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She does NHS and private, has amazing knowledge of anatomy, and can immediately visualise the likely problems with wear/strain caused by deformities and previous injuries and operations
I did have a good NHS physio (in his 20s) last year for something, was quite impressed, not certain he could deal with non-standard stuff yet, but was on the right track
I once had an NHS physio patronising me for being lazy when I had muscle wastage in one arm (triceps). Turned out I had subacromial compression, for which I had surgery a year later. What a dickhead, I could not believe how incompetent you would need to be to not spot one of the most common conditions.
My points are:
- chiro does fix some stuff better than anything else I have tried. Lower back, neck
- It also claims to fix stuff that few would believe.
- The public are used to accepting a risk for medical treatments
- There should be an acceptable risk/benefit ratio on any medical treatment. Even normal prescription drugs can kill, I have had various operations that can disable patients sometimes
- I now try to avoid chiro on my neck, unless I have been in pain for weeks, AFAIK there is no risk for lower back manipulation
btw Allanah Myles, the rather attractive woman who sang "Black velvet" has permanent injury from daily chiro on her neckhttp://www.680news.com/2011/07/01/alannah-myles-shares-tragic-health-news-with-canada-day-crowd/
Personally, I align this with the over-use of treatments that can arise when the rich use compliant practitioners to over-use treatments (e.g. Michael Jackson)
Ideally, physios would be taught the most effective chiro manoeuvres, and then all will be well
The "chiro manoeuvres" are called spinal manipulations, or just manipulation.
The techniques of manipulation are pretty similar whether a Chiropractor, or an osteopath, or a physio does them. There are some technical differences in some techniques but let's just say they're mostly identical.
The thing is manipulation is not without risk. Really, you can ruin someone's day if you do it wrong.
Osteopaths and Chiros learn to manipulate from the get go. Their training is all geared toward private practice and musculoskeletal (MSK) treatment. By the time they're let loose on the public they should be able to manipulate safely.
Physios have a very different career path.
It is much broader at the base when you're training and newly qualified. But you get to see and work in pretty much everything. Later on, when you specialise, that long, broad training really pays off because you've got experience of lots of stuff that osteopaths and chiros have no first-hand knowledge about.
Here's the point: a newly qualified physio isn't ready to do spinal manipulation. But once we've specialised in MSK plenty of us do learn how to do it. (I learnt from osteopaths as it happens.) But it's all post-grad.
Here's the thing: consider all of the crappy problems that backs can have. Really, they can have lots.
Manipulation is really good at fixing a couple of them. Sorted. If I hear a certain history and the assessment checks out... click, crack, job done. Very happy patient.
But... manipulation also has a fairly good short-term effect on a whole bunch of other back problems. And here's where it's trickier, and I won't complicate it, but you can see where I'm going with this. Do you give short term relief or work toward a long term solution?
What are you gonna say if you're in pain and want the short-term relief? How keen are you gonna be for the long-term solution which may well seem pointless (cos you're in pain and it's doing nothing) and is a lot of effort too?
Well, why can't you do both?
You can. If it's a straight-forward enough problem.
But there are a bunch of back problems which are anything but straight-forward.
And that's absolutely where, for the long-term benefit of the patient, you don't want to be taking away their self-efficacy by having them rely on short-term treatment effects. (And they do come to rely on manipulation, very quickly.)
And I think that's probably the area where you'll start to see the significant differences between physios and the other therapists.
That was probably way too long!
The difference is that conventional medicine changed with the presentation of further evidence. Chiro doesn't and can't, because its core is based on the principles of subluxation, for which nobody has managed to find any evidence whatsoever in over a century of trying; equating that with conventional medicine is fundamentally broken logic.
My point was actually that nobody should really have to accept a risk of death, strokes and other such unrelated damage for unnecessary manipulations performed due to the practitioner following dogma rather than actually having a clue how the body works.
I know I'm using quite strong language here - it's genuinely not directed at you, and I know you're trying to look at both sides
If, for example, I hadn't intervened with those wonks I referred to in my post above, they'd have convinced my wife to go for it - she was in huge amounts of pain, and that seriously affects the critical thought process. We talked it over with the consultant who performed the surgery on her, and his opinion - based on decades of surgical experience - was that any cervical manipulation of the sort they proposed would likely have left her paralysed from the waist down...and that's the best case scenario.
That makes me pretty angry. Idiots without the first clue what they're doing (or the damage they can cause) preying on the vulnerable and in pain, combined with a "regulatory body" who are similarly unqualified and turn a blind eye to the massive disparity in knowledge, capability and practices within the group they're supposed to regulate for the safety of the public.
And, by the way, that article has absolutely zero to do with my post.
EDIT: Meant to say it has absolutely zero to do with refuting my post, which is what I presumed was the intention (in the absence of an explanation). @Grunfeld has a better analysis below...
The article castigates the popular press for getting hyped up about a study. But the opinions of the popular press don't really matter.
There is seldom a definitive study which is "the evidence".
Good evidence is more like a a collection of studies which start to stack up and all point in the same general direction.
There are problems with evidence based medicine. But Ioannidis (who is also referenced in that recent link you've posted) is actually one of the guys who wants to examine how science relates to medicine. His ideas are interesting. The problem he had after he published his essay (your first link) is that lots of pseudoscientists and basically cranks used it as justification for their very non-evidence based theories. That guy Dr Zamboni and his "liberation therapy" for MS -- he's a good example of what digitalscream said: the original research was iffy (because it lacked prior plausibility) but it was worthy of investigation at least. Well, it's been investigated and shown to be useless. Has it stopped him touting his useless "cure" for MS? I know he was still doing it a couple of years ago, (long after being disproved).
Ben Goldacre, who writes on this stuff, said about this: "flaws in aircraft design do not prove the existence of flying carpets". And it case it's not clear: just cos scientific research is not perfect doesn't mean that claptrap is real.
and also highlights again the problem of people self-referring to any kind of practitioner (in my case chiros) - who is ensuring the combination of treatments is genuinely a good idea?
I didn't give you a passive aggressive lol, but I do disagree.
I worked with someone who treated themselves with a homeopathic medicine for a cold, which contained heavy metals and neurotoxins. I can't remember the specifics, but I'll never forget them fighting to not have medical treatment because drugs and surgery are dangerous.
However, ordinarily the harm comes from not treating something but believing you are, so in that sense you are right.
The answer is that the therapist, the doctor, the professional, should be giving you treatments in a way informed by evidence.
It's difficult to do sometimes. Because you get experience with "what works". Experience is invaluable.
Evidence based research sometimes goes against what you've learnt by experience.
But the whole point of evidence based research is that it's "bigger" than our individual experience and the cognitive biases that we can't escape. And that, @west , is why on the whole evidence based medicine is so useful.
It does not mean jumping on the latest study and doing a U-turn; it means evaluating the research, looking at the quality of the meta-analyses, and then using that and clinical reasoning with the individual patient in front of you.
It's actually quite humbling because it makes you evaluate what you think you know. E.g. there are treatments I no longer give and it's the same for the doctors -- they've now got patients going, "Why aren't you going to inject my facet joints? [for the umpteenth time]" and the answer is "Cos the evidence says it doesn't work."
And for me, with neck manipulation, "Why won't you crack my neck? [for the umpteenth time]" -- Cos the evidence says it doesn't work! And Allanah Myles would probably agree.
After my broken elbow, I got good NHS physio for my elbow and wrist from the hospital. But they wouldn't look at the soft tissue damage in my shoulder as it wasn't on their chart - which in the end was more painful than the fracture. Fracture is all better (thanks ), GP referred me for "urgent" physio treatment at the end of October - wait time allegedly 2-3 weeks, non-urgent 3-4 months. After a 3 month wait without a peep from local physio dept, GP told me the service was in chaos and if I could, go and see a private Physio or Osteo, which I did yesterday (Osteo) - instant relief.
Feedback
"Direct harm" does that include killing people by inducing them to refuse normal treatment. I think so, since that is a direct consequence of following homeopathic guidance
http://www.iflscience.com/health-and-medicine/cancer-patients-who-turn-to-alternative-medicine-are-25-times-more-likely-to-die/
https://www.ncbi.nlm.nih.gov/pubmedhealth/behindtheheadlines/news/2017-08-16-alternative-cancer-therapies-may-increase-your-risk-of-death/
https://sciencebasedpharmacy.wordpress.com/2013/11/23/use-of-homeopathy-kills-child/
http://whatstheharm.net/homeopathy.html
http://www.telegraph.co.uk/technology/apple/8841347/Steve-Jobs-regretted-trying-to-beat-cancer-with-alternative-medicine-for-so-long.html
http://www.telegraph.co.uk/technology/apple/8841347/Steve-Jobs-regretted-trying-to-beat-cancer-with-alternative-medicine-for-so-long.html
https://www.theguardian.com/uk-news/2014/jan/31/neon-roberts-cancer-treatment-recovering
there are hundreds of stories like this
check again, looks like the NHS disagree:
https://www.nhs.uk/conditions/osteopathy/
https://www.nhs.uk/conditions/chiropractic/#uses-of-chiropractic
https://www.ncor.org.uk/practitioners/practitioner-information-communicating-benefit-and-risk-in-osteopathy/risk-and-patient-incidents/#question4
Bit more info:
http://www.sportsinjuriesspecialist.co.uk/info/75-how-safe-is-osteopathy
I just had a quick look
both subjects are available at a few UK universities, the grades required for chiropractic are slightly higher:
https://www.whatuni.com/degree-courses/search?subject=chiropractic
My dilemma is " what do I do when I am in great pain, and my SI joint or neck has seized up?"
Perhaps I should try an osteopath one day too
I am very impressed with my physio though, and the chiro I have is the best I have used