MD, PhD, FMedSci, FSB, FRCP, FRCPEd

The British Chiropractic Association (BCA) has lost all credibility after suing Simon Singh for drawing the public’s attention to the fact that they were ‘happily promoting bogus treatments’. Now, it seems, they are trying to re-establish themselves with regular, often bogus or dubious pronouncements about back pain. It looks as though they have learnt nothing. A recent article in THE INDEPENDENT is a good example of this ambition, I think:

START OF QUOTE

Skinny jeans and coats with big fluffy hoods can contribute to painful back problems, chiropractors have warned.

Nearly three-quarters of women have experienced back pain, according to a survey by the British Chiropractic Association (BCA), who said fashionable clothing including backless shoes, oversized bags and heavy statement jewellery were partly to blame.

Wearing very tight jeans can restrict mobility and force other muscles to strain as they try to compensate for the resulting change in posture, chiropractor Rishi Loatey told The Independent.

“If they’re incredibly tight, you won’t be able to walk as you normally would,” he said.

“You’ve got a natural gait, or stride, that you would take, and the knee, hip and lower back all move to minimise the pressure coming up through the joints.

“However, if one of those areas isn’t moving as it should be, it’s going to cause more pressure elsewhere.”

While 73 per cent of women from a sample of more than 2,000 said they have had back pain, more than a quarter – 28 per cent – said they were aware their clothing affects their posture and back and neck pain, but did not take this into account when choosing what to wear.

Lower back pain is the most common cause of disability worldwide, with 9.4 per cent of people suffering from it, according to a previous study.

High heels, which cause muscles in the back of the leg and the calf to tighten and pull on the pelvis differently, have long been culprits of back pain.

A number of high-profile campaigns against “sexist” dress codes requiring women to wear high heels at work have made reference to this fact.

But backless shoes, flimsy ballet pumps and some soft boots can also damage your back if they are worn too often, said Mr Loatey.

“If you imagine the back of a shoe, the bit that goes round the back is supposed to be quite firm, so it grips the rear foot,” he said. “If you don’t have that, then your foot is more mobile in the shoe.”

“If they’re not the right size, they’re a bit loose or they don’t have the bit at the back, you’re almost gripping the shoe as you walk, which again changes the way you walk,” said Mr Loatey, adding that ideally shoes should be laced up at the front to make sure the foot is held firmly.

A third of women surveyed by the BCA were unaware that their clothing choices could harm their backs and necks.

Mr Loatey said people should try and wear clothes that allow them to move more freely. Heavy hoods and over-shoulder bags can both restrict movement.

They should also consider limiting the amount of time they spent wearing high heels or backless shoes and consider travelling to work or social events in trainers or other well-supported shoes instead, he said.

END OF QUOTE

This piece strikes me as pure promotion of chiropractic – health journalism at its worse, I’d say. What is more objectionable than the promotion, it is full of half truths, ‘alternative facts’ and pure invention. Let me list a few statements that I find particularly doggy:

  1. “Skinny jeans and coats with big fluffy hoods can contribute to painful back problems.” Do they have any evidence for this? I don’t know of any!
  2. “…fashionable clothing including backless shoes, oversized bags and heavy statement jewellery were partly to blame [for back problems].” Idem!
  3. “Wearing very tight jeans can restrict mobility and force other muscles to strain…” Idem!
  4. “…it’s going to cause more pressure elsewhere.” Idem!
  5. 28% of women said “they were aware their clothing affects their posture and back and neck pain, but did not take this into account when choosing what to wear.” To make the findings from a survey look like scientific evidence for cause and effect is at best misleading, at worst dishonest.
  6. “…according to a previous study“. It turns out that this previous study was of occupational back pain which has nothing to do with tight jeans etc.
  7. “High heels, which cause muscles in the back of the leg and the calf to tighten and pull on the pelvis differently, have long been culprits of back pain.” A link to the evidence would be nice – if there is any.
  8. “But backless shoes, flimsy ballet pumps and some soft boots can also damage your back – if they are worn too often…” Evidence needed – if there is any.
  9. “Mr Loatey said people should try and wear clothes that allow them to move more freely. Heavy hoods and over-shoulder bags can both restrict movement.” Concrete recommendations require concrete evidence or a link to it.
  10. Women “should also consider limiting the amount of time they spent wearing high heels or backless shoes and consider travelling to work or social events in trainers or other well-supported shoes instead.” Idem.

At this point congratulations are in order, I feel.

Firstly to THE INDEPENDENT for publishing one of the most inadequate health-related article which I have seen in recent months.

Secondly to the BCA for their stubborn determination to ‘happily promoting bogus’ notions. Instead of getting their act together when found out to advertise quackery in 2008, they sued Simon Singh (unsuccessfully, I hasten to add). Instead of cutting out the nonsense once and for all, they now promote populist ‘alternative facts’ about the causes of back pain. Instead of behaving like a professional organisation that promotes high standards and solid evidence, they continue to do the opposite.

One cannot but be impressed with so much intransigence.

22 Responses to The BCA: still happily promoting bogus notions

  • Here is the Chartered Society of Physiotherapists reply detailed in a BBC online article:

    The Physiotherapy response. “Dr Mary O’Keeffe, who is a back pain expert at the University of Limerick, says their research is “complete scaremongering and there is no scientific evidence to support any of it”.

    The research has been rejected by the Chartered Society of Physiotherapy and other back experts.
    They say we shouldn’t be afraid of our clothes.

    http://www.bbc.co.uk/news/health-39266383?SThisFB

  • I got as far as ‘jewellery causes back pain’. Did it get any better later on?

    • I thought ‘big fluffy hoods’ was even worse, and counterintuitive by their lights too, keeping warm stops you tensing up!

      • /coats with big fluffy hoods can contribute to painful back problems

        Sounds possible but I live near a university in Canada. If this is true perhaps 75% of our female students and 20% of our male students should be crippled.

        And those hoods are not just a fashion statement, two days ago I think everyone wih a hood had it up as they slogged into driving snow and 50km winds at -10 degrees. Scarfs and the odd balaclava were also in evidence. And I live in the tropical south.

  • It seems as though someone is getting desperate to find fault with paramedical disciplines when common-sense suggestions are criticized for a “lack of evidence.” As a PM&R, it shouldn’t be too difficult to comprehend the correlation between behaviors, use of heavy backpacks, inadequate footwear, and resultant postural changes, and spinal stress/potential pain.

    Non-supportive shoes don’t resist pronation in people who naturally over-pronate; this increses serial postural strain and promotes an increased lumbar lordosis which can exacerbate facet joint arthrosis, spondylolisthesis, and disc-disorder pain. A similar situation exists for some who wear high-heeled shoes.

    The use of heavy backpacks by college students is commonly seen in young adults who present with MBP and LBP. This is nothing new to professionals who treat NMS conditions. Does one really need to provide evidence for such an obvious claim?

    Virtually every one of the suggestions noted in this article is sensible. Yet Edzard views the article as a “pure promotion of chiropractc.” Contrary to Edzard’s opinion, the article really did not appear to be promotional in the least, as it provided information which might help keep patients OUT OF chiropractic offices, not attract patients to them.

    Chronic headaches are a major problem for many people and Edzard has opined in various threads that good evidence/positive-outcome research is necessary to warrant a treatment’s or a durg’s use; sans such provenance, the treatment should be viewed(per Edzard) as quackery). The IMATCH program is generating up to $30K for a 3-week program for “modern medicine” clinics and hospitals across the USA. “Elizabeth Loder, MD, chief, Division of Headache and Pain, Department of Neurology, Brigham and Women’s Hospital, Boston, Massachusetts, said the approach to treatment offered by the IMATCH program “has promise(despite limited evidence).”

    “Comprehensive multimodality treatment is likely (weasel word, according to Edzard in past threads) to be the best approach for severely disabled headache patients, but evidence to support that assumption is LIMITED,” said Dr Loder. “The improvements in outcome for patients who completed this study are encouraging (yet evidence is still limited).”

    She pointed out, however, that “a substantial amount of information about outcomes is missing and that could affect the findings.”

    Also, she said, without a control group, “it’s not possible to know how much of the improvement is due to the intervention itself or other factors such as natural improvement over time or expectation or belief.”(These words are similar to those Edzard has written myriad times relative to paramedical research).

    Dr Loder agreed that, as with all studies that evaluate complex interventions, it is not possible to study the contribution of individual treatment components.” Yet “modern medicine” has continued to utilize IMATCH protocol despite a lack of evidence for its use….and is profiting handsomely. Go figure!

    • Eh…? Paramedical disciplines is not the same as pseudomedical disciplines. The latter is the subject of this blog.

      • From medicine.net, a definition:

        Para- (prefix): A prefix with many meanings, including: alongside of, beside, near, resembling, beyond, apart from, and abnormal.

        Normally tagged with ‘medicine’ or ‘medical’ in the first two senses. Used by L-B in any of the last three. In fact, the list of meanings is a perfect gradation of shades from true medicine to pseudo-medicine.

      • It’s revealing that Geir gets “hung up” on my (correct) choice of using “paramedical” to describe chiropractic, yet he is loathe to comment on the pith of my post to which he has responded. Perhaps such reticence is a sign of his tacit capitulation to my stated positions?

      • Regarding Geir’s apparent concern regarding SMT safety, the following is submitted.

        A nursing assistant died while undergoing stomach reduction surgery, and the hospital said Thursday it is suspending such operations while it investigates. Brett Davey, spokesman for Roger Williams Medical Center, would not say went wrong during the surgery or whether any doctors would be disciplined.

        Robert Mesa Jr., 27, who worked at the hospital, died Tuesday about a half-hour into the laparoscopic gastric bypass operation, Davey said.
        It was the third death among the 340 gastric bypass procedures performed at the hospital over the past three years, chairman of surgery Paul Liu said.
        Liu said the hospital will stop performing both open and laparoscopic procedures. The newer laparoscopic technique uses smaller incisions and leads to less scarring and quicker recovery.
        He said the doctor who performed the surgery has not been suspended. He would not identify the doctor, but said he’s “very experienced.”
        Last month, Boston’s Brigham and Women’s Hospital stopped performing the laparoscopic procedure after a 38-year-old woman there died after the staple gun apparently misfired during the procedure.
        “I think what’s happening is the fact that it’s become so visible with celebrities and others who have had it done … the numbers who are having it done are going up dramatically, and I think the true risk of this procedure is becoming more known,” said Dr. Vincent Pera, director of the weight management program at Miriam Hospital in Providence.” Indeed…perhaps Geir should take note!

        Pera said the death rate for gastric bypass surgery is one in 200(and Geir complains about the 1 in 5+ million deaths with SMT).
        Gastric bypass surgery aids weight loss in a morbidly obese patient by shrinking the stomach from the size of a football to the size of an egg; unfortunately, some surgeons market the procedure to improve the aesthetics of the patient who is considering or being “soft-sold” the surgery.
        The smaller stomach pouch is created by stitching or stapling part of the stomach closed. A part of the small intestine is bypassed to reduce nutrient absorption, causing the patient to lose weight. Typically, patients lose 70 percent to 80 percent of their excess body weight in about a year.
        But the surgery comes with risks, including postoperative complications that can include blood clots floating to the lungs or stomach juices leaking into the blood and causing infections.
        Though the procedure is commonly known as stomach stapling, the hospital would not confirm whether staples were used during Messa’s procedure.
        Davey said Messa underwent about three months of preparation for the surgery, including consulting with a cardiologist, psychiatrist and dietitian and attending a three-hour seminar on the risks and benefits of the procedure.

        Despite these precautions, Messa still died. BWH discontinued the performing of this procedure due to safety concerns.

        • Logos-Bios, you have omitted the fact that some people do survive bariatric and laparoscopic surgery. You should take into account that this is real medicine as opposed to paramedical twaddle like CAM.

          • @Greg

            Geir obviously doesn’t like me. Still, I’m flattered when he posts primarily for my consumption, I surmise, a link to anything that casts chiropractic in a negative public light. I know he does this for at least two reasons: 1. he is willfully ignorant about the low risk of chiropractic SMT, and 2. he hopes to get under my skin. I feel obliged to point out the many post-bariatric surgery deaths which greatly outnumber those dubiously imputed to chiropractic SMT. Geir is often flummoxed when the high 1-year death rate of such surgeries is exposed, or when the cherry-picking of clinical outcomes relative to only the very best bariatric surgeons(omitting outcomes of “average” surgeons is deceptive) regarding death rates is revealed.

  • It seems the BCA are 9 years behind the advice given by the chartered society of physiotherapy:
    http://www.csp.org.uk/press-releases/2008/09/15/get-catwalk-confidence-season%C2%92s-fashion

  • Surely the BCA has heard of the invention of Lycra? There were, indeed, issues with tight denim jeans in the 1970s, when the fabric didn’t stretch, and people used to put them on and sit in the bath to shrink them in situ. WHere were the chiros then? Now, lycra and split knees – skinny jeans are flexible. As usual, chiros are stuck in the past.

  • Given the way fashions change it should be simple enough to correlate reports of back pain with fashion trends. Did we all start feeling better when baggy jeans were in?

    • Simon B
      I think you’re on to omething here..
      What seems like a ridiculous fashion of wearing your trousers halfway down your backside is obviously a Heath-inspired campaign, the effects on occasion being somewhat countered by the extraordinary amounts of ‘bling’ being sported, and by the strange, loping way of walking which was briefly in vogue. THis of course could have been a result of the new-found lrelief and liberation from back pain.
      Much more’research’ needed here I feel.

    • I’m very glad that this lady’s life was saved by excellent care after having suffered cerebrovascular issues post-manipulation. Although such developments are incredibly rare and, in this case, might not be directly related to the chiropractic treatment, it is good that they are publicized so that discussions regarding the exact type of SMT and adjunctive procedures that were utilized can be discovered so that a clear picture of causality might be determined.

      • “… such developments are incredibly rare …”
        how do you know?
        which post-marketing surveillance data set do you rely on?

        • How quickly you forget, Edzard. Perhaps you are experienceing temporal lobe dysfunction?

          Feel free to review my post of 2/16/17 at 18:01 regarding the alleged causation of serious harm by upper neck manipulations to refresh your memory regarding my countenance of the rarity of adverse vascular events. I posted it in response to your comments posted on the same day.

          • Logos-Bios, it is more likely to be the natural ageing process and from this point is tends to gather momentum until it reaches its termination point; expectancy 84.

          • @Greg

            The problem with the majority of Edzard’s claque is that they forget(purposely or unintentionally) what has been presented regarding certain recurring topics when one has provided evidence contrary to their personal beliefs or world views. Then the same old process recapitulates, with the same anti-paramedical actors’ regurgitating the same old tired(and unconvincing) foundation-less arguments which have been previously debunked. Reading their tired memes repetitively makes me think I’m living Groundhog Day.

  • No Logos-Bios, it is not Groundhog Day; it is their psychosis and it is very interesting studying it.

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