This overview by researchers from that Arthritis Research UK Primary Care Centre, Research Institute for Primary Care & Health Sciences, Keele University, UK, was aimed at summarising the current best evidence on treatment options for 5 common musculoskeletal pain presentations: back, neck, shoulder, knee and multi-site pain. Reviews and studies of treatments were considered of the following therapeutic options: self-management advice and education, exercise therapy, manual therapy, pharmacological interventions (oral and topical analgesics, local injections), aids and devices, other treatments (ultrasound, TENS, laser, acupuncture, ice / hot packs) and psychosocial interventions (such as cognitive-behavioural therapy and pain-coping skills).
Here are the findings for those treatments most relevant in alternative medicine (it is interesting that most alternative medicines were not even considered because of lack of evidence and that the team of researchers can hardly be accused of an anti-alternative medicine bias, since its senior author has a track record of publishing results favourable to alternative medicine):
EXERCISE
Current evidence shows significant positive effects in favour of exercise on pain, function, quality of life and work related outcomes in the short and long-term for all the musculoskeletal pain presentations (compared to no exercise or other control) but the evidence regarding optimal content or delivery of exercise in each case is inconclusive.
ACUPUNCTURE
The evidence from a good quality individual patient data meta-analysis suggests that acupuncture may be effective for short-term relief of back pain and knee pain with medium summary effect sizes respectively compared with usual care or no acupuncture. However, effects on function were reported to be minimal and not maintained at longer-term follow-up. Similarly for neck and shoulder pain, acupuncture was only found to be effective for short-term (immediately post-treatment and at short-term follow-up) symptom relief compared to placebo.
MANUAL THERAPY
Current evidence regarding manual therapy is beset by heterogeneity. Due to paucity of high quality evidence, it is uncertain whether the efficacy of manual therapy might be different for different patient subgroups or influenced by the type and experience of professional delivering the therapy. On the whole, the available evidence suggests that manual therapy may offer some beneficial effects on pain and function, but it may not be superior to other non-pharmacological treatments (e.g. exercise) for patients with acute or chronic musculoskeletal pain.
Overall. the authors concluded that the best available evidence shows that patients with musculoskeletal pain problems in primary care can be managed effectively with non-pharmacological treatments such as self-management advice, exercise therapy, and psychosocial interventions. Pharmacological interventions such as corticosteroid injections (for knee and shoulder pain) were shown to be effective treatment options for the short-term relief of musculoskeletal pain and may be used in addition to non-pharmacological treatments. NSAIDs and opioids also offer short-term benefit for musculoskeletal pain, but the potential for adverse effects must be considered. Furthermore, the optimal treatment intensity, methods of application, amount of clinical contact, and type of provider or setting, are unclear for most treatment options.
These findings confirm what we have pointed out many times before on this blog. There is very little that alternative therapies have to offer for musculoskeletal pain. Whenever it is possible, I would recommend exercise therapy initiated by a physiotherapist; it is inexpensive, safe, and at least as effective as acupuncture or chiropractic or osteopathy.
Practitioners of alternative medicine will, of course, not like this solution.
Acupuncturists may not be that bothered by such evidence: their focus is not necessarily on musculoskeletal but on a range of other conditions (with usually little evidence, I hasten to add).
But for chiropractors and osteopaths, this is much more serious, in my view. Of course, some of them also claim to be able to treat a plethora of non-musculoskeletal conditions (but there the evidence is even worse than for musculoskeletal pain, and therefore this type of practice is clearly unethical). And those who see themselves as musculoskeletal specialists have to either accept the evidence that shows little benefit and considerable risk of spinal manipulation, or go in a state of denial.
In the former case, the logical conclusion is to look for another job.
In the latter case, the only conclusion is that their practice is not ethical.
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I beg to differ, slightly, with the conclusion that chiropractors and osteopaths need to look for ‘another job’.
In terms of strict semantics, I agree, but in practice, IMHO, they should continue training (as should all health care professionals), and take additional courses in counseling and possibly massage – gradually setting aside those elements of practice for which they have no evidence of benefit (adjusting the skeleton). They could stay in the same ‘job’, but shoud redefine its parameters and criteria.
Surgeons adopt this approach all the time (though it may take some years to put into effect). The internal-mammary artery is no longer ligated for chest pain; metal on metal hip replacements are being used less frequently; etc. etc. But the surgeon remains a surgeon. Similar considerations apply to physicians and GPs. Modern science-based ‘Medicine’ supplies the alternatives to anachronistic systems based on the supernatural, imaginative and paranormal.
Some osteopaths/chiropractors might even consider re-training as physiotherapists, or doctors. That would represent a change of job. But otherwise the ‘job’ should reflect the reality of experience – and evidence.
The problem is, that for many osteopaths and chiropractors, their chosen ‘professions’ are belief systems (and there is precious little difference between them) – and faith is hard to set aside. Patients must be warned they are dealing with faith healing.
yes, but id surgeons had had just internal mammary artery ligations and similarly useless operations in their repertoire, they would have ceased to exist, don’t you think?
Indeed!
That is why we have moved on!
And I go further – that is why we trained in medicine to be doctors in the first place, rather than cop out and be inveigled into training in condimentary medicine (adds spice and flavour, but no other essential effect).
The first step would be for the regulating authorities of the GOC and GCC to combine (as the Nightingale Collaboration suggests). Then there might be a chance that an ethical profession could develop which was capable of supporting patients with musculo-skeletal problems. There is precious little difference between either faith/doctrine (a set of beliefs incapable of verification). No chiropractic web site explains how chiropractic differs from osteopathy; and vice versa . For those of you who like your vice versa , this could be important!
That would beg the question as to why the osteopaths/chiropractors had not qualified as physiotherapists – but that would be for them to explain! I knew a good physiotherapist who then qualified as a chiropractor: “There was more money in it!” But if money making is the principle or only factor in career decision making, patients must be told.
Dear Ernst, I believe you need to explain the following remark within your article in light of your concluding claims because there appears to be an inconsistency… as follows, you state in your conclusion:
“But for chiropractors and osteopaths, this is much more serious, in my view. Of course, some of them also claim to be able to treat a plethora of non-musculoskeletal conditions (but there the evidence is even worse than for musculoskeletal pain, and therefore this type of practice is clearly unethical). And those who see themselves as musculoskeletal specialists have to either accept the evidence that shows little benefit and considerable risk of spinal manipulation, or go in a state of denial.”
However, only afew lines above your concluding claims, you state: “Whenever it is possible, I would recommend exercise therapy initiated by a physiotherapist; it is inexpensive, safe, and at least as effective as acupuncture or chiropractic or osteopathy”. At “least as effective” would mean you are effectively advocating that the three professions are “at least as effective as each other”, or are you claiming none of them are effective. If either point holds true, what is your basis in recommending physiotherapy specifically. Please explain.
Further, you maintain a historical notion of osteopathic scope of practice, potentially relevant to the UK but not Australia. Most osteopaths do not use spinal manipulation as frequent as chiropractors who are guided by notions of sublaxation. Conflating the two disciplines is quite problematic. No such concept really exists in osteopathy. In Australia at least 70% of osteopathic practice is exercise prescription based, so I think you over generalise. Additionally, what would you have to say about so called “manipulative physiotherapists”, of which there are thousands who often do spinal manipulation- also known as “musculoskeletal physiotherapists”?
There is no defined scope of practice for osteopaths or chiropractors in the UK: they are free to use whatever quackery they like.
Dear Alan, would you like to elaborate on what you mean by “quackery”? Again, you conflate two different disciplines and fall into a trap of generality without cause. Please explain which supposed “quack based practices” span both disciplines so that I can understand the substance in your comment. We have already been over the fact that sublaxation and frequent spinal manipulation is the domain of chiropractors- not osteopaths.
Peter Lalli said:
That’s entirely the problem: absolutely any treatment, diagnostic tool or device can be used under the guise of chiropractic or osteopathy regardless of whether there exists any evidence or rational for their use because the regulators fail to stipulate what is and what isn’t chiropractic and osteopathy. Is the situation different in Australia? Is it a case that anything goes there too?
But please tell us what the difference – official or otherwise – is between chiropractic and osteopathic manipulation.
..regarding “osteopathy” in Australia mentioned above it was forgotten to mention that Australian osteopaths apply visceral manipulation VM regularly like any other Commenwealth osteopathic manipulators do and this is dangerous and without any medical benefit at all.
The only benefit it has is to fill the pocket of the osteopathic manual practitioner and to sell pseudoscience and esoteric magic.
There is another blog here about VM
http://edzardernst.com/2014/01/visceral-manipulation-you-couldnt-make-it-up/
… and they still use high velocity low amplitude manipulations on the cervical and lumbar spine as choripractors do. If you would be the person who receives an insult or another trauma from this it won’t help that “osteopaths do less of such manipulations than chiros do.” They still do it. But it is not necessary to do because there are better options with less risk!
“The problem is, that for many osteopaths and chiropractors, their chosen ‘professions’ are belief systems…” The other problem is that chiros and osteos enjoy the esteem they get from being able to call themselves ‘Doctor’. (It probably also has an impact on the fees they can charge.) And, of course, in the USA, osteopaths are fully trained MDs.
In the discussions on this blog we have a small number of regular chiropractor posters who say they want to reform the ‘profession’. When they’re asked directly why they don’t simply convert to ‘physiotherapist’, they dissemble but never directly grasp the nettle.
No.
In the US, osteopaths are fully trained DOs, not MDs
The clue is in the name on the tin!
Thanks. I accept that the clue is in the name on the tin.
But read this from Wikipedia: “In the 21st century, the training of osteopathic medical physicians in the United States is equivalent to the training of Doctors of Medicine (M.D.s).[8] Osteopathic medical physicians attend four years of medical school followed by an internship and a minimum two years of residency. They use all conventional methods of diagnosis and treatment. Though still trained in osteopathic manipulative treatment (OMT),[9] the modern derivative of Still’s techniques,[10][11] they work in all specialties of medicine. Discussions about the future of modern medicine frequently debate the utility of maintaining separate, distinct pathways for educating physicians in the United States.[6][12]”
From comments on other threads on this blog I had certainly gained the impression reflected in the Wikipedia article (https://en.wikipedia.org/wiki/Osteopathic_medicine_in_the_United_States) and that’s the basis of my original (semantically incorrect) comment.
Yes, in the US Osteopaths train with MD’s in the same internships and residencies. I never understood this or why have Osteopathic schools. Why don’t they just go to medical school rather than osteo school?
Richard, your post illustrates a very poor knowledge of the training of a chiropractor. It also illustrates a similarly poor comprehension of the training of a physiotherapist. Sadly, therefore, any commentary you make is undermined by this lack of basic knowledge.
Historically, there have been numerous physiotherapists who retrain as a chiropractor, you will not find chiropractors retraining as physiotherapists, because why would you go on a course to “train” you in things that you had already learnt from one’s chiropractic course.
Like Professor Ernst, you seem to have a belief that all chiropractors do is manipulate the spine.
You state that chiropractors should retrain as doctors. There is an error on both levels here. First chiropractors are doctors of chiropractic. Secondly, in their undergraduate training a medical student spends less than 3 weeks on orthopaedic training in their 5 years. Whereas in a chiropractors training they spend 5 years on the subject that they then practice. It seems very strange that a GP, who spends almost 30% of his time in practice dealing with patients presenting with musculoskeletal conditions, only has 3 weeks experience to do so. Why therefore, would a chiropractor wish to retrain as a doctor, when like with physiotherapy, his knowledge is much more superior than the GP in the first place?
No the main problem in dealing with MSK conditions is the ignorance of GP’s in comprehending the presentation of these conditions, which results in misdiagnosis, prolonging the duration of the symptoms with the resultant effects.
I imagine from your commentary Richard, that you were not aware that the first rehabilitation gym was set up by chiropractors. Chiropractors have always advocated exercise as part of a treatment regime.
You also suggest that chiropractors should train to by psychologists because of the importance of comprehending this aspect in regards to patients.
Chiropractors have been aware of the biopsychosocial model Richard since Gordon Waddell introduced it back in the late 1960’s. Sadly, I have had reason to realise, from being present at an NHS seminar two years ago which included, GP’s, orthopaedic consultants, anaesthetists, commissioners of medication, physiotherapist, and psychologists, that the new concept was the biopsychosocial model. So the NHS were getting excited about a model that chiropractors had been utilising for almost 40 years.
In regards to Professor Ernest, he has spent the last 25 years attacking chiropractors and now chiropractors and osteopaths, for no better reason, than it gives him a daily purpose. His arguments were discredited over 20 years ago. Any honourable person would have accepted the evidence provided 20 years passed, but sadly, that is not the criteria under which Professor Ernst operates.
So in conclusion Richard, I would respectfully ask you to appraise the content of the training of a chiropractor and that of a physiotherapist so that in future any comments made can be made from having appropriate evidence.
1) ‘you will not find chiropractors retraining as physiotherapists’ this is not true; I know several.
2) ‘Like Professor Ernst, you seem to have a belief that all chiropractors do is manipulate the spine’. please do not put words in my mouth. I have never said such a thing.
3) ‘ It seems very strange that a GP, who spends almost 30% of his time in practice dealing with patients presenting with musculoskeletal conditions, only has 3 weeks experience to do so.’ another falsehood; you seem to excel at them!
4) ‘In regards to Professor Ernest, he has spent the last 25 years attacking chiropractors’. do you know the difference between conducting rigorous research that tests hypotheses by trying to falsify them and an ‘attack’?
5) ‘His arguments were discredited over 20 years ago. Any honourable person would have accepted the evidence provided 20 years passed, but sadly, that is not the criteria under which Professor Ernst operates.’ you could not stoop lower!
ANY EVIDENCE?
https://edzardernst.com/2012/12/ad-hominem-attacks-are-signs-of-victories-of-reason-over-unreason/
I have stopped practicing Osteopathy for just that reason. I was never confident that my interventions were superior to exercise.
Contemplating the wasted years is painful. Switching to employment at a decent level of renumeration seems impossible. I don’t have the time, money or inclination to retrain in Physiotherapy.
Support for those leaving their faith systems would be much appreciated. Unfortunately I lacked the ability to think critically about the course when I enrolled at 18 yoa. The fact that I could do an honours degree in such bullshit is risible.
Any suggestions?
it is hard to make suggestions. you need to ask where your abilities and inclinations lie.
my immediate suggestion would be to sit down and write a book about your experience. you can start by doing a guest post on this blog and see what reactions you get. my invitation stands.
Thank you. Much appreciated.
“osteopathy” ….
please always say precisely which “osteopathy” you mean and please make a distinction between osteopathic physicians fully trained and accepted as medical doctors in all fields of medical practice and European/Commonwealth osteopathic manipulators still depending on vitalism and iatromechanic…
Interesting as usual, though not quite as enticing as the dead-vagina.
The “critical-chiro” frequenting the blog tends to suggest the thorough disengagement of the “big idea” from Chiropractic represents its best reformation. The Problem with that is, as has been pointed out innumerable times; WHAT would such a profession look like other than a wannabe PT? Or a lower-tier PT who spent $200K on a non-transferable degree built from the dregs of pre-scientific dogmas?
Even Chiropractic apologists routinely point out “subluxation” is the WHY of Chiropractic…without it, all uniqueness disappears and it’s USP (unique selling proposition) is lost. A “reformed” Chiropractor is just superfluous. This is especially true in the US where the number of DCs hovers (plateaus) near 60K with PTs (and PTassistants) nearing 200K and growing.
Chiropractors can’t agree what Chiropractic actually IS. IF that definition includes or is exclusive to the: ‘adept and effective addressing of NMS complaints via any sort of manual “whacking” ‘then indeed another vocation is in order.
@MK
If you follow the evidence there should be little difference between the professions treating NMS conditions Michael. To quote Jason Silvernail fron Soma Simple “Combine the professionals, not the professions”.
The subluxationists are being marginalized and feel threatened. The Rubicon groupis a prime example. In physiotherapy the likes of Barret Dorko who has been fighting the good fight for over 20+ years lament that they are a lone voice in the wilderness and face apathy and hubris from within physiotherapy and an institutionalized resistance to change.
Do the physiotherapists have vocal external critics? Just look at the tags above. The referenced article is in regards to physio’s, osteo’s and chiro’s manual therapy (which is a very broard), yet Edzard tags this blog:
” alternative therapist, back pain, chiropractic, evidence, medical ethics, osteopathy, pain, politics, progress, risk/benefit, spinal manipulation, systematic review” which speaks volumes.
The pain specialist who I meet to discuss cases admits that they are practicing more and more like a chiropractor short of adjusting (and like a physio for that matter). The only difference is they primarily see motor vehicle insurance and workers compensation cases where once a patient enters the compensation system and gets a lawyer the prognosis deteriorates rapidly. Some of their case presentations are exercises in frustration with ridiculous amounts of paperwork.
Maybe its time doctors start retraining as chiro’s and physio’s. That would be a first.
Exercises are great, but it doesn’t matter what you do, from gardening, walking, cycling, gym, what ever, it is irrelevant what you do. So, why is there an industry of “shake, bake and fake physiotherapy”, that has exercises as the only method of treatment that is vaguely evidence based. We all know that ultrasound (still used in the U.K. and taught in physio schools in the U.K.) is non-evidence. We know that TENS, corsets, biofeedback, pilates (all standard physio treatments) do not work and that has been proven. One could go so far as to say that physiotherapy is no more effective than homeopathy, and in some quarters is correctly referred to as, “hands on homeopathy”.
To reiterate. The primary thing thing a physiotherapist does for neuro-musculo-skeletal disorders is to prescribe an exercise. No one exercise is better than another. The patient may as well rake the lawn, polish the floor or clean the windows. To think that patients and insurance companies (NHS) are wasting their money, paying a physio for advice that is useless is a travesty. It is time that the physio profession took a damn good look at itself and realised that what they do doesn’t work. Time is the great healer in their field and that all a physio exercise does is keep the patient occupied, the practitioner amused and entertained, whilst nature takes its course and heals the problem.
I’m a physio who used to be an osteopath. I retrained because I hated working in alternative medicine, because osteopathy (and chiropractic) is so badly integrated into the wider medical system and because I wanted a more science based approach to clinical practice.
You’re right that time is the best healer for MSK pain. Tissues heal themselves. But what physios understand and you apparently don’t is that tissues heal without the need for half baked pseudoscience and flaky mysticism. Most manual therapy including chiropractic manipulation is a placebo. It reduces anxiety while the body heals itself.
The role for physio in the treatment of MSK pain is to screen for red flags and psychosocial yellow flags, assess for muscle weakness and joint stiffness which will benefit from specific rehab and give the person reassurance and encouragement to gradually increase their tolerance to movement.
No subluxation correction is required.
James Winterborn, you picked a dud profession if you think that physiotherapy is “science based”. It is beyond the normal scope of practice for physios to screen for “red flags” and/or psychosocial yellow flags. Physios are not trained as primary health care providers. Muscle weakness and assessment is an interesting concept, so please answer these questions.
If you give an exercise to someone who has a muscle weakness, how long does it take to strengthen that muscle? More importantly, how long does that muscle retain its strength after the exercise is ceased? Hours, days, weeks? Does the muscle return to a default strength based upon the normal use of the muscle, irrespective of the exercise you have given them? What is disuse atrophy?
In regard to joint function, when you give an exercise, e.g. to the lumbar spine for stiffness, some joints will be hypermobile and some hypo mobile. How do you isolate those joints to ensure that the correct joint increases mobility and the hypermobile segment does not become unstable.
You obviously have no understanding of the neurophysiology of spinal function as it relates to neuromuscloskeletal complaints. I suggest to read authors such as Haldeman, Beck, Haavik, Jull, Nachemsom and Souza (just to name a few).
Finally, who mentioned “subluxations”? I didn’t.
GibleyGibley wrote: “I suggest to read authors such as … Haavik… Finally, who mentioned “subluxations”? I didn’t.”
@GibleyGibley
So that will be the same (Heidi) Haavik whose stated mission is to “run a ridiculously successful and Vitalistic International Centre for Chiropractic Research”? See slide 5 here: https://www.slideshare.net/heidihaavik/dr-heidi-haavik-melbourne-presentation
The same Heidi Haavik who adjusts ‘subluxations’ and lectures on how best to communicate vitalistic chiropractic to health professionals, patients, and the public?
Ref: http://www.sca-chiropractic.org/files/Heidi%20Haavik%20Seminar%20April%202012.pdf
I think your understanding of physiotherapy is a little outdated there fella.
In the UK self referral to physiotherapy was introduced a few years ago. This gives people direct access to physiotherapy in the NHS without needing to be referred by their GP. What this means in practice is that physios are starting to work in primary care and taking over the musculoskeletal workload from GPs. It has been shown to be cost effective and reduces the pressure on the GP system.
http://bmjopen.bmj.com/content/bmjopen/7/3/e012987.full.pdf
https://www.sciencedirect.com/science/article/pii/S0031940611004251
My current job is to work in several GP practices where I triage MSK problems, assess for red and yellow flags (we use the Keele Startback tool for this) decide whether the person in pain needs imaging, referral to secondary care, referral to a GP for medication or advice on self management.
If a person mentions that they have seen a chiropractor I always advise them to google the potentially serious risks of chiropractic manipulation so that they have a full picture of the risks versus benefits.
@ James
What is the science based approach for assessing joint stiffness?
Stiffness in peripheral joints can be assessed with passive range of movement and comparing to the opposite side. For example the British Elbow and Shoulder Society defines frozen shoulder as a passive restriction of external rotation in the presence of a normal x ray.
Stiffness in spinal joints is a self reported perception. There is a broad spectrum of normal in spinal flexibility. A person may be very stiff but manages fine and is not worried about it, therefore its not a problem. If an individual feels their spine is stiffer than they would like then some active approaches to improving it can be suggested.
Hope that helps.
Hi James
I would be interested to know how you made the transition from Osteoporosis to Physio.
Kind regards
Mark
Hi Mark,
I moved on from osteopathy by doing a pre registration MSc in physio. It was two years full time. Those degrees are aimed at people with a background in other areas of healthcare who want to become physios.They are expensive and hard to get a place on but for me worth every penny.
I just reached a point as an osteopath where I didn’t believe in what I was doing and the cognitive dissonance was too much.
The bottom line with osteopathy and chiropractic is that they are based on flawed ideas. AT Stills revolutionary idea (that disease is caused by disordered anatomy) was wrong. There is now an ever-increasing body of evidence which casts doubt on osteopathic and chiropractic philosophy. Therefore those ideas are becoming less and less convincing and persuasive and increasingly difficult to defend. There comes a point when a theory becomes so riddled with anomalies, so weighed down with auxiliary hypotheses and flies so much against the facts of the world that it is easier to set it to one side and move on. Which is what I did.
James.
A higher German court (LG Karlsruhe 14th November 2014 Az 14 O 49/14 KfH 3 III) in his decision followed the conclusion that there is poor evidence on manual medicine at all and that (European and Commonwealth) “osteopathy” is ESSENTIALLY unscientific and PARTIALLY esoteric.
So it doesn’t matter where you switch to in manual medicine … the explanations about what you are doing or how your techniques are working are more or less reflecting the system of believe but not what is really going on in all of the different professions and techniques.
… oldfashioned OMT/OMM and Chiropractor’s explanations still relate to vitalism and iatromechanic and therefore most of the techniques applied refer to magnetic healing or bone setting.
In European Commonwealth oldfashioned osteopathy there is a very strong tendency to soft touch (visceral manipulation craniosacral e.s.o. and even to healing by thought or nearly no touch (Biodynamics in osteopathy , osteopathic trauma healing or osteopathic healing by thought).
The manipulative techniques via hard grip VM (visceral osteopathy) or via high velocity low amplitude to the spine area (chiropractic AND osteopathy) are very dangerous and although I was trained in all of them I never had a need to use them because there are better ways with positive results and no risk!!)
The isometric long lever techniques (osteopathy) are mostly with good results if necessary to apply (this was the first way A.T. Still was teaching in his small class room)…
On the other hand there is a problem with ICD 10 which is not reflecting the musculosceletal reactions in diseases as part of the picture and this historically has to do with separating the body in different departments in medicine. E.g the orthopedic surgeon looks after the skeleton and the internal physician looks after the organs… and mostly they don’t talk to each other so much 🙂
There are a few manual systems who in my opinion are more or less effective without any alternative explanation and this is the Feldenkrais method declaring themselves as a pedagogic movement not involved in the medical context and in traditional medicine it is the Nuad Thai and some traditional bone setting done for hard working people after work… they don’t need to tell pseudoscientific and esoteric explanations and they don’t claim to heal medical named ICD 10 diseases.
As I am trained in nearly everything in this context with more than 15.000 full hours of training and I am working in a hospital centre for 18 years by now in a evidence based medical clinical context responsible for the treatment of FUNCTIONAL disorders focussed onto the movement apparatus I mostly use the Feldenkrais method combined with some techniques from osteopathy (long lever techniques) some techniques from CRAFTA (cranio facial) nearly no high velocity low amplitude (never !! in areas of cervical or lumbar spine because it’s really not necessary and there are much better manual solutions) and from Nuad Thai and other massage therapy and mostly it’s a mixture of all of this . I don’t need to sell just one method! I use what’s most effective in the individual case and I use drugs against pain as evidence based recommended.
… and I am focussing on the understanding by self-experimenting and self-experiencing and the options to change behaviour. For that I use everything what I have learned in medicine, Feldenkrais, Nuad Thai, massage, OMM/OMT, Quigong, Yoga, martial arts (Aikido, Judo, Karate) Kneipp Hydrotherapy nutritional advice e.s.o.
… and I love it to explain and inform the clients about the history and ineffectiveness of any alternative therapy and they appreciate this !!! as soon as they understand the circumstances ! and as soon as the äy start to became self responsible by understanding the principles of experimenting and experiencing of alternatives in live and behaviour…
because in functional disorders I consider self responsibility as the only acceptional alternative to medicine… why not call this “alternative medicine” 🙂 ???
Here is the German court’s decision:
https://openjur.de/u/897943.html
I believe that the fear of Brexit means that seasonal workers from other EU countries have decided not to come pick fruit and vegetables in the UK from media reports. I believe that many CAM practitioners are well qualified for these kinds of roles.
They have long experience of cherry-picking…
James Winterborn, it always concerns me when I read this type of mis-information. It does you no credit, as you should know better.
“If a person mentions that they have seen a chiropractor I always advise them to google the potentially serious risks of chiropractic manipulation so that they have a full picture of the risks versus benefits”
Chiropractors do not have the monopoly on Spinal Manual Therapy. It is practiced by others included physios (probably one of the few things that they do that is remotely science based), osteopaths, orthopaedic surgeons and “others”.
It is the process of “spinal manual therapy” that may cause issues, not the practitioner type. The only reason chiropractors get singled out is simply because they do more of it than anybody else.
You did not adequately answer my questions on joint function and the neurophysiology of joint dysfunction.
@gg: your repeated animus against Chiropractic nay-sayers by pointing to the relative worthlessness of “PT” is fallacious i.e. pointing to bad behavior to rationalize other bad behavior….or in the case of Chiropractic, worse behavior.
Since Chiropractic is a non-falsifiable religious premise (like Scientology) negative side-effects MUST be deflected elsewhere. The religion can not be at fault.
Rational professions accept their problems and try to expand through them, that’s a “philosophy”…Chiropractors maintain a “dogma”.
I think the evidence supports the premise that “PT” as typically practiced for LBP (for instance) costs more to the society than it delivers. I’ve seen research suggesting it is actually a “negative” when travel time & costs and the diminished sense-of-well being are factored in.
However Physical Therapy is a critically-rational, evolving aspect of science-based medicine, Chiropractic is NOT (though a tiny percent of Chiropractors may be) and really doesn’t want to be since THAT has far reaching and devastating ramifications on income potential.
How would your income look if you had to stop calling yourself “doctor”, had to stop referring to Chiropractic as a “science” and call it a religion, had to stop suggesting your procedures had ANY effect on spinal “alignment”, your fingers can’t “feel” spinal bones or their “motion”, cracking-joints had Zero long-term benefits and the spines “alignment” was NOT responsible for real-health????
So do you want to be science-based or to maintain your lifestyle….?
Michael Kenney. You are patently ignorant on things “MSK or neuro-musculo-skeletal”. You understanding on thing that are neuro-physiologically based” is abysmal, and sad.
As a physiotherapist, I would expect you to know better.
I am waiting in anticipation for your incandescent rages, when physios start to use the title “Doctor” as they in the U.S.A., with the DPT degrees they are getting.
Things that make you go ummm.
Given your articulate, erudite and cogent response(s) It Is clear you indeed know all things “neuro-physiologically based” and I know nothing. Please give me the reading list you use to become a leading authority as I tend to only read science books.
Peter Lalli ..regarding “osteopathy” in Australia mentioned above :
Australian osteopaths are trained and apply visceral manipulation VM as a CORE subject regularly like any other Commenwealth osteopathic manipulators do and this is dangerous and without any medical benefit and evidence at all.
The only benefit it has is to fill the pocket of the osteopathic manual practitioner and to sell pseudoscience and esoteric magic.
There is another blog here about VM
http://edzardernst.com/2014/01/visceral-manipulation-you-couldnt-make-it-up/
Osteopathic Manual Therapist
Osteopathy is a drug-free, non-invasive manual therapy that aims to improve health across all body systems by manipulating and strengthening the musculoskeletal framework.
Therefore, it is a therapeutic discipline and a body of knowledge based on:
• The anatomy and physiology of the human body,
• The knowledge of how the different tissues involved in the production of the disease and
• The application of normalization techniques. Techniques developed over more than a century of evolution of the discipline (the first school of Osteopathy was opened in 1892 in the U.S.A) through Schools of Osteopathy or Osteopathic medical schools, depending on the development of discipline in each country.
https;//www,eomcanada,com
and…???
It’s spam – I disabled the url but thought readers would like to read it.
One small point. Physio is ‘less expensive’?? A 30 minute private physio session in UK costs £50- Ironically this is less than a typical chiro charge. It may be cheaper for NHS to hire a physio but for the paying public it is very expensive considering that in the absence of manual therapy a lot of what they do can be got from the internet – sorry to all physios but there it is!
I have often wondered why physios feel they can charge quite so much?
I said exercise is less expensive. once a physio has taught a patient the optimal exercises, the patient can be instructed to do them unsupervised at home.
teaching exercises is not that difficult. Do we need physios to do this ? We have fitness trainers and gym instructors. If all a physio does is to hand out exercise sheet then we have the internet. I am being a bit grumpy I know but without MT what do we nerd physio for. Everthing else a physio does is also done by another profession eg dietician , nutritionist
nerd physio – a Freudian slip?
:). Agreed my comment did not need a response.
I actually respect physiotherapy as a profession as it is grounded in evidence and tries to evolve responding to latest research. I am just a bit sick of conference this and systematic review that when many still live their lives racked with chronic pain and ultimately given ‘nursery treatments’.
Still – blog is for scientific comment and not the emotional!