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Rapid Responses: Rapid Responses published:
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Osteopathy and Chiropractic - An International Perspective.
- Anette Mnabhi (29 October 1999)
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Chiropractic Rot
- Patrick Bramwell-Wesley (29 October 1999)
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Shameful redefinition of osteopathy
- Anne Cooper (30 October 1999)
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Re: Ignorance, fear and Chiropractic
- Patrick McKenna (30 October 1999)
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The Difference Between Osteopathy and Physiotherapy
- Ian Cassidy (30 October 1999)
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Re: Chiropractic Rot
- Susan D White (30 October 1999)
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What do chiropractors do ?
- Patrick Hanrahan (31 October 1999)
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Re: Chiropractic Rot
- Anette Mnabhi (3 November 1999)
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Re: Re: Chiropractic Rot
- Jonathan D Comins (5 November 1999)
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Osteopaths and Chiropracters are not the same in the US.
- Warren S Goff (6 November 1999)
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Re: Chiropractic Rot
- Michael D Freeman (7 November 1999)
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American osteopathy and chiropractic: enough already
- Andrew Vickers (9 November 1999)
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Clinical Cleansing
- Mark N K Christensen (11 November 1999)
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DC/DO - real "doctors"
- Robert A King (12 November 1999)
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Find out for yourself ...
- Mark A Kestner (17 November 1999)
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Chiropractic Leading The Way
- Gregory Price (17 December 1999)
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How do you define mainstream chiropractic ?
- J Rajagopalan (27 March 2000)
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Chiropractic patients more satisfied with chiropractic treatment
- David S Stodolsky, Jonathan D Comins (3 September 2000)
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Re: Re: Chiropractic Rot
- Peter G Bomgarden (2 October 2000)
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Problems With Chiropractic in the USA
- Allen J Botnick (13 March 2003)
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Re: Osteopaths and Chiropracters are not the same in the US.
- James F. Williams DC (2 December 2006)
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Anette Mnabhi, Second year resident in Osteopathic Family Medicine Residency Chicago Osteopathic Family Practice, Chicago, Illinois, USA
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It was with interest that I read the review of osteopathy and chiropractic by Andrew Vickers and Catherine Zollman. I am an Osteopathic Physician in the United States and my husband is a Chiropractor. While it is true that there are commonalities in the techniques used in chiropractic and osteopathy around the world there are also significant differences, and that is especially true in the United States. Since the authors chose to identify that Osteopathy and Chiropractic were both systematiised in the United States they should have acknowledged the current practice of Osteopathy in the States and the reason for the differences in practice and title of D.O.'s (Doctor of Osteopathic Medicine) in the US and in Europe. Andrew Taylor Still was an MD trained in the practice of medicine. There was a split in early Osteopathy when the use of pharmaceuticals was introduced into the curriculum. And that led to the development of the European branch of Osteopathy which remained solely manipulative and drug free. There are D.O.'s who practice as neuromusculoskeletal medicine specialist's in this country, and in those cases there are many similarities between how many chiropractors might practice. The diagnosis and treatment of somatic dysfunction is at the core of the practice of Osteopathy around the world. An examination of this concept would have been useful to readers. More helpful also would have been the statements of the philosophy undergirding each profesion and the definition of each by the professions themselves. Schools of Chiropractic in the US have a heavy emphasis on nutrition in the curriculum. In the United States, Many states do license the chiropractors as Doctors of Chiropractic-it is NOT purely a courtesy title (although there are many MD's who would like it to be)but a professional licensure and designation with legal obligations a privileges. In all, I feel that this article gives a very superficial, limited and inadequate representation of both the professions of Osteopathy and Chiropractic. From the article content aside from the high velocity technique the titles of phsyical therapist or massage therapist could have been substituted and little would change. Sincerely, Anette Mnabhi, RN, MSN, D.O. (Doctor of Osteopathic Medicine) (USA) |
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Patrick Bramwell-Wesley, Private Practice N/A
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The claim that chriropractic is somehow validated by randomised trials will simply not stand up to close examination. Chiropractic is, in fact isolated from scientific medicine: indeed, it is isolataed from common sense and logic. The majority of chiropractors in the US and Canada espouse treatments based on a world view totally at odds with modern Science. A majority espouse an anti-vaccination stance. A majority believe in the "innate healing potential of the body". A majority believe that birth traumatises the spine such that a chiropractor shoud be present in the birth room I am at a loss to understand why the BMJ, surely an organ devoted to REAL medicine, should be giving house-room to chiropractic rot. |
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Anne Cooper, Osteopath, private practice, Lecturer, Osteopathic Practice Sydney, Australia
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Contrary to your article and the current political climate in the UK, Osteopathic medicine remains a complete system of medicine, treating much more than musculoskeletal disorders. It treats the musculoskeletal aspect of bodily dysfunction; all disease manifests itself through the musculoskeletal system, and all dysfunction can be treated or alleviated through treatment of the musculoskeletal system. The "currency" of osteopathic medicine remains somatic dysfunction; this is essential to the understanding and practise of Osteopathy. The four principles of Osteopathic medicine are as follows: The body is a unit, the person is a unit of body, mind and spirit. The body is capable of self regulation, self-healing and health maintenance. Structure and function are reciprocally inter-related. Rational treatment is based upon an understanding of these three principles. Without these concepts, those calling themselves Osteopaths are no different from masseurs and physiotherapists, and treatment will be as devastatingly ineffective. The difference between Osteopaths and other practitioners isn't in what we do, it is why we do it. It is the philosophy and principles of Osteopathy (unchanged since Andrew Taylor Still) that allow us to practice so effectively. The re-definition of Osteopathy in the UK is shameful and tragic; in order to gain some degree of acceptance, that is, registration, the definition of Osteopathic medicine has been "officially" changed. So be it. Osteopaths in other countries, including my own, have acheived government registration without hiding how they think and consequently practice their craft. Our proof in in the pudding; that is, effectiveness and the cost of a course of treatment. I remain perplexed as to why this deception has become the standard in the UK; but then so do many osteopaths in the UK! Their massive registration fees serve them very poorly. You would be telling less than the truth if your article went to press as is. I trust, in the interests of veracity, that corrections are made. Sincerely Anne Cooper DO Sydney, Australia |
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Patrick McKenna, private practice Edmonton, Alberta. Canada
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Well, Dr. Bramwell-Wesley certainly seems to be a man at the mercy of his passions. Here we see an example of how ignorance and fear lead to unfounded, unwarranted attacks. In the past, mid-wives were literally burned as witches. In 1988, the American Medical Association was found guilty in the Supreme Court of the United States of a conspiracy to eliminate Chiropractic as a healthcare competitor. Today, irrespective of validation in the scientific literature, chiropractors continue to be persecuted and branded as "unscientific". It is my greatest hope that physicians such as Dr. Bramwell-Wesley set aside their biases, and act in a scientific manner. In true science, regardless of our pre-conceptions, it is vital that we let the research outcomes form our opinions. A tirade such as Dr. Bramwell-Wesley's, has no place in the British Medical Journal. |
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Ian Cassidy, Osteopathic Student; Exercise Physiologist Sydney, Australia
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"From a general practitioner's perspective, there are few important practical differences between the three types of practitioner". Hmmmm. From an Exercise Physiologist's, turned Osteopathic student, perspective who has worked with physiotherapists, there are but few similarities between the two professions. Sure treatment modalities may be similar, or even identical in certain cases, but the outcome of the treatment is far from identical. Why? As reported in a response to this article by an Australian Osteopath, it's not what an Osteopath does, it's why they do it. I consistently see patients walking into our clinic with a history of physiotherapy treatment 2-3 times per week for up to the past 2 years! I doubt very much you would see a patient with the same Osteopathic treatment history. Why? One simple reason. Osteopathy has an uniting philosophy behind their treatment. I once asked a physiotherapist what their uniting treatment philosophy was and their answer: "it depends on the practitioner". Now where are the but few practical differences between Osteopathy and Physiotherapy? Surely not the treatment outcome. Isn't that what really matters. I'm sure if one was to analyse the number of treatments and total cost of treatment we would certainly see what practical differences there are. Yours sincerely Ian Cassidy |
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Susan D White private practice
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The good doctor apparently does not know very many of today's chiropractors, especially those of us practicing in the U.S. and Canada. For the record, most of us conduct full neurological and othropedic testing, monitor vital signs, and then provide a thorough musculoskeletal analysis of posture and joint/soft tissue dysfunction before creating a working diagnosis and treatment protocol -- which, by the way, is different for each patient. That is hardly an unscientific approach to patient care by any standard one could choose to apply. True, SOME chiropractors are anti-vaccine; so are many some medical doctors, nurse practitioners, and other well-qualified educators and researchers. True, SOME chiropractors are perhaps too-zealously focused on the innate healing aspect of what chiropractic can do, but most of us probably view "innate" as but one compenent of the total healing process: removing dysfunction and enabling the person to resume activities of daily living or demands of employment, and educating the patient on how to avoid future problems is what most of seek to achieve. And as for the cradle-to-grave aspect? Well, I can only speak from a very limited experience, but the people I treat or know through life's other channels who have been treated musculoskeletally since a young age do, in fact, have remarkably "empty" negative health histories compared to the rest of us raised in "traditional" Western medicine protocols. It is an area that does need research, as does many other aspects of chiropractic and manual medicine procedures of all types. However, we chiropractors live in a world where drug-company-funded research dollars are non-existent, and we have to work hard for every dollar we can get. THe research is starting at several very highly-regarded and "scientific" facilities, but it will take time to get the results - ANY results - back. Be patient -- why not wait until you have concrete evidence before you diss an entire profession? |
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Patrick Hanrahan, Private Practice Rheumatologist South Perth, Western Australia
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The article gives the impression that " osteopathy and chiropractic are therapies of the musculoskeletal system " and indeed chiropractic in particular has attempted to establish legitimacy by focussing, at least publicly, on management of back pain through manipulation. While there is some soft evidence to support a short term role in the treatment of back pain it is difficult to know how many chiropractors confine themselves to this type of problem. By endorsing chiropractic treatment of back pain are we inadvertently also endorsing their management of asthma, preventative mobilisation of neonates and prophylactic " adjustment " of the spine in the well adult. If chiropractors are to access health funds the onus is on them to make it perfectly clear what they stand for, and provide the evidence to justify what they do, rather than accusing those opposed of bias and ignorance. |
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Anette Mnabhi
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It is unfortunate that there are still so many individuals in the world who react rather than try to understand. It is clear that Dr. Bramwell-Wesley does not understand the concept of the "innate healing potential of the body". All physicians deal with this concept however many do not realize it as the traditional education of physician's has placed the emphasis on the physician being the "healer". Anyone who has ever had any illness or wound has experienced the innate healing potential of the body. What is the immune system? How do wounds heal? if not through "the innate healing potential of the body". No physician can cause a wound to heal. However it is possible for a physician to facilitate healing by cleansing a wound, removing debris and if it is deep by suturing the edges together so that the body may do the task of healing. Before summarily dismissing the Chiropractic or Osteopathic professions it would be prudent to gain a better understanding of how these professions function. Unfortunately the article in question is so superficial that it does not allow anyone unfamiliar with either profession to gain a true understanding of the philosopies and practice of either. Dr. Anette Mnabhi |
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Jonathan D Comins, Staff Physical Therapist Copenhagen, Denmark
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As an orthopedic sports physical therapist, I agree with Dr. Bramwell-Wesley . It is imperative that the principals of evidence based medicine (EBM) are observed and adhered to by all health care practitioners. I am extremely sceptical of chiropractic treatment, in that the risk/benifit of chiropractic diagnosis and treatment does not appear to be worth it. So long as chiropractors continue to maintain they can treat systemic dysfunction through manipulation of the spine and that the cause of systemic disease is rooted in subluxation theory, they will remain alternative, non EBM, non scientific therapists. Chiropractors have always skirted the scientific fence. On the one hand criticizing traditional medicine, playing up to non-rational populist opinion, and on the other hand claiming to be as scientifically well founded as traditional medical practicioners, which is manipulation in itself. Jonathan D. Comins P.T. |
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Warren S Goff, Academic Director Northside Hospital and Heart Institute; St. Petersburg, FL
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Dear Sirs, I appreciate your excellent coverage of Alternative Medicine. The British Medical Journal has been a source of Evidence Based Medicine for me. Thus I was a bit surprised with your recent article, "ABC of complementary medicine: The manipulative therapies: osteopathy and chiropractic." Since your audience is cosmopolitan I thought you would better understand DO's (Doctors of Osteopathy) in the US. It is not true that "osteopathic and chiropractic techniques are converging, and much of their therapeutic repertoire is shared" in this country. In the first place Osteopathic and Chiropractic manipulative techniques are distinct. Chiropractic typically delivers High Velocity over a diffuse area, while Osteopathic is typically High Velocity to a localized lesion. I believe that this is why there have never been any reported "strokes" associated with Osteopathic Manipulative Therapy (OMT). In fact the only report of spinal cord injury associated with OMT that I could find using Medline was reported in BMJ in 1985 (below). It was a case report and followed by 2 letters. I believe Case Reports to be of limited value and perhaps the lowest hierarchy of evidence and then, only one such report. Please furnish me the evidence that OMT causes "stroke and spinal cord injury after cervical manipulation". I am a Board Certified Internist and also Board Certified in Pulmonary and Critical Care Medicine. All of my training has been in Osteopathic institutions in the USA. I would refer you to a recent article in New England Journal of Medicine with it's accompanying editorial: The New England Journal of Medicine -- November 4, 1999 -- Vol. 341, No. 19 "A Comparison of Osteopathic Spinal Manipulation with Standard Care for Patients with Low Back Pain & The New England Journal of Medicine" -- November 4, 1999 -- Vol. 341, No. 19 "The Paradox of Osteopathy". In fact, in the USA, Osteopaths and Allopaths (MD's) are converging for better or worse. TITLE: Osteopathic manipulation resulting in damage to spinal cord. AUTHORS: Davis C SOURCE: Br Med J (Clin Res Ed) 1985 Nov 30;291(6508):1540-1 CITATION IDS: PMID: 3933742 UI: 86052544 MAIN MESH HEADINGS: Manipulation, Orthopedic/*adverse effects *Osteopathic Medicine Spinal Cord Injuries/*etiology ADDITIONAL MESH HEADINGS: Aged Case Report Human Male Middle Age PUBLICATION TYPES: JOURNAL ARTICLE LANGUAGES: Eng |
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Michael D Freeman, Clinical Assistant Professor, Trauma Epidemiologist Oregon Health Sciences University School of Medicine, Department of Public Health and Prev Medicine
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Dr. Bramwell-Wesley's letter is an interesting mass of contradictions. He states that chiropractic is not validated by randomised controlled trials, and thus it is not scientific. He does not, however, account for the fact that such trials of chiropractic exist.[1] [2] He then goes on to state that the majority of chiropractors believe in birth trauma, anti-vaccination, and the innate ability of the body to heal itself. Did I miss a survey? I am a practicing doctor of chiropractic (not a courtesy title, thanks very much) and nobody asked my opinion about such matters. Indeed, it is clear that Dr. Bramwell-Wesley has fabricated a statistic to support his argument that chiropractic is unscientific, a wholly unscientific act, and one that tends to invalidate his arguments. As a medical researcher and educator as well as a chiropractor I have the opportunity to observe the weaknesses and strengths in the practitioners of both professions. These petty arguments do a very effective job of focussing attention away from what is best for the most important population in the equation; the patients. For his misuse of science and unsupported claims regarding the chiropractic profession, Dr. Bramwell-Wesley gets an "F." 1 Meade TW et al, Low Back Pain of Mechanical Origin: Randomised Comparison of Chiropractic and Hospital Outpatient Treatment, BMJ 1990;300(2):1431-1437. 2 Randomised comparison of chiropractic and hospital outpatient management for low back pain: results from extended follow up T W Meade, Sandra Dyer, Wendy Browne, and A O Frank BMJ 1995; 311: 349-351. |
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Andrew Vickers, Co-author of "ABC of complementary medicine"
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Numerous responses to the "ABC on osteopathy and chiropractic" have pointed out, in short, that things are a bit different in the USA." I did actually know this but would like to point out that the paper was published in the British Medical Journal, aimed at a British audience and written under a strict word limit. Obviously, it's going to be difficult to give a full description of variations in training, qualifications and approaches in different countries of the world.... |
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Mark N K Christensen Private practice
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It is disappointing to see that so many practitioners are still engaging in unashamed denegration of recognised professions. Surely the primary concern of any treatment protocol is the patient. I am a third generation chiropractor and now a chiropractic educator. I am also a private practice owner, employing chiropractors, osteopaths and physiotherapists in my clinic's. We dont work individually but as a team, selecting the best in-house treatment protocol for the patient or refer back to the General Practitioner, ensuring patient's get the best treatment available. There is no doubt that each profession offers something, and that equally every profession suffers from the extremist behaviour seen in all walks of life (Bosnia, Northern Ireland, ACA, AMA etc etc) and bad pratitioners. Let's keep the debate and research centred on relevant clinical issues and stay away from personal vindictive attacks on professions. Every profession has its black sheep, who are conducting themselves in ways that cannot be condoned, this also applies to the medical establishment. Anybody who has been in practice long enough should have realised that patients vote with their feet, and that you are only as good as your last consultation. If you are busy, then you must be doing something good. |
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Robert A King, Private practice/UR/QA
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I would like to simply remind the readers that manipulation is a small part of the practice of chiropractic and osteopathy. I too, who lecture, have been guilty of focusing in on the role of manipulation in both practices. This was unfair and inaccurate. To believe that either a DC or DO has only one thing to offer is rather frightening. The world of physical medicine is vast, and yes, although essentially a musculo- skeletal practitioner, I am consulted for other medical conditions for which my patient's trust me, to refer them to the proper medical specialist, who may be you! It may be my (our) patient with diarrhea following cervical fusion who concurrently is vomiting (projectile), losing weight, has night sweats, myalgia, and backache. Could this be segmental dysfunction (subluxation) or C. difficile and a Zenker's diverticulum secondary to the c spine fusion? Only a ________ would know for sure. Come now, we are all doctors and we need to rise to the occasion, how do we help this patient? I suppose I can adjust his back before the GI/GU consult, it might make him more comfortable this evening. |
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Mark A Kestner, Private Practice Tennessee, USA
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Regarding this article, my response was mixed. Although I am glad to see chiropractic care receive more coverage, I was disappointed to see what I believe to be errors going unchecked. In particular, the education I received was four years undergraduate, and four years in graduate level classes at a chiropractic college. In particular, chiropractic college required about double the average uindergraduate load for each semester. As to the term "Doctor" being merely a "courtesy", who decided that? I refer to all educated professionals who have attained doctorate level training with this courtesy. I would suggest that any primary care physicians who are even the slightest bit interested in the care their patients are receiving at the hands of chiropractors or osteopaths take the time to visit a few members of those professions. I feel sure that most medical physicians who are asked by their patients about chiropractic would venture forth with an opinion. However, how many have actually learned much about this profession, rather than simply repeating the same old tired generalizations. I realize that many tradional physicians are uncomfortable with dealing with treatment philosophies that are different from the way they have been trained. However, many physicians in my area are taking an interest in learning more about why chiropractic care is so popular with patients, rather than hiding from it. Pick up a phone, call a chiropractor or an osteopath, and go for a visit. I'm sure once you see what goes on in those offices you will have much greater understanding than this or any article can convey. Sincerely, Mark A. Kestner, DC |
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Gregory Price, Executive Officer General Chiropractic Council
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Whilst this article has lead to some criticism of the chiropractic profession, it should be noted that the General Chiropractic Council (GCC) and the chiropractic profession have been praised for the example they are setting in statutory self-regulation. Yvette Cooper, Parliamentary Under Secretary of State recently wrote: At a time when my colleagues and I are actively promoting the need for all health professions to have the most effective and transparent self- regualtory systems, the General Chiropractic Council is setting a very good example indeed of what can be achieved. The GCC is further leading the way by being the only statutory regulatory body in the health sector to ensure that all its Statutory Committees are chaired by lay members. This should assist in countering the perceptions of bias experienced by other bodies whose Committees are chaired by practitioners. Finally, the GCC will be one of the first regulatory bodies to introduce compulsory CPD as a requirement for annual retention of registration. A wide-spread consultation with the chiropractic profession and other interested parties will be undertaken during 2000 and it is proposed that the requirement for CPD will be introduced in 2001. |
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J Rajagopalan, Head Of research and Education MTimoney Chiropractic College
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The article on complementary therapies was highly informative. Taking into account the range of therapies discussed, I must congratulate the authors for their effort. I agree that all therapies ,including conventional medicine , should embrace Evidence Based approach for the benifit of the patients. The authors have described The McTimoney method of chiropractic as not being part of the main strem chiropractic. I would like to know the criteria that have been used to decide whether a chiropractic technique is main stream or not. I would also like to point to the authors that they are erroneous in their assumption that McTimoney method of chiropractic does not involve high velocity adjustments. Could the authors state their source of information on the adjustment tecniques used in the McTimoney method of chiropractic. |
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David S Stodolsky, DSS: Senior Scientist; JDC: Sports/Research Physical Therapist DSS: Institute for Social Informatics, Copenhagen, DK; JDC: Bispebjerg Hospital, Copenhagen, DK, Jonathan D Comins
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Most recently, Meade (1) has argued that improved patient satisfaction justifies chiropractic treatment for low back pain. Since satisfaction is a psychological factor, and others have suggested the results are artifactual, it could be instructive to evaluate the claims in the Meade et al (2, 4) study in light of current criteria for empirically supported therapies (3). In the Meade study, a large number of measurements were taken in the data collection stage and a large number of possible tests were possible as a result. The Oswestry scores used in the analysis yield a hundred possible tests and 29 additional scores result from subsidiary measures. Adding these measurements together, gives a total of 129 potential tests. If we wish to maintain a .05 overall significance level, this requires a probability below .000388 if any individual test is to be considered significant. In light of current criteria for empirically supported therapies, Meade's study does not show that chiropractic treatment can be considered efficacious for low back pain, because a treatment manual or its logical equivalent was not used, the data analysis was not appropriate, and superiority has not been shown in at least two independent research settings. If we disregard these deficiencies, we can conclude from the study that back patients previously treated by chiropractors are more satisfied with chiropractic treatment and that they report less pain at six months. The fact that chiropractic patients are more satisfied with chiropractic treatment can hardly be considered a finding that supports the efficaciousness of chiropractic. It does, however, suggest that there is some kind of commitment or indoctrination process operating. It is well known that commitment and suggestion can have powerful effects on pain, and this is directly used, for example, in medical hypnosis. Thus, the fact that there was less pain reported is hardly meaningful. We have reviewed some of the factors operating within chiropractic treatment that could generate commitment. The American Medical Association has characterized chiropractic as "an unscientific cult." Some of the informational materials distributed by chiropractors in the United States of America have been denounced as misleading, even by chiropractic practitioners. Consumers Union (5) concluded that "chiropractic is a significant hazard to many patients" and "urge that chiropractors be prohibited from treating children." The British Medical Journal failed in its duty to prevent the publication of misleading reports in its pages. The Meade studies do not meet the journal's current criteria for acceptance and should not have been published. Chiropractic has achieved its acceptance by a combination of political action and professionalization. The appearance of a journal article pretending to show the benefit of chiropractic treatment, whether valid or not, is used by chiropractic practitioners as "proof" of the validity of their method in public statements and in the press. Even when operating at their best, the scientific controls over publication are not appropriate for the political arena, within which chiropractic operates to maintain its accreditation. When a profession systematically distorts findings about its practices, it is outside the realm of science. Thus, scientific journals are not an appropriate venue for "studies" of chiropractic. 1. Meade TW. Patients were more satisfied with chiropractic than other treatments for low back pain. BMJ 1999 Jul 3; 57: 319. 2. Meade TW, Dyer S, Browne W, Frank AO. Randomised comparison of chiropractic and hospital outpatient management for low back pain: results from extended follow up. BMJ 1995 Aug 5; 311: 349-51. 3. Chambless DL, Hollon, SD. Defining empirically supported therapies. J. Consulting & Clinical Psychology 1998; 66: 7-18. 4. Meade TW, Dyer S, Browne W, Townsend J, Frank AO. Low back pain of mechanical origin: randomised comparison of chiropractic and hospital outpatient treatment. BMJ 1990; 300: 1431-37. 5. Editors of Consumers Reports Books. Health Quackery. Mount Vernon, New York: Consumers Union; 1980. |
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Peter G Bomgarden private practice
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Apparently the good doctor feels that since chiropractors believe in an "innate healing potential of the body" this clearly demonstrates that the field clearly "is isolataed (good spelling Dr.) from common sense and logic." Of course it would be ludicrous to suggest that for millions of years, people have been living without modern medicine to heal them! It would be clearly pseudo-scientific to suggest that a broken bone, set and casted by an orthopedic surgeon, is actually HEALED by the body itself! Malarky! And to suggest that there may be diminishing returns on many of todays vaccines (live attenuated polio) would be downright bad science! Since the good doctor suggests that there is no "innate healing potential of the body" he must give medications to dead men. Sincerely, Pete Bomgarden |
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Allen J Botnick, Chiropractor, USA 07202
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As a chiropractor residing in the United States I would like to share some impressions I have of the field. First, because the entrance requirements (grade point averages, no undergraduate degree requirement) are lower the field attracts students who are not able to grasp the theoretical mechanisms and competently assess the research, making them therapists or technicians who are frozen in their own biases and the limited training they receive from their college. Another problem is with the college's themselves. It is erroneous to believe that chiropractic schools teach modern systems of biomechanics, the underlying science which you would think manipulation would be based. Instead, what I encountered were outdated and erroneous biomechanical systems that were devised by chiropractors in the 1950s but were taught as gospel to unknowing students. For example, these methods do not account for joint tranlations and have the wrong axis of rotation for the sacro-iliac joints (the acetabulum instead of the pubic symphysis). This lack of knowledge leaves student in a very disadvantaged position as they end up losing their original goal of understanding and improving spinal biomechanics to becoming back popping therapists who use largely unreliable procedures to indiscriminately cavitate spinal facet joints. Because of this many clinics are no more than back cracking mills. Another big problem is the lack of formalized training in myofascial release. Many times patient's have apparrent joint fixations which are actually due to muscular adhesions and myospasm. After releasing these muscles the fixations spontaneously resolve. The profession here has a "live and let live" mentality and is very reluctant to standardize its methods and rout out the bad techniques. This lack of a focus on quality makes the field very frustrating because at many schools in the USA students are told that they are trained to correct biomechanical problems yet they are actually trained only to provide a limited therapy which temporary relaxes myospasm by cavitating joints, no more. I privately hope that if the chiropractic profession is incapable of getting itself together that the Doctors of Physical Therapy can improve the level of service by keeping a focus on true biomechanics and science. Allen Botnick D.C. Elizabeth, NJ, USA Competing interests: None declared |
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James F. Williams DC, Private practice Advanced Chiropractic Silverdale
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It is interesting that as Academic Director of a hospital Warren S Goff would have his facts so twisted. He states as a principle difference between chiropractic and osteopathy, "chiropractic delivers a thrust over a diffuse area and osteopathy is typically deliverved to a localized area". The opposite is actually true. Osteopaths typically employ a long lever techniques, with out direct doctor contact with the spine and rarely specific to a particular joint complex. Chiropractic adjustments are specific to the individual joint complex, the direction of joint restriction and are delivered by direct contact to the spine. In regards to the safety of chiropractic, serious sequelae to chiropractic adjustments are generally defined in the ones of millions. Conventional medicine including osteopathy have a much more sinister iatrogenic morbidity and mortality rate as evidenced by actuarial analysis and the resulting malpractice insurance costs payed by them. Competing interests: None declared |
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