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Hi, I've been suffering with chronic headaches for many years. I get them all the time, although they have been improving. I went to a neurologist and he said it was chronic daily headache, with probably a migrainous origin, although I thought it was chronic tension headache because it doesn't feel like migraine. I thought a continuous, as in 24/7 headache couldn't be migraine, and it does feel like it's related to muscle tension, and I don't get auras. He put me on propranolol, but I discontinued that after a week or so because it seemed to make the headaches worse, I felt my neck stiffen after taking them in the evening. Anyway, I'm now considering chiropractic or physio. I'm somewhat sceptical about chiropractic, and I've heard stories about people being worse because of it so maybe physio would be better. I don't know a lot about either. I just want to feel better because it's having a big impact on my life, I used to love playing snooker but don't play anymore because it makes the headaches worse because of the way you bend your neck on the shot. Could anyone please advise me on what would be the best route to take?
In reply to jamesgreenfield:
I have had both chiropractic treatment and physio for a neck problem that I have. Every time, chiro sorts it in one treatment whereas physio takes several goes. But we are all different and you will have to make your own mind up about this one. GP any use?
I have had both chiropractic treatment and physio for a neck problem that I have. Every time, chiro sorts it in one treatment whereas physio takes several goes. But we are all different and you will have to make your own mind up about this one. GP any use?
In reply to Ava Adore:
Thanks for the reply, it feels like a neck problem, with pain referred to around the head, so chiro sounds like it might help me too. Doctors have prescribed me things which haven't worked, but I've found that lifestyle changes are helping, I've been better recently but am seeking any solution that might help.
Thanks for the reply, it feels like a neck problem, with pain referred to around the head, so chiro sounds like it might help me too. Doctors have prescribed me things which haven't worked, but I've found that lifestyle changes are helping, I've been better recently but am seeking any solution that might help.
In reply to jamesgreenfield:
Do be aware that chiropractic neck adjustments have left people with herniated disks and paralysed from the neck down. I go to a chiropractor for lower back pain, which he is very good for, but never let him touch my neck.
Do be aware that chiropractic neck adjustments have left people with herniated disks and paralysed from the neck down. I go to a chiropractor for lower back pain, which he is very good for, but never let him touch my neck.
In reply to jamesgreenfield:
Potentially worth a dental check and saying you're having problems up to rule out any problems with cranial nerves, jaw joint and muscles or occlusion.
It may sound bizarre but it can happen.
Potentially worth a dental check and saying you're having problems up to rule out any problems with cranial nerves, jaw joint and muscles or occlusion.
It may sound bizarre but it can happen.
In reply to tlm: thats very alarmist..
Doctors have removed the wrong kidney.. amputated the wrong leg...
I'd go to a chiropracter for neck issues over a physio. If you have neck pain it needs dealing with, if you are out of line a chiropracter is the person to see. Better that then a lifetime of pain and no mobility.
Doctors have removed the wrong kidney.. amputated the wrong leg...
I'd go to a chiropracter for neck issues over a physio. If you have neck pain it needs dealing with, if you are out of line a chiropracter is the person to see. Better that then a lifetime of pain and no mobility.
In reply to IainRUK:
Whatever. I looked at the research when I found out that chiropractic isn't based on evidence based research and that was the conclusion that I came to. However, feel free to look for yourself and make your own mind up. I would recommend it.
> (In reply to tlm) thats very alarmist..
Whatever. I looked at the research when I found out that chiropractic isn't based on evidence based research and that was the conclusion that I came to. However, feel free to look for yourself and make your own mind up. I would recommend it.
In reply to jamesgreenfield: I'd avoid chiropractor personally. To my thinking it's not much more than witchdoctoring, not based of medicine standard evidence, or in fact any evidence when i spoke to a recent Chiropractor trainee/newly qualified. I'm sure some of what they do can be beneficial but I'd rather go to someone who bases their practice on the principles of science.
In reply to jamesgreenfield:
Think of it logically.
If you have had it for years then it's not a case of getting someone to manipulate something that has recently slipped out of place.
Having established that, the next thing is to begin to consider your pain. 24/7 you say. But is that constant unvarying 24/7 or is there any relationship to particular times of day/activity/ posture?
Note them down.
With patients I often hear the refrain 'nothing makes it better, it's always painful'. it's rarely the case, more likely that they've got used to coexisting with the symptoms and are not actively managing them.
If your symptoms worsen for no apparent reason see your GP. Otherwise see someone who can look at basic issues of posture, alignment, etc. Your observations as outlined above will likely give them something to work on, linked to an objective assessment.
If it's something you've had for years then, if it has a biomechanical origin, you'll need to address what you're doing with your body and you're unlikely to be able to do that via a quick chiro' visit (and bearing in mind the caveats about manipulation of the neck already mentioned upthread).
Try a physio - even a hard pressed for time NHS outpatient one!
Think of it logically.
If you have had it for years then it's not a case of getting someone to manipulate something that has recently slipped out of place.
Having established that, the next thing is to begin to consider your pain. 24/7 you say. But is that constant unvarying 24/7 or is there any relationship to particular times of day/activity/ posture?
Note them down.
With patients I often hear the refrain 'nothing makes it better, it's always painful'. it's rarely the case, more likely that they've got used to coexisting with the symptoms and are not actively managing them.
If your symptoms worsen for no apparent reason see your GP. Otherwise see someone who can look at basic issues of posture, alignment, etc. Your observations as outlined above will likely give them something to work on, linked to an objective assessment.
If it's something you've had for years then, if it has a biomechanical origin, you'll need to address what you're doing with your body and you're unlikely to be able to do that via a quick chiro' visit (and bearing in mind the caveats about manipulation of the neck already mentioned upthread).
Try a physio - even a hard pressed for time NHS outpatient one!
In reply to tlm: I have and I do... I see the specialist which suits the issue.. osteopaths, chiropracters, physio's. All have their roles and all haveput me back together again after various issues.
In reply to IainRUK:
Seconded
> (In reply to tlm) I have and I do... I see the specialist which suits the issue.. osteopaths, chiropracters, physio's. All have their roles and all haveput me back together again after various issues.
Seconded
In reply to tlm:
Food for thought..http://home.comcast.net/~jasoncillo/Alternative%20EBM.pdf
and duelling chiropractors:
http://www.dcscience.net/?p=1686
> (In reply to IainRUK)
> [...]
>
> Whatever. I looked at the research when I found out that chiropractic isn't based on evidence based research and that was the conclusion that I came to. However, feel free to look for yourself and make your own mind up. I would recommend it.
> [...]
>
> Whatever. I looked at the research when I found out that chiropractic isn't based on evidence based research and that was the conclusion that I came to. However, feel free to look for yourself and make your own mind up. I would recommend it.
Food for thought..http://home.comcast.net/~jasoncillo/Alternative%20EBM.pdf
and duelling chiropractors:
http://www.dcscience.net/?p=1686
In reply to IainRUK: I'm curious about the evidence you've found Ian? I'm open to having my mnd opened.
In reply to puppythedog: I go in in pain.. feeling out of line.. I can feel it when I run. I go to see a chiropractor or osteopath and they put me straight and I leave running freely. A number of times I get quite badly twisted pelvis/SI joint issues and they've always sorted me out.
In reply to IainRUK: I think there is a difference between osteopath and chiropractor.
Aside from that point you've not reviewed evidence? you have experience?
Aside from that point you've not reviewed evidence? you have experience?
In reply to puppythedog: so evidence..
And no there can be differences there can be similarities. Osteopaths take a much broader look at the system but the actual work they do, especially for such issues as twisted pelvis, SI joint issues is extremely similar if not the same.
And yes.. I have..
Low back pain of mechanical origin: randomised comparison of chiropractic and hospital outpatient treatment.
T W Meade, S Dyer, W Browne, J Townsend, and A O Frank
Abstract
OBJECTIVE--To compare chiropractic and hospital outpatient treatment for managing low back pain of mechanical origin. DESIGN--Randomised controlled trial. Allocation to chiropractic or hospital management by minimisation to establish groups for analysis of results according to initial referral clinic, length of current episode, history, and severity of back pain. Patients were followed up for up two years. SETTING--Chiropractic and hospital outpatient clinics in 11 centres. PATIENTS--741 Patients aged 18-65 who had no contraindications to manipulation and who had not been treated within the past month. INTERVENTIONS--Treatment at the discretion of the chiropractors, who used chiropractic manipulation in most patients, or of the hospital staff, who most commonly used Maitland mobilisation or manipulation, or both. MAIN OUTCOME MEASURES--Changes in the score on the Oswestry pain disability questionnaire and in the results of tests of straight leg raising and lumbar flexion. RESULTS--Chiropractic treatment was more effective than hospital outpatient management, mainly for patients with chronic or severe back pain. A benefit of about 7% points on the Oswestry scale was seen at two years. The benefit of chiropractic treatment became more evident throughout the follow up period. Secondary outcome measures also showed that chiropractic was more beneficial. CONCLUSIONS--For patients with low back pain in whom manipulation is not contraindicated chiropractic almost certainly confers worthwhile, long term benefit in comparison with hospital outpatient management. The benefit is seen mainly in those with chronic or severe pain. Introducing chiropractic into NHS practice should be considered.
Efficacy and Risks of Chiropractic Manipulation: What Does the Evidence Suggest?
Abstract
Chiropractors account for around 90% of the manipulation in the United States, and more than 94% of chiropractic patients receive some form of manipulation. This article reports on two studies of the appropriateness of manipulation conducted at RAND using systematic literature reviews and expert panels. Two areas were focused on: manipulation for low-back pain and manipulation and mobilization of the cervical spine. The systematic review of the literature (including a meta-analysis) for the evidence for manipulation for low-back pain indicated that spinal manipulation was more efficacious than the comparison treatments for patients with acute or sub-acute low-back pain uncomplicated by sciatica. For cervical manipulation, the systematic literature review indicated efficacy for neck pain and for patients with muscle-tension-type headache. For both cervical manipulation and manipulation for low-back pain, the literature reports low levels of complications. For cervical manipulation, the estimated risk for serious complications is 6.39 per 10 million manipulations. For lumbar manipulation the estimate is 1 serious complication per 100 million manipulations. Although the evidence of the efficacy for manipulation is not overwhelming, there is sufficient evidence to establish efficacy for acute conditions and sufficient evidence to warrant serious investigation of its efficacy in other areas. The risk from manipulation is low and compares favorably to other forms of therapy for the same conditions (e.g., 15.6 complications per 1000 cervical spine surgeries, 3.2 per 1000 subjects for nonsteroidal anti-inflammatory drugs).
Evidence-Based Practice and Chiropractic Care
Abstract
Evidence-based practice has had a growing impact on chiropractic education and the delivery of chiropractic care. For evidence-based practice to penetrate and transform a profession, the penetration must occur at 2 levels. One level is the degree to which individual practitioners possess the willingness and basic skills to search and assess the literature. Chiropractic education received a significant boost in this realm in 2005 when the National Center for Complementary and Alternative Medicine awarded 4 chiropractic institutions R25 education grants to strengthen their research/evidence-based practice curricula. The second level relates to whether the therapeutic interventions commonly employed by a particular health care discipline are supported by clinical research. A growing body of randomized controlled trials provides evidence of the effectiveness and safety of manual therapies.
Is chiropractic paediatric care safe? A best evidence topic
Matthew F. Doyle
Level 3, 41 St. Vincent Place, Glasgow, UK
Summary
Objective
To review the literature as to the safety of paediatric chiropractic care and to offer recommendations for congruent consistent terminology use.
Design
Best Evidence Topic.
Methods
Formulation of a clinical question based on a patient query. PubMed, Index to Chiropractic Literature and the Cochrane Library were searched on the 19th of June 2010. A total of nine specifically relevant articles were retrieved and critically reviewed.
Results
The reviewed published chiropractic literature suggests a rate of 0.53% to 1% mild adverse events (AE) associated with chiropractic paediatric manipulative therapy (PMT). Put in terms of individual patients, between one in 100 to 200 patients presenting for chiropractic care; or in terms of patient visits, between one mild AE per 1310 visits to one per 1812 visits. For a comparison, Osteopathic PMT have a reported rate of 9%, and medical practitioners utilising PMT under the auspices of ‘chiropractic therapy’ have reported a rate of 6%. No serious AE has been reported in the literature since 1992 and no death possibly associated with chiropractic PMT has been reported for over 40 years.
Conclusion
The application of modern chiropractic paediatric care within the outlined framework is safe. A reasonable caution to the parent/guardian is that one child per 100 to 200 attending may have a mild AE, with irritability or soreness lasting less than 24 h, resolving without the need for additional care beyond initial chiropractic recommendations.
And no there can be differences there can be similarities. Osteopaths take a much broader look at the system but the actual work they do, especially for such issues as twisted pelvis, SI joint issues is extremely similar if not the same.
And yes.. I have..
Low back pain of mechanical origin: randomised comparison of chiropractic and hospital outpatient treatment.
T W Meade, S Dyer, W Browne, J Townsend, and A O Frank
Abstract
OBJECTIVE--To compare chiropractic and hospital outpatient treatment for managing low back pain of mechanical origin. DESIGN--Randomised controlled trial. Allocation to chiropractic or hospital management by minimisation to establish groups for analysis of results according to initial referral clinic, length of current episode, history, and severity of back pain. Patients were followed up for up two years. SETTING--Chiropractic and hospital outpatient clinics in 11 centres. PATIENTS--741 Patients aged 18-65 who had no contraindications to manipulation and who had not been treated within the past month. INTERVENTIONS--Treatment at the discretion of the chiropractors, who used chiropractic manipulation in most patients, or of the hospital staff, who most commonly used Maitland mobilisation or manipulation, or both. MAIN OUTCOME MEASURES--Changes in the score on the Oswestry pain disability questionnaire and in the results of tests of straight leg raising and lumbar flexion. RESULTS--Chiropractic treatment was more effective than hospital outpatient management, mainly for patients with chronic or severe back pain. A benefit of about 7% points on the Oswestry scale was seen at two years. The benefit of chiropractic treatment became more evident throughout the follow up period. Secondary outcome measures also showed that chiropractic was more beneficial. CONCLUSIONS--For patients with low back pain in whom manipulation is not contraindicated chiropractic almost certainly confers worthwhile, long term benefit in comparison with hospital outpatient management. The benefit is seen mainly in those with chronic or severe pain. Introducing chiropractic into NHS practice should be considered.
Efficacy and Risks of Chiropractic Manipulation: What Does the Evidence Suggest?
Abstract
Chiropractors account for around 90% of the manipulation in the United States, and more than 94% of chiropractic patients receive some form of manipulation. This article reports on two studies of the appropriateness of manipulation conducted at RAND using systematic literature reviews and expert panels. Two areas were focused on: manipulation for low-back pain and manipulation and mobilization of the cervical spine. The systematic review of the literature (including a meta-analysis) for the evidence for manipulation for low-back pain indicated that spinal manipulation was more efficacious than the comparison treatments for patients with acute or sub-acute low-back pain uncomplicated by sciatica. For cervical manipulation, the systematic literature review indicated efficacy for neck pain and for patients with muscle-tension-type headache. For both cervical manipulation and manipulation for low-back pain, the literature reports low levels of complications. For cervical manipulation, the estimated risk for serious complications is 6.39 per 10 million manipulations. For lumbar manipulation the estimate is 1 serious complication per 100 million manipulations. Although the evidence of the efficacy for manipulation is not overwhelming, there is sufficient evidence to establish efficacy for acute conditions and sufficient evidence to warrant serious investigation of its efficacy in other areas. The risk from manipulation is low and compares favorably to other forms of therapy for the same conditions (e.g., 15.6 complications per 1000 cervical spine surgeries, 3.2 per 1000 subjects for nonsteroidal anti-inflammatory drugs).
Evidence-Based Practice and Chiropractic Care
Abstract
Evidence-based practice has had a growing impact on chiropractic education and the delivery of chiropractic care. For evidence-based practice to penetrate and transform a profession, the penetration must occur at 2 levels. One level is the degree to which individual practitioners possess the willingness and basic skills to search and assess the literature. Chiropractic education received a significant boost in this realm in 2005 when the National Center for Complementary and Alternative Medicine awarded 4 chiropractic institutions R25 education grants to strengthen their research/evidence-based practice curricula. The second level relates to whether the therapeutic interventions commonly employed by a particular health care discipline are supported by clinical research. A growing body of randomized controlled trials provides evidence of the effectiveness and safety of manual therapies.
Is chiropractic paediatric care safe? A best evidence topic
Matthew F. Doyle
Level 3, 41 St. Vincent Place, Glasgow, UK
Summary
Objective
To review the literature as to the safety of paediatric chiropractic care and to offer recommendations for congruent consistent terminology use.
Design
Best Evidence Topic.
Methods
Formulation of a clinical question based on a patient query. PubMed, Index to Chiropractic Literature and the Cochrane Library were searched on the 19th of June 2010. A total of nine specifically relevant articles were retrieved and critically reviewed.
Results
The reviewed published chiropractic literature suggests a rate of 0.53% to 1% mild adverse events (AE) associated with chiropractic paediatric manipulative therapy (PMT). Put in terms of individual patients, between one in 100 to 200 patients presenting for chiropractic care; or in terms of patient visits, between one mild AE per 1310 visits to one per 1812 visits. For a comparison, Osteopathic PMT have a reported rate of 9%, and medical practitioners utilising PMT under the auspices of ‘chiropractic therapy’ have reported a rate of 6%. No serious AE has been reported in the literature since 1992 and no death possibly associated with chiropractic PMT has been reported for over 40 years.
Conclusion
The application of modern chiropractic paediatric care within the outlined framework is safe. A reasonable caution to the parent/guardian is that one child per 100 to 200 attending may have a mild AE, with irritability or soreness lasting less than 24 h, resolving without the need for additional care beyond initial chiropractic recommendations.
In reply to puppythedog: So in summary to your rather arrogant suggestion was yes I have.. the incidence of adverse outcomes is less or comparable to most other types of intervention.
As an international athlete I take my fitness seriously and do not gamble with who i see. Only last month I paid to fly back to the UK to see a physio rather than risk treatment with someone I did not trust. I always read up on who I see and what is available.
I know chiropractors have been questioned. For me it does not add up. If I have an alignment issue I will see a chiropractor or osteopath. Whoever is nearest and ideally recomended. I've personally had great positive outcomes from being dealt with by them.
For me there is not that much evidence against them; anecdotally or empirically.
As an international athlete I take my fitness seriously and do not gamble with who i see. Only last month I paid to fly back to the UK to see a physio rather than risk treatment with someone I did not trust. I always read up on who I see and what is available.
I know chiropractors have been questioned. For me it does not add up. If I have an alignment issue I will see a chiropractor or osteopath. Whoever is nearest and ideally recomended. I've personally had great positive outcomes from being dealt with by them.
For me there is not that much evidence against them; anecdotally or empirically.
In reply to jamesgreenfield:
If you have properly diagnosed tension headaches, either will do, as long as they are specialized in treating neck problems. I would probably go to a physio, because I can´t get this
youtube.com/watch?v=mUwnkTnHrtI&
out of my mind.
Have ben treated by chiros before, though, with good success, especially for lower back and pelvic problems. In my experience often there is not much difference in what they actually do to you, rather in which professional qualification they hold.
Most importantly you should get your work ergonomics sorted out. From what you describe I would almost bet that you are either working in front of a computer screen or are driving a lot. Getting my desk height, monitor distance, seat height and position adjusted helped me no end with my neck tension problems.
CB
If you have properly diagnosed tension headaches, either will do, as long as they are specialized in treating neck problems. I would probably go to a physio, because I can´t get this
youtube.com/watch?v=mUwnkTnHrtI&
out of my mind.
Have ben treated by chiros before, though, with good success, especially for lower back and pelvic problems. In my experience often there is not much difference in what they actually do to you, rather in which professional qualification they hold.
Most importantly you should get your work ergonomics sorted out. From what you describe I would almost bet that you are either working in front of a computer screen or are driving a lot. Getting my desk height, monitor distance, seat height and position adjusted helped me no end with my neck tension problems.
CB
In reply to IainRUK: Excellent so manipulation is not dangerous for children with lower back pain and the outcomes are better than those receiving standard hospital care.
I think I will take some time to have another look through the evidence becuase since I last did some of the anti-chiropractor reports I reda have been strongly critiscised.
Maybe my judgement is coloured by converstaions I have had with chiropractors and friends who have visited chriopractors which relay all sorts of stories about mumbo jumbo. Tiny realignments of soft tissue by applying a short pressure or tap, these being the treatment for many things.
I think I will take some time to have another look through the evidence becuase since I last did some of the anti-chiropractor reports I reda have been strongly critiscised.
Maybe my judgement is coloured by converstaions I have had with chiropractors and friends who have visited chriopractors which relay all sorts of stories about mumbo jumbo. Tiny realignments of soft tissue by applying a short pressure or tap, these being the treatment for many things.
In reply to jamesgreenfield:
NICE have recentl published a guideline on headache. Have a read and decide from there.
NICE have recentl published a guideline on headache. Have a read and decide from there.
In reply to puppythedog: Fair enough.. I have heard horror stories but I have always gone in with clear large mis-alignment issues. So its been prett obvious what was needed.
Once I went in and my legs were literally 0.5 cm difference in length.. it was clear my pelvis was out and one leg was lower. So I knew I needed cracking back in line. TBH for that I saw no other option other than some large small manipulation.
Once I went in and my legs were literally 0.5 cm difference in length.. it was clear my pelvis was out and one leg was lower. So I knew I needed cracking back in line. TBH for that I saw no other option other than some large small manipulation.
In reply to IainRUK: I think my basis for thinking at the moment is that manipulation is probably, according to some evidence, helpful in some circumstances where there is back pain. I'm not offerring scare stories about injuries, I am deeply sceptical of a profession which says it can, without evidence cure other things such as asthma, infantile collic and so on.
I'm happy to get into this discussion becuase it's making me re-look at evidence. It seems that since I last looked the chiropractic professions are moving away from ideas of it being a complimentary medicine that can cure lots of things and are now more strongly aligning themselves with the manipulation.
That said the American Chiropractic Association still describes it as a treatment for other aspects of health and say things like "A Doctor of chiropractic is one who is involved in the treatment and prevention of disease, as well as the promotion of public health, and a wellness approach to patient healthcare." which I took from their what is chiropractic pages.
Also it's not long ago I was talking to a newly qualified chiropractor who still spoke about benefits to organs and such like.
My view for now is that until I can review the research again i will stay away from a profession (?is it one though?) that makes claims i consider ludicrous when other professions that don't can provide the interventions shown to work.
I'm happy to get into this discussion becuase it's making me re-look at evidence. It seems that since I last looked the chiropractic professions are moving away from ideas of it being a complimentary medicine that can cure lots of things and are now more strongly aligning themselves with the manipulation.
That said the American Chiropractic Association still describes it as a treatment for other aspects of health and say things like "A Doctor of chiropractic is one who is involved in the treatment and prevention of disease, as well as the promotion of public health, and a wellness approach to patient healthcare." which I took from their what is chiropractic pages.
Also it's not long ago I was talking to a newly qualified chiropractor who still spoke about benefits to organs and such like.
My view for now is that until I can review the research again i will stay away from a profession (?is it one though?) that makes claims i consider ludicrous when other professions that don't can provide the interventions shown to work.
In reply to IainRUK: I don't argue against manipulation so much as I argue against Chiropractic.
In reply to puppythedog: Ok I have no evidence for the rest.. I see them purely for biomechanical issues which I suffer from. But do think nerve compression could be an issue for head aches. Asthma et al absolutely no idea.
In reply to IainRUK:
You've thrown up a few abstracts from various journals which appear to support chiropractic intervention, but of course there are others, including a recent Cochrane Review, which question both the safety and efficacy of cervical manipulation.
The side-effect we're talking about is undoubtedly a very rare one, but it's potentially so devastating that my own view is that any intervention in that area, surgical or chiropractic, can only be justified by robust evidence of clear benefits to severe symptoms. And I don't think that evidence has been produced yet.
You've thrown up a few abstracts from various journals which appear to support chiropractic intervention, but of course there are others, including a recent Cochrane Review, which question both the safety and efficacy of cervical manipulation.
The side-effect we're talking about is undoubtedly a very rare one, but it's potentially so devastating that my own view is that any intervention in that area, surgical or chiropractic, can only be justified by robust evidence of clear benefits to severe symptoms. And I don't think that evidence has been produced yet.
In reply to MHutch:
Of course, I was just pointing out there is evidence supporting it. I think the evidence is strong for alignment issues in the lower spinal region, very strong.
Regards treating the rest I'm suspicuous, but think the same regarding accupuncture. I think it's great for musculature issues, I used to see a guy in NZ and he'd do electroacupuncture on muscular spasms etc, and it made a huge difference. Whether accupuncture can treat more mental issues I have no idea.
> (In reply to IainRUK)
>
> You've thrown up a few abstracts from various journals which appear to support chiropractic intervention, but of course there are others, including a recent Cochrane Review, which question both the safety and efficacy of cervical manipulation.
>
> The side-effect we're talking about is undoubtedly a very rare one, but it's potentially so devastating that my own view is that any intervention in that area, surgical or chiropractic, can only be justified by robust evidence of clear benefits to severe symptoms. And I don't think that evidence has been produced yet.
>
> You've thrown up a few abstracts from various journals which appear to support chiropractic intervention, but of course there are others, including a recent Cochrane Review, which question both the safety and efficacy of cervical manipulation.
>
> The side-effect we're talking about is undoubtedly a very rare one, but it's potentially so devastating that my own view is that any intervention in that area, surgical or chiropractic, can only be justified by robust evidence of clear benefits to severe symptoms. And I don't think that evidence has been produced yet.
Of course, I was just pointing out there is evidence supporting it. I think the evidence is strong for alignment issues in the lower spinal region, very strong.
Regards treating the rest I'm suspicuous, but think the same regarding accupuncture. I think it's great for musculature issues, I used to see a guy in NZ and he'd do electroacupuncture on muscular spasms etc, and it made a huge difference. Whether accupuncture can treat more mental issues I have no idea.
In reply to jamesgreenfield: I was in a lot of continuous pain and took it seriously and got an MRI scan. I was diagnosed with "tension headaches" and prescribed 400mg of ibuprofen a day indefinitely. I wasn't very happy about it, but it worked after about a month. Cure or coincidence, I don't know but that was my experience.
In reply to jamesgreenfield:
My daily headaches were pretty much solved by drinking much more fluid (tea, and a lot of it) regularly through the day, getting a laptop riser and giving up alcohol during the week. 5 years of constant (afternoon) headaches gone in a week!
Re chiropractors, there is very little (none perhaps?) high quality evidence if favour. The two spinal surgeons I know are scathing of them ("nothing more than quackery"). Worked for me following one particularly severe episode though (anecdotes - the highest quality of all evidence...).
My daily headaches were pretty much solved by drinking much more fluid (tea, and a lot of it) regularly through the day, getting a laptop riser and giving up alcohol during the week. 5 years of constant (afternoon) headaches gone in a week!
Re chiropractors, there is very little (none perhaps?) high quality evidence if favour. The two spinal surgeons I know are scathing of them ("nothing more than quackery"). Worked for me following one particularly severe episode though (anecdotes - the highest quality of all evidence...).
In reply to iksander: Were you diagnosed through the MRI scan or through describing your symptoms? I went to a neurologist and he said because I had been experiencing the headaches for such a long time that a MRI scan wouldn't be necessary. It's interesting what you say about ibuprofen, it works to diminish the pain a little for me but I'm wary of taking it for a long period of time because of the risk of rebound headaches, but maybe that might work for me too...? Thanks
In reply to jamesgreenfield: Thanks everyone for your advice, quite an interesting discussion on chiropractic, I think I feel more comfortable going to a physio. I'm going to start exercising more, going for regular runs which should help also.
In reply to Toccata:
You really should google scholar before such statements... hold on.. shock news.. rival group opposes them..
> (In reply to jamesgreenfield)
>
>
> Re chiropractors, there is very little (none perhaps?) high quality evidence if favour. The two spinal surgeons I know are scathing of them ("nothing more than quackery"). Worked for me following one particularly severe episode though (anecdotes - the highest quality of all evidence...).
>
>
> Re chiropractors, there is very little (none perhaps?) high quality evidence if favour. The two spinal surgeons I know are scathing of them ("nothing more than quackery"). Worked for me following one particularly severe episode though (anecdotes - the highest quality of all evidence...).
You really should google scholar before such statements... hold on.. shock news.. rival group opposes them..
In reply to jamesgreenfield: I'd be wary of ibuprofen long term for a number of issues..
In reply to IainRUK:
I used a database of peer reviewed papers when I looked into it, to make sure that I was looking at up to date information. There seems to be a lot of stuff published by various chiropractic organisations on the interweb (including google scholar) which is not peer reviewed...
> You really should google scholar before such statements... hold on.. shock news.. rival group opposes them..
I used a database of peer reviewed papers when I looked into it, to make sure that I was looking at up to date information. There seems to be a lot of stuff published by various chiropractic organisations on the interweb (including google scholar) which is not peer reviewed...
I've had back pain for about 18 months now, saw an osteo to try and fix it. I've recently started seeing an NHS physio and part of my treatment plan is manipulations and massage which is identical to the work the osteo was doing. Make of that what you will.
In reply to Toccata:
leaving aside the subject of 'mission creep' and chiropractors..
A few observations:
Most episodes of back pain are self limiting and episodic. In other words you can intervene in any way, physio/chiro/crystal therapy, and it'll still get better.
The body has an amazing capacity to right itself. If you can sell your version of treatment whilst the 'patient' is recovering naturally then its 'ker-ching' (or nowadays, 'if you'd just like to enter your PIN number') time.
Even better, as you haven't fixed it, they'll likely be back at the next episode.
Part of any 'successful' intervention is developing the so- called therapeutic relationship. Trust in me and I'll get you better. I've lost count of the number of NHS patients who tell me 'I've been seeing this really good chiropractor,..been seeing him for years. Often, they'll proudly show me an A4 colour printed sheet of their ' digital diagnostic thermal image' which in their mind cements the validity of their relationship with the chiro'. The fact that it shows very little more than that where they've been sitting on the chair is warmer is irrelevant to them. So, as a physio I have to gradually move them away from the pseudoscience without hurting their pride, and deal with the problem now that they've run out of money. They evidently enjoyed the 1:1 whilst it lasted.
NHS back pain patients, because of the demand on the service, by the time they're seen, are generally chronic pain and the focus of treatment is on self management. It's time consuming to get someone to take ownership of their problem.
Passive consumption of goods and services typifies modern life for many. You could eat less. There again, you could demand gastric surgery. Similarly you could attend to the basics of attending to posture and ergonomics, to an individualised approach to activity, an understanding of monitoring and pacing. In an ideal world.
Consumer neurosis- get faster, climb longer and harder.
The notion that energy gels and 2g off your ice axe will get you there.
It's not so much that the best is the enemy of the good, but the perceived best is the enemy. The seductive lure of the quick fix will I suppose tend to favour the chiro'. Unfortunately, in the NHS, the drive to see more patients seems to having similar effects- have some ultrasound and a sheet of exercises. Be seeing you again soon?
Be aware that back pain is multifactorial.
Top end athletes are a somewhat different case. Yes, they;re still possessed of the same anatomy but are a self selected bunch. Generally, they'll have served their apprenticeship and demonstrate the practice of a sustainable training regime to get to that level. A weekend warrior rarely has this.
I'm not about to question or defend IanR's approach. He seems to be managing his symptoms, in a way that suits him.
> (In reply to jamesgreenfield)
>
> Re chiropractors, ...Worked for me following one particularly severe episode though (anecdotes - the highest quality of all evidence...).
>
> Re chiropractors, ...Worked for me following one particularly severe episode though (anecdotes - the highest quality of all evidence...).
leaving aside the subject of 'mission creep' and chiropractors..
A few observations:
Most episodes of back pain are self limiting and episodic. In other words you can intervene in any way, physio/chiro/crystal therapy, and it'll still get better.
The body has an amazing capacity to right itself. If you can sell your version of treatment whilst the 'patient' is recovering naturally then its 'ker-ching' (or nowadays, 'if you'd just like to enter your PIN number') time.
Even better, as you haven't fixed it, they'll likely be back at the next episode.
Part of any 'successful' intervention is developing the so- called therapeutic relationship. Trust in me and I'll get you better. I've lost count of the number of NHS patients who tell me 'I've been seeing this really good chiropractor,..been seeing him for years. Often, they'll proudly show me an A4 colour printed sheet of their ' digital diagnostic thermal image' which in their mind cements the validity of their relationship with the chiro'. The fact that it shows very little more than that where they've been sitting on the chair is warmer is irrelevant to them. So, as a physio I have to gradually move them away from the pseudoscience without hurting their pride, and deal with the problem now that they've run out of money. They evidently enjoyed the 1:1 whilst it lasted.
NHS back pain patients, because of the demand on the service, by the time they're seen, are generally chronic pain and the focus of treatment is on self management. It's time consuming to get someone to take ownership of their problem.
Passive consumption of goods and services typifies modern life for many. You could eat less. There again, you could demand gastric surgery. Similarly you could attend to the basics of attending to posture and ergonomics, to an individualised approach to activity, an understanding of monitoring and pacing. In an ideal world.
Consumer neurosis- get faster, climb longer and harder.
The notion that energy gels and 2g off your ice axe will get you there.
It's not so much that the best is the enemy of the good, but the perceived best is the enemy. The seductive lure of the quick fix will I suppose tend to favour the chiro'. Unfortunately, in the NHS, the drive to see more patients seems to having similar effects- have some ultrasound and a sheet of exercises. Be seeing you again soon?
Be aware that back pain is multifactorial.
Top end athletes are a somewhat different case. Yes, they;re still possessed of the same anatomy but are a self selected bunch. Generally, they'll have served their apprenticeship and demonstrate the practice of a sustainable training regime to get to that level. A weekend warrior rarely has this.
I'm not about to question or defend IanR's approach. He seems to be managing his symptoms, in a way that suits him.
In reply to tlm: Well show them.
I quoted peer reviewed papers off google scholar.
I'm talking solely about biomechanical issues.. compressed nerves, lower back issues.
I'm not talking about curing diseases.. that sounds odd but something I've not looked into.
My experiences are the same as Erics, osteopaths, physios and chiropracters will take very similar approaches. However I've found some physios unwilling to be forceful enough to crack me into line. But the two I use, who also work with UKAthletics, works on Mo Farah, puts me in line.
I went to see him the night before the world champs with a tight hamstring and knowing me he was convinced it was glutes and lower back issues.. never even touched my hamstring and I walked out feeling free.
I quoted peer reviewed papers off google scholar.
I'm talking solely about biomechanical issues.. compressed nerves, lower back issues.
I'm not talking about curing diseases.. that sounds odd but something I've not looked into.
My experiences are the same as Erics, osteopaths, physios and chiropracters will take very similar approaches. However I've found some physios unwilling to be forceful enough to crack me into line. But the two I use, who also work with UKAthletics, works on Mo Farah, puts me in line.
I went to see him the night before the world champs with a tight hamstring and knowing me he was convinced it was glutes and lower back issues.. never even touched my hamstring and I walked out feeling free.
In reply to IainRUK:
Easy tiger!
You seem to have missed the part where I said that I regularly go to a chiropracter for lower back stuff...
> (In reply to tlm) Well show them.
Easy tiger!
> I'm talking solely about biomechanical issues.. compressed nerves, lower back issues.
You seem to have missed the part where I said that I regularly go to a chiropracter for lower back stuff...
In reply to tlm:
If yo enjoy the chiro bashing, here's an 'entertaining' bunch of people from both sides of the argument
http://www.chirobase.org/00AboutChirobase/comments.html
Unfortunately this 'Chirobase' website could be seen as scoring an own goal:
Debunking the chiro's is all well and good if consistently underpinned by logic. At the bottom of their page they're advertising herbal therapy!
Don't get me started on Holland and Barratt!
If yo enjoy the chiro bashing, here's an 'entertaining' bunch of people from both sides of the argument
http://www.chirobase.org/00AboutChirobase/comments.html
Unfortunately this 'Chirobase' website could be seen as scoring an own goal:
Debunking the chiro's is all well and good if consistently underpinned by logic. At the bottom of their page they're advertising herbal therapy!
Don't get me started on Holland and Barratt!
In reply to jamesgreenfield:
Diagnosis via describing symptoms, MRI was to rule out anything else.
> (In reply to iksander) Were you diagnosed through the MRI scan or through describing your symptoms?
Diagnosis via describing symptoms, MRI was to rule out anything else.
In reply to IainRUK:
I assure you I did, about 2 years ago before I went. Most of the papers were of poor quality, low evidence base or significant result of bias (grades 3 or 4 if you know about evidence based medicine). Some were genuinely rubbish. Those that weren't had significant flaws leading to bias.
> (In reply to Toccata)
> [...]
>
> You really should google scholar before such statements... hold on.. shock news.. rival group opposes them..
> [...]
>
> You really should google scholar before such statements... hold on.. shock news.. rival group opposes them..
I assure you I did, about 2 years ago before I went. Most of the papers were of poor quality, low evidence base or significant result of bias (grades 3 or 4 if you know about evidence based medicine). Some were genuinely rubbish. Those that weren't had significant flaws leading to bias.
In reply to tlm:
Firstly, to those who are going to complain this is too long, or isn't spaced out enough etc... I understand that so there is no need to point it out. If you wish to read my post carry on, if not read something else...
But..
sorry Tim, but that information is incorrect. From 5 years of undergraduate training and 12 years in practice as a chiropractor I haven't heard of a single serious adverse event like the one you mention. If such events occurred I would have heard about it in the literature and such events would be major news.
Check the research and you'll find that current studies show that neck manipulation has 0 incidence in 10,000 of causing serious side effects. 1 major study looked at 50,000 neck manipulations without a single adverse reaction.
Given that, for example, 1 months continual maximum dose use of ibuprofen results in a 1 in 1200 risk of death due to stomach bleeds, I'd say neck manipulation poses significantly less risk, especially as manipulation has been shown to be more beneficial and is recommended by NICE as a treatment option.
Added that hundreds of studies, including ones conducted by the medical research council have shown neck manipulation to be safe, effective and cost effective for neck pain and headaches compared to other treatments including best practice (ie prescription of anti-inflammatories, combined with advice on pain management).
It's high time people start looking at research when it comes to making recommendations on such websites. I hear ridiculous claims all the time and mostly ignore them but suggesting that either osteopathy or physiotherapy or chiropractic are more superior than another is just incorrect and based on nonsense.
Read the NHS-NICE guidelines. Modern care doesn't care who provides what, its about qualified providers providing evidence based care. Manipulative therapy has been tested thoroughly by research institutes world wide and been found to be safe and effective compared to other treatments and is now included as a major treatment for conditions such as low back pain on the NHS.
http://www.nice.org.uk/nicemedia/live/11887/44345/44345.pdf
Look at the choice of treatments and you'll see that manipulative therapy is one of the main choices and can be provided by chiropractors, osteopaths and physiotherapists and doctors with post graduate training (ie an MSc in Manipulative therapy)
Chiropractors follow a 4 or 5 year full time undergraduate masters degree and all chiropractors are regulated by the General Chiropractic Council.
Chiropractic was found to be safe, effective and cost effective for a number of musculo-skeletal conditions. Reviews by the Kings fund report, the Bronfort report and the National Institute for Clinical Excellence (NICE) have all supported the effectiveness, safety and cost effectiveness of chiropractic.
Chiropractic has been a statutory regulated profession since 1994 and osteopathy since 1992. Osteopathy and chiropractic share nearly identical training and practice and regulation though individual practitioners may practice slightly differently due to the wide variety of manipulative techniques available.
In short the British public deserve to be better educated by the government and NHS to understand their choices. It is clear most members of the public rely on hear-say and myths to form their healthcare choices. This is not the fault of such individuals but it shows a clear lack of information available to the wider public.
I urge those suffering with back or neck pain to seek out professional care with a specialist provider which could include chiropractic, osteopathy, physiotherapy or a GP with special interest in musculoskeletal disorders. Exercise therapy, acupuncture and manual therapy and manipulation have all been shown to be effective, safe and cost effective and patients should have the choice offered to them.
What is concerning is that there are a number of massage therapists and lay persons with minimal training offering manipulative therapy without formal training or regulation. The studies done in manipulation have been carried out using formally trained chiropractors, osteopaths and physiotherapists. Manipulation provided by unregulated providers may pose greater risk, though this has, to my knowledge, not been thoroughly studied.
If you choose manipulative therapy, I do recommend you choose a regulated and fully qualified professional. If seeing a physiotherapist, it is also worth noting that manipulation (grade 4 mobilisation) is not included as part of the undergraduate training so physiotherapists should have done post-graduate training, preferably an MSc in Manipulative Therapy.
I hope this illuminates the situation for those with musculoskeletal injuries. I am happy to discuss chiropractic and manipulative therapy and its place with the healthcare system with those genuinely interested in rational discussion but please don't harass me if you just want to be rude.
Firstly, to those who are going to complain this is too long, or isn't spaced out enough etc... I understand that so there is no need to point it out. If you wish to read my post carry on, if not read something else...
But..
sorry Tim, but that information is incorrect. From 5 years of undergraduate training and 12 years in practice as a chiropractor I haven't heard of a single serious adverse event like the one you mention. If such events occurred I would have heard about it in the literature and such events would be major news.
Check the research and you'll find that current studies show that neck manipulation has 0 incidence in 10,000 of causing serious side effects. 1 major study looked at 50,000 neck manipulations without a single adverse reaction.
Given that, for example, 1 months continual maximum dose use of ibuprofen results in a 1 in 1200 risk of death due to stomach bleeds, I'd say neck manipulation poses significantly less risk, especially as manipulation has been shown to be more beneficial and is recommended by NICE as a treatment option.
Added that hundreds of studies, including ones conducted by the medical research council have shown neck manipulation to be safe, effective and cost effective for neck pain and headaches compared to other treatments including best practice (ie prescription of anti-inflammatories, combined with advice on pain management).
It's high time people start looking at research when it comes to making recommendations on such websites. I hear ridiculous claims all the time and mostly ignore them but suggesting that either osteopathy or physiotherapy or chiropractic are more superior than another is just incorrect and based on nonsense.
Read the NHS-NICE guidelines. Modern care doesn't care who provides what, its about qualified providers providing evidence based care. Manipulative therapy has been tested thoroughly by research institutes world wide and been found to be safe and effective compared to other treatments and is now included as a major treatment for conditions such as low back pain on the NHS.
http://www.nice.org.uk/nicemedia/live/11887/44345/44345.pdf
Look at the choice of treatments and you'll see that manipulative therapy is one of the main choices and can be provided by chiropractors, osteopaths and physiotherapists and doctors with post graduate training (ie an MSc in Manipulative therapy)
Chiropractors follow a 4 or 5 year full time undergraduate masters degree and all chiropractors are regulated by the General Chiropractic Council.
Chiropractic was found to be safe, effective and cost effective for a number of musculo-skeletal conditions. Reviews by the Kings fund report, the Bronfort report and the National Institute for Clinical Excellence (NICE) have all supported the effectiveness, safety and cost effectiveness of chiropractic.
Chiropractic has been a statutory regulated profession since 1994 and osteopathy since 1992. Osteopathy and chiropractic share nearly identical training and practice and regulation though individual practitioners may practice slightly differently due to the wide variety of manipulative techniques available.
In short the British public deserve to be better educated by the government and NHS to understand their choices. It is clear most members of the public rely on hear-say and myths to form their healthcare choices. This is not the fault of such individuals but it shows a clear lack of information available to the wider public.
I urge those suffering with back or neck pain to seek out professional care with a specialist provider which could include chiropractic, osteopathy, physiotherapy or a GP with special interest in musculoskeletal disorders. Exercise therapy, acupuncture and manual therapy and manipulation have all been shown to be effective, safe and cost effective and patients should have the choice offered to them.
What is concerning is that there are a number of massage therapists and lay persons with minimal training offering manipulative therapy without formal training or regulation. The studies done in manipulation have been carried out using formally trained chiropractors, osteopaths and physiotherapists. Manipulation provided by unregulated providers may pose greater risk, though this has, to my knowledge, not been thoroughly studied.
If you choose manipulative therapy, I do recommend you choose a regulated and fully qualified professional. If seeing a physiotherapist, it is also worth noting that manipulation (grade 4 mobilisation) is not included as part of the undergraduate training so physiotherapists should have done post-graduate training, preferably an MSc in Manipulative Therapy.
I hope this illuminates the situation for those with musculoskeletal injuries. I am happy to discuss chiropractic and manipulative therapy and its place with the healthcare system with those genuinely interested in rational discussion but please don't harass me if you just want to be rude.
In reply to matt pigden: There's a large Simon Singh shaped hole in your post
In reply to toad: Please explain? Simon Singh criticised an antiquated view that I for one was not taught and was dissuaded from at university when I studied between 1998 and 2002. At University we were taught evidence based practice with no mention whatsoever of treating colic or childhood illnesses or any kind of organ disease. I was taught straight musculoskeletal care. Any chiropractor practising anything other than MSK care is out of step with the GCC and is liable for being struck or at least disciplined by the GCC. These are outdated views, which hold no relevance in modern provision. I would like to point out that I along with every chiropractic colleague I know is sick to the teeth with such views as we simply don't practice like this and haven't for decades. I would lie to remind everyone that a hundred years ago medical doctors were doing all sorts of weird stuff too and more recently. I read that a surgeon was performing unsupported types of breast cancer surgery recently and is under investigation and put hundreds of lives at risk because of a practice that is unsubstantiated and out of step with clinical guidelines, does that make ALL surgeons unsafe? NO. Yes there are a few wackos out there (in all professions) but they hopefully get reported and disciplined or struck off, thats what our regulating bodies are for, but I can assure you that chiropractic in the UK does not support treatment for anything other than MSK disorders.
With regards Simon Singh, the BCA took him to court for deformation as he made statements that were not true and the BCA WON, a fact that is often missed. He then appealed on the basis that, as a reporter, he should have freedom of speech and based on this argument the ruling was over turned. He was found to be incorrect in the statements he made and was fined for this and he merely got out of it based of a technicality. I do not think this demonstrates that what he was accusing the BCA of was actually correct and when his statements were examined he was found to be wrong. Getting off on a technicality is very different to being proved right in your accusations and he has not made any more defamatory statements about chiropractic since.
Check out the Governments Bronfort report to see what Lord Bronforts report demonstrated chiropractic to be effective for and what the Advertising Standards Agency have approved for advertising based on evidence based reviews.
With regards Simon Singh, the BCA took him to court for deformation as he made statements that were not true and the BCA WON, a fact that is often missed. He then appealed on the basis that, as a reporter, he should have freedom of speech and based on this argument the ruling was over turned. He was found to be incorrect in the statements he made and was fined for this and he merely got out of it based of a technicality. I do not think this demonstrates that what he was accusing the BCA of was actually correct and when his statements were examined he was found to be wrong. Getting off on a technicality is very different to being proved right in your accusations and he has not made any more defamatory statements about chiropractic since.
Check out the Governments Bronfort report to see what Lord Bronforts report demonstrated chiropractic to be effective for and what the Advertising Standards Agency have approved for advertising based on evidence based reviews.
In reply to matt pigden: Apologies for a couple of spelling errors, I was typing quickly Deformation should be defamation and lie should be like. apologies
In reply to matt pigden: Honestly, if people realised the level of training chiropractors and osteopaths go through and how evidence based the training is we wouldn't be having these conversations. These hear-says and bigoted views are completely incorrect and out of touch. Manipulative therapy is a highly researched area and has been included in NHS-NICE guidelines due to it's effectiveness, cost effectiveness and safety. Chiropractors and osteopaths have been found to be ideally placed to provide such provisions and included in the NHS AQP system for back pain care provision. A number of my colleagues are now signed up providers of MSK care for the NHS seeing large numbers of NHS patients in their clinics. The government, NHS and NICE would not be regulating chiropractic and osteopathy and paying them for their services if it didn't work, was not cost effective or was dangerous when researched and compared to other types of treatment. Read the Kings Fund report, the Bronfort report or the NICE guidelines if you ned evidence for this as they are all independent government reports forming healthcare policy in the UK. Many of the online chiro bashing sites are run by maniacs that are just "skeptics" and seem to be skeptical for skepticals sake and uninterested in logical or reasonable debate, because anyone involved with chiropractic or osteopathy know that the research is now of very high quality and vast in demonstrating its effectiveness, cost effectiveness and safety for MSK disorders.
In reply to jamesgreenfield:
I was getting headaches about once a month for several years. That increased to about once per week earlier this year. I saw a doctor who came up with a diagnosis of cluster headaches: no known cause or cure. Prescribed some very expensive drug (£7 for two doses) and when I read the label one of the side effects was possible heart attack. They even stressed the fact that heart attacks might occur in people who had never had heart attacks before. Great! Anyway I gave up on the drug route.
Finally I watched the programme on the 5:2 fasting diet and have been sticking to that for about the last 3 months and my headaches have reduced significantly [1]. (Fasting is shown to put your body into a repair state) I haven't had a headache for around a month and half now so hoping it keeps going.
A friend reckoned that wheat and dairy cause inflammation which is what headaches are and interestingly I am eating much less wheat now - though dairy is about the same so don't know if that has anything to do with it or not yet.
Anyway hope you find something that works for you.
(BTW I went to a chiropractor once and a physio several times for my back and it didn't really do much. Later on I found out my bed was too soft and harder mattress pretty much cured it.)
[1] http://www.dailymotion.com/video/xvdbtt_eat-fast-live-longer-hd_shortfilms?...
I was getting headaches about once a month for several years. That increased to about once per week earlier this year. I saw a doctor who came up with a diagnosis of cluster headaches: no known cause or cure. Prescribed some very expensive drug (£7 for two doses) and when I read the label one of the side effects was possible heart attack. They even stressed the fact that heart attacks might occur in people who had never had heart attacks before. Great! Anyway I gave up on the drug route.
Finally I watched the programme on the 5:2 fasting diet and have been sticking to that for about the last 3 months and my headaches have reduced significantly [1]. (Fasting is shown to put your body into a repair state) I haven't had a headache for around a month and half now so hoping it keeps going.
A friend reckoned that wheat and dairy cause inflammation which is what headaches are and interestingly I am eating much less wheat now - though dairy is about the same so don't know if that has anything to do with it or not yet.
Anyway hope you find something that works for you.
(BTW I went to a chiropractor once and a physio several times for my back and it didn't really do much. Later on I found out my bed was too soft and harder mattress pretty much cured it.)
[1] http://www.dailymotion.com/video/xvdbtt_eat-fast-live-longer-hd_shortfilms?...
In reply to matt pigden: Tanks for taking the time t post so fully. I'm curious about the non manipulation therapy aspects of what Chiropractors do also. My understanding though potentially flawed is that that is only a part of the approach which is more holistic and relates to more than simply back pain/trapped nerve type stuff. Am I right and could you explain more?
The reason for my asking is that there is some evidence for manipulation but that that is a specific treatment and Chiropractic is not a specific treatment much like physiotherapy is not a treatment or nursing is not a treatment.
The reason for my asking is that there is some evidence for manipulation but that that is a specific treatment and Chiropractic is not a specific treatment much like physiotherapy is not a treatment or nursing is not a treatment.
In reply to matt pigden:
I don't know what type of adverse event you're talking about above - is it arterial dissection/stroke associated with cervical manipulation?
I'm sure you must have come across case reports and studies in the last decade or so which suggest this as a rare but potentially devastating complication. Even five minutes on Google comes up with this study in a decent journal:
http://www.neurology.org/content/60/9/1424
You didn't give us the link to the published studies which found zero serious adverse events for cervical manipulation, I'd be interested to see them. Obviously I can only guess at the methodology, but given there would only ever be a tiny number of serious side-effects in that sample, I'd be wary of any study which relied on patient self-reporting in these circumstances. The approach in the Neurology study - looking back from these rare strokes to see whether patients had undergone manipulation in the previous 24 hours - seems quite robust to me.
I've got no beef whatsoever with lower back manipulation - as you say, some evidence of efficacy.
Your argument about Simon Singh is disingenuous though. He was sued not because he argued wrongly that the evidence base for some chiropractic treatments is weak, but because he used a word which foolishly implied that the motivations of chiropractors were dishonest. The BCA's action against him used his very poor judgement in one phrase to try to discredit the underlying content of his piece.
I don't know what type of adverse event you're talking about above - is it arterial dissection/stroke associated with cervical manipulation?
I'm sure you must have come across case reports and studies in the last decade or so which suggest this as a rare but potentially devastating complication. Even five minutes on Google comes up with this study in a decent journal:
http://www.neurology.org/content/60/9/1424
You didn't give us the link to the published studies which found zero serious adverse events for cervical manipulation, I'd be interested to see them. Obviously I can only guess at the methodology, but given there would only ever be a tiny number of serious side-effects in that sample, I'd be wary of any study which relied on patient self-reporting in these circumstances. The approach in the Neurology study - looking back from these rare strokes to see whether patients had undergone manipulation in the previous 24 hours - seems quite robust to me.
I've got no beef whatsoever with lower back manipulation - as you say, some evidence of efficacy.
Your argument about Simon Singh is disingenuous though. He was sued not because he argued wrongly that the evidence base for some chiropractic treatments is weak, but because he used a word which foolishly implied that the motivations of chiropractors were dishonest. The BCA's action against him used his very poor judgement in one phrase to try to discredit the underlying content of his piece.
In reply to puppythedog: Hi Yes, some chiropractors do do other treatments such as massage and may use machines such as interferential or ultrasound etc... At university we did limited training in these additional modalities as well as extensive training in rehabilitation. However, overwhelmingly our training is in manipulative therapy and over 90% (guesstamate) is based on palpation of physical landmarks to identify where dysfunction is occurring and then manipulative corrections. 5% is rehabilitation based and 5% other modalities. Any chiropractor providing other treatments such as acupuncture or nutritional advice or anything else is doing that based on his or her external experience or further training and is not strictly chiropractic. We have to do 30-60 hrs of CPD per year and this CPD can be in other modalities but the GCC require chiropractors to be qualified in other modalities and should a chiropractor be acting outside the regulations laid down in legislation then they may be subject to disciplinary hearings. Its the publics responsibility to report poor or spurious chiropractic treatment or claims to the General Chiropractic Council who will act accordingly. Many of the here-says on this website are based on bad chiropractic treatment and do not reflect the profession at all. Chiropractic is a serious medical healthcare profession who are legislated and monitored to the highest standards. We are required to have a very high level of training and work to the highest standards of patient care.
In reply to matt pigden:
Well, no. That's not what happened. Justice Eady made a ruling on the meaning of Singh's actual statement at a preliminary hearing, Singh appealed and as a result the BCA dropped their libel case and paid Singh's costs. In no way, shape or form did the BCA ever 'win' anything.
Andrew.
> With regards Simon Singh, the BCA took him to court for deformation as he made statements that were not true and the BCA WON, a fact that is often missed. He then appealed on the basis that, as a reporter, he should have freedom of speech and based on this argument the ruling was over turned. He was found to be incorrect in the statements he made and was fined for this and he merely got out of it based of a technicality.
Well, no. That's not what happened. Justice Eady made a ruling on the meaning of Singh's actual statement at a preliminary hearing, Singh appealed and as a result the BCA dropped their libel case and paid Singh's costs. In no way, shape or form did the BCA ever 'win' anything.
Andrew.
In reply to MHutch: I will find the study and forward it. It was conducted by one the universities and was funded by the medical research council. I believe it was deemed to be a very high quality study which was accepted by the government and NICE when reviewing risk assessment for recommendations for utilisation of chiropractic for headaches and neck pain. In relation to strokes, the research has shown that the forces exerted by manipulation are lower then normal daily movement such as turning your head to 90 degrees. Professor Herzog, a professor of Biomechanics at the university of Calgary was employed by the Canadian government to assertain the safety and efficacy of neck manipulation. After numerous studies he stated that manipulation could not be a causative factor regarding strokes/VBAI. Whilst strokes have occurred post manipulation it was found that this was incidental. One study showed that more patients had strokes at or afetr seeing a GP than chiropractors. This is not because GPs cause strokes but merely because patients seek care for pain such as headaches and neck pain which are symptoms of stroke, so it appears the rare incidence (1 in 5.85 million) where patients have had strokes whilst receiving chiropractic care would statistically be likely to be having the stroke anyway and the fact they are receiving chiropractic is not the cause. In fact there are numerous cases where a patient has had a stroke and chiropractic has been blamed where in fact chiropractic couldn't possibly be the cause. For example a coroner ruled the cause of death for one patient to be chiropractic but it was later found that the chiropractor had been treating the patients ankle and had never touched the patients neck or spine. Another case was to do with neck manipulation where the coroner took several hundred thousand slices of the neck artery and could not find any trauma to it at all and the stroke was found to be coming from an artery inside the patients head that couldn't possibly be caused by neck movement of any kind (as concluded by the inquest). I also know of a patient who had a stroke at the chiropractors office a few minutes before his appointment!! In other words 1 in 5.85 million people will suffer these rare types of stroke due to abnormality of the arteries in their necks, Manipulation has been shown not to increase the this and is not a causative factor. Unfortunately, patients may have a stroke in the super market, their own house, the library, their GP's office and very occasionally a chiropractors office. Chiropractic is the 3rd largest healthcare profession in the world delivering millions of adjustments daily. There will inevitably be the occasional story of such events but the research has demonstrated that these rare events will occur with or without a chiropractic adjustment and the connection that has been made in the past was purely based on perception, not fact or accurate data. In terms of forces, 90 degrees of neck rotation causes a little of 5 newtons of force in the the vertebral artery, whilst a neck adjustment causes under 5 newtons to less rotation (we rotate no further than 45 degree). The average vertebral artery requires over 19 newtons to cause damage. To achieve this you would most likely cause other damage first and chiropractic manipulation goes nowhere near this level of rotation or force. All bodies accept that this is not a risk and that the data shows that the risk to benefit ratio of treatment to adverse reaction is very very good. Other adverse reactions would have been reported as being such responses as pain, other injury or symptoms. in 50,000 neck adjustments there were no reactions at all. The study followed the patients up after each treatment with a questionairre and again at 2 weeks post adjustment and the same was done after each adjustment, so not reliant on patients self-reporting.
In reply to planetmarshall: What you are quoting occurred on appeal. The BCA won the original case but it was dropped on appeal.
In reply to matt pigden:
http://www.sciencebasedmedicine.org/chiropractic-strokes-again-an-update/
It is evident that the overlap between chiro/physio/osteopath is confusing for the layman and professional alike. I have heard colleagues argue that an evidence based practice chiropractor is potentially offering the same treatment as a physiotherapist with post grad training in manipulation (to reinforce the basic training in it they recieved at degree level).
UK chiropractors seem to have distanced themselves from some of the more outlandish claims that chiropractors only recently made. What is concerning is that the drive to do this seems to have come from the evidence closing in on them rather than questioning from within. I guess this is a stage in the maturation/coming of age of a profession.
As I see it, chiropractors are moving from complementary to mainstream medicine. In doing so they have had to distance themselves from and jettison a lot of baggage. But what they got rid of was part of what set them apart from the physio/osteopath.
Crudely put, The norm is that nowadays physio's rehab, chiropractors manipulate. Yet you'll likely get some physio's better at manipulation than some chiro's, and chiro's more skilled in rehab than some physio's.
Despite commenting upthread on the expensive thermal imaging of patient's back commonly sold by chiropractors, I do not offer that physio's are squeaky clean and chiro's tarnished to the core. As an example, both continue to offer treatments of dubious efficacy- particularly in the field of electrotherapy.
http://www.sciencebasedmedicine.org/chiropractic-strokes-again-an-update/
It is evident that the overlap between chiro/physio/osteopath is confusing for the layman and professional alike. I have heard colleagues argue that an evidence based practice chiropractor is potentially offering the same treatment as a physiotherapist with post grad training in manipulation (to reinforce the basic training in it they recieved at degree level).
UK chiropractors seem to have distanced themselves from some of the more outlandish claims that chiropractors only recently made. What is concerning is that the drive to do this seems to have come from the evidence closing in on them rather than questioning from within. I guess this is a stage in the maturation/coming of age of a profession.
As I see it, chiropractors are moving from complementary to mainstream medicine. In doing so they have had to distance themselves from and jettison a lot of baggage. But what they got rid of was part of what set them apart from the physio/osteopath.
Crudely put, The norm is that nowadays physio's rehab, chiropractors manipulate. Yet you'll likely get some physio's better at manipulation than some chiro's, and chiro's more skilled in rehab than some physio's.
Despite commenting upthread on the expensive thermal imaging of patient's back commonly sold by chiropractors, I do not offer that physio's are squeaky clean and chiro's tarnished to the core. As an example, both continue to offer treatments of dubious efficacy- particularly in the field of electrotherapy.
In reply to matt pigden:
Could you explain what you mean by this please (I understand that it is difficult to ask you to summarise a lot of training), it sounds different to realigning backs and joints by moving them which is the sort of manipulation I was understanding to have been evidenced.
> (In reply to puppythedog) H over 90% (guesstamate) is based on palpation of physical landmarks to identify where dysfunction is occurring and then manipulative corrections. 5% is rehabilitation based and 5% other modalities.
Could you explain what you mean by this please (I understand that it is difficult to ask you to summarise a lot of training), it sounds different to realigning backs and joints by moving them which is the sort of manipulation I was understanding to have been evidenced.
In reply to llechwedd: I agree completely with your thread. I personally feel that my job as a chiropractor is to be the best I can be at manipulative therapy. I don't do anything else and I urge all chiropractors to do the same. Personally I treat a patient with pain and dysfunction until the area in question is less painful, more mobile and settling. When I increase the time between sessions to 3 weeks and the patient is remaining pain-free and mobile I recomend they see a physiotherapist for core stabilisation to help re-strengthen the area that was irritated by the injury. Research studies done by the likes of Jull and Hodges (2 PhD Physios from Australia) show that local muscle atrophy (wasting) occurs within 2 weeks of spinal joint injury and that a 2 month problem takes up to 6 months for the muscles to re-strengthen back to pre-injury levels. For me care should take 2 distinct phases, early intervention should focus on re-ducing pain and irritation with treatments such as manipulation, mobilisation, acupuncture/dry needling and/or stretching. Then once the area is settled and the inflammatory phased has passed and the area is starting to naturally settle and stabilise I feel patients should follow rehabilitation to fully re-strengthen the injured area. As a chiropractor I can offer the patient the option of manipulation, thats what I do. If they choose acupuncture, stretching or massage/mobilisation then I'm not the practitioner for them. Patient deserve to be offered choice as to how they have their pain treated and manipulation is at least as good as any other modality available and is safe compared to other treatment options and cost-effective. Price wise chiropractic is generally relatively cheap because manipulation is fast and so appointments can be shorter compared to acupuncture sessions or massage or exercise therapy so this is an additional cost to benefit ratio.
In reply to matt pigden:
No, they did not - because there was no original 'case'. In order for Singh to defend himself against the libel accusation, Eady had to make a ruling on the meaning of what Singh said. The ruling made would have made such a defence extremely difficult, which is why Singh appealed. The libel case never even went to trial, so how could the BCA have 'won' it? This is all a matter of public record.
> (In reply to planetmarshall) What you are quoting occurred on appeal. The BCA won the original case but it was dropped on appeal.
No, they did not - because there was no original 'case'. In order for Singh to defend himself against the libel accusation, Eady had to make a ruling on the meaning of what Singh said. The ruling made would have made such a defence extremely difficult, which is why Singh appealed. The libel case never even went to trial, so how could the BCA have 'won' it? This is all a matter of public record.
In reply to puppythedog: palpation is the diagnostic tool (ie feeling where the spine is dysfunctional). A big part of our job is feeling and diagnosing where things are tight and dysfunctional. We then learn how to manipulate the joints that we find to be dysfunctional. This process of hands on diagnosis and treatment starts from day 1. I had 3 hours of practical class a week as 1 module (out of 10) per semester. We also had theory as part of this module and were expected to practice palpation and manipulative set-up in our own time and were assessed every semester.
I terms of joints being out of place, this too is a myth, joints do go out of place. The small intrinsic muscles such as the rotatores brevis and longus, interspinalis muscles, intertransversarii muscles and multifidus muscles tighten up in response to mechanical overload from repetitive strain, prolonged strain or traumatic strain. 9 out of 10 episodes of this increased muscle tone self alleviate (is self limiting) within 2-3 weeks, however, after 2-3 weeks the muscles become less and less likely to self release due to a vicious cycle of muscle spasm causing increased inflammatory chemical production including substance p, calcitonin gene related peptide, prostaglandins, histamine, neurokinin 1 and 2, lactate, bradykinin bind to chemoreceptors which increase irritability and cause further increase in muscle tone causing more increased inflammatory response and the cycle goes on and on. Manipulation hyperstimulates the nervous system causing an inhibitory response relaxing these tight muscles. This is also how stretching, mobilisation, acupuncture and all other treatments also work, by hyperstimulation leading to a reduction in neuro-musclular tone. Ice and anti-inflammatories along side this help to reduce inflammatory response reducing the likelihood of the the area tightening back up. When local intrinsic muscles are tight they pull on the joints causing slight positional changes but this is not the joint being out of alignment, merely the fact the muscles are reducing joint mobility and slightly affecting the alignment of the joint. Manipulation does not put joints back into place, it merely reduces the local muscle spasm allowing the joint to move freely. The analogy I use with patients is that each spinal joint is like the gear stick in a car, it should sit in a neutral position and be mobile. When the musculature tightens in response to over load it pulls the joint into an abnormal position and restricting movement and changing the alignment, much like a driver actively pushing the gear stick into first. Once in first its now misaligned and restricted. Therapy merely stimulates the area so the muscles release/relax and the joint is back in neutral so to speak. The area is then inflammed still so continues to be painful and due to muscle atrophy and inflammatory irritation the joint is highly susceptible to retightening in the early stages. By treating frequently early on and advising the patient to be careful and stay mobile and use ice and anti-inflammatories the joint will start to stay more and more relaxed until it is sttled and stable. In chronic conditions that have been present for months or years, the joints become very degenerative and atrophied and therefore unstable meaning the joint is weak and vulnerable to relapse. This is an ethical dilemma as these patients can have their joints released but often relapse frequently and require further care. These patients can become dependant on care and this is an area of debate as many chiropractors continue chronic patients for months, years or decades. However, research into chronic care is growing and finding the best practice for chronic patients will no doubt be debated for a while yet. Personally I am honest with patients and tell them the facts as I know them. I can reduce the tone in this joint and I can reduce the symptoms. It is a chronic issue and may take a long time before we see increased stability and can reduce frequency of treatment. We can use rehab to further stabilise the area once it is settled and less inflamed and irritable. Ultimately its the patients own choice how they manage their condition and I try to empower patients with sounds explanations of what causes back problems and the pitfalls of managing them. I don't make promises I can't keep and I give as objective and evidence based information as I can. Over 12 years of practice I have had some fantastic results with chronic pain patients who have slowly stabilised after choosing to continue having their tight joints adjusted and using rehabilitation. As yet we don't have ethical guidelines as what is deemed best for chronic patients so I try and be as current in the research as possible and honest with patients as to what are realistic outcomes given the circumstances of their condition and lifestyle. Some patients have a short course of treatment, others choose to come for more ongoing care but honesty and integrity is crucial.
I terms of joints being out of place, this too is a myth, joints do go out of place. The small intrinsic muscles such as the rotatores brevis and longus, interspinalis muscles, intertransversarii muscles and multifidus muscles tighten up in response to mechanical overload from repetitive strain, prolonged strain or traumatic strain. 9 out of 10 episodes of this increased muscle tone self alleviate (is self limiting) within 2-3 weeks, however, after 2-3 weeks the muscles become less and less likely to self release due to a vicious cycle of muscle spasm causing increased inflammatory chemical production including substance p, calcitonin gene related peptide, prostaglandins, histamine, neurokinin 1 and 2, lactate, bradykinin bind to chemoreceptors which increase irritability and cause further increase in muscle tone causing more increased inflammatory response and the cycle goes on and on. Manipulation hyperstimulates the nervous system causing an inhibitory response relaxing these tight muscles. This is also how stretching, mobilisation, acupuncture and all other treatments also work, by hyperstimulation leading to a reduction in neuro-musclular tone. Ice and anti-inflammatories along side this help to reduce inflammatory response reducing the likelihood of the the area tightening back up. When local intrinsic muscles are tight they pull on the joints causing slight positional changes but this is not the joint being out of alignment, merely the fact the muscles are reducing joint mobility and slightly affecting the alignment of the joint. Manipulation does not put joints back into place, it merely reduces the local muscle spasm allowing the joint to move freely. The analogy I use with patients is that each spinal joint is like the gear stick in a car, it should sit in a neutral position and be mobile. When the musculature tightens in response to over load it pulls the joint into an abnormal position and restricting movement and changing the alignment, much like a driver actively pushing the gear stick into first. Once in first its now misaligned and restricted. Therapy merely stimulates the area so the muscles release/relax and the joint is back in neutral so to speak. The area is then inflammed still so continues to be painful and due to muscle atrophy and inflammatory irritation the joint is highly susceptible to retightening in the early stages. By treating frequently early on and advising the patient to be careful and stay mobile and use ice and anti-inflammatories the joint will start to stay more and more relaxed until it is sttled and stable. In chronic conditions that have been present for months or years, the joints become very degenerative and atrophied and therefore unstable meaning the joint is weak and vulnerable to relapse. This is an ethical dilemma as these patients can have their joints released but often relapse frequently and require further care. These patients can become dependant on care and this is an area of debate as many chiropractors continue chronic patients for months, years or decades. However, research into chronic care is growing and finding the best practice for chronic patients will no doubt be debated for a while yet. Personally I am honest with patients and tell them the facts as I know them. I can reduce the tone in this joint and I can reduce the symptoms. It is a chronic issue and may take a long time before we see increased stability and can reduce frequency of treatment. We can use rehab to further stabilise the area once it is settled and less inflamed and irritable. Ultimately its the patients own choice how they manage their condition and I try to empower patients with sounds explanations of what causes back problems and the pitfalls of managing them. I don't make promises I can't keep and I give as objective and evidence based information as I can. Over 12 years of practice I have had some fantastic results with chronic pain patients who have slowly stabilised after choosing to continue having their tight joints adjusted and using rehabilitation. As yet we don't have ethical guidelines as what is deemed best for chronic patients so I try and be as current in the research as possible and honest with patients as to what are realistic outcomes given the circumstances of their condition and lifestyle. Some patients have a short course of treatment, others choose to come for more ongoing care but honesty and integrity is crucial.
In reply to matt pigden:
The chap i was talking to described the palpation as sometimes simply being a little tap that would have affect the possible discrepancies you dscribe. Is that right? I have vissions of someboday tapping my back like playing a piano.
The chap i was talking to described the palpation as sometimes simply being a little tap that would have affect the possible discrepancies you dscribe. Is that right? I have vissions of someboday tapping my back like playing a piano.
In reply to jamesgreenfield:
James, what do you do in your daily life? It could be your working postures that generate the headaches, via poor/off posture.
Sx
James, what do you do in your daily life? It could be your working postures that generate the headaches, via poor/off posture.
Sx
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