Anti-Quackery & Science Blog
One question I like to ask chiropractors, and one I have never received an answer to, is how organs systems continue to function after transection of the spinal cord due to trauma. They don't seem to understand that many functions of our body do not need the spinal cord intact. Quadraplegics still filter blood with their kidneys. There hearts continue to beat. A chiropractor recently came to Vanderbilt to speak to the 4th year medical students and put up a slide showing how specific subluxations effect specific organs. When will they learn.
Great question - by the way, I am a Doctor of Chiropractic. I appreciate the confusion about my profession, and many claims some of the Doctors make. In response to your question about people with damage to the spinal cord. When a spinal injury occurs, this affects the motor nerves /sensory nerves that allow a person to move muscles and feel sensations. This happens because the damage occurs within the spinal column and signals from the spinal nerves are not properly transmited to and from the brain via the spinal column. Your body has a variety of other pathways for neurologic communication. Your ability to digest food, have bowel movements, breath, or even a heart beat is controlled by the autonomic nervous system - a little diffent than the voluntary motor system. What is also amazing is that both the heart, and the intestines, have additional self stimulating systems. The heart can beat even outside the body, and the intestines can self regulate. Every organ does have a spinal nerve that goes to it, but it isn't the only nerve. The amount of damage you recieve depends on the level of spinal damage, and if any nerves are directly damaged. This is why some people have to use breathing tubes following spinal injury and others don't.
The most common sign for emergency surgury associated with a disc bulge is the loss of bladder and bowel function. Yes, you pinch a nerve hard enough and your "organs" don't work properly. But lets get real, very few people actually have a pinched nerve. Most people have over fascilitated (irritated) nerves. And not the big spinal nerves you think about, but the microscopic nerve endings found in the surrounding tissue and facet joints.
Ever bump you head? You rub it to calm down the pain. This is because mechanoreceptors (nerve endings) will calm down the pain receptors (nerve endings). Guess what? A manipulation of the spinal joints is done to fire those mechanoreceptors to help modulate pain. More importantly, if you can keep the joints moving, ie. exercise - the pain will continue to decrease. Same reason your stiff in the morning - lack of joint motion!!
In comment to the stroke issue - the stats show about 1 in 2 million have a cerebrovascular event following manipulation of the neck. You have a greater chance of a stroke from turning your head to quickly while trying to look out your car window then from receiving a manipulation of the spine. More people have serious complications from taking asprin than from getting an adjustment. Insurance companies understand this - and this is why my malpractice insurance cost are about 1/5 that of a medical doctor.
Transplanted organs - give me a break. You don't think nerve supply is required?
You don't have to like chiroprators, lawyers, or mechanics. The truth is that every profession has idiots and liars. That doesn't discredit the whole profession. I spent four years postgraduate, taking the same classes as a medical doctor, reading the same text books, cutting up the same dead bodies in gross anatomy. Give me a little credit. Most chiropractors are to lazy to try to educate their patients - and that is why stupid comments, like the chiropractor you reference, are made.
Read my blog if you want a better understanding.
http://advancedehealth.blogspot.com
Steve Vanden Hoek, D.C.
"Most people have over fascilitated (irritated) nerves. And not the big spinal nerves you think about, but the microscopic nerve endings found in the surrounding tissue and facet joints."
Really? How is this measured? What studies support this?
"A manipulation of the spinal joints is done to fire those mechanoreceptors to help modulate pain."
This has as much scientific support as saying that manipulation allows for better flow of life energy from god.
"In comment to the stroke issue - the stats show about 1 in 2 million have a cerebrovascular event following manipulation of the neck. You have a greater chance of a stroke from turning your head to quickly while trying to look out your car window then from receiving a manipulation of the spine."
Where did you get these numbers from. I've heard higher rates.
"More people have serious complications from taking asprin than from getting an adjustment. Insurance companies understand this - and this is why my malpractice insurance cost are about 1/5 that of a medical doctor."
Aspirin has a proven mechanism of action whereas chiropractic has theory and conjecture. Your simplistic analogy fails to take into account the potential indirect damage of chiropractic such as delayed medical care for problems that a chiropractor is not trained to detect and may not even think about. This is particularly an issue when chiropractors attempt to treat children. The chiropractic community is very secretive about just how much malpractic goes on. Your cost is lower because people don't sue alternative practitioners like they do MD's. That speaks volumes about the ability of alternative practitioners to connect with their patients, something MD's can stand to learn from. It does not speak to the legitimacy of your profession which is suspect except in the realm of acute lower back pain.
Do you really want a pissing match?
I game!
Alright Doc - Call me on this if I'm wrong. That is the point of having an open discusion. Please do not be "irritated" by my answers - as I want anyone, not just a doctor to understand what we are talking about.
As much as I hate to admit it – most of the support for chiropractic manipulations comes from the medical community and not chiropractic. Unfortunately they are doing most of the research that show the neurological connection between joint manipulation and the benefits the patient experiences.
I will kindly address each issue you raise in response to my reply.
1.) "Most people have over fascilitated (irritated) nerves. And not the big spinal nerves you think about, but the microscopic nerve endings found in the surrounding tissue and facet joints."
Q: Really? How is this measured? What studies support this?
A: The microscopic nerve endings I speak of are nociceptive and mechanoreceptors nerve endings. When a joint has altered kinematics – effusion or swelling (inflammation) is initiated in the area of altered biomechanics. This (inflammation) is a natural response to any proposed injury. Inflammation causes a whole host of reactions. These include increased fluid build up, increased chemicals to the regions, increased blood, etc. This is why when you cut yourself you it swells, gets red and hot, and is more tender. As you know spinal nerves exit the spinal column via the foramen formed by the joints of the spine. If anything – be it a spur, degenerative disc disease, or inflammation and swelling, or a disc herniation encroaches on the nerve directly or indirectly – the nerve will fire. i.e. increased pain, or motor or sensory loss. Basic neurology shows that pressure, even very slight pressure – will cause inflammation of the nerve and increase the firing rate and frequency. You can pump the body with an anti-inflammatory to help the reaction – or you can help improve motion to get rid of the fluid and swelling. Now as you can tell – this doesn’t work when spinal stenosis is present, nor is it as effective with severe disc degeneration or a disc herniation. My study is every neurology, physiology, pathology, and anatomy text book. Look it up – its basic science.
Nerve facilitation - I assume you understand the concept of pain and that you understand that inflammation causes pain? This knowledge is the basis for why docs give “anti-inflammatory” medication to patients in pain. That’s why you take ibuprofen. Stop the inflammation, and you decrease the pain. Do I really need a journal article to demonstrate this concept – or will millions of Rx’s for anti-inflammatory meds due the trick. Ever heard of joint effusion – or capsular swelling? Swelling, huh, could this be swelling as in one of the cardinal signs of inflammation – rubor, calor, etc.
2.) "A manipulation of the spinal joints is done to fire those mechanoreceptors to help modulate pain."
Q: This has as much scientific support as saying that manipulation allows for better flow of life energy from god.
A: Mechanoreceptors modulating pain – scientific proof?
You will need three things any 1st year med student will have. 1.) anatomy book 2.) neurology book 3.) physiology book. READ THEM.
This isn’t even up for debate. Even the M.D.’s know this - Dr. Mark Sontag – a physiatrist noted “neurological studies show motion tends to block pain impulses to the brain….the more action, the less pain is likely to be felt…”
“The perception of pain is dependent upon the balance of activity in large (mechanoreceptor) and small (nociceptive) afferents.
John Nolte, The Human Brain, Mosby Year Book, 1993, p. 139.
“If large my myelinated fibers (mechanoreceptors) were selectively stimulated, then normal “balance” of activity between large (mechanoreceptors) and small (nociceptive) fibers would be restored and the pain would be relieved.”
John Nolte, The Human Brain, Mosby Year Book, 1993, p. 203
It has been shown that in the neck – much neck pain comes from the zygapophysial joints – the very joints chiropractors manipulate.
http://www.ncbi.nlm.nih.gov/
entr...l=pubmed_docsum
Mechanoreceptor Endings are in human cervical facet joints as per:
SPINE volume 19, number 5, pp. 495-501 (March 1, 1994)
SPINE 1998;23:168-173
And we also see that these mechanoreceptors provide “afferent input to the central nervous system (CNS); because the endings identified were primarily mechanoreceptive, it follows that the mechanical status … is being monitored at the CNS level.”
http://
www.askewchiropractic.com..._adjustment.htm
“The transmission of pain signals up the spinal cord can be increased by lack of proprioceptive signals (sensory information to the spinal cord on the movements and positions of muscles); or reduced by greater proprioceptive input. This is Melzack and Wall's "gate" mechanism - the gate is opened to pain (nociceptive signals) by reduced other sensory input.”
Bottom line –
1.) mechanoreceptors exist within the joints of the spine.
2.) mechanoreceptors affect the CNS
3.) damaged/injured z-joints cause pain
4.) properly functioning z-joints don’t cause pain
5.) get the z-joint moving, and you help control pain
6.) chiropractors restore normal motion to the z-joints thus helping increase joint motion and pain modulation.
3.) "In comment to the stroke issue - the stats show about 1 in 2 million have a cerebrovascular event following manipulation of the neck. You have a greater chance of a stroke from turning your head to quickly while trying to look out your car window then from receiving a manipulation of the spine."
Q: Where did you get these numbers from. I've heard higher rates.
A: Lets start with this one: (covers the stroke and NSAID issue)
http://stroke.ahajournals.org/cg.../full/32/9/
2207
As shown in their Table 1, the entire argument as to whether spinal manipulation is a significant risk factor appears to hinge on a total of 5 cases over 5 years, or 1 case per year. To put this matter in the proper perspective, one should be forever cognizant of the fact that death rates following cervical manipulation calculate to be anywhere between 1/100 to 1/400 the rates seen in the use of NSAIDs for similar conditions.11,12 Death rates from lumbar spine operations have been reported to be 300 times higher than those produced by cerebrovascular accidents in spinal manipulation.13,14 For cervical surgeries, recent death rates have been estimated to be 700-fold greater.14 As Rome7 has pointed out, risks for "virtually all" medical procedures ranging from the taking of blood samples15 or use of vitamins or drugs16 are routinely accepted by the public as a matter of course.
Then this one: (stroke again)
http://www.webmd.com/content/art.../
1728_80109.htm
“As pointed out in Rothwell's study, says Rondberg, the rate of stroke is estimated at 1.3 incidents per one million adjustments given. "Other studies, including one covering a 28-year period reviewing 110 million chiropractic visits, showed conclusively that the risk of stroke from chiropractic adjustments is so small that it's statistically insignificant," he says.”
Oh wait, I forgot about this one: (even better – stroke again)
http://www.chiroweb.com/archives...s/19/23/
04.html
A paper1 published in the October 2 issue of the Canadian Medical Association Journal (CMAJ) by Scott Haldeman,DC, MD,PhD, Paul Carey, et al. ("Arterial Dissections following Cervical Manipulation: the Chiropractic Experience") reports that the chances of arterial dissection after cervical manipulation is approximately 1 in 5.85 million manipulations.
4.) "More people have serious complications from taking aspirin than from getting an adjustment. Insurance companies understand this - and this is why my malpractice insurance cost are about 1/5 that of a medical doctor."
Q: Aspirin has a proven mechanism of action whereas chiropractic has theory and conjecture. Your simplistic analogy fails to take into account the potential indirect damage of chiropractic such as delayed medical care for problems that a chiropractor is not trained to detect and may not even think about. This is particularly an issue when chiropractors attempt to treat children. The chiropractic community is very secretive about just how much malpractic goes on. Your cost is lower because people don't sue alternative practitioners like they do MD's. That speaks volumes about the ability of alternative practitioners to connect with their patients, something MD's can stand to learn from. It does not speak to the legitimacy of your profession which is suspect except in the realm of acute lower back pain.
A: Again lets start with this one: (covers the stroke and NSAID issue)
http://stroke.ahajournals.org/cg.../full/32/9/
2207
To put this matter in the proper perspective, one should be forever cognizant of the fact that death rates following cervical manipulation calculate to be anywhere between 1/100 to 1/400 the rates seen in the use of NSAIDs for similar conditions.
Then this one:
http://www.medpagetoday.com/tbin...x.cfm?
tbid=1612
“…the researchers calculated that the national death rate from aspirin or other NSAID-related GI events was approximately 15.3 deaths per 100,000 NSAID and aspirin users. NSAIDs included over-the-counter and prescription drugs.
Low-dose aspirin alone accounted for between 8.2% and 12.2% of all GI complications and deaths, the research team reported in the August issue of the American Journal of Gastroenterology. “
Lets look at this one: (malpractice cost)
http://tampatrib.com/Business/
MG...GA2EYCO2HD.html
“Baycare estimates its average premium for a doctor is $20,000 a year; UCH estimates its average at $20,000 to $25,0
(CONTINUED) ---- $25,000. But each insures a large number of physicians in what are considered low-risk specialties, which lowers the average.
The cost of the policies generally range from $10,000 to $60,000 - though a few physicians have been given quotes of more than $100,000, Archbell said. “
I paid $1,200 last year for my malpractic – for the whole year – and that was for 1mill/3mill coverage. Sorry I was wrong – it isn’t 1/5th but 1/10th to 1/100th the cost. And bull to not getting sued as much. People can sue for any reason, any time – in fact most the time they know it won’t go to court, but the doc will settle just so his name doesn’t get smeared. Cost are based on pay out – and the more damage you cause – the bigger the pay out. We can’t cause that much damage since we don’t cut on the patient, or rot their liver with powerful drugs. The most we can do is crack a rib, sprain a joint, or exacerbate a current condition.
Training:
Not trained to detect potential problems? Do you have any idea what are training involves? Per not being trained to detect more complicated problems – is that why I am considered a primary physician – is that why the description of what I can treat and how sasys the following: “…a chiropractic physician(is)licensed to treat human ailments without the use of drugs and without operative surgery.” http://ilga.gov/legislation/ilcs...+Act+of+1987%
2E
Now from what I read, this means any – yes any – human ailment. I’m sure you understand that you aren’t legally allowed to treat something you can’t first diagnose. And you can’t diagnose something you haven’t been trained to diagnose. And the training had to come from an approved school – regulated by the government. Look if the government says I can do it – I can. Even if you don’t like it. Even if some of my colleagues choose not to diagnose or treat anything other than a subluxation – which has an ICD-9 code associated with it. Oh that ICD-9 means it is a recognized problem/disease. I guess a subluxation is a disease – at least as much as acid reflux is a disease. Or are only things that can be treated with a drug or knife a true disease?
And per future adverse events as the result of a manipulation – give me a break medical mistakes at hospitals cause more serious complications and deaths than all the chiropractic manipulations will ever cause. And if this is such a problem, why are the Physical therapist lobbying congress for the right to give manipulations? Why are Medical doctors taking continuing ed classes to learn how to provide manipulations? Come one – every one wants a piece of our action – b/c it works.
I appreciate your willingness to stand up for what you believe is right and wrong. I even agree with your comment that chiropactors haven't proven a great need for children - and the scoliosis screening thing is a scam, a marketing tactic - about the same as those hearing test they give your kids?
Honesty - I do appreciate your comments and even your own blog - not bad. Do I treat my own kids – sure. I have three kids – ages 7, 5,4. Guess what – between all three we have had to use one round of antibiotics. I haven’t had one of them sick for more than 24 hours. I feed them good, adjust them, give them food supplements. My son has been in the hospital once – after a bad reaction to a vaccine – guess what, I don’t tell patients not to get vaccinated – that would be practicing medicine. Just like you telling a patient not to get an adjustment is practicing chiropractic. Every profession has to prove itself. Medicine use to use leaches to get the evil spirits out, chiropractors thought they could cure cancer with a spinal manipulation. M.D.’s thought nerves carried air, D.O.’s thought they carried blood, and D.C.’s thought they carried electricity. Guess we got one correct. D.C.’s were doing physical therapy on patients before physical therapist were around. Yeh – we got a lot of quacks out their, but hey, so do you. Feel free to chop up the chiro’s doing crazy stuff , but not the profession – just the person – some of us have our head on straight, and would love to work with you, not against you.
Steven L. Vanden Hoek, D.C.
Is chiropractic care dangerous? My malpractice insurer doesn't think so. I pay $ 1900 per year for $1 million / $3 million coverage - the standard amount required by most health care professionals. Compare that to MD's of various types, particularly spinal surgeons. Why do they pay more for malpractice insurance? Good question...maybe if they didn't prescribe drugs like Vioxx they'd represent less of a risk to their malpractice insurers.
I am a Chiropractic student and I appreciate all the comments and research articles cited here. Let me make this clear; I am pro research and I am actually working on a case study right now.
There is one problem with research on BOTH ends of the spectrum. NO 1 person (MD, DC, DO, researcher, etc) knows or will EVER know the ENTIRE inner workings of the human body for each individual person!
I like to think of human beings like snow flakes. As everyone knows, not one snowflake is like the other. Humans are exactly like that. SO, how can research be the end all know all?
Also, in this country especially, in the science world chiropractic = guilty until proven innocent. How is this fair when so many times other health care providers have dispensed medication like candy that either a) wasn't meant for that particular ailment, or b) given to an unresearched population. exp. certain drugs given to kids for ADD/ADHD that was tested on adults and for a short period of time. The dosage for the kids was GUESSED. GEE, that's smart, but DON'T EVER go see a chiropractor for that condition. The DC might actually help you without meds or side-effects. But again ... no research, right.
Certain important research has been tainted, manipulated, and been completely disproved over the years. How many people have died over political $$$ floating around? And yet you all want to base your opinions on research??? What about that makes sense? You can't accurately measure PREVENTATIVE outcomes. Tell me, IF chiropractic adjustments are soooo bad, then why are physiotherapists and medical doctors taking a "weekend" class to learn how to manipulate? Why are DOs more accepted than chiropractors in the medical world? WE spend YEARS learning adjusting techniques and why we do what we do and when to do it. We are specialists...at the VERY LEAST, believe that we are the back specialists. I am saying that because that is the VERY least, but if you can't even believe that; then I beg you to go to Palmer College of Chiropractic in Davenport, Iowa and sit through Mr Morter's Spinal Anatomy II class.
Did you know that the first chiropractic adjustment given by DD Palmer in 1895 regained a man's hearing? His name was Harvey Lillard. But hey, maybe he should have waited for the research first.
All I know is I had severe pain down my left arm from a non-ergonomic work station at work causing a pinched nerve in my neck or something similar. Someone suggested seeing a chiropractor and I did. It took more than one treatment, but eventually the pain went away. It came back about two years later, and again the chiropractor fixed me right up. I now see him on a semi-regular basis to prevent the pain from coming back yet again.
Having experienced this first hand I am a believer now. 
Josie,
Some people are coming around. My employer used to only pay for 50% of the cost for seeing a chiropractor or a psychiatrist. All other doctors were covered 80% except these two.
But a while back they changed their tune and now ALL doctors are covered 80%. So there is yet hope.
I anticipate, someday you'll blog a question about how is it possible for our heart to work once it is transplanted. :D
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Firstly, I'm a chiropractic student at one of the finest chiropractic institutions in Austalasia. I couldn't be more proud of the profession that I am a part of.
Does it hurt when I see my profession being bashed under the title of quacks? Sure.
Does it hurt when MDs put the word out to their patients to NOT see any chiropractors or "those types of doctors"?
Sure.
Does it hurt when we are told in public that chiropractors should have no say in the 'vaccine issue' because there is no evidence for the claims they make?
Oh god yes.
What hurts me most is that these and several other unsubstantiated claims of western medicine on chiropractic and other health issues are accepted without question by the minds of rational, thinking professionals of our society.
What happened to using our minds to question what is being constantly shoved at us?
Ask if its rational; ask where the biased opinions are coming from; look at it from an objective point of view rather than accepting it as fact.
That's all I ask because that's all I need to ask because then and only then will we stand on a level ground and do good to our patients.
Ask what would happen to the funding of medical schools around the world if today they would renounce pharmaceutical medicine? Would they not come on the same 'level' as every other health practitioner out there? Skeptics say that chiropractic has contributed little to research; I say give us a piece of those billions that the pharmaceuticals provide the medics and we'll show you what we have!!
With respect and love,
Chandan S Brar
(This is my first comment on any blog, do critique what you must because I can back up anything I've said)
lucky me...my orthopaedic surgeon loves the fact i see a chiropractor weekly. had way to much fun as a kid, my chiro relieves the pain.
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