 Great question - by the way, I am a Doctor of Chiropractic. I appreciate the confusion about my profession, and many claims some of the Doctors make. In response to your question about people with damage to the spinal cord. When a spinal injury occurs, this affects the motor nerves /sensory nerves that allow a person to move muscles and feel sensations. This happens because the damage occurs within the spinal column and signals from the spinal nerves are not properly transmited to and from the brain via the spinal column. Your body has a variety of other pathways for neurologic communication. Your ability to digest food, have bowel movements, breath, or even a heart beat is controlled by the autonomic nervous system - a little diffent than the voluntary motor system. What is also amazing is that both the heart, and the intestines, have additional self stimulating systems. The heart can beat even outside the body, and the intestines can self regulate. Every organ does have a spinal nerve that goes to it, but it isn't the only nerve. The amount of damage you recieve depends on the level of spinal damage, and if any nerves are directly damaged. This is why some people have to use breathing tubes following spinal injury and others don't.
The most common sign for emergency surgury associated with a disc bulge is the loss of bladder and bowel function. Yes, you pinch a nerve hard enough and your "organs" don't work properly. But lets get real, very few people actually have a pinched nerve. Most people have over fascilitated (irritated) nerves. And not the big spinal nerves you think about, but the microscopic nerve endings found in the surrounding tissue and facet joints.
Ever bump you head? You rub it to calm down the pain. This is because mechanoreceptors (nerve endings) will calm down the pain receptors (nerve endings). Guess what? A manipulation of the spinal joints is done to fire those mechanoreceptors to help modulate pain. More importantly, if you can keep the joints moving, ie. exercise - the pain will continue to decrease. Same reason your stiff in the morning - lack of joint motion!!
In comment to the stroke issue - the stats show about 1 in 2 million have a cerebrovascular event following manipulation of the neck. You have a greater chance of a stroke from turning your head to quickly while trying to look out your car window then from receiving a manipulation of the spine. More people have serious complications from taking asprin than from getting an adjustment. Insurance companies understand this - and this is why my malpractice insurance cost are about 1/5 that of a medical doctor.
Transplanted organs - give me a break. You don't think nerve supply is required?
You don't have to like chiroprators, lawyers, or mechanics. The truth is that every profession has idiots and liars. That doesn't discredit the whole profession. I spent four years postgraduate, taking the same classes as a medical doctor, reading the same text books, cutting up the same dead bodies in gross anatomy. Give me a little credit. Most chiropractors are to lazy to try to educate their patients - and that is why stupid comments, like the chiropractor you reference, are made.
Read my blog if you want a better understanding.
http://advancedehealth.blogspot.com
Steve Vanden Hoek
, D.C.
Steven L. Vanden Hoek, D.C. | Homepage | 04.10.06 - 3:23 am | #
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Alright Doc - Call me on this if I'm wrong. That is the point of having an open discusion. Please do not be "irritated" by my answers - as I want anyone, not just a doctor to understand what we are talking about.
As much as I hate to admit it – most of the support for chiropractic manipulations comes from the medical community and not chiropractic. Unfortunately they are doing most of the research that show the neurological connection between joint manipulation and the benefits the patient experiences.
I will kindly address each issue you raise in response to my reply.
1.) "Most people have over fascilitated (irritated) nerves. And not the big spinal nerves you think about, but the microscopic nerve endings found in the surrounding tissue and facet joints."
Q: Really? How is this measured? What studies support this?
A: The microscopic nerve endings I speak of are nociceptive and mechanoreceptors nerve endings. When a joint has altered kinematics – effusion or swelling (inflammation) is initiated in the area of altered biomechanics. This (inflammation) is a natural response to any proposed injury. Inflammation causes a whole host of reactions. These include increased fluid build up, increased chemicals to the regions, increased blood, etc. This is why when you cut yourself you it swells, gets red and hot, and is more tender. As you know spinal nerves exit the spinal column via the foramen formed by the joints of the spine. If anything – be it a spur, degenerative disc disease, or inflammation and swelling, or a disc herniation encroaches on the nerve directly or indirectly – the nerve will fire. i.e. increased pain, or motor or sensory loss. Basic neurology shows that pressure, even very slight pressure – will cause inflammation of the nerve and increase the firing rate and frequency. You can pump the body with an anti-inflammatory to help the reaction – or you can help improve motion to get rid of the fluid and swelling. Now as you can tell – this doesn’t work when spinal stenosis is present, nor is it as effective with severe disc degeneration or a disc herniation. My study is every neurology, physiology, pathology, and anatomy text book. Look it up – its basic science.
Nerve facilitation - I assume you understand the concept of pain and that you understand that inflammation causes pain? This knowledge is the basis for why docs give “anti-inflammatory” medication to patients in pain. That’s why you take ibuprofen. Stop the inflammation, and you decrease the pain. Do I really need a journal article to demonstrate this concept – or will millions of Rx’s for anti-inflammatory meds due the trick. Ever heard of joint effusion – or capsular swelling? Swelling, huh, could this be swelling as in one of the cardinal signs of inflammation – rubor, calor, etc.
2.) "A manipulation of the spinal joints is done to fire those mechanoreceptors to help modulate pain."
Q: This has as much scientific support as saying that manipulation allows for better flow of life energy from god.
A: Mechanoreceptors modulating pain – scientific proof?
You will need three things any 1st year med student will have. 1.) anatomy book 2.) neurology book 3.) physiology book. READ THEM.
This isn’t even up for debate. Even the M.D.’s know this - Dr. Mark Sontag – a physiatrist noted “neurological studies show motion tends to block pain impulses to the brain….the more action, the less pain is likely to be felt…”
“The perception of pain is dependent upon the balance of activity in large (mechanoreceptor) and small (nociceptive) afferents.
John Nolte, The Human Brain, Mosby Year Book, 1993, p. 139.
“If large my myelinated fibers (mechanoreceptors) were selectively stimulated, then normal “balance” of activity between large (mechanoreceptors) and small (nociceptive) fibers would be restored and the pain would be relieved.”
John Nolte, The Human Brain, Mosby Year Book, 1993, p. 203
It has been shown that in the neck – much neck pain comes from the zygapophysial joints – the very joints chiropractors manipulate.
http://www.ncbi.nlm.nih.gov/ entr...l=pubmed_docsum
Mechanoreceptor Endings are in human cervical facet joints as per:
SPINE volume 19, number 5, pp. 495-501 (March 1, 1994)
SPINE 1998;23:168-173
And we also see that these mechanoreceptors provide “afferent input to the central nervous system (CNS); because the endings identified were primarily mechanoreceptive, it follows that the mechanical status … is being monitored at the CNS level.”
http:// www.askewchiropractic.com..._adjustment.htm
“The transmission of pain signals up the spinal cord can be increased by lack of proprioceptive signals (sensory information to the spinal cord on the movements and positions of muscles); or reduced by greater proprioceptive input. This is Melzack and Wall's "gate" mechanism - the gate is opened to pain (nociceptive signals) by reduced other sensory input.”
Bottom line –
1.) mechanoreceptors exist within the joints of the spine.
2.) mechanoreceptors affect the CNS
3.) damaged/injured z-joints cause pain
4.) properly functioning z-joints don’t cause pain
5.) get the z-joint moving, and you help control pain
6.) chiropractors restore normal motion to the z-joints thus helping increase joint motion and pain modulation.
3.) "In comment to the stroke issue - the stats show about 1 in 2 million have a cerebrovascular event following manipulation of the neck. You have a greater chance of a stroke from turning your head to quickly while trying to look out your car window then from receiving a manipulation of the spine."
Q: Where did you get these numbers from. I've heard higher rates.
A: Lets start with this one: (covers the stroke and NSAID issue)
http://stroke.ahajournals.org/cg.../full/32/9/ 2207
As shown in their Table 1, the entire argument as to whether spinal manipulation is a significant risk factor appears to hinge on a total of 5 cases over 5 years, or 1 case per year. To put this matter in the proper perspective, one should be forever cognizant of the fact that death rates following cervical manipulation calculate to be anywhere between 1/100 to 1/400 the rates seen in the use of NSAIDs for similar conditions.11,12 Death rates from lumbar spine operations have been reported to be 300 times higher than those produced by cerebrovascular accidents in spinal manipulation.13,14 For cervical surgeries, recent death rates have been estimated to be 700-fold greater.14 As Rome7 has pointed out, risks for "virtually all" medical procedures ranging from the taking of blood samples15 or use of vitamins or drugs16 are routinely accepted by the public as a matter of course.
Then this one: (stroke again)
http://www.webmd.com/content/art.../ 1728_80109.htm
“As pointed out in Rothwell's study, says Rondberg, the rate of stroke is estimated at 1.3 incidents per one million adjustments given. "Other studies, including one covering a 28-year period reviewing 110 million chiropractic visits, showed conclusively that the risk of stroke from chiropractic adjustments is so small that it's statistically insignificant," he says.”
Oh wait, I forgot about this one: (even better – stroke again)
http://www.chiroweb.com/archives...s/19/23/ 04.html
A paper1 published in the October 2 issue of the Canadian Medical Association Journal (CMAJ) by Scott Haldeman,DC, MD,PhD, Paul Carey, et al. ("Arterial Dissections following Cervical Manipulation: the Chiropractic Experience") reports that the chances of arterial dissection after cervical manipulation is approximately 1 in 5.85 million manipulations.
4.) "More people have serious complications from taking aspirin than from getting an adjustment. Insurance companies understand this - and this is why my malpractice insurance cost are about 1/5 that of a medical doctor."
Q: Aspirin has a proven mechanism of action whereas chiropractic has theory and conjecture. Your simplistic analogy fails to take into account the potential indirect damage of chiropractic such as delayed medical care for problems that a chiropractor is not trained to detect and may not even think about. This is particularly an issue when chiropractors attempt to treat children. The chiropractic community is very secretive about just how much malpractic goes on. Your cost is lower because people don't sue alternative practitioners like they do MD's. That speaks volumes about the ability of alternative practitioners to connect with their patients, something MD's can stand to learn from. It does not speak to the legitimacy of your profession which is suspect except in the realm of acute lower back pain.
A: Again lets start with this one: (covers the stroke and NSAID issue)
http://stroke.ahajournals.org/cg.../full/32/9/ 2207
To put this matter in the proper perspective, one should be forever cognizant of the fact that death rates following cervical manipulation calculate to be anywhere between 1/100 to 1/400 the rates seen in the use of NSAIDs for similar conditions.
Then this one:
http://www.medpagetoday.com/tbin...x.cfm? tbid=1612
“…the researchers calculated that the national death rate from aspirin or other NSAID-related GI events was approximately 15.3 deaths per 100,000 NSAID and aspirin users. NSAIDs included over-the-counter and prescription drugs.
Low-dose aspirin alone accounted for between 8.2% and 12.2% of all GI complications and deaths, the research team reported in the August issue of the American Journal of Gastroenterology. “
Lets look at this one: (malpractice cost)
http://tampatrib.com/Business/ MG...GA2EYCO2HD.html
“Baycare estimates its average premium for a doctor is $20,000 a year; UCH estimates its average at $20,000 to $25,0
Steven L. Vanden Hoek, D.C. | Homepage | 04.12.06 - 5:03 am | #
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(CONTINUED) ---- $25,000. But each insures a large number of physicians in what are considered low-risk specialties, which lowers the average.
The cost of the policies generally range from $10,000 to $60,000 - though a few physicians have been given quotes of more than $100,000, Archbell said. “
I paid $1,200 last year for my malpractic – for the whole year – and that was for 1mill/3mill coverage. Sorry I was wrong – it isn’t 1/5th but 1/10th to 1/100th the cost. And bull to not getting sued as much. People can sue for any reason, any time – in fact most the time they know it won’t go to court, but the doc will settle just so his name doesn’t get smeared. Cost are based on pay out – and the more damage you cause – the bigger the pay out. We can’t cause that much damage since we don’t cut on the patient, or rot their liver with powerful drugs. The most we can do is crack a rib, sprain a joint, or exacerbate a current condition.
Training:
Not trained to detect potential problems? Do you have any idea what are training involves? Per not being trained to detect more complicated problems – is that why I am considered a primary physician – is that why the description of what I can treat and how sasys the following: “…a chiropractic physician(is)licensed to treat human ailments without the use of drugs and without operative surgery.” http://ilga.gov/legislation/ilcs...+Act+of+1987% 2E
Now from what I read, this means any – yes any – human ailment. I’m sure you understand that you aren’t legally allowed to treat something you can’t first diagnose. And you can’t diagnose something you haven’t been trained to diagnose. And the training had to come from an approved school – regulated by the government. Look if the government says I can do it – I can. Even if you don’t like it. Even if some of my colleagues choose not to diagnose or treat anything other than a subluxation – which has an ICD-9 code associated with it. Oh that ICD-9 means it is a recognized problem/disease. I guess a subluxation is a disease – at least as much as acid reflux is a disease. Or are only things that can be treated with a drug or knife a true disease?
And per future adverse events as the result of a manipulation – give me a break medical mistakes at hospitals cause more serious complications and deaths than all the chiropractic manipulations will ever cause. And if this is such a problem, why are the Physical therapist lobbying congress for the right to give manipulations? Why are Medical doctors taking continuing ed classes to learn how to provide manipulations? Come one – every one wants a piece of our action – b/c it works.
I appreciate your willingness to stand up for what you believe is right and wrong. I even agree with your comment that chiropactors haven't proven a great need for children - and the scoliosis screening thing is a scam, a marketing tactic - about the same as those hearing test they give your kids?
Honesty - I do appreciate your comments and even your own blog - not bad. Do I treat my own kids – sure. I have three kids – ages 7, 5,4. Guess what – between all three we have had to use one round of antibiotics. I haven’t had one of them sick for more than 24 hours. I feed them good, adjust them, give them food supplements. My son has been in the hospital once – after a bad reaction to a vaccine – guess what, I don’t tell patients not to get vaccinated – that would be practicing medicine. Just like you telling a patient not to get an adjustment is practicing chiropractic. Every profession has to prove itself. Medicine use to use leaches to get the evil spirits out, chiropractors thought they could cure cancer with a spinal manipulation. M.D.’s thought nerves carried air, D.O.’s thought they carried blood, and D.C.’s thought they carried electricity. Guess we got one correct. D.C.’s were doing physical therapy on patients before physical therapist were around. Yeh – we got a lot of quacks out their, but hey, so do you. Feel free to chop up the chiro’s doing crazy stuff , but not the profession – just the person – some of us have our head on straight, and would love to work with you, not against you.
Steven L. Vanden Hoek, D.C.
Steven L. Vanden Hoek, D.C. | 04.12.06 - 5:28 am | # Posted by Dr. Clerge |
It seems as if we won that one folks.
Chiropractic Won!!!
Mike (NYCC)
Posted by: mike | November 07, 2006 at 06:44 AM
Interesting interpretation. Many would argue that it looks like the chiropractor made a fool of himself. Guess it depends which side you are on.
Posted by: Clark Bartram | November 10, 2006 at 11:17 AM
Dr. Bartram,
How could you possibly say the chiropractor made a fool of himself by giving scientifically-referenced (and in many cases, medical journal references) responses to your emotionally-driven questions? Do you have an equally intelligent rebuttal, or must you resort to name-calling in lieu of a real argument?
Incidentally, my 7-year-old was never vaccinated (I don't tell my patients not to do this either, but I will give them the other side of the story, as will our pediatrician, who supports us not vaccinating), has had one round of antibiotics in his life (the infection came back after the meds, and was then successfully and completely resolved with homeopathy), and has only once been sick for more than 24 hours (the chicken pox--no scratching, thanks to homeopathics and adjustments). I have adjusted him since he was 3 hours old.
I would add that my malpractice is so much lower because the "side effects" of my treatments are improved immunity (as reported to me by my patients, who are thrilled to not have so many colds), better digestion and elimination, and improvement in conditions such as asthma (I don't claim to cure it, but know from clinical and personal experience that regular adjustments drastically reduce the need for rescue inhalers--I've thrown away 2 of my own half-full inhalers because they expired.)
How is it that the chiropractor lost? I think it is your patients who are losing because of your unwillingness to learn.
Tina Warren DC
Posted by: Tina Warren DC | November 15, 2006 at 09:15 AM
It's unfortunate that we have to call this a "battle" between DCs and MDs. It's also unfortunate that people like Clark Bartram do not embrace our chiropractic profession, but that is his opinion and he doesn't represent the whole medical community.
I belong to a family of medical doctors, nurses, and podiatrists and we always engage in wonderful conversations about science and health. My father, who is a general practitioner, now refers many of his patients who have suffered from years of migraines to chiropractors. His patients come back to him thanking him, for had he not referred them to a chiropractor, they might never have gotten better. My father now thanks me for educating him on what chiropractors do.
The point here is that MANY medical doctors really have no idea what we treat and think all we treat is acute low back pain. That is not their fault. In fact we need people like Dr. Bartram to ask these important questions so that we can educate the public.
What is also wonderful is that many other medical doctors, in addition to my father, DO ACCEPT chiropractic. Just yesterday I had a patient with sciatica down her right leg who was told by her medical doctor to see a chiropractor for her sciatica. I feel a great sense of joy every time I see evidence of the medical and chiropractic profession getting along.
As long as the these two professions together with other health care professions get along can we really reach our common goal, which is to HELP OUR PATIENTS. Folks, this shouldn't be a battle between us, it should be a battle to HELP PEOPLE GET BETTER.
Thank you to Dr. Vanden Hoek for educating those who don't understand chiropractic.
Thank you to Dr. Bartram for asking about our profession. Without questions nothing will ever be answered.
Posted by: Anna Marie | November 16, 2006 at 01:32 PM
I would just like to thank Dr. Vanden Hoek for such an educated and intelligent response. This is the way in which intelligent debates should be fought: with references! It's nice to see something other than mudslinging in a debate such as this.
Dr. Donnelly
Posted by: Traci Donnelly D.C. | November 26, 2006 at 04:00 PM
There are some interesting articles on this site. The battle between the chiropractor and the MD was very interesting.
It's a very well designed website. Great job doc...
Posted by: Dr Nathan | November 29, 2006 at 09:55 PM
I've being researching about Chiropractic Care and reading your blog, I found your post very helpful :) . I thought I would leave my first comment. I don't know what to say except that I have enjoyed reading. Nice blog!
Posted by: Chiropractic Care | January 20, 2010 at 12:43 AM