Should I see a chiropracter, doctor?

I was pleased to come across A Country Doctor writing about the interface (or lack thereof) between traditional-othodox-allopathic medicine, and complementary medicine:

When patients ask me if they should see a chiropractor, I usually answer their question this way:

“You wouldn’t ask your rabbi how often you should go to confession, would you? Chiropractic and allopathic medicine are like two religions. We don’t speak the same language and we use different tools. But even though our practices are different, we ultimately work for the same higher purpose, and it may be that our differences are smaller than we were taught. We don’t know enough about each other’s practices to make specific recommendations, but support you, our patients, in your pursuit of better health and wellbeing.”

My patients are often suprised when I can’t advise on whether to see a chiropracter or not. I think chiropractic has an “orthodox” feel to it amongst patients – they are very often suprised when I tell them that it’s not considered part of mainstream medical practice. I have always said something similar (but not as eloquent) as A Country Doctor – it might help, it might not, there may be risks that we don’t know of, it might give you some relief, it’s your choice and your money,  etc etc. I am more uncomfortable when asked for a private referral under private medical insurance that covers complementary therapies, so my referral letter is always carefully worded so that I am not seen to be endorsing an unproven practice.

I have suffered with back pain in the past so I do have great sympathy with patients who are desperate and in pain and looking for someone to cure them, but I think I’m too much of a traditionalist to suspend that disbelief and allow the placebo effect to take hold. I’m sure HRH The Prince of Wales would be disappointed in me.

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15 Comments

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15 responses to “Should I see a chiropracter, doctor?

  1. Hoddy

    OK – that’s Chiropractors dealt with

    [BTW I agree – I had a bad back and the Chiro I tried started waffling on about black walnut pills – and I’m allergic to nuts, too]

    But what about Osteopaths? There’s less mumbo-jumbo to what they do (and they use x-rays etc.). I’ve had some very successful manipulation of my duff back – especially at the British School of Osteopathy.

    Does allopathic medicine accept Osteopathy?

    Hoddy

  2. NiceLadyDoctor

    Nope, osteopathy is considered alternative/complementary too. Most of my patients seem to see chiropracters ratther than osteopaths, although “cranial osteopathy” for infantile colic is a popular remedy for infantile colic. What’s the difference between osteopaths and chiropracters? I haven’t a clue. I have always a bit concerned about osteopaths using xrays as they seem to see things on xrays that radiologists don’t, and I also worry about the radiation doses, and radiation exposure in general given by people without a medical or dental degree.

  3. The Armchair Daddy

    I agree with your post, but I am strangled with my own hipocrisy when I find myself signing a form to say the patient can have chiropractic treatment privately. In my neck of the woods a Westfield form is shoved in front of my face and there is a tick box which needs to be filled to say the GP has recommended Chirpractic treatment – if left blank the patient has to pay.

  4. Jambo

    How about the Alexander Technique? This method recently got a good write up in the orthodox medical press yet is not something studied by traditionalists at medical school.
    http://press.psprings.co.uk/bmj/august/Alex.pdf

    Also, out of interest do you think that having had personal experience of the same condition as your patient eg. back pain, pregnancy etc. makes it easier or more difficult to understand and manage? Or does it have no bearing?

    Jambo

  5. Julie

    NLD, well said. I’m a little biased as I used to be a physio, but I’m very sceptical about both osteopathy and chiropractic as they seem to mainly use manipulation which necessitates the patient returning to get any lasting benefit. Physios can and do use manipulation, but only very sparingly and after much postgraduate, specialist training, which in my mind, is better as most patients are taught to manage their own problems rather than spending more time and money than needed. Also, I’m not sure about the differenc either!

  6. NiceLadyDoctor

    Alexander technique – again, no. I tend to work on the (possibly slightly lazy) assumption that if it really does work, the NHS will start providing it one day, and until then it’s your platinum BUPA plan or a chequebook.

    Regarding personal experience – can I say yes and no – then leave you on tenterhooks? I think it’s a really interesting topic and I’d like to consider it properly and blog about it in good time.

  7. acountrydoctorwrites

    Thanks for the link. I was pleased to discover your blog and will return.

  8. Thanks for that perspective on it…it is a much more useful one than many I hear from medicos.

  9. My GPs surgery have an acupuncturist and an osteopath as attached staff and patients can be referred to them if the doctors consider it appropriate. About a year ago I injured my arm while at the gym but didn’t think anything of it. When several months later my arm was no better and was causing me some significant problems because of severe pain on movement and being unable to sleep properly because of the pain if I rolled over in my sleep, I mentioned it on a routine visit to my GP. He checked it out, diagnosed a frozen shoulder and decided to refer me to the osteopath. After a few weeks the osteopath rang me, arranged an appointment, and within a few weeks I was discharged with almost completely pain-free movement again.

    I have had to have treatment from physioterrorists (I’m sorry I mean physiotherapists) in the past, and in every case I have found them to be sadists. They rarely start a process gently, and are unsympathetic to your cries of pain. Because of these past experiences I was somewhat concerned what my experience with an osteopath would be like. As it turned out it was fantastic. She was friendly, explained all that she was going to do, checked out my posture, compared movement in both shoulders/arms, and each time she began treating the affected arm she would ensure that the muscles were properly warmed up before the exercises began. It did not take long for the range of movement to improve, and because the exercises that she asked me to do at home needed no specialist equipment, were designed to be easy to do and yet as effective as possible without causing undue pain, it only took about six visits until I was fit to be discharged.

    I was advised to carry on doing the exercises until I felt that I had fully regained movement and no further pain was felt. Today I am hardly aware that I ever had anything wrong with the shoulder, and yet I was told right from the start that a frozen shoulder can take a very long time to improve. Getting dressed, and in particular getting into blouses and jackets, which was almost impossible is now something that I can do without thinking, or wincing in pain, so I am for osteopathy.
    Okay, so maybe it isn’t considered to be mainstream medical treatment, but it is at least as effective as physiotherapy for many afflictions, and to suggest that it should be linked with chiropracters and homeopathy as alternative medicine, is I believe, unhelpful.

  10. NiceLadyDoctor

    Hi madasagirl, thanks for popping by again.]

    Your story illustrates nicely why I don’t disregard complementary medicine totally out of hand, because individual patients often wax lyrical about them. If you feel it’s worked, brilliant. The thing is, frozen shoulders will often get better spontaneously, despite what we do or don’t do and sadly osteopathy has not been proven to work against placebo. It would be geat if it did but it doesn’t. For more on the placebo effect, I can’t do any better than point you towards the wonderful bad science blog http://www.badscience.net, and the author’s marvellous new book (http://www.amazon.co.uk/Bad-Science-Ben-Goldacre/dp/0007240198).

  11. jayann

    I’ve been helped greatly by osteopaths. I began seeing them because the first time I hurt my back, the GP I went to manipulated the disks back in (I’m telling you what he said he did, but certainly I felt a click — *before* he said what he’d done — and the pain immediately began to ebb. I carried on seeing them because an orthopaedic surgeon said, to my GP’s anger and distress, that there was nothing wrong with my back.
    Finally, I got a new GP to refer me to an NHS physio, who gave me core strengthening exercises, which have helped greatly. (Madasagirl, the UHW physios who’ve assessed and/or treated me have been very receptive to my pleas for gentle treatment!; but I do know how awful a lot of physios are.) And I haven’t seen an osteopath or chiropractor since. They do though often help.
    The GP who sent me to the orthopaedic surgeon believed in osteopaths, he told me he’d thought they could do nothing at all till he went on a course about osteopathy; after that though he didn’t believe in their holistic claims, he was convinced they could help people with bad backs.

    osteopathy has not been proven to work against placebo.

    what placebo did they use?! 🙂 How did they choose the patients? — as you say, we’re dealing with some self-limiting conditions here. But not only them.

    — do you think physio’s a placebo?

  12. NiceLadyDoctor

    Hi Jay-ann, thanks for your comment.

    Yes, physio does have a placebo effect. So does what I do. They call it “the doctor as drug” (Balint again). Just being with a practitioner, whether that be an orthodox medic or a total quack (and every variation in between), can make you feel better. There is some evidence that paying for treatment makes things feel better too (greater placebo effect), and certainly the longer consultation has an effect too. In other words, if I see a patient in a standard 10-minute slot, and do nothing, they might feel a bit better. If you then saw an ostepath, paid him £50 and he spent an hour with you, and he did his (unproven) thing, you’d probably feel much better than you did after your ten minutes with me.

    A placebo for an osteopathy trial might be someone who’s not an ostepath, moving your joints, saying convincing things, but not doing anything that is officially “osteopathy”. Then comparing the results from the two arms of the trial.

  13. jayann

    I agree, nice lady doctor, that GPs and physios have, on occasion, a placebo effect, so I should have asked whether physios ever have more than a placebo effect. Do you think they do?

    A placebo for an osteopathy trial might be

    might be, yes. I wondered what they’d actually used as a placebo.

    Do you prescribe — e.g. — SSRIs?

  14. There was some question about the difference between osteopathy and chiropractic. Perhaps as an osteopath I could give my view. It would be interesting if there are any chiropractors out there who would contribute their opinion on the matter.
    We both use manipulative techniques, but, from what I have heard of chiropractic, It seems that osteopaths have a wider variety or types of manipulation to draw on, depending on the needs of the patient. As well as the famous low amplitude high velocity thrust – that can be used to cavitate synovial joints, but which might be contra-indicated in some patients (eg wity osteoprosis or VBI) – we use for example, soft tissue stretching of muscles, joint articulation (“mobilisation”), muscle energy techniques, positional techniques, and others. Usually an osteopathic treatment will combine several of these to improve mobility and function. Conceptually, osteopaths look at joint mobility and removing restrictions to normal joint movement, whereas chiropractors have a “subluxation” model which aims treatment at repositioning vertebrae. It is said that osteopathic treatments last longer (20 to 30 minutes) and a course of treatment usually needs less visits. As for x-rays, it is chiropractors who usually do their own x-rays. Osteopaths refer for x-rays (or blood tests, scans) if there is an indication for them from the case history and examination. I hope I haven’t traduced chiropractic here.
    David Rodway DO.

  15. Gillian

    I keep hearing an Eddie Izzard line: “Chiropractors are different to osteopaths; because of the spelling!”

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