poking needles in their left foot would help their heart when you know it's scientifically known poking needles in the right foot help the heart. By the way that needle thing was a total made up fabrication. Just an example to see how people relate even similar Placebo effects. I think doctors or certain practitioner should be allowed to use Placebo effects to heal people. Why people don't realize how powerful their own mind is and if we could tap into the placebo effect imagine how little medicine we would actually need. Like as a country we would need a lot less medicine. then again there's convincing people that they're getting treatment. so that have to take some kind of pill
This sounds like a throughly unreseached opinion. There are all sorts of “alternative” medicines and things like crystal healing shouldn’t be lumped in acupuncture, which has a lot of evidence to be highly effective with some conditions.
My father slipped a disk in his lower back in 1982. After five days of terrible pain, he opted for surgery, which solved the problem. BUT for his recovery, he was sent to a Chiropractor. There was no manipulation, but rather he was given exercises to help his lower back recover. This was the only instance I know of where a chiropractor gave the kind of treatment that was actually helpful.
Glad to hear it. I've experienced both sides with chiropractic care. Several years ago I injured my back lifting weights and the pain got worse and worse over a few months until I went to a chiropractor. I had two adjustments a week for 6 weeks, seeing a lot of improvement between each visit. At the end my back only hurt when my posture was bad all day, or when I twisted or lifted something in a bad way. But I've also had other experiences where repeated visits didn't improve my symptoms at all (notably with different chiropractors). I think it varies a lot from chiropractor to chiropractic, but it also depends on what is actually wrong with your back.
Hi Dr. Carroll, I don’t think you made a clear enough distinction between upper and lower back, stroke risk, and what exactly is legitimate. Maybe try to break it down more in a future video
Thanks for this video Dr. Carroll! As a chiropractor I can understand the hesitation of the medical community to get behind spinal manipulation because it has not been as well studied up to recently as well as some ugly history (that I won't get into) between MDs and DCs. I also understand why doctors and patients are skeptical of chiropractors that claim they can deliver the moon to their patients with only very low quality or no evidence to back it up. This of course is not best practice and I think lies in deficiencies in chiropractic education. It is widely known among the profession that there is a deep split between those chiropractors with a philosophical approach and those with an evidence based approach. The choice of school a student makes will make a huge difference as to where along this spectrum a chiropractor will fall, which is a failing of the profession. This is the complete opposite of medical and osteopathic schools where education looks about the same no matter where you end up. As a side note, more chiropractic schools should be more rigorous in their admission of students, including requiring a science background, completed bachelor's degree and graduate school entrance exam testing. We will never be taken seriously until the profession as a whole can slough off the old straight philosophical chiropractic model. As much as do not want to put down my colleagues this old model is unproven and unhelpful towards the greater picture of patient-centered, multi-disciplinary healthcare. I believe that we will see an even deeper split in the profession if this is not corrected, there will be straight philosophy based chiropractors and science based chiropractic physicians. There are thousands of good chiropractors that believe in and practice evidence-based chiropractic care that can partner with MDs to treat back pain, instead of relying on addictive opioids or ulcer causing NSAIDs. Patients seem to be trending towards a holistic approach to health, putting emphasis on nutrition, non invasive treatments and drug free therapies, and many insurance companies have chiropractic care as an option in their plans, even Medicare nationwide and Medicaid in some states. Gone are the days of the solo practitioner, integrated healthcare is definitely the future. This is an awesome opportunity to cross the divide and have MDs, DOs, DCs, LAcs, LMT, and PTs work together towards what is best for the patient.
Angela Mess, Agreed.
I should know who you are--you get it.
Thanks Mike! I appreciate the compliment. I've always tried to see both sides of an issue even when I may disagree with the other side. How else can we grow and learn? I'm a solo practitioner in Philadelphia, trying to help patients and build a few bridges.
What are your qualifications? How many years did you go to university for and what did you study?
God bless you sister
A osteopath helpped me once i almost tore my foot off, after the doctors set it, weeks later my foot was still purple so she somehow see unpinched my blood vessels.
Seeing John Green as the producer here makes me sad. Did he even read the study. The conclusion said that they were not sure how much the placebo effect had on those results.
Good note, glad someone read the study
I love my chiropractor. I find my posture improves and I find tremendous relief of back pain, both lower and mid back. Combined with excercises to strengthen my back to both strengthen a muscle damaged in an accident years ago and to generally improve my posture I've seen tremendous improvement.
I have never met a chiropractor that was a quack and claimed he could do anything outside the skeletal/nervous/ muscular systems. Perhaps it is because in Canada we require they have they have standardised testing and government regulated licensing? It really is too bad to hear there are some making wild claims like that.
I personally have had a good experience with chiropractors for sciatic nerve pain and once when I stretched my arms wrong and messed up my entire right shoulder blade area. I had been icing my shoulder and taking an ibuprofen + methocarbamol combo for a week and it didn't help so much but I tell you when the chiropractor did her thing it was sweet sweet relief. I walked out of there feeling giddy and the swelling finally subsided over two days. BUT do take this with a grain of salt, it worked for me but might not work for you, it is an anecdote after all.
The only thing Chiropractors ever talked to me about was having good posture and that my backpack was too heavy.
The episode did feel a tad short today, seemingly glossing a lot of content and specifications. I'll read the Upshot article perhaps it's more through.
Chiropractic itself emerged as a pseudoscience and still is. Check this out: bigthink.com/surprising-science/chiropractic-pseudoscience?rebelltitem=1#rebelltitem1
you are lucky, a quick glance around youtube will show that there are a lot of quack chiros,especially in america.Even the ones that stick to the musculoskeletal system are quacks,theres no rationale for their treatments or diagnosis.The vast majority of lower back pain resolves with no treatment so that is what is happenening when you go to a chiro for adjustment,the treatment had no effect..From what ive seen and I trained in physiotherapy many yrs ago but work as a physician assistant now, quacks are the rule rather than the exception in chiros.
isn't 10 percent improvement borderline placebo?
El Loco you can't tell without a comparison placebo rate. Just because it looks small doesn't mean it isn't statistically significant.
It isn't 10%, it is a rating of 10 on a 100 point scale. This "rating" is a number people give and is subjective. Saying 10% implies some non-subjective measurement that can be put into a formula. This really can't be as it is a number people give for how they feel. That being said, sure it sounds small but as Maddy said, you need a comparison group.
In chronic low back pain treatment, open-label placebo scores an improvement of 1.5 on a scale of 10. This is a better result than the physical treatments given by these pseudo-doctors.
Yes, both are the result of the brain's reward mechanisms, but that doesn't condone the risks attached to the manipulation of such a critical structure as is the spine.
results of any treatment/intervention may be up tp 30% placebo
Have you done an episode on upper spine chiropractic care? I used to go to a guy but stopped because of a lack of noticeable results and spurious claims of what it could do.
Alan Gebhardt
There is absolutely no evidence that manipulation to the cervical spine has any benefits for pain, or any other issue for that matter, and it even comes with risks (stroke, fracture).
if you have any type of back pain, go to a physical therapist, not a chiropractor. PTs practice evidence-based treatments, most chiropractors do not.
depending on which segmental region of the spine you are looking at, there are around a dozen joints on one vertebrae. these joints can become misaligned for various reasons and cause a change in tissue behavior or non optimal nerve function etc. if a muscle isn't receiving it's proper impulse from the nerves which innervate it, it won't have optimal function. manipulation or corrective tissue work can realign the segments and return optimal function, same to be said with all innervations.
I've got a bulging disk in my neck, and I was in agony for about 3 months. Physical therapy (including traction and electronic stimulation) did wonders for it!!!! I don't recommend a chiropractor for though, because when I went to a chiropractor, it seemed like he did more harm than good.
I love how this channel broadens my medical knowledge. I wouldn't have considered spinal manipulation until very recently. Good to hear more about it though
a 10 point drop on a 100 point scale is still better than most medical interventions will fewer, if any side effects. so... yeah it is a little worth it.
Actually it is a very good video of an MD that changed his mind by looking at the available evidence. Today in the U.S. lower back pain is the number one reason to be prescribed an opioid for non cancer pain, it is the most disabling disease in the US (and the fastest growing disabling condition according to the social security administration) and according to the AMA in an article in December it is the third most expensive condition to treat in the US behind diabetes and heart disease (these costs are attributed to advanced imaging and referral to specialists like pain management and orthopedic surgeons). We have got to change how we treat this common problem. The current way of prescribing NSAID and pain killers has not helped and the condition is getting worse.
The problem is that nearly half of the chiropractic community are christian fundamentalists that think Chiropractic gives you the healing powers of Jesus. My father spent his entire life battling these quacks, sitting on the national board of Chiropractic, helping set rational standards for the profession. I'm really glad to hear his work was not in vain.
Yoru, what should we do then? Not treat anything? Sometimes things don't work. Sometimes they do. So many variables to account for in studies. But at least we are trying to research practices that may offer help but if they don't, the side effects are low or relatively harmless. We all wish we had better options for everything, many times we don't though
Raven L The other half are Scientologists.
Most insurance companies cover chiropractic care, Kaiser, Cigna, Blue Cross, Blue Shield, United Health
I went for 6 months twice a week and my symptoms worsened. I dropped 40 lbs and continued to hit the gym and focused on physical therapy, yoga, and mobility at home. My symptoms worsened. I got a cervical spine steroid injection that offered no relief and followed up with an epidural that offered some relief for about 5 days. They want to remove a rib and several muscles and do an Arthroscopy surgery in the joint space to clean up scar tissue. I asked for another month of supervised physical therapy on top of hitting the gym. I have 5 days until I go back to the surgeon to decide if I am making positive progress. All of the specialists are recommending surgery at this point. It's looking more and more like that is going to happen. I will be referred to Felix H. "Buddy" Savoie III at Tulane Medical to look over everything before getting a final recommendation.
Placebos work very well with pain. Raise your hand if you didn't already know that.
My mother was told by doctors she wouldn't walk again without spinal surgery, thanks to an injury caused to her by a chiropractor, who said she had scoliosis. She walked into the chriopractor with minor lower back pain. She wasn't able to walk out. When a doctor and later physical therapist looked at the x-rays the chiropractor had drawn on, they said the markings she had made were nonsensical, and that there was no way my mother had scoliosis.
Don't let unqualified people near your spine. Physical therapists (=phisiotherapists) know what they are doing. Chiropractors are not qualified, it's guess work.They don't have to do proper courses, they believe everyone has scoliosis because they don't know what scoliosis means. They might help you, like a massage therapist can help you, but they do not know how or why.
In the end my mom recovered, thanks to physiotherapy. Physiotherapists have at least 4 years of university education in Europe, and many more in the US. Chiropractors and osteopaths do not have any similar qualifications.
To throw all spinal manipulation in together is ridiculous, not every person who manhandles your spine for a living has any idea what they are doing.
Dear rabbitthat,I would like to clarify a few things, your assumptions are in fact incorrect, physios have 3 years training in the UK and Europe,Whereas Osteopaths and Chiros have 4 or 5 years training with a minimum of 1200 clinical hours before qualifying after rigorous clinical competency examinations.I am an Osteopath, with a Masters degree, and also have a physiotherapy degree.Now there are many overlaps between the professions,however,the philosophies and treatment approaches are completely different.Now I do not disregard Chiropractors but in my experience very rarely does manipulation resolve a MSK issue by itself, Osteopaths implore a large variety of gentle techniques ,like articulation , muscle energy technique,soft tissue massage and stretches amongst many more etc.,manipulating joints solely can't physiologically change muscle mechanics and improve posture,therefore an entire holistic approach needs to be incorporated looking at all the biomechanics,whilst taking into consideration predisposing and maintaining factors, if those aren't adressed, its a waste of money; patients need an exercise or rehab program to create long term change,not only does it improve their postures etc. but hands some responsibility back to the patient, and their exercise compliance is vital for medium and long term rehabilitation .Next time try an osteopath the treatment approach is definitely a lot more hands on and gentle,then you can make an informed comment.
interesting, but I do still worry as chiropractor isn't a protected title (in the UK), so results could be very variable. As the training isn't standardised like it is for physiotherapists. Physio, and heat would still be my gut first recommendations for my patients, but this does open up options for further treatment.
So would another way to evaluate the data be that we still don’t have an effective treatment for low back pain? The data may provide some guidance on new studies but none of this sounds all that impressive. Have there been any studies on how a long term strength training program improves back pain? Is there a specific type of spinal manipulation that is more effective according to the studies?
I prefer OMM practicing DOs. They're board certified doctors, and don't claim OMM can cure your cancer. My experience there was identical to my experience with my physical therapist (they just use different jargon to explain the same concept). I'll stay as far away from chiropractors as possible.
Chiropractors are also board certified doctors. They are experts in spinal manipulation and also use physical therapy as well. I’m sorry that you had a bad experience with a chiropractor previously, but like with any doctor, if you don’t like that one try another. You wouldn’t just give up on all MD’s from not liking one, you would find a different one. I hope you can give it another chance.
@@liannarepecki948 no they are not .. doctor maybe some but it not required
@@imGerry123456 I'm not sure where you are located but in the United states it is required for chiropractors to be board certified in order to get licensed.
@@liannarepecki948 it their own organization and it has nothing to do with the scientific medical side at all
Lots of people bashing anecdotal stories in the comments here, but I'mma go ahead anyways. I've been seeing a chiropractor since my teenage years for back pain, mostly caused by sitting at the computer too much. I've seen a few different ones, and there are absolutely chiropractors that do it better, and chiropractors that are quacks, and chiropractors that just suck. My absolute favorite is Dr. Mark Akers in Golden, Colorado, as he is also trained as a kinesiologist and has helped me with minor tissue manipulation as well, such as moving my stomach out of my diaphragm when I was experiencing depression accompanied by an upset stomach. However, Dr. Akers never gave me much advice for how to keep my body from needing chiropractic adjustment.
Separately, I also saw Pelvic Therapy Specialists in Boulder, Colorado to treat dyspareunia or painful sexual intercourse, and they also worked within my spine and hips to provide lower back pain relief and relaxation. Unlike Dr. Akers, the PTs gave me a lot of exercises to do to help keep my lower spine and hips in better shape, and relieve the tightness that causes much of the pain.
Of course, it doesn't matter what your medical issue is, having a doctor that understands your issue and also understands the treatment is the key, from family doctors to chiropractors to physical therapists. Be a thoughtful doctor shopper!
Best to anyone with back pain,
Kayla
Sure, and if chiropractors would just focus on the lumbar spine for LBP, that _might_ be okay. But they tend to insist on treating patients "holistically", which means they'll probably treat the cervical spine anyway--sometimes even when the patient tells them repeatedly not to.
Since when has the application of heat or massage to spasming muscle, been 'non-traditional'?
Well done. Patients have been finding relief with spinal manipulation for decades. Thanks for thinking outside the the box. You're right though, there are lots of practitioners who make overblown claims about the applications of spinal manipulation.
Yeah, as a OMS 3, Osteopathic Manipulation is essentially massage/physical therapy with some extra techniques added in. Specific techniques can be very effective (subjectively) for specific things, generally musculoskeletal problems. Most DO students remain skeptical about it's application beyond MSK problems, so don't adopt it as a panacea.
Was gravity valuable before or after science proved it worked? If science proves gravity does not work can we still use it? Is it wrong to believe in gravity if we don’t have science to back it up?
What about the effects on something like scoliosis? Is spinal manipulation for that useful or needed?
1) There are clinical prediction rules for the use of spinal mobilization that physical therapists use, I cannot say if DC's do or not. This helps us to determine when it's truly safe to apply a Grade V joint mobilization or if it's contraindicated.
2) Most Physical Therapists (DPT) and Chiropractors (DC) ARE doctors. Correct, we are not medical doctors, but, we are doctors nonetheless. Physicians must start to honor and respect that title the same as you would honor a PhD, DDS, etc. We won't typically refer to ourselves or introduce ourselves as doctors, but to say we aren't is a difficult thing to hear.
3) PT and Chiro was talked about together, or at least I interpreted that way. To be clear, Physical Therapists do not believe spinal manipulation helps anything systemic or non-mechanical. We also believe that you must reinforce spinal mobilization with corrective exercises to make a joint mobilization truly effective. Bones don't move unless muscles move them. Fix the muscle imbalance and you often fix the problem. Give the patient a home exercise program and show them how to treat symptoms so their back pain is self managed just like you know to take OTC meds for the common cold. That's how you save the healthcare system money. Patient education.
4) Expensive? You should do your next video on the money that PT saves the healthcare system. Most insurance plans cover PT. The copays can be ridiculous, I won't disagree with that. We are billed as a specialist copay.
Well, you see a specialist once every now and then but usually you're in PT 3x/week. Tough for the middle class to get the care they deserve with copays like that. I hope policy reform can help to reduce PT copays.
I'd go to a chiropractor if I could, but just for the relief/relaxation it can offer, rather than as any sort of physiological treatment. If I had a chronic issue, I'd look to see if there was a lifestyle change or physical training I could undergo to before anything more drastic. My job left me with standard back stiffness/soreness, so I looked up some professional training advice and worked out the right parts of my body instead of going to my doctor and getting any prescription.
4:46
I am a great magician!... Your clothes are blue!
The name’s Betty, you son of a pig.
RED CLOTHES! Lol, what a blast from the past.
Can you do a video on massage specifically?
Point of correction: Most insurances cover spinal manipulation. Not sure where "some physicians" came up with the conclusion that they don't.
Did these studies control for physical therapy ofered in many cyro offices?
yourfullofsheite Yes. But there are many modalities used in both physical therapy and in chiropractic. Lots of overlap. In general, spinal manipulation is great, and spinal manipulation with exercise is even better. But it all depends on how the patient presents.
a well done manual assessment and treatment would fix up a lot of pressure and reactive muscles in a quick time. Rarely does a well done treatment need to be repeated unless scar has dragged the tissues back to the old place.
Chiro needs to know its roll and focus on chief complaint. Acute LBP should not involve a cervical manipulation. Risks and Benefits and Consent need to be verbalize before adjustment. DDx needs to also be considered BEFORE treatment (seen too many UTIs with CC of back pain after many Chiro visits).
Drs in the the hospital cant fix my scoliosis... They recommended me to do surgery, wear the super uncomfortable brace or wait until i gt older, so that it would straightened out itself... I waited for 11 yrs all i gt was daily headaches, nausea, stiffness and short of breathe.... For someone who feels shes doom, chiro has helped me..
Great recap of the evidence!
most get better with or without chiro,by placebo,regression to the mean or spontaneous healing.If chiro helps its by exercise therapy or plain recognised physio treatments.Its the bogus diagnoses,irrelevant xray findings and manipulations that real doctors have trouble with.
I'm glad more and more research is pointing to the benefits of drugfree care for back pain. I hope in the future people will seek an MD to determine there is no red flags and safety of care for low back pain. They seek the chiropractor for proper alignment of their spine and joints and they seek the physiotherapist for their muscles and soft tissue related disorders. Hopefully this competition between professions can end and each profession can work in harmony with the other for the benefit of the patient.
It just depends on your Chriopractor I take physical therapy thank god my wife is a physical therapist she said going 2 times a year is ok but not all the time that’s when you get injured well for some people who are delicate I’ve gone to two times a year plus therapy for my bulging disk and sciatica
are we talking about slowly reshaping the spine or forcibly realigning the spine by pushing on it "the right way"? Every part of the spine is meant to shield the delicate command center of your body within. Forcing it to move unnaturally... how is that a good idea in the slightest? Doesn't that tear up stuff between the segments that is there to cushion the spinal cord as much as possible while retaining some flexibility?
I think its also very important to look at the literature into physical exercise for chronic non-specific low back pain (which is also recommended by the American College of Physicians).
A core concept of modern physiotherapy is to empower individuals to be physically active and not reliant on passive treatment modalities, such as manipulations, massage or acupuncture. I fear that this article and the recommendations discussed will only further encourage passive treatment approach which leaves patients feeling they are fragile and will fall apart if they don't get their weekly "alignment".
well, an accurate assessment of joint motion and muscle tone with hands-on treatment for same is more specific than exercise. Exercise can be inhibited if the muscles are refusing to go into a painful range, so these perk up when you correct the joint motion. THEN exercise works so much better. it's not either/or.
But are you using hands-on muscle and joint palpation as a form assessment or treatment? I have no issues with palpation assessment or with some use of passive treatment modalities, particularly in the acute stages. I'm just suggesting that the current literature would indicate that exclusive use of passive treatment modalities, such as spinal manipulations, is not recommended.
Yes yes yes, this is a very poorly researched and misleading and potentially harmful video. Promoting pseudo-science based on misleading evidence.
I only saw a chiropractor once. They fixed my sciatica. Would i ever go for any other reason? No. Upkeep? No. My mom needed a level 4 spinal fusion surgery. She saw a chiropractor once. He did a few manipulations and did some traction exercises and told her to see a neurologist because she needed spinal fusion, he was right. Has she been back for any other purpose? Nope. Just that one time. There is a time & place for chiropractic, but is it as needed as people make it out to be? Probably not. Is it a cure all? Also nope.
I will say timing is everything. Three weeks ago doing intervals on my bike I did something to my lower back. The pain was so intense I nearly blacked out got a regimen of steroids from my PCP -- helped. Saw him said it was inflammation gave me some exercises but it is S L O W heal. I am going to send him this, thank you. Hope he is not above internet evidence based videos.
Nothing stated here is new. Chiropractors, physiotherapists, massage therapists, acupuncture, tai chi, herbal tea, reiki, smooth jazz. Choose whatever treatment you like. 90% of lower back pain resolves by itself, regardless of which ineffective treatment you use. Saying that spinal manipulation is as effective as other ineffective therapies is not saying anything. I'm disappointed in this offering from healthcare triage.
a really good one would knock your socks off. have to know whom to see
physiotherapists do not belong in that list. They study at university for an absolute minimum of 4 years (depending on the country) and do evidence based exercises and give people evidence based advice for home exercises they can do to relieve their pain. None of the other stuff has any basis in science or anatomy.
Thank you, spinal manipulation is powerful. Not many chiropractors keep it simple. That's how we keep our doors open.
placebos are super safe and often effective.
Another alternative form of treatment for lower back pain which you don't mention is Yoga. I have suffered with lower back pain on and off for several years. I really did not have much success with chiro so went on to Ortho doc, PT, R/F ablation, etc..... along my path. Now learning from a Yoga specialist who focuses on lower back pain. No big breakthrough yet, but it is really not all that different from PT , and pretty cost effective.
Aaron, love hearing you on Sirius XM when you are on!!
-T
I would be interested to have seen more mentioned of osteopathic physicians (D.O.'s) who practice OMM/OMT. Many don't know that this treatment is available.
EDIT: osteopaths are not osteopathic physicians. I edited this for clarification.
Ryan Stevens It's my understanding that the vast majority of DOs do not use OMT in the field. I've worked with a dozen DO ER docs and none of them use it.
I've studied this - many of it shares similarities with chiropractors. They both branched from the same ideas back in the late 1880s or so. The difference is, with the D.O.'s interconnection with the AMA in the mid 20th century they more or less stopped emphasizing on OMT. Thus it never really developed. Chiropractic, on the other hand, continues to research new forms of manipulation, and is perhaps more advanced in performing it. If not only to help with the problem, new forms of manipulation focus more on doctor and patient care. Gone are the days of potentially harmful cervical rotations which can cause adventitious tear of the vertebrobasilar artery - new manipulation protocol doesn't twist the head around its crazy path behind C1 (and takes into consideration a posterior ponticus should the patient have one). While a manipulation from an OMT and chiropractor might objectively have the same result, the latter is used more commonly now and thus has a higher level of care behind it. After all, it's an optional part of D.O. training in some schools, and only briefly touched on at that. It's the entire focus of a D.C.'s 4 year degree.
here, the chiro school still teaches the rotatary manips. Not a degree either. More than half their focus is marketing and human resources and accounting, poor anatomical reasoning. Any manipulations I have had from a DO were super accurate and wonderful.
where is "here"?
The money issue aside because I feel this is a problem with the medical industry as a whole. I don’t like how the go to is often to just use pain medication (narcotic or not). Not to say medication doesn’t have its place but I do think if there’s a way to fix something without medication that’s preferable, even if this route requires more work on the part of the patient. I do think most if not all medication isn’t good for us, or at the minimum not responsible for some kind of adverse effect. And sometimes the benefit outweighs the risk, but if avoidable I think this is better
I swear by my chiropractor's! My spondolo in the L5 has been improved along with upper-back pain. I seldom have any spondolo pain nowadays and mainly visit for an overall adjustment every 6-8 weeks.
Personally I'm very nervous of chiropractors, because of the possibility of breaking the neck or spine, or causing stroke. Therapeutic massage on the other hand, has helped me a great deal. I *always* have lots of knots in my back, so getting someone to loosen them up every so often helps reduce neck/shoulder/back pain and headaches. And sometimes I tweak a muscle that then doesn't let me move my head in a certain direction, and a professional massage helps clear that up quite a bit too. Acupuncture sounds too much like pseudo-science to me, so it seems like if it works, it's probably a placebo effect. (I obviously have nothing to back this up, though.)
It's really interesting and somehow funny to realize the difference between America and Germany on this topic. I am from Germany and chiropractic here is mostly used and done by medical doctors (mostly general practioners). You don't have to go somewhere else and pay a lot of money, you just go to your doctor. And no one would even think of using chiropractic for anything else than back pain/orthopedic problems...
You clearly don't understand the difference between allopathic, osteopathic, and chiropractic care.
Thank you god. Maybe if I had this NONE evasive treatment Beforehand in 2005, I may not have Shiny Titanium in my spine. But who knows right?
I have to say that I think HCT seriously dropped the ball here. IN THEORY, this all sounds good. In practice, I have major concerns that were not addressed.
First, is there evidence that what a chiropractor does is substantially different from and better than what a physiotherapist could do without adding in a bunch of pseudoscience?
Second, by mentioning acupuncture in the same breath as chiropractic, you implied tacit support for acupuncture without offering any supporting evidence. I am not aware of any studies showing that acupuncture works better than placebo for anything, and many that show that it doesn't. These are two completely unrelated practices and should have been separated more completely.
Finally, I cannot ignore the fact that many chiropractors overstep their bounds and claim to treat conditions they have no business treating, something you gave only the briefest of mentions. Furthermore, many chiropractors espouse harmful pseudoscientific beliefs and recommend other pseudoscience treatments to their patients. For just one example, some even recommend against vaccines. How can you, the primary care physician, be confident that your patient won't find one of these practitioners when you suggest chiropractic care? Do you accept that risk? Do you comb through chiropractors in your area to find one that doesn't, and then recommend him or her in particular? In good conscience, can you ever recommend chiropractic care even knowing how deeply this problem is embedded in the field?
I would love to have my mind changed about chiropractic, but this video hasn't done it yet. Sometimes the focus needs to be a little broader than the singular question "does it work?".
what is the evidence for fasting like the 16/8, can you make a video on it ?
Can you do a video about subscription based medicine?
I have no idea what spinal manipulation is.
weird. these things are the first thing you get prescribed when you complain about back pain to an austrian GP. more people over 25years old i know have had massages, heat, or electric therapy prescribed than have not. you can even get 3 week long treatments at a health resort paid by your regular insurance (part from a small part you have to pay yourself depending on your income). we've been doing this for dozens of years. i am sure insurances wouldn't pay for all this if it didn't help
do you think this could be because of psychosomatic factors? pain is rather subjective. Chiropractic work is not physical therapy. just because patients are reporting better mitigation of symptoms does not prove that the treatment is actually doing anything.
Just think: heat and going to chiropractor is WAY BETTER than prescribing opioids.
I think more doctors should be recommending less harmful methods (although I'm not advocating homeopathy)
Very solid episode again. Already shared.
this can be solved pretty simply, do a very public case study on something they promise like regenerating the disc heights by proper adjustments and giving specific exercises for rehydrating the spine proper sleep nutrition etc.. do one with every thing but adjustments and compare the two. find the best know chiropractor who gets the best results for this too. lets get this shit settled so there are no more agruements
I have chronic pain from degenerative disc disease in my cervical spine and I would never consider seeing a chiropractor. I have seen physiotherapists extensively, I have more trust in a therapy backed by a university degree. Australia does cover chiro through private health insurance and even chronic disease treatment plans through Medicare, but I don't think they should without chiropractors at least requiring a biology degree and only being licensed for treating pain associated with the spine. Licenses should be revoked for anyone purshing anti vaccination or other quack treatments
His shirt changes at the end lol
Most channels shoot a shoutout just one time and then just copy paste it onto the end of all there videos that are sponsored by that company.
The vast majority of studies have found chiropractic to do more harm than good. It's alarming to see it promoted.
...and acupuncture? It's a placebo effect.
Love the show. Seems odd that Aaron is going through some pretty weird lengths lately to remind everyone he's a doctor. He literally mentions it twice in the first minute of the show.
Duloxotine is a newer medicine that provides incredible relief for my chronic lower back pain. It is primarily an antidepressant with a miraculous side effect!
It's got to be quite hard to do a blind study with spinal manipulation though.
You can't exactly do a placebo massage, it would be pretty obvious that someone was giving you a pretend spinal manipulation.
The problem is that nearly half of the chiropractic community are christian fundamentalists that think Chiropractic gives you the healing powers of Jesus. My father spent his entire life battling these quacks, sitting on the national board of Chiropractic, helping set rational standards for the profession. I'm really glad to hear his work was not in vain.
I have no idea where you get these misconceptions from.
Nothing to do i guess
@@drrosemariejabbourchiropra1591 My father was Lester Lamm.
So Dr. Carroll changed shirts at the end why? I mean that just comes across to me as really really really weird. Is he going to start changing his shirts and clothes through the show from now on?
"I'm Dr. Carroll and I like changing shirts. This is Health Care Triage."
4:46 Triggered
The theory why spine manipulation helps with all kinds of things, is that the spine is putting pressure on nerves altering the information transmitted from one part of the body to another.
Trust in Dog
That doesn't prove anything and why do they assume that altering the information is something positive?
What about the harms of the chiropractor pushing their pseudoscience?
SciReview Not this chiropractor, my friend.
Todd Lloyd, Good to know! There is no shortage of quack DCs in my area.
A chiropractor I use to go to had a sign on his entrance door that claimed manipulation made vaccination unnecessary. The fact that so many DCs tend to snake oil is a caution. Just go for the spine care and avoid the silly stuff