This systematic review, meta-analysis, and meta-regression investigated the effects of individualized interventions, based on exercise alone or combined with psychological treatment, on pain intensity and disability in patients with chronic non-specific low-back pain.
Databases were searched up to January 31, 2022, to retrieve respective randomized clinical trials of individualized and/or personalized and/or stratified exercise interventions with or without psychological treatment compared to any control.
The findings show:
- Fifty-eight studies (n = 10084) were included. At short-term follow-up (12 weeks), low-certainty evidence for pain intensity (SMD -0.28 [95%CI -0.42 to -0.14]) and very low-certainty evidence for disability (-0.17 [-0.31 to -0.02]) indicates superior effects of individualized versus active exercises, and very low-certainty evidence for pain intensity (-0.40; [-0.58 to -0.22])), but not (low-certainty evidence) for disability (-0.18; [-0.22 to 0.01]) compared to passive controls.
- At long-term follow-up (1 year), moderate-certainty evidence for pain intensity (-0.14 [-0.22 to -0.07]) and disability (-0.20 [-0.30 to -0.10]) indicates effects versus passive controls.
Sensitivity analyses indicate that the effects on pain, but not on disability (always short-term and versus active treatments) were robust. Pain reduction caused by individualized exercise treatments in combination with psychological interventions (in particular behavioral-cognitive therapies) (-0.28 [-0.42 to -0.14], low certainty) is of clinical importance.
The certainty of the evidence was downgraded mainly due to evidence of risk of bias, publication bias, and inconsistency that could not be explained. Individualized exercise can treat pain and disability in chronic non-specific low-back pain. The effects in the short term are of clinical importance (relative differences versus active 38% and versus passive interventions 77%), especially in regard to the little extra effort to individualize exercise. Sub-group analysis suggests a combination of individualized exercise (especially motor-control-based treatments) with behavioral therapy interventions to boost effects.
The authors concluded that the relative benefit of individualized exercise therapy on chronic low back pain compared to other active treatments is approximately 38% which is of clinical importance. Still, sustainability of effects (> 12 months) is doubtable. As individualization in exercise therapies is easy to implement, its use should be considered.
Johannes Fleckenstein, the 1st author from the Goethe-University Frankfurt, Institute of Sports Sciences, Department of Sports Medicine and Exercise Physiology, sees in the study “an urgent health policy appeal” to strengthen combined services in care and remuneration. “Compared to other countries, such as the USA, we are in a relatively good position in Germany. For example, we have a lower prescription of strong narcotics such as opiates. But the rate of unnecessary X-ray examinations, which incidentally can also contribute to the chronicity of pain, or inaccurate surgical indications is still very high.”
Personally, I find the findings of this paper rather unsurprising. As a clinician, many years ago, prescribing exercise therapy for low back pain was my daily bread. None of my team would have ever conceived the idea that exercise does not need to be individualized according to the needs and capabilities of each patient. Therefore, I suggest rephrasing the last sentence of the conclusion: As individualization in exercise therapies is easy to implement, its use should be standard procedure.
93 Responses to Individualized exercise therapy for chronic low back pain
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I attempted to review a range of papers relating to physiotherapy for chronic pain without sufficient explanatory pathology and was unable to find any evidence that showed any program to be superior to merely remaining active.
Psychotherapy appeared to offer non-existent, minimal, or moderate short term effects on quality of life scores compared to placebo, but no effect on medication or on pain scores, and unrelated to type of therapy utilised, more likely therapist effect.
The important takeaway is that remaining as active as possible (within constraints, eg physical limitations, chronic fatigue, etc) is generally a good idea.
My thoughts on all of this is that for this client group physiotherapists should not be prescribing individual exercises, nor graded exercise programs, but should be assisting and supporting clients to engage with appropriate and enjoyable activities which have a high likelihood of being sustainable.
Unfortunately physios seem to be stuck on the “program” paradigm as a way of justifying their involvement in the treatment of this group. I think they have a vastly more important role to play.
Simply: get people moving and being active by doing what they like to do.
“Nevertheless, people with chronic low back pain should be encouraged to perform the exercise that they enjoy to promote adherence.”
https://pubmed.ncbi.nlm.nih.gov/34538747/
There radio adverts for arch supports to help with lower back pain.
The key word, “exercise” was used, but, not “physiotherapy”, per se. This is an important distinction because it underscores the myth that it requires a particular profession, like PT. That is marketing, nothing more. As if this is rocket science, IT ISN’T. Monopolizing, medicalizing, commoditizing movement is a cult movement in healthcare. Yes, movement is important. Rehab needs to get cleaned up.
Over my forty-five years of dealing with back pain, exercise has been the single most effective treatment. Exercise, more specifically walking thirty minutes per day. Furthermore, is not only a treatment, but a preventative measure. I found out over time that the solution for low back pain is NOT the easy chair. On the contrary, the solution is movement.
I did not come to this revelation on my own, no. Daily walking was advised to me by a Doctor of Chiropractic, NOT by even one of the many MD’s I visited.
@RG
I think we have reason to celebrate: we actually agree on something.
Then you must have been exceedingly unlucky in selecting doctors. Because so-called pain-guided activity has been the standard of care for lower back pain many for decades now, and on the very rare occasions that I saw a doctor, they both confirmed that this was the best approach. And yes, this includes walking, cycling and other forms of regular light physical exercise.
@Richard Rasker
Richard, clearly the majority of the treatments advised to me from MD’s included rest, meds, heat/cold treatments, injections and potential eventual surgery. Yes, some did refer me to physical therapy. However, even the PT was mostly focused on exercise and stretching rather than simple walking.
RR: Because so-called pain-guided activity has been the standard of care for lower back pain many for decades now
decades? This is from 2010. Has much changed since then?
“The usual care provided by GPs for LBP does not match the care endorsed in international evidence-based guidelines and may not provide the best outcomes for patients.”
https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/415588
“The usual care provided by GPs for LBP does not match the care endorsed in international evidence-based guidelines and may not provide the best outcomes for patients.”
What is your obsession with Australia, and with changing the subject, which is:
Individualized exercise therapy for chronic low back pain.
“The usual care provided by [Australian] GPs for [acute] LBP does not match the care endorsed in international evidence-based guidelines and may not provide the best outcomes for patients.”
@DC
My doctor here in the Netherlands advised it already in 1983, and told me at that occasion that bed rest with painkillers was no longer the recommended treatment (which it was until ~1975 IIRC).
But maybe the standard of care is different where you live. Or maybe you just want to criticize real doctors.
RR: exercise has been a part of chiropractic profession at least since the 1940s (as a general approach to health, one can go back to 1910/1917). It is nice to see the medical profession is finally catching on to what we have known for 80 plus years.
Now what percentage of MDs are actually recommending exercise for LBP, that’s a great question.
where I’m from it’s ~100%
This in general (not specific to LBP)
“In 2010, about one in three adults who had seen a physician or other
health professional in the past year had been advised to begin or continue
to do exercise or physical activity.”
NCHS Data Brief ■ No. 86 ■ February 2012
Trends in Adults Receiving a Recommendation for
Exercise or Other Physical Activity From a Physician or
Other Health Professional
Patricia M. Barnes, M.A., and Charlotte A. Schoenborn, M.P.H.
@DC
Especially in the US with its obesity epidemic this may still be lower that desirable, but it clearly shows that physical activity is certainly one of the most prescribed healthcare interventions. So there goes RG’s suggestive complaint out the window that doctors don’t advise this to their patients, generally giving worse advice than alternative practitioners.
Then there is of course the problem of patients themselves: there is often a rather big gap between what the doctor advises and what patients actually manage to do – ingrained lifestyle habits are often very, very hard to change. Many people who should really take up serious exercise often give in to the temptation to prop up their ailing health with medication that only addresses the consequences, not the causes, of their sedentary lifestyle. Even the most well-meaning doctor can’t force these people to join Boot Camp, and they can’t really refuse to prescribe medication either – since they would then be withholding healthcare that would reduce someone’s health risks and improve quality of life, even if it is not the preferred or best way.
Then there is of course a significant group of patients who would not do better with exercise, such as people with serious heart conditions or people whose medical complaints are not related to their physical fitness.
RR: Then there is of course the problem of patients themselves: there is often a rather big gap between what the doctor advises and what patients actually manage to do – ingrained lifestyle habits are often very, very hard to change.
Oh I know, I deal with it every working day with patients.
However, the paper addressed how often exercise is advised/recommended.
Going by my what my patients tell me, it’s not common that their MD recommends exercise. Usually it’s: take this pill and if it’s still bothering you in a few weeks come back.
We all can do better.
Richard,
RG not only agrees with you but also with THE DEVIL, called liberal media: https://www.cnn.com/2022/12/06/health/how-to-prevent-back-pain-habits-wellness/index.html
Apocalypse is nigh!
@talker
“RG not only agrees with you but also with THE DEVIL, called liberal media:”
Is it only the so called “liberal media” that you damn with such conviction? Or is it all peoples that relate to a liberal political and social philosophy that promotes individual rights, civil liberties, democracy, tolerance, acceptance, and general compassion for all?
What justifiable evidence can you produce that would support your labeling and conviction of CNN Cable News Channel or any other news channel as “THE DEVIL” Liberal Media? Your conjecture, is simply a proposition that is believed to be true by few, but for which there is no proof. To be clear there is no liberal media bias in which news stories political journalists choose to cover.
https://www.science.org/doi/10.1126/sciadv.aay9344
I’d be damned! MDs never asked you to exercise, RG?
All MDs I visited for my back pain advised some form of exercise and/or PT. I live in US.
I have not seen a Doctor of Chiropractic, I tend to stay away from quackery.
It seems MDs are having a difficult time following clinical guidelines.
“Opioid and imaging prescribing rates were non-concordant with clinical guidelines.”
https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(21)00075-4/fulltext
Maybe they are doing so with exercise? I have my doubts.
OMG DC! You have uncovered a bombshell! Evidence of non-compliance in a different matter (imaging and opioid prescription) is not evidence that MDs are non-compliant with guidelines in prescribing exercise.
If I were to use your typical whataboutery BS, I would say this:
BUT WHAT ABOUT when chrios don’t comply or follow evidence or commit outright fraud?
https://edzardernst.com/2022/11/the-most-common-conditions-that-chiropractors-cannot-help-kids-with/
https://www.chiroeco.com/chiropractic-noncompliance/
Talker: Evidence of non-compliance in a different matter (imaging and opioid prescription) is not evidence that MDs are non-compliant with guidelines in prescribing exercise.
I’ve been looking to see how often, or what percentage, of MDs recommend exercise for MSK conditions like nsLBP. Interestingly enough, I haven’t found any recent papers on the topic. That’s strange IMO as LBP is one of the most common reasons to see a PCP and exercise is the first line treatment option.
However, one can look to see how they are doing following the recommendations in other areas of nsLBP and then question how well are they doing in recommending the first line treatment…exercise.
Got it or do I need to take your hand and walk you slowly through it?
DC,
I apologize for not being able to read your mind. Let’s see if I understand your technique:
Chiropractic is quackery (numerous times discussed here and elsewhere) that means chrios are perpetrating fraud on their patients. Therefore, one must wonder what else they are doing.
The answer to that apparently is Medicare fraud, as I alluded to in my earlier post: https://edzardernst.com/2022/11/individualized-exercise-therapy-for-chronic-low-back-pain/#comment-142456
I went digging for more evidence and I found the following case-studies:
https://www.justice.gov/usao-cdca/pr/former-chiropractor-found-guilty-health-care-fraud-charges-she-schemed-defraud-health
https://www.justice.gov/usao-mdfl/pr/boca-raton-chiropractor-sentenced-four-years-imprisonment-20-million-health-care-fraud
https://libn.com/2022/08/16/east-meadow-chiropractor-pleads-guilty-to-1m-healthcare-fraud-scheme/
https://oig.hhs.gov/fraud/enforcement/former-waldo-chiropractor-pleads-guilty-to-3-million-medicare-fraud/
https://www.jdsupra.com/legalnews/ny-chiropractor-sentenced-to-nine-years-8691248/
https://www.smpresource.org/News/20210615/447/Former-Chiropractor-Convicted-of-Health-Care-Fraud.aspx
https://archives.fbi.gov/archives/washingtondc/press-releases/2011/wfo012511a.htm
https://www.postandcourier.com/business/summerville-chiropractor-pleads-guilty-to-health-care-fraud-conspiracy/article_c796a184-f2fe-11ec-8786-c3d92d532bb5.html
In this study less than half of MDs recommended some type of exercise/stretching. Table 2.
https://www.liebertpub.com/doi/10.1089/acm.2020.0392
“82.5% of non-surgical LBP episodes did not include a first-line service at any time during an episode.”
“Most individuals with non-surgical LBP initially contact a PCP 17. These individuals receive a CPG recommended non-pharmaceutical first-line service at any time in less than 20% of episodes.”
https://www.medrxiv.org/content/10.1101/2022.06.30.22277102v2.full
Talker. I know you have difficulty following along, so let me break it down for you.
Ernst wrote: “As individualization in exercise therapies is easy to implement, its use should be standard procedure.“
I agree.
Several folks commented that this is standard of care “for decades” and some stated this is what their MDs have done in their cases.
Since the topic of MDs/exercise/standard of care came up (I didn’t initiate the topic) I questioned how common is this in MD practices especially considering that exercise is a first line non pharm approach.
I shared a few papers on the topic. It appears to be a minority of MDs but I am open to other evidence.
Then you come back with non related links. I suppose that’s the best you can do.
DC,
LOL, so you really do not understand why I posted nonrelated links, even though I alluded to it in one of my earlier posts?
Let me break it down for you: I used your usual go to technique of whataboutery against you. Got it?
Besides, chrios defrauding the govt on a large scale is much more interesting that small potatoes story of MD non-compliance.
Talker, so you have nothing to add to the topic.
DC,
Like I said, chiros defrauding the govt on a large scale is more interesting. It does fall under the topic of non-compliance, albeit a serious one. Since you claim to be a chiro, I thought it would be of interest to you. But it appears that you don’t want to talk about it, I wonder why.
Talker, this isn’t that difficult for most people to follow.
Ernst stated : where I’m from it’s (exercise for chronic LBP) ~100%
So I shared a few studies that showed it’s not universally ~100%. Not even close.
Deal with it.
‘DC’, this isn’t that difficult for most people to follow:
Where I’m from, no GP is daft enough to refer patients to a chiropractor, or any vendor of bogus diagnostics and/or bogus treatments.
As commentator Admedical said to Logos-Bios: “your debating technique is like that of a small child. It’s amusing.”
Pete. If one actually reads Ernst original blog one would see that he brings up the medical approach. There was no mention of CAM. In fact chiropractors we’re only mentioned by one person in the responses if I recall.
Then the subtopic of how often MDs recommend exercise (mentioned by Ernst and another) of which I responded with a few papers. Now I know those results may cause some cognitive dissonance with some folks but that’s not my problem.
Thus it seems I am the only one who is actually willing to look into the topic that Ernst put forth.
DC says:
DC,
Allow me to quote someone I come across on this “little” blog ever so often:
DC on Tuesday 04 October 2022 at 12:57
It may seem like cognitive dissonance and/or diversion to you but we are looking at the topic of non-compliance (which RG raised on which you happily jumped on) in a larger context of healthcare and that includes non-compliance of the law by chiros. Too bad you are not willing to deal with it. Maybe you are chiro, like you claim to be.
Dumb and Confused,
“In fact chiropractors we’re [sic] only mentioned by one person in the responses if I recall.”
RG on Wednesday 07 December 2022 at 12:43 “Daily walking was advised to me by a Doctor of Chiropractic, NOT by even one of the many MD’s I visited.”
DC on Wednesday 07 December 2022 at 18:10 “RR: exercise has been a part of chiropractic profession at least since the 1940s…”
DC on Thursday 08 December 2022 at 14:14 “Going by my what my patients tell me, it’s not common that their MD recommends exercise. Usually it’s: take this pill and if it’s still bothering you in a few weeks come back.”
LOL! Those MDs also didn’t recommend visiting you, obviously. So MDs aren’t as incompetent as you keep insinuating 🤣
I know that small yet important details escape your attention, so I’ll make it a bit easier for you to grasp. This article, which you are currently spamming, states:
Posted in back pain, chiropractic, EBM, evidence, experience, meta-analysis, musculoskeletal problems, osteopathy, pain, physiotherapists, symptom-relief, systematic review
@Talker
I find no problem with the CNN post, now just get the MD’s to get in line with the program.
Nothing in there about prescribing meds. What the CNN article is prescribing has a much to do with posture and body ergonomics more than walking…. although a brief mention of walking is there.
AGAIN NO, no MD of mine ever suggested to me walking or exercise. Only referrals to PT…. and I visited many different MDs. The PT I was prescribed was much more like light stretching than exercise. Not that I’m opposed to stretching, I think it’s beneficial. Many SIMPLE back issues are related to tight or muscle spasms.
Says you based on anecdotes.
As I said, I never had a MD straight up prescribe meds without trying exercise first. Based on my experience, I think MDs are already doing just that. Bottom line is, my anecdotes trump yours.
It doesn’t appear that you are trained in any related field to asses whether a back issue is a SIMPLE one or not, let alone detect root cause of the problem.
@Talker
My experience with a particular medical issue is MY anecdote. My history with me consulting my doctors is fact… and not up for questioning.
You say you never had an MD prescribe meds without prescribing exercise first. If that is your experience, then YOU are the exception, not the rule. In the USA, if you walk out of the examination room without a prescription in hand, it’s because the doctor had writer’s cramp from giving to many prescriptions previously.
“Never let a good crisis go to waste”.
https://www.mayoclinic.org/diseases-conditions/back-pain/diagnosis-treatment/drc-20369911
https://www.niams.nih.gov/health-topics/back-pain/diagnosis-treatment-and-steps-to-take
LOL, in your case, I have little doubt! Whereas, people who are not random Internet trolls usually base their anecdotes on their experience.
At the time of writing, the United States population is equivalent to 4.25% of the total world population.[Worldometer]
@Pete Atkins
Pete, I’m well aware of the population of the USA.
I punctuated the statement with the USA reference because I was responding to the post from Talker, who specifically mentioned “in the USA”.
You would do well to read the context of the response.
Beyond that, I don’t have personal experience in many other places, so I try not to pretend I know what goes on elsewhere. Cuz ya know what Pete, I can’t be certain of what I read any longer.
“I can’t be certain of what I read any longer.”
Especially your own comments, it appears.
If that is the case, then it is very good for people who are heavily invested in big-pharma and that includes you, RG. This is what you have expressed in the past:
https://edzardernst.com/2022/10/my-interview-for-lexpress-homeopathy-is-implausible-but-energy-healing-takes-the-biscuit/#comment-141572
As you already know, part of the money you invested in big-pharma goes in marketing drugs to MDs and patients. If we were to assume that your criticism (that MDs readily prescribe meds without exploring other options) is true, then you should know that you are a willing contributor to the problem that you are so passionately criticizing.
@Talker (Edzard)
Yes, MD’s do actually prescribe meds without exploring other options. However, it’s not their fault completely. They are strongly encouraged to follow AMA protocol, which includes the usage of pain killers/ muscle relaxers.
RG,
Ah…it’s the AMA’s fault. That absolves you and your big pharma investments? But I thought AMA is run by big pharma. Is it not?
@Talker
I can’t say which is the dog and which is the tail (who dictates to who). Yes, my best guess would be that Pharma feeds the BS to AMA… AMA to MD’s. But it doesn’t much matter what order, they’re in cahoots together is the bottom line.
As for my stock profits, they’re almost guaranteed. Only the congress will stand in the way of drug pricing, but the politicians are bought off by the drug lobby. So, it won’t happen easily. Follow the $$$
RG,
Follow the money! I didn’t think I’d say this but, I could not agree more with you.
Fun fact: in this case money trail leads back to your pocket i.e. your investments in pharma.
May be of interest:
“Policies for conflict of interests and publicly available data are lacking, suggesting that enhanced oversight and transparency are needed to protect patient care from commercial influence and to ensure public trust.”
https://www.bmj.com/content/375/bmj-2021-066576
https://www.bmj.com/content/375/bmj-2021-066576
@Taker
” in this case money trail leads back to your pocket i.e. your investments in pharma.”
Yes… exactly, I said it first.
We can all play DC‘s incessant game of whataboutery.
May be of interest:
Summary of problems by Chris MacDonald, The Business Ethics Blog:
● The payments put referring physicians into a conflict of interest;
● The payments, which are based on completion of a course of care, induce physicians to encourage patients to complete a course of care independent of whether that’s in the patient’s best interests;
● The payments risk jeopardizing patients’ trust in their physicians;
● The payments risk the professional reputation of the medical profession quite generally;
● Referring to the payments as being “In compliance with the C.P.S.O. standards” falsely implies that the payments are required by the C.P.S.O.
MacDonald, Chris. “Chiropractic Referral Fees & Conflict of Interest”, The Business Ethics Blog.
https://businessethicsblog.com/2010/07/13/chiropractic-referral-fees-conflict-of-interest/
(Posted July 13, 2010)
This at least relates to the general topic of LBP.
“Many patients who develop new LBP receive guideline nonconcordant care such as early advanced imaging and opioids before other modalities like PT and prescription NSAIDs.”
https://journals.lww.com/lww-medicalcare/Abstract/2020/02000/Evaluation_and_Treatment_Patterns_of_New_Low_Back.3.aspx
“This at least relates to the general topic of LBP.”
The topic is in the title of the article on which you are spamming:
Individualized exercise therapy for chronic low back pain
Pete: The topic is in the title of the article on which you are spamming:
Individualized exercise therapy for chronic low back pain
You do know these discussions often go in different directions. I am simply responding to what others have shared.
But one can look at the recommendation of exercise in the broader sense to see how MDs follow other guidelines for this condition (hence my use of “general topic”).
It appears not to be very good and a general trend seems to be present.
DC says:
DC,
Your unwillingness to respond to articles I shared regarding fraudulent activities of chrios goes against your argument.
Talker. If you want to find a blog on fraud you can post your links there.
Meanwhile this blog has to do with LBP and exercise as a standard procedure. Which brings into question other approaches, such as:
“Even though spinal surgery does have a role in alleviating symptoms of radiculopathy or neurogenic claudication, or in circumstances where back pain is related to cancer, infection or gross instability, its role in the management of degenerative LBP is not supported by the studies currently available.”
https://www.mja.com.au/journal/2022/218/1/role-spinal-surgery-treatment-low-back-pain?fbclid=IwAR0-V5iJtvPFIVhvsdTc2xBrXxFM4_hTyo5bmoh8Op37SE4CxTOfxgOYqWc&mibextid=Zxz2cZ
DC says:
DC,
I don’t need to find a different blog. We are taking about SCAM fraud, not investment fraud or some other unrelated fraud. Most SCAMs tend to defraud patients with bogus claims, hence SCAM fraud falls well within the purview of this blog. Lot of posts on this very blog are tagged under the category fraud: https://edzardernst.com/category/fraud/
Besides, EE blogged about fraud perpetrated by chiros several times and that includes insurance fraud, let me refresh your memory:
https://edzardernst.com/2022/09/a-2-6m-insurance-fraud-by-chiropractors-and-doctors/
https://edzardernst.com/2021/07/fraud-and-sex-offences-by-chiropractors/
https://edzardernst.com/2013/11/chiropractic-abuse-and-how-we-can-protect-ourselves-from-it/
You are right, these discussions do tend to go in different directions and many times you happily deflect the discussion yourself and/or tend to be a willing participant, when it suits you. However, when it comes to topic of chiro fraud and non-compliance, your silence is deafening.
Talker: EE blogged about fraud perpetrated by chiros several times and that includes insurance fraud
Fine, post your links there. I’ll respond if I wish to.
DC says:
It is hilarious how you suddenly care about where certain comments are posted. I have already posted the links here; respond here if you want to or not. We all know you are not going to anyway.
@Taker
” in this case money trail leads back to your pocket i.e. your investments in pharma.”
Yes… exactly, I said it first.
But by no means does that imply that I consume the pills today. I already ate enough to last me a lifetime.
Relax RG, no one is stealing your thunder.
Is Rodney Gneckow your real name or one of many monikers that you use to comment on here?
“Chiropractors frequently recognised the importance of physical activity (PA) promotion, as demonstrated by the proportion of respondents reporting that they:
support the importance of providing physical activity or exercise information and counselling (64% to 100%)
are prepared to provide PA or exercise information and/or counselling to patients (91% to 92%,)
frequently obtain PA or exercise information from patients (87% to 97%,)
frequently discuss PA or exercise and/or provide PA or exercise information to patients (68% to 99%)
frequently provide PA counselling to patients (50% to 81%.)”
Chiropractic & Manual Therapies volume 30, Article number: 55 (2022)
“Chiropractors frequently recognised the importance of physical activity”
so do bus conductors, butchers, secretaries, hairdressers, and the rest of us.
…and they also recognize the importance of making money by defrauding the govt:
https://edzardernst.com/2022/11/individualized-exercise-therapy-for-chronic-low-back-pain/#comment-142456
“Chiropractors frequently recognised the importance of physical activity”.
so do bus conductors, butchers, secretaries, hairdressers, and the rest of us.
Unfortunately, too often that is about as far as it goes for those others, which also appears to be a common problem among MDs.
However chiropractors often: support, obtain, discuss and provide regarding exercise/PA.
‘DC’ claimed “However chiropractors often: support, obtain, discuss and provide regarding exercise/PA.”
Often? So, they are not trustworthy, hence:
Appears chiropractors are better at following clinical guidelines than MDs for LBP.
Surveys reveal that 68-99% of chiropractors discuss and/or provide PA or exercise information to patients.
Perhaps someday more MDs will admit their pharmaceutical approaches aren’t very good for people with CLBP.
Another example needed?
“Pharmacotherapy used to manage CLBP provided improvements in sleep in adults with CLBP. Given that these effects were small and unlikely clinically significant, clinicians could consider alternative treatments (e.g., non-pharmacological interventions) for managing sleep in adults with CLBP.”
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9678954/?fbclid=IwAR0VI2l3r6G_-EIridfK5yK3FrZH0J_YBdGWFhA-56ViZP9j3cNiXHNMnbM&mibextid=Zxz2cZ
What good are the guidelines when the field of chiropractic is pretty much quackery?
According to this chiro: https://www.dailydot.com/irl/chiropractor-scam-tiktok/ “literally 99% of my profession” is a scam.
See: Literally 99% of chiropractic is a scam
https://edzardernst.com/2022/08/literally-99-of-chiropractic-is-a-scam/
A blog about a YouTube video of a new chiropractor. I don’t think that even registers on the evidence pyramid.
DC says:
To put things in context:
1. The author of this blog is not anonymous.
2. Chiropractor who made the YT video is not anonymous.
3. The person calling himself DC, who claims to be a Doctor of Chiropractic and comments regularly on this blog remains anonymous.
‘DC’ emitted “A blog about a YouTube video of a new chiropractor. I don’t think that even registers on the evidence pyramid.”
Obviously, ‘DC’ didn’t bother to read the blog post (which is not about a YouTube video), yet it has 12 of the 31 comments posted by an anonymous nymshifting posturing sock puppet who sometimes attempts to impersonate a chiropractor.
If the best you can come up with is a YouTube video, so be it.
And yet there is this:
“Up to one-fifth of patients with chronic low back pain may be prescribed opioids in a manner that is not adherent to CPGs, thereby placing them at risk for poor outcomes.”
https://www.jabfm.org/content/35/4/724.long
‘DC’ emitted “If the best you can come up with is a YouTube video, so be it.”
QUOTE
Literally 99% of chiropractic is a scam
…
None of what DC Zierke said can surprise those who have been following my blog. On the contrary, I could add a few recent posts to his criticism of chiropractic, for example:
• Pediatric chiropractic seems to be on the rise
• Catastrophic injuries after chiropractic treatment
• Chiropractic: “a safe form of treatment”?
• Malpractice Litigation Involving Chiropractic Spinal Manipulation
• Best Practices for the Chiropractic Care of Children
• No effect from adding chiropractic manipulations to exercises for neck pain
• Hurray! The new professional standard by the General Chiropractic Council protects UK chiropractors
• Manual therapy (mainly chiropractic and osteopathy) does not have clinically relevant effects on back pain compared with sham treatment
• Chiropractic Paediatric Courses … it is high time to stop this dangerous nonsense
• Chiropractic ‘subluxation’ is by no means a notion of the past
• Another indirect risk of chiropractic
• And again: chiropractic for infant colic
• Chiropractic misinformation during the COVID-19 pandemic
• The lack of chiropractic ethics: “valid consent was not obtained in a single case”
I rest my case.
END OF QUOTE
QUOTE
Malpractice of chiropractors – just the tip of an iceberg?
Note: DrDale was one of many pseudonyms used prior to DC.
Bart B. Van Bockstaele on Saturday 07 July 2018 at 21:49
Perhaps, but it seems that chiropractors don’t know that themselves. As you said:
That is a scary proposition to me, even more so because chiropractors claim to have an education. What is the worth of this education that doesn’t even seem to teach them what the job entails?
END OF QUOTE
Zierke is entitled to his opinion.
If he has credible evidence of the 99% then he should reveal it.
I’ll wait.
An educated opinion of a Chiropractor who is NOT anonymous and doesn’t hide behind multiple pseudonyms. His opinions carry more weight than someone who claims to be a chiropractor.
Still his opinion.
“Still his opinion.”
True, and more valuable than anonymous persons like youself, who claim to be a DC.
LOL. Your opinion about who has a better opinion. Sure, go with the kid who graduated last year.
DC says.
“Sure, go with the kid who graduated last year.”
Who has the ba!!s to criticize chiropractic publically without hiding behind pseudonyms.
OTH….who are you? 😂🤣
Who am I? Someone who know the definition of scam which apparently he does not.
DC says “Someone who know the definition of scam which apparently he does not.”
Perhaps you do! If you are a chiropractor like you claim to be, it is hard not to know what it means when you are the one perpetrating it on unsuspecting patients.
“Who am I? Someone who know the definition of scam which apparently he does not.”
Someone who know how to bastardize the English language which apparently happen alot.
Chiropractic: “pretending to get sick people well since 1895”.
— Michael Kenny
“If you are a chiropractor like you claim to be, it is hard not to know what it means when you are the one perpetrating it on unsuspecting patients.”
Actually, it’s called a dictionary.
“Actually, it’s called a dictionary.”
Good to know you have access to a dictionary. It will serve you well if you look up the word hypocrisy.
“Actually, it’s called a dictionary.”
‘DC’ deploys not just lying by omission and quote mining, but also cherry-picks dictionaries — here’s a previous episode for the word “scam“.
Pete: ‘DC’ deploys not just lying by omission and quote mining, but also cherry-picks dictionaries
Sigh, I pull the relevant information from the abstract or paper as it pertains to the topic or discussion. Of course papers have limitations. I could list everyone of them plus other limitations they didn’t list. Maybe someone like Pete needs that kind of help but that’s not my problem.
Any astute reader would know I almost exclusively use the Cambridge dictionary. On occasion Cambridge doesn’t have the appropriate definition for the context of the discussion so I may fall back to Oxford.
If this is the best Pete has to offer regarding a discussion on CLBP and exercise then I will go back to ignoring him.
‘DC’ emitted “On occasion Cambridge doesn’t have the appropriate definition for the context of the discussion so I may fall back to Oxford.”
QED.
‘DC’ emitted “If this is the best Pete has to offer regarding a discussion on CLBP and exercise then I will go back to ignoring him.”
My comment wasn’t addressed to ‘DC’ because I have no desire to engage in a pseudo-discussion with anyone who deploys a plethora of fallacies and deceptions in their promotion of pseudo-medicine.
scam noun infml US: a dishonest or illegal plan or activity, esp. one for making money.
— Cambridge Dictionary
scam noun: a fraudulent or deceptive act or operation.
— Merriam-Webster
scam noun infml: a dishonest scheme; a fraud.
— Oxford Reference
https://edzardernst.com/2022/10/arguments-used-to-defend-so-called-alternative-medicine/#comment-141412
Nailed it Edzard:-)
Nope.
How often do bus conductors, butchers, secretaries and hairdressers provide support, obtain and discuss regarding exercise/PA?
Never, but that is not the point, and you know it. If you don’t, let me to explain it to you.
Everyone and their mom recognize the importance of physical activity. It is not special if a chiro recognizes. In fact, they should…duh!
“Chiropractors frequently recognised the importance of physical activity”. Is like saying: a clown recognizes the importance of slapstick at making people laugh.
One should see that is the introduction and then authors provide a list of how chiropractors recognize PA.
“Chiropractors frequently recognised the importance of physical activity (PA) promotion, as demonstrated by the proportion of respondents reporting that they:…”
“One should see that is the introduction and then authors provide a list of how chiropractors recognize PA.”
Good for them for stating the obvious and allowing you to quote mine.
‘DC’ quote mined “Chiropractors frequently recognised the importance of physical activity…”
Immediately preceding that sentence is:
Fernandez, M., Young, A., Milton, K. et al. Physical activity promotion in chiropractic: a systematic review of clinician-based surveys. Chiropr Man Therap 30, 55 (2022).
https://doi.org/10.1186/s12998-022-00467-9
QUOTE
Lying by omission, otherwise known as exclusionary detailing, is lying by either omitting certain facts or by failing to correct a misconception.
https://rationalwiki.org/wiki/Lying_by_omission
QUOTE
Quote mining (also contextomy) is the fallacious tactic of taking quotes out of context in order to make them seemingly agree with the quote miner’s viewpoint, to make the comments of an opponent seem more extreme, or to make it seem that the opponent holds positions they don’t in order to make their positions easier to refute or demonize. It’s a way of lying. …
Quote mining is an informal fallacy and a fallacy of ambiguity, in that it removes context that is necessary to understand the mined quote.
https://rationalwiki.org/wiki/Quote_mining
Appears to be what most chiropractors are doing as well (for the past 70 years or more).
How about most MDs? Are they considering the clinical guidelines?
Note the use of the word “should”.
Exercise for Chronic Low Back Pain
Physical therapists should use exercise training interventions, including trunk muscle strengthening and endurance, multimodal exercise interventions, specific trunk muscle activation exercise, aerobic exercise, aquatic exercise, and general exercise, for patients with chronic LBP.
Manual and Other Directed Therapies for Chronic Low Back Pain
Physical therapists should use thrust or nonthrust joint mobilization to reduce pain and disability in patients with chronic LBP.
https://www.jospt.org/doi/10.2519/jospt.2021.0304
“For patients with chronic low back pain, clinicians and patients should initially select nonpharmacologic treatment …”
https://www.acpjournals.org/doi/10.7326/M16-2367