Another victim of cult medicine

This is another one migrated from my old blog. It is the first in a series that generated an unusually large number of comments. Thanks, PalMD

This particular woo-encounter was non-fatal. A patient came to see me. He's middle-aged, generally quite healthy, and physically active. After a recent return to physical activity, his elbow began to hurt, so rather than call his internist, he visited a chiropractor. Not surprisingly, the back-cracker was unable to effect a cure. What did he do next? Asked his friend for the name of a "better chiropractor" (which is a bit like trying to find a better wrench to turn a screw). This one took a totally different approach to not helping the patient, but that damned elbow still hurt.

Like most cult medicine, there is little that chiropractic will not claim as their own. How tennis elbow could possibly be helped by back manipulation is beyond me. One website did, however, give some good insight:

Not always thought of as a "chiropractic" condition by patients, chiropractic's conservative approach to elbow pain is often very effective, avoiding more invasive, risky treatment options.

An excellent example of "hurry up and do nothing", which is not always bad advice, but is not unique to chiropractic. I guess when all you have is a hammer, and nails are notably absent, a wise chiropractor steps back and says, "abra cadabra!" I'm sure chiropractic cures the common cold as well---whereas the common cold, when left untreated, usually lasts a week to a week and a half, visit the chiropractor and your cold is gone in 7-10 days.

Anyway, I gave the guy a tennis elbow strap, told him to rest and ice it, and take ibuprofen if he needed it. If he's patient and follows my advice, he'll probably save a few bucks. A strap is usually covered by insurance, but cheap anyway. Ice is basically free. And a visit to me is about sixty bucks---and if he gets better, he doesn't have to return for multiple "manipulations".

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I've gone to chiropractors--for back pain. Once in awhile, my back would go "out"; I'd bend over or twist to get something and get stuck, can't get up, can't get down, can't tie my shoes. Doctors would say, "Physical therapy, blah, blah, blah...MRI...blah, blah...pay me and my friends lots of money." to which I would say, "Do I look like I have lots of money?" The chiropractor would crunch and voila! I can move again.

When they started talking about chiropractic care for my sinus infections, I thought they were crazy. How about I quit smoking? That'll fix it. Oh, and antibiotics.

Even with back pain, a person needs to use sense. When I popped two discs in my lower spine by...uh...skysurfing*, yeah, skysurfing! That's the ticket! I knew that it wasn't just a "my back is out" situation and I went to a doctor, did the MRI (the disc goo was sitting right on my ciatic nerve bundle thingie, however you spell that), had the physical therapy and in just a year, I was able to walk normally again. Well, I still have a slight limp but no one would notice it unless they looked at the wear on my shoes.

So, long irrelevant personal story short, folks really need to use some sense.

*I actually slipped on coffee beans at Wal*mart. Skysurfing sounds better.

Hi Christina,

As another victim of skysurfing*, I agree that common sense is lacking when people visit the doctor... it's a shame that some doctors would take advantage :(

*I pulled my groin playing kickball

I would say, "Do I look like I have lots of money?" The chiropractor would crunch and voila! I can move again.

You seem to be suggesting that chiropractic efforts are less expensive than having your GP handle your lower back problems. If so, wellm let's just say that for most other people that turns out not to be the case.

By Alexandra (not verified) on 22 Mar 2008 #permalink

Just one citation to support the above...
Carey TS, Garrett J, Jackman A, McLaughlin C, Fryer J, Smucker DR. The Outcomes and Costs of Care for Acute Low Back Pain among Patients Seen by Primary Care Practitioners, Chiropractors, and Orthopedic Surgeons, N Engl J Med 333:913, October 5, 1995 Special Article.

Chiropractic as usually been shown to be more costly than standard primary care for low back pain. That, plus the danger of a chiropractor overstepping their bounds should keep you away.

You seem to have made a classic mistake in assuming chiropractors only treat the spine. A chiropractor would certainly not fix your elbow problem by adjusting your spine. It's almost foolish to make that type of comment. Rather they would actually adjust the elbow and treat the soft tissues using many of the same techniques a physical therapist would use, with some slight variations. Chiropractors effectively treat elbow problems with some regularity, including the elbows of just about every major league baseball player would happen to have an elbow problem. Just about every professional and olympic athlete uses a chiropractor nowadays for treatment of all sorts of conditions, not just spinal. Many elite athletes use chiriopractors just to stay at an optimal performance level even when not suffering from any injury. Most chiropractors, like myself, emphasize treatment of the soft tissues such the muscles and ligaments of the injured area. I'd say 30% of my practice is non spinal and that is somewhat typical. As for the cost effective ness of chiropractic it has been shown in study after study that chiropractors save money in any health care where system where they are utlized fully. We are very safe, very effective and are a lot less costly. You really should try it and if you didn't like one chiro then try another.

Wonderful.

I'd love to see the citations showing effectiveness of chiropractic in treating lateral epicondylitis, and the studies showing cost-effectiveness. Citations alone will do, I have access to MedLine and PubMed.

This is, unfortunately, one of those fields that is "needed" rarely, "used" often, and "forced" to make up what is little better than the same woo woo that Acupuncture runs off of, and most of its practitioners believe themselves, just to pay off the costs needed to learn to provide the treatment correctly on the rare instances it "is" needed. Its a bit like antibiotics, but without the development of resistant strains of body pain. Sure, it works, but often its unnecessary, can cause additional side effects, delay healing in some cases, or , and this does make it different than over use of anti-biotic, won't treat the "condition", even if it does treat the symptoms.

Sure, if you specialize in physical therapy as the main system, and Chiropractic treatment as merely "one" therapy, you might help people. The problem is, this is usually *not* the way 90% of them operate.

My back used to go out. When I mean "out", I mean I actually walked around in a bent position just like the old sit-coms would depict back problems.

It was quite annoying. The last time was just before Christmas season. A time I spent on my stomach with a heating pad on my back watching DVDs on a laptop (while my loving family took over decorating and de-decorating the tree, yet I still had to make most of Christmas dinner!).

I went to the doctor and found out (again!) that I cannot tolerate narcotics (I think I got ocycotin or vicodin, no matter it was thrown away).

But I have not had my back go out since. I did not go to a chiropractor. It was an outgrowth of my attempt to lose weight and lower my cholesterol: lots of swimming!

I now swim 2000 yards two to three times a week. Unfortunately I am still about 10 pounds away from "obese" to "overweight", and my cholesterol levels went from "high" to "normal" back to "high" (there seems to be some self correcting going on!, but my HDL are very high!).

But my back is very strong! I can load up a wheel barrel of pea gravel and push it up an incline without any problems (moving the stuff from a former kid play area to under the porch). I can carry cases of canned food without any problem. I've not had back problems for at least three years. Oh, and apparently my dress size seems to be less than the "obese weight" numbers, something about having real muscle (I noticed my shoulders are fairly broad, no need of shoulder pads).

I never visited a chiropractor!

Doesn't a "better chiropractor" = an osteopath? My understanding is that the former are resistant to making referrals to the latter, and that the latter's view of the former is best left unstated on a family blog.

By Steve Bloom (not verified) on 22 Mar 2008 #permalink

"which is a bit like trying to find a better wrench to turn a screw"

You imply chiropractic has a valid use for which it is the best suited tool.

By Excluded Layman (not verified) on 22 Mar 2008 #permalink

There is an excellent video here (42 min.):
http://ph-ms.ouhsc.edu/ah/rehab/kinsinger.wmv

Bill Kinsinger (MD) explains why true chiropractic is useless, and why it is safer to be manipulated by a professional (e.g., a physical therapist).

Mike wrote "Just about every professional and olympic athlete uses a chiropractor nowadays for treatment of all sorts of conditions, not just spinal. Many elite athletes use chiriopractors just to stay at an optimal performance level even when not suffering from any injury."

They also pray a lot. That does not help, either.

That is pretty funny since I treated a guy with tennis elbow last night at my son's tennis tournament.

You are a student and so have not seemed to learn enough yet. Look at the attachments of the Latissimus Dorsi to the lower thoracic vertebra. If the mechanics of the lower thoracics are not right the lat will pull on the arm in a way that can cause tennis elbow or even carpal tunnel like symptoms (it is not the only reason but one of them).

I corrected that area and they guy could no longer get his elbow to hurt when he swung the raquet.

Again, it is not the only answer or the only cause but it is one of them. Not to know that, and many chiros do not just like many medical docs don't know things, is one of the fine points of practice in the healthcare field. You need to expand your knowledge. Try Breig MD or Yamada MD.

To say asking for a better chiropractor is like trying to find a better wrench to turn a screw is ignoring the point that one doc may know more or doing things better than another. Restricting that to chiros ignores that many MDs are just as ignorant in their fields and that you probably know about 1000 people who did not like what one doc recommended and decided to go to a better MD.

Your comments show an ignorance that is quite distressing in a person who will be trusted with the health of others. I suggest you expand your knowledge or narrow the scope of your comments to areas you know well. It is a shame you seem to have a doctor's arroagance already.

Dr. Jutkowitz

You are a student and so have not seemed to learn enough yet.

I haven't been a student for a number of years, but thanks for thinking I look young.

Lateral epicondylitis is not a spinal disorder. The "attachments of the Latissimus dorsi" are pretty irrelevant. The extensor carpi radialis brevis and longus tendons are relevant, and they aren't attached to the spine.

Mike "A chiropractor would certainly not fix your elbow problem by adjusting your spine."

meet

Jesse "If the mechanics of the lower thoracics are not right the lat will pull on the arm in a way that can cause tennis elbow or even carpal tunnel like symptoms (it is not the only reason but one of them).

"I corrected that area [of the back] ..."

You guys perfectly illustrate the lack of education and of quality control in your cult.

PalMD, I think Jesse was referring to me because I have been a 'student' of quackery for about 30 years; hence my arrogance.

I was thinking Jesse probably saw Mark's profile on the top left, which mentions he is a 3rd year medical student, and assumed that was who wrote the article.

I wonder if the Dr. Mike posting comments in this thread is the same Dr. Mike who left such gushing praise on the right-hand side of Dr. Jutkowitz's webpage. That would certainly be interesting ...

Lets see if I have this right Jesse.. Because some back conditions can cause ansulary symptoms, the best method of treatment is to ignore diagnosis directed *at* the apparent symptom, and hope that its triggered by an indirect problem? Seriously, this is absurd, not just due to the fact that it fails to diagnose the correct problem, but worse due to the fact that treatment of a non-existent condition, where there are connective tissue or nerves that relate to the real condition, *may* cause, as a similar side effect, a decrease in the expression of the real problem (and that is without the contribution of placebo effects, which are strong enough in those susceptible to them to entirely negate the pain, for limited amounts of time). Its irrelevant whether something *works* to treat the symptoms, if it doesn't treat the underlying condition, or in fact, may actually exacerbate the real problem (by, for example, allowing someone to play and further damage tissues) and/or undermine actual recovery, by preventing regeneration of the same.

You are absolutely right, if you go in to a chiropractor weekly and have adjustments done the way it's "supposed" to be done, it certainly would be more expensive.

That's not what I did.

I did assume the article was by the student Dr. Mike. That you are ignorant of the mechanism is even worse. In 30 years you have seen none of the studies DO BY MEDICAL DOCTORS showing chirorpactic the most effective treatment for musculoskeletal disorders?

Ignorant by choice is it?

As for your question about "ansulary symptoms" This is a laugh, would you look at the big toe first if a patient complained of pain? Of course. But when there was nothing wrong at the toe that you could find would you not suspect an L5 disc? there are thousands of examples in any text on medical diagnosis of symptoms or actual pathology occurring remotely from the actual cause. Do you know this or, are you just playing upon the assumed ignorance of the general public or, are you just generally incompentent?

I note you call it the "apparent" symptom, is that because the problem is only apparently at that point but not really?

As for not diagnosising the correct problem, the treatment was effective and eliminated the problem while the elbow brace given by his orthopedist did nothing to correct the problem and left him in pain after playing.

Update, called him last night and he played yesterday with no pain for the first time in over 10 months. Seems like he finally got a correct diagnosis and treatment to me.

I agree with your statement about something not treating the underlying condition allowing things to get worse. That was what was happening. The elbow brace was treating the symptom rather than the underlying mechanical problem in the lower thoracic spine and he was getting worse as he told me he could only play a set and it has been getting worse and worse as time went on. I guess an operation on the elbow that left the back problem there to get worse is your idea of good treatment. You seem to be a very silly man.

Dr. Jutkowitz

Mr. Jutkowitz,

Chiros are only "doctors" in their own, fevered, circle-jerk. Your confusion, addressing multiple people as (the singular) "you" and mistaking 'Mark' for 'Mike,' exemplifies the poor quality of chiropracty "education."