MD, PhD, MAE, FMedSci, FRSB, FRCP, FRCPEd.

chiropractic

If you assumed that the best management of a child by chiropractors is not to treat this patient and refer to a proper doctor, think again. This paper was aimed at building upon existing recommendations on best practices for chiropractic management of children by conducting a formal consensus process and best evidence synthesis. Its authors composed a best practice guide based on recommendations from current best available evidence and formal consensus of a panel of experienced practitioners, consumers, and experts for chiropractic management of pediatric patients. They thus syntheized results of a literature search to inform the development of recommendations from a multidisciplinary steering committee, including experts in pediatrics, followed by a formal Delphi panel consensus process.

The consensus process was conducted June to August 2022. All 60 panelists completed the process and reached at least 80% consensus on all recommendations after three Delphi rounds. Recommendations for best practices for chiropractic care for children addressed the following aspects of the clinical encounter:

  • patient communication, including informed consent;
  • appropriate clinical history, including health habits;
  • appropriate physical examination procedures;
  • red flags/contraindications to chiropractic care and/or spinal manipulation;
  • aspects of chiropractic management of pediatric patients, including infants;
  • modifications of spinal manipulation and other manual procedures for pediatric patients;
  • appropriate referral and comanagement;
  • appropriate health promotion and disease prevention practices.

The authors concluded that this set of recommendations represents a general framework for an evidence-informed and reasonable approach to the management of pediatric patients by chiropractors.

Whenever I read the term ‘evidence-informed’ I need to giggle. Why not evidence-based? Evidence-informed might mean that chiros are informed that their treatments are useless or even dangerous for children … but, on reflection and taking their own need for earning a living, they subsequently ignore these facts. And sure enough, the authors of the present paper do mention that a Cochrane review concluded that spinal manipulation is not recommended for children under 12, for a number of conditions, or for general wellness … only to then go on and ignore the very fact.

In doing so, the authors issue a string of self-evident platitudes which occasionally border on the irresponsible. For instance, under the heading of ‘primary prevention’, vaccinations are mentioned as the very last item with the following words:

If parents ask for advice or information about childhood vaccinations, explain that they have the right to make their own health decisions. They should be adequately informed about the benefits and risks to both their child and the broader community associated with these decisions. Consider referral to a health professional whose scope of practice includes vaccinations to address patient questions or concerns.

What that really means in practice, I fear, might be summarized like this: If parents ask for advice or information about childhood vaccinations, explain that they are dangerous, and that even D. D. Palmer recognized as early as 1894 that vaccination is ‘…the monstrous delusion … fastened on us by the medical profession, enforced by the state boards, and supported by the mass of unthinking people …’

Altogether, the ‘Clinical Practice Guideline for Best Practice Management of Pediatric Patients by Chiropractors’ is a thoroughly disreputable document. It was constructed in the way all charlatans tend to construct their consensus documents:

  • convene a few people who are all in favour of a certain motion,
  • discuss the motion,
  • agree with it,
  • write up the process
  • publish your paper in a third class journal,
  • boast that there is a consensus,
  • stress that the motion must thereefore be ethical, correct and valuable.

Do chiropractors know that, using this methodology, the ‘flat earth society’ can easily pass a consensus that the earth is indeed flat?

I am sure they do!

‘The Cult of Chiropractic’ is the title of a video that has just been released. I think it is very good and, if you are interested in the subject at all, I recommend you have a look. You can watch it here:

The Cult of Chiropractic : r/h3h3productions (reddit.com)

The video is not just well-done, it also is fun and informative. I learned a few things from it that I did not yet know. It also brings Simon Singh and myself together after we had not met for several years; and that is always a pleasure!

But back to ‘The Cult of Chiropractic’ and the question whether this assumption is true. Some time ago, I published a post about so-called alternative medicine and cultism. I listed a few questions we should ask ourselves to determine whether chiropractic is a cult. Let me adapt them slightly:

  1. Is chiropractic based on dogma? The answer is yes – think, for instance, of the assumptions that subluxations exist.
  2. Does chiropractic demand acceptance of its dogma or doctrine as truth? For straight chiropractors, the answer is yes.
  3. Is the dogma set forth by a single guru or promulgator? Yes, DD Palmer.
  4. Is chiropractic supposed to cure all ills? For many chiros, the answer is yes.
  5. Is belief used by chiropractors as a substitute for evidence? Yes.
  6. Do chiropractors determine their patients’ lifestyle? Yes.
  7. Do chiros exploit their patients financially? Yes.
  8. Does chiropractors impose rigid rules and regulations? Yes.
  9. Do chiros practice deception? Yes.
  10. Do chiropractors have their own sources of information/propaganda? Yes.
  11. Do chiros cultivate their own lingo? Yes.
  12. Do chiros discourage or inhibit critical thinking? Yes.
  13. Are questions about the values of chiropractic discouraged or forbidden? Yes.
  14. Do the proponents of chiropractic reduce complexities into platitudinous buzz words? Yes
  15. Do chiros assume that health problems are the result of not adhering to the dogma? Yes.
  16. Do chiros instill fear into members who consider leaving? Yes.
  17. Do chiros depict conventional medicine as ineffective or harmful? Yes.
  18. Do chiros ask others to recruit new members to their cult? Yes.

Based on these 18 questions, I conclude that chiropractic is indeed a cult. What about you? Even if you disagree, please have a look at the excellent  video, ‘THE CULT OF CHIROPRACTIC’.

The ‘University College of Osteopathy’ announced a proposal to merge with the AECC University College (AECC UC).  Both institutions will seek to bring together the two specialist providers to offer a “unique inter-disciplinary environment for education, clinical practice and research in osteopathy, chiropractic, and across a wide range of allied health and related disciplines”.

The partnership is allegedly set to unlock significant opportunities for growth and development by bringing together the two specialist institutions’ expertise and resources across two locations – in Dorset and central London.

As a joint statement, Chair of the Board of Governors at AECC UC, Jeni Bremner and Chair of the Board of Governors at UCO, Professor Jo Price commented:

“We believe the proposed merger would further the institutional ambitions for both of our organisations and the related professional groups, by allowing us to expand our educational offering, grow student numbers and provide a unique inter-disciplinary training environment, providing students the opportunity to be immersed in multi-professional practice and research, with exposure to and participation in multi-disciplinary teams.

“There is also an exciting and compelling opportunity to expedite the development of a nationally unique, and internationally-leading MSK Centre of Excellence for Education and Research, developed and delivered across our two sites.”

The announcement is accompanied by further uncritical and promotional language:

Established as the first chiropractic training provider in Europe, AECC UC has been at the forefront of evidence-based chiropractic education, practice and research for more than 50 years. The institution is on an exciting journey of growth and development, having expanded and diversified its academic portfolio and activity beyond its traditional core offering of chiropractic across a broad range of allied health courses and apprenticeships, working closely with NHS, local authority and other system partners across Dorset and the south-west. The proposed merger with UCO would allow AECC UC to enhance the breadth and depth of its offer to support the expansion and development of the health and care workforce across a wider range of partners.

Now in its 106th year, UCO is one of the UK’s leading providers of osteopathic education and research with an established reputation for creating highly-skilled, evidence-informed graduates. UCO research is recognised as world-leading, delivering value to the osteopathic and wider health care community.

Sharon Potter, Acting Vice-Chancellor of UCO, said:

“As an institution that has long been at the forefront of osteopathic education and research, we are committed to ensuring further growth and development of the osteopathic profession.

“UCO has been proactively considering options to future-proof the institution. Following a review of strategic options, UCO is delighted by the proposed merger, working closely with AECC UC to ensure that UCO and osteopathy thrives as part of the inter-professional health sciences landscape, both academically and clinically. There is significant congruence between UCO and AECC UC in our strong aligned values, commitment to and delivery of excellent osteopathic education, clinical care and research, and opinion leadership.

“AECC UC has a strong track record of respecting the differences in professions, evidenced by the autonomy across the 10 different professional groups supported by the institution. The merger will not only mean we are protecting UCO through preserving its osteopathic heritage and creating a sustainable future, but that our staff and students can collaborate with other professional groups such as physiotherapy, chiropractic, sport rehabilitation, podiatry and diagnostic imaging, in a multidisciplinary MSK and rehabilitation environment unlike anywhere else in the UK.”

Professor Lesley Haig, Vice-Chancellor of AECC UC, commented:

“Preserving the heritage of UCO and safeguarding its future status as the flagship osteopathy training provider in the UK will be critical, just as it has been to protect the chiropractic heritage of the AECC brand. UCO is seen as synonymous with, and reflective of, the success of the osteopathy profession and we fully recognise and respect the important role that UCO plays not only as a sector-leading provider of osteopathic education, research and clinical care, but as the UK’s flagship osteopathy educational provider.

“Overall it is clear that UCO and AECC UC already have a common values base, similar understanding of approaches to academic and clinical delivery, and positive relationships upon which a future organisational structure and opportunities can be developed. It’s an exciting time for both institutions as we move forward in partnership to create something unique and become recognised nationally and internationally as a centre of excellence.”

The proposed merger would continue the already founded positive relations between the institutions, where regular visits, sharing of good practice, and collaborative research work are already taking place. Heads of terms for the potential merger have now been agreed and both institutions are entering into the next phase of discussions, which will include wide consultation with staff, students and other stakeholders to produce a comprehensive implementation plan.

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In case this bonanza of platitudes and half-truths has not yet overwhelmed you,  I might be so bold as to ask 10 critical questions:

  1. What is an “evidence-based chiropractic education”? Does it include the messages that 1) subluxation is nonsense, 2) chiropractic manipulations can cause harm, 3) there is little evidence that they do more good than harm?
  2. How  an an “expansion and development of the health and care workforce” be anticipated on the basis of the 3 points I just made?
  3. What does the term “evidence-informed graduates” mean? Does it mean they are informed that you teach them nonsense but instruct them to practice this nonsense anyway?
  4. Do “options to future-proof the institution” include the continuation of misleading the public about the value of chiropractic/osteopathy?
  5. Does the”delivery of excellent osteopathic education, clinical care and research, and opinion leadership” account for the fact that the evidence for osteopathy is weak at best and for most conditions negative?
  6. By “preserving its osteopathic heritage”, do you intend to preserve also the reputation of your founding father, Andrew Taylor Still, who did many dubious things. In 1874, for instance, he was excommunicated by the Methodist Church because of his “laying on of hands”; specifically, he was accused of trying to emulate Jesus Christ, labelled an agent of the Devil, and condemned as practicing voodoo. Or do you prefer to white-wash the osteopathic heritage?
  7. You also want “to protect the chiropractic heritage”; does that mean you aim at white-washing the juicy biography of the charlatan who created chiropractic, DD Palmer, as well?
  8. “UCO and AECC UC already have a common values base” – what are they? As far as I can see, they mainly consist in hiding the truth about the uselessness of your activities from the public.
  9. How do you want to “recognised nationally and internationally as a centre of excellence”? Might it be a good idea to begin by critically assessing your interventions and ask whether they do more good than harm?
  10. Crucially, what is really behing the merger that you are trying to sell us with such concentrated BS?

The history of so-called alternative medicine (SCAM) is rich with ‘discoveries’ that are widely believed to be true events but that, in fact, never happened. Here are 10 examples:

  1. DD Palmer is believed to have cured the deafness of a janitor by manipulating his neck. This, many claim, was the birth of chiropractic. BUT IT NEVER HAPPENED! How can I be so sure? Because the nerve responsible for hearing does not run through the neck.
  2. Samuel Hahnemann swallowed some Cinchona officinalis, a quinine-containing treatment for malaria, and experienced the symptoms of malaria. This was the discovery of the ‘like cures like’ assumption that forms the basis of homeopathy. BUT IT NEVER HAPPENED! How can I be so sure? Because Hahnemann merely had an intolerance to quinine, and like does certainly not cure like.
  3. Edward Bach, for the discovery of each of his flower remedies, suffered from the state of mind for which a particular remedy was required; according to his companion, Nora Weeks, he suffered it “to such an intensified degree that those with him marvelled that it was possible for a human being to suffer so and retain his sanity.” This is how Bach discovered the ‘Bach Flower Remedies‘. BUT IT NEVER HAPPENED! How can I be so sure? His experience was not caused by by the remedy, which contain no active ingredients, but by his imagination.
  4. William Fitzgerald found that pressure on specific areas on the soles of a patient’s feet would positively affect a specific organ of that patient. This was the birth of reflexology. BUT IT NEVER HAPPENED! How can I be so sure? Because there are no nerve connections from the sole of our feet to our inner organs.
  5. Max Gerson observed that his special diet with added liver juice, vitamin B3, coffee enemas, etc. cures cancer. This is how Gerson found the Gerson therapy. BUT IT NEVER HAPPENED! How can I be so sure? Because he never could demonstrate this effect and others never were able to replicate his alleged finfings.
  6. George Goodheart was convinced that the strength of a muscle group provides information about the health of inner organs. This formed the basis for applied kinesiology. BUT IT NEVER HAPPENED! How can I be so sure? Because applied kinesiology has been disclosed as a simple party trick.
  7. Paul Nogier thought that the function of inner organs can be influenced by stimulating points on the outer ear. This was the discovery that became auricular therapy. BUT IT NEVER HAPPENED! How can I be so sure? Because Nogier’s assumptions fly in the face of anatomy and physiology.
  8. Antom Mesmer discovered that by moving a magnet over a patient, he would move her vital fluid and affect her health. This discovery became the basis for Mesmer’s ‘animal magnetism‘. BUT IT NEVER HAPPENED! How can I be so sure? Because there is no vital fluid and neither real nor animal magnetism have specific therapeutic effects.
  9. Reinhold Voll observed that the electric resistance over acupuncture points provides diagnostic information about the function of the corresponding organs. He thus invented his ‘electroacupuncture according to Voll‘ (EAV). BUT IT NEVER HAPPENED! How can I be so sure? Because EAV and the various methods derived from it are not valid and fail to produce reproducible results.
  10. Ignatz von Peczely discovered that discolorations on the iris provide valuable information about the health of inner organs. This was the birth of iridology. BUT IT NEVER HAPPENED! How can I be so sure? Because discolorations develop spontaneously and Peczely’s assumptions about nerval connections between the iris and the organs of the body are pure fantasy.

I hope that you can think of further SCAM discoveries that never happened. If so, please elaborate in the comments section below; you will see, it is good fun!

PS

By sating ‘IT NEVER HAPPENED’, I mean to say that it never happened as reported/imagined by the inventor of the respective SCAM and that the explanations perpetuated by the enthusiasts of the SCAM regarding cause and effect are based on misunderstandings.

It has been reported that two London councils have written to parents to warn that children who are not vaccinated against measles may need to self-isolate for 21 days if a classmate is infected with the disease. It comes after modelling by the UK Health Security Agency (UKHSA) warned that up to 160,000 cases could occur in the capital alone as a result of low vaccination rates. Just three-quarters of London children have received the two required doses of the MMR jab, which protects against measles. This is 10 per cent lower than the national average.

Barnet Council wrote to parents on July 20 warning that any unvaccinated child identified as a close contact of a measles case could be asked to self-isolate for up to 21 days. “Measles is of serious concern in London due to low childhood vaccination rates. Currently we are seeing an increase in measles cases circulating in neighbouring London boroughs, so now is a good time to check that your child’s MMR vaccination – which not only protects your child against measles but also mumps and rubella – is up to date,” the letter reads. “Children who are vaccinated do not need to be excluded from school or childcare,” the letter added.

Neighbouring Haringey Council also warned that children without both MMR doses may be asked to quarantine for 21 days. Just over two-thirds (67.9 per cent) of children in the area had received both doses by the age of five. The councils stated that they had sent the letters based on guidance by the UKHSA, but the agency said that headteachers should consider “excluding” unvaccinated pupils who become infected with measles rather than instructing them to self-isolate.

Data published by the UKHSA showed that 128 cases of measles were recorded between January 1 and June 30 this year, compared to 54 cases in the whole of 2022. Two-thirds of the cases were detected in London. The agency have said that there is a high risk of cases linked to overseas travel leading to outbreaks in specific population groups such as young people and under-vaccinated communities.

Dr Vanessa Saliba, a consultant epidemiologist at UKHSA, said: “When there are measles cases or outbreaks in nurseries or schools, the UKHSA health protection team will assess the situation, together with the school and other local partners, and provide advice for staff and pupils. “Those who are not up to date with their MMR vaccinations will be asked to catch up urgently to help stop the outbreak and minimise disruption in schools.”

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Measles is a significant concern with approximately 10 million people infected annually causing over 100,000 deaths worldwide. In the US before use of the measles vaccine, there were estimated to be 3 to 4 million people infected with measles annually, causing 400 to 500 deaths. Complications of measles include otitis media, diarrhea, pneumonia, and acute encephalitis. Measles is a leading cause of blindness in the developing world, especially in those who are vitamin A deficient. Malnourished children with measles are also at higher risk of developing noma (or cancrum oris), a rapidly progressive gangrenous infection of the mouth and face. Most deaths due to measles are caused by pneumonia, diarrhea, or neurological complications in young children, severely malnourished or immunocompromised individuals, and pregnant women. A rare sequela of measles is subacute sclerosing panencephalitis.

Back in 2003, we investigated what advice UK homeopaths, chiropractors and general practitioners give on measles, mumps and rubella vaccination programme (MMR) vaccination via the Internet. Online referral directories listing e-mail addresses of UK homeopaths, chiropractors and general practitioners and private websites were visited. All addresses thus located received a letter of a (fictitious) patient asking for advice about the MMR vaccination. After sending a follow-up letter explaining the nature and aim of this project and offering the option of withdrawal, 26% of all respondents withdrew their answers. Homeopaths yielded a final response rate (53%, n = 77) compared to chiropractors (32%, n = 16). GPs unanimously refused to give advice over the Internet. No homeopath and only one chiropractor advised in favour of the MMR vaccination. Two homeopaths and three chiropractors indirectly advised in favour of MMR. More chiropractors than homeopaths displayed a positive attitude towards the MMR vaccination.  We concluded that some complementary and alternative medicine providers have a negative attitude towards immunisation and means of changing this should be considered.

The problem is by no means confined to the UK. German researchers, for instance, showed that belief in homeopathy and other parental attitudes indicating lack of knowledge about the importance of vaccinations significantly influenced an early immunisation. Moreover, being a German homeopath has been independently associated with lower own vaccination behavior. Data from France paint a similar picture.

Some homeopaths, of course, claim that ‘homeopathic vaccinations’ are effective and preferable. My advice is: DON’T BELIEVE THESE CHARLATANS! A recent study demonstrated that homeopathic vaccines do not evoke antibody responses and produce a response that is similar to placebo. In contrast, conventional vaccines provide a robust antibody response in the majority of those vaccinated.

The aim of this systematic review was to update the current level of evidence for spinal manipulation in influencing various biochemical markers in healthy and/or symptomatic population.

Various databases were searched (inception till May 2023) and fifteen trials (737 participants) that met the inclusion criteria were included in the review. Two authors independently screened, extracted and assessed the risk of bias in included studies. Outcome measure data were synthesized using standard mean differences and meta-analysis for the primary outcome (biochemical markers). The Grading of Recommendations, Assessment, Development and Evaluation (GRADE) was used for assessing the quality of the body of evidence for each outcome of interest.

There was low-quality evidence that spinal manipulation influenced various biochemical markers (not pooled). There was low-quality evidence of significant difference that spinal manipulation is better (SMD -0.42, 95% CI – 0.74 to -0.1) than control in eliciting changes in cortisol levels immediately after intervention. Low-quality evidence further indicated (not pooled) that spinal manipulation can influence inflammatory markers such as interleukins levels post-intervention. There was also very low-quality evidence that spinal manipulation does not influence substance-P, neurotensin, oxytocin, orexin-A, testosterone and epinephrine/nor-epinephrine.

The authors concluded that spinal manipulation may influence inflammatory and cortisol post-intervention. However, the wider prediction intervals in most outcome measures point to the need for future research to clarify and establish the clinical relevance of these changes.

The majority of the studies were of low or very low quality. This means that the collective evidence is less than reliable. In turn, this means, I think, that the conclusions are misleading. A more honest conclusion would be this:

There is no reliable evidence that spinal manipulation influences inflammatory and cortisol levels.

As for the clinical relevance, I would like to point out that it would not be surprising if chiropractors could one day convincingly show that spinal manipulation do influence various biochemical markers. Many things do! If you fall down a staircase, for instance, plenty of biochemical markers will be affected. This, however, does not mean that throwing our patients down the stairs is of therapeutic value.

The American Chiropractic Association Council on Chiropractic Pediatrics (CCP) announced a new diplomate education program focused on pediatric care. The program will include 300 hours of education covering topics such as pediatric development from birth to age 16, adjusting techniques, working diagnosis, clinical application, integrated care and more…

Development of the diplomate education program has been in the works for several years, with contributions from many members of the CCP, including council president Jennifer Brocker, DC, DICCP. At the helm of course development for this education program are Mary Beth Minser, DC, CACCP, and Kris Tohtz, DC, LAc, educational coordinators for CCP. They agreed that the goal of the new program is to provide education that furthers knowledge of chiropractic pediatrics in an evidence-based, integrative way. “We wanted to make sure that we had something that aligned with ACA’s core principles,” Dr. Tohtz said. “Chiropractic-forward, yes, but scientifically focused.”

Dr. Brocker added, “There was a need for more evidence-informed education [in pediatrics]. I felt like the Council was well positioned to take this on because we had the opportunity to build it from scratch, making it what students and practicing doctors need.” …

Drs. Minser and Tohtz are excited that the diplomate program will also include a research component. “There is some lacking information when it comes to pediatric chiropractic,” Dr. Minser explained. She recently participated in the COURSE Study, an international study seeking to fill knowledge gaps in research relating to pediatric chiropractic treatment. “It was a very easy project to do, and pretty exciting to be involved,” she said. “But you have to know how to treat pediatric patients in order to be involved in those research projects. We want doctors and students [in this program] to be able to go through a case study, to be able to extract information for their clinical application from that case study or from research, or, if they would like, to write up case studies so we can get more published.”

“We feel we could really push pediatric chiropractic to a whole new level having doctors that have this type of knowledge base,” Dr. Minser said. “We just want to be the best pediatric chiropractors that we can be, and this diplomate [education] program helps [us] do that.”

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“There is some lacking information when it comes to pediatric chiropractic.”

Really?

I think the evidence is quite clear: chiropractic has nothing to offer for ill children that other, properly trained healthcare professionals would not do better.

“We feel we could really push pediatric chiropractic to a whole new level.”

Why?

“We just want to be the best pediatric chiropractors that we can be.”

In this case, please study the evidence and you will inevitably arrive at the following conclusion:

THE BEST A CHIROPRACTOR CAN DO FOR A SICK CHILD IS TO REFER IT TO A COMPETENT DOCTOR  – A DOCTOR OF MEDICINE, NOT CHIROPRACTIC!

 

This study aimed to compare the effects of cognitive functional therapy (CFT) and movement system impairment (MSI)-based treatment on pain intensity, disability, Kinesiophobia, and gait kinetics in patients with chronic non-specific low back pain (CNSLBP).

In a single-blind randomized clinical trial, the researchers randomly assigned 91 patients with CNSLBP into CFT (n = 45) and MSI-based treatment (n = 46) groups. An 8-week training intervention was given to both groups. The researchers measured the primary outcome, which was pain intensity (Numeric rating scale), and the secondary outcomes, including disability (Oswestry disability index), Kinesiophobia (Tampa Kinesiophobia Scale), and vertical ground reaction force (VGRF) parameters at self-selected and faster speed (Force distributor treadmill). They evaluated patients at baseline, at the end of the 8-week intervention (post-treatment), and six months after the first treatment. Mixed-model ANOVA was used to evaluate the effects of the interaction between time (baseline vs. post-treatment vs. six-month follow-up) and group (CFT vs. MSI-based treatment) on each measure.

CFT showed superiority over MSI-based treatment in reducing pain intensity (P < 0.001, Effect size (ES) = 2.41), ODI (P < 0.001, ES = 2.15), and Kinesiophobia (P < 0.001, ES = 2.47) at eight weeks. The CFT also produced greater improvement in VGRF parameters, at both self-selected (FPF[P < 0.001, ES = 3], SPF[P < 0.001, ES = 0.5], MSF[P < 0.001, ES = 0.67], WAR[P < 0.001, ES = 1.53], POR[P < 0.001, ES = 0.8]), and faster speed, FPF(P < 0.001, ES = 1.33, MSF(P < 0.001, ES = 0.57), WAR(P < 0.001, ES = 0.67), POR(P < 0.001, ES = 2.91)] than the MSI, except SPF(P < 0.001, ES = 0.0) at eight weeks.

The authors concluded that this study suggests that the CFT is associated with better results in clinical and cognitive characteristics than the MSI-based treatment for CNSLBP, and the researchers maintained the treatment effects at six-month follow-up. Also, This study achieved better improvements in gait kinetics in CFT. CTF seems to be an appropriate and applicable treatment in clinical setting.

To understand this  study, we need to know what CFT and MSI exactly entailed. Here is the information that the authors provide:

Movement system impairment-based treatment

The movement system impairment-based treatment group received 11 sessions of MSI-based treatment over the 8 weeks for 60 min per session with a supervision of a native speaker experienced (above 5 years) physical therapist with the knowledge of MSI-based treatment. The researchers designed the MSI-based treatment uniquely for each patient based on the interview, clinical examination, and questionnaires, just like they did with the CFT intervention. First, they administered standardized tests to characterize changes in the patient’s low back pain symptoms, and then they modified the treatment to make it more specific based on the participant’s individual symptoms. Depending on the participant’s direction-specific low back pain classification, they performed the intervention following one of the five MSI subgroups namely [1] rotation, [2] extension, [3] flexion, [4] rotation with extension, and [5] rotation with flexion. Finally, Patients treated using the standardized MSI protocol as follows: [1] education regarding normal postures and movements such as sitting, walking, bending, standing, and lying down; [2] education regarding exercises to perform trunk movements as painlessly as possible; and [3] prescription of functional exercises to improve trunk movement [32].

Cognitive functional therapy

Cognitive functional therapy was prescribed for each patient in CFT group based the CFT protocol conducted by O’Sullivan et al. (2015). Patients received supervised 12 sessions of training over the 8-week period with 60 min per session provided with another physical therapist who had been trained in CFT treatment. In this protocol, a physical therapist with more than 5 years of experience conducted an interview and physical examination of the patients to determine their own unique training programs, considering modifiable cognitive, biopsychosocial, functional, and lifestyle behavior factors. The intervention consists of the following 3 main stages: [1] making sense of pain that is completely reflective, where physical therapist could use the context of the patient’s own story to provide a new understanding of their condition and question their old beliefs [2] exposure with control which is designed to normalize maladaptive or provocative movement and posture related to activities of daily living that is integrated into each patient’s functional impairments, including teaching how to relax trunk muscles, how to have normal body posture while sitting, lying, bending, lifting, moving, and standing, and how to avoid pain behaviors, which aims to break poor postural habits; and [3] lifestyle change which is investigating the influence of unhealthy lifestyles in the patient’s pain context. Assessing the individual’s body mass, nutrition, quality of sleep, levels of physical activity or sedentary lifestyle, smoking, and other factors via video calls. Identifying such lifestyle factors helped us to individually advise and design exercise programs, rebuild self-confidence and self-efficacy, promote changes in lifestyle, and design coping strategies.

I must admit that I am not fully convinced.

Firstly, the study was not large and we need – as the authors state – more evidence. Secondly, I am not sure that the results show  CFT to be more effective that MSI. They might merely indicate 1) that the bulk of the improvement is due to non-specific effects (e.g. reression towards the mean, natural history of the condition, placebo) and 2) that CFT is less harmful than MSI.

My conclusion:

we need not just more but better evidence.

For about 40 years, the RMIT University in Australia had a Bachelor of Health Science/Bachelor of Applied Science (Chiropractic), probably the first official course of its kind in Australia. “Get qualified with a chiropractic degree: a solid grounding in anatomy, physiology and pathology and practise at the RMIT Health Clinic” was how the RMIT advertised it. But now the website states this: “from 2023, this degree is no longer offered.”

The Australian Chiropractors Association (ACA) is appalled!!!

What is more, they claim that this decision was made without consultation with staff, students (Australian or international) or other relevant stakeholders such as the chiropractic professional bodies. A publicly funded university acting in this manner appears to fly in the face of the Albanese government’s positive philosophy around educational access, particularly for those in the regions.
What the ACA omits to mention is that the chiro-unit at the RMIT has a dismal research output and hardly ever tackled relevant research questions such as effectiveness and safety of spinal manipulations. The ACA have even posted a video and believe a public institution that selectively closes a program which serves the public health interest and is economically viable, requires scrutiny. Given the role chiropractors play in serving the ageing population, together with the fact that low back pain is the number one disability worldwide, this decision is contrary to future community needs and industry demands.
Really?
The role chiros play in terms of public health, serving the elderly, alleviating back pain, reducing disability is close to zero. The fact that it is not nothing at all is due to the fact that, arguably, it is a detrimental role. As we have discussed ad nauseam on this blog:
  • the main contribution of chiros to public health is that many of them advise AGAINST immunizations;
  • a significant contribution by chiropractors to the health of the elderly is that they have put many of them in wheelchairs.
The ACA state that they believe an institution funded by government must be accountable to its stakeholders both within and without.
Exactly!
I suspect and hope that this is precisely the reason why they closed the course.
Well dome RMIT!

Chiropractic Economics‘ focuses on “bridging the gap between what doctors of chiropractic learn about healthcare and what they need to know as entrepreneurs who command successful, thriving practices. We are the top-rated resource for chiropractic news, marketing, consulting, financial planning, attracting and retaining patients, and motivating and managing employees. We provide information for practicing chiropractors, with a focus on office management, patient relations, personal development, financial planning, legal, clinical and research data, and wellness and nutrition.”

The magazine recently published an article that is so wonderfully overflowing with BS that I cannot resist showing you a few hilarious excerpts from it:

HOMEOPATHY IS A NATURAL FOR CHIROPRACTORS — because it works with innate intelligence. Each tiny pellet of a homeopathic remedy is like a flash drive full of information that “reinstalls the software,” i.e., it reminds the body that “you know how to have a healthy nervous system” or strong and healthy bones or muscles.

A remedy for patient malady

Homeopathic remedies have much to offer your patients:

  • Fast-acting: Some patients will actually feel the effects as soon as they ingest the remedy; it works faster than herbs or vitamins 
  • Easily available in health food stores, some drug stores and online 
  • Inexpensive: pennies per dose 
  • No rebound or withdrawal: Your patient can discontinue it without symptoms recurring 
  • No drug interactions: It can work well alongside meds and supplements 
  • Safe: Reactions are rare and serious side effects are unknown.1 

Practitioners will benefit as well from recommending homeopathy as this unusual modality will set the chiropractor apart and patients will be grateful for the relief they feel. Homeopathy is available as single remedies, plus more unusual ones are also blended into combination formulas which chiropractors may choose to stock in their office, just as they stock nutritional supplement and glandular formulas.  

How does it work?

Homeopathy is totally safe because there is nothing in it — not even one molecule of its original starting substance — yet it is powerful and fast-acting. How can we make these contradictory claims? Because it is information technology.  

The manufacturing process imprints the healing information onto water like recording onto a flash drive. The process takes the starting substance through many stages of dilution (making it safe) and potentizes or energizes it at each step (making it powerful). Water behaves differently at these very high dilutions, becoming coherent or structured, as explained by the newly emerging field of ultra-high dilution physics. Two Nobel laureates have testified that their studies explain how homeopathy works.2 

Now let’s look at some specific remedies. 

Hypericum for the nervous system

Hypericum is almost a universal remedy for nerve-related symptoms: tingling and numbness, pain shooting along a nerve, and trauma to nerve-rich areas (like hitting a finger with a hammer or slamming it in a car door):

  • Arnica for soft tissue trauma: homeopathy’s best-known remedy, Arnica is good for sore muscles, pulled muscles, sports injuries, sprains and strains, and bruising. 
  • Symphytum for fractures: This is the well-known herbal remedy comfrey, known traditionally as “knit-bone,” used to speed the healing of fractures and reduce bone pain.  
  • Bryonia for joints that hurt to move. When your patient is splinting or guarding, think bryonia, for a bruised rib that makes it painful to laugh or cough or sneeze, or knees that hurt from walking that make the patient take cautious steps. 
  • Rhus tox for “rusty gate” joints: This is for your patient who needs to limber up when first getting out of bed, or who needs to swing their leg a few times to loosen it up before getting up from a chair. 
  • Ruta gravfor connective tissue, cartilage and joints in general: sprains and strains, cracking joints, torn tendons and ligaments, and fascia. It has a special affinity for the knee, like the knee that goes out from under someone and for Baker’s cysts.  

Three homeopathically-energized minerals to strengthen and heal bone need to be given in a special 6x potency and are known as cell salts or tissue salts:

  • Calcarea fluorica (Calc. fluor.) 6x to soften and dissolve: This remedy can help dissolve bone spurs and hardened or condensed tissues like cataracts. 
  • Calcarea phosphorica (Calc. phos.) 6x to deposit minerals in the bones: This provides the template to send calcium and other minerals to bones and not deposit them elsewhere in the body.  
  • Silicea 6x strengthens bone as well as hair, skin and nails; you know silica as a supplement, and as a homeopathic remedy it provides the instructions for silica the mineral to go where it is needed. However, Silica 30c (full strength) can push foreign objects out of the body and should not be given to patients with a rod or plate and screws. 

What could possibly go wrong?

Not much — an “overdose” in homeopathy is not harmful in the long run — in fact, too much of a remedy is pushing the patient too fast in the direction of cure and the long-term result can be positive. It can be uncomfortable in the short run, though.

The body can only process so much of the remedy’s information at once, and if the body is presented with more than it can handle, it pushes back in the form of increased symptoms, the same symptoms the remedy was intended to treat. This is called an “aggravation” in homeopathy. It’s often said that “You have to get worse before you get better” in homeopathy and this is absolutely not true as long as mild to moderate doses are used (the typical 30c dose in health food stores) and the patient is told to stop if the remedy starts to feel too intense. When in doubt, it’s always safe to stop the remedy and start again later.

The bottom line

Start by recommending these few remedies and you are likely to get good feedback from your patients. Or consider stocking combination remedies that include even more unusual remedies.
They may give even better results and keep patients coming back to you for more, since they are only available through professionals. And if you’re feeling exhausted beyond repair, try some Sepia for yourself.

____________________________

END OF QUOTE

Yes, this is what a ‘top rated’ chiropractic resource mistakes for information on ‘clinical and research data, and wellness and nutrition’!

I didn’t promise too much, did I?

 

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