I received chiropractic "adjustments" from a very young age nearly every week for over 20 years, and sometimes I wonder if it contributed to AS and other severe chronic pain I have such as in my neck and head. It's been a long time since I stopped doing it (I never would consider doing it again after having researched it) just wonder if anyone else thinks it could have contributed at all to their pain.
Pre-emptive: I'm not saying "don't see a chiropractor." It's just worth seeing the information and being informed.
Formal research tends to be lacking on chiropractic care. However, at least two studies indicate some significant level of risk associated with chiropractic manipulation.
The first study analyzed existing documentation to find that "[s]pinal manipulation, particularly when performed on the upper spine, is frequently associated with [...] adverse effects. It can also result in [...] vertebral artery dissection followed by stroke." The findings continue to state that "[d]issection of the vertebral arteries was the most common problem; other complications included dural tear, oedema, nerve injury, disc herniation, haematoma and bone fracture. The symptoms were frequently life-threatening, though in most cases the patient made a full recovery. In the majority of cases, spinal manipulation was deemed to be the probable cause of the adverse effect." Finally: "Collectively, these data suggest that spinal manipulation is associated with frequent, mild and transient adverse effects as well as with serious complications which can lead to permanent disability or death. Yet causal inferences are, of course, problematic."
The second study weighs two cohorts with each other: Medicare B beneficiaries aged 66-99 seeing either chiropractic providers or primary care physicians (but not both):
"The proportion of subjects with stroke of any type in the chiropractic cohort was [0.12%] at 7 days, and [0.51%] at 30 days. In the primary care cohort, the proportion of subjects with stroke of any type was [0.14%] at 7 days, and [0.28%] at 30 days. In the chiropractic cohort, the adjusted risk of stroke was significantly lower at 7 days as compared to the primary care cohort [...], but at 30 days, a slight elevation in risk was observed for the chiropractic cohort [...] [ indicated by this figure ]."
Among the diagnoses confirmed to have prevailed after a chiropractic manipulation were:
- Vertebrobasilar Stroke (ICD-10 I63.219)
- Vertebral Artery Dissection (ICD-10 I77.74)
- Dural Tear (ICD-10 G96.11)
- Horner's Syndrome
Interesting information about how the adjustment can get a neurological response, as well as some information about current theories of how acute pain becomes chronic pain. The article also clearly states several times that spinal manipulation is an effective, safe treatment for chronic low back pain.
Hello all. Long story short, I was unexpectedly offered a position as part of a research team that is focused on spinal manipulative therapy (SMT). I am strongly opposed to chiropracty's efficacy as a treatment option and the pseudoscience that often influences those who practice as chiropractors.
However, members of the team all have physical therapy and athletic training backgrounds with no apparent tie to chiropractics. I understand from reading discussions on /r/medicalschool that curriculum focusing on manipulations are seen by some students as a quirk of D.O. education with little utilization/application in real-world practice.
I have limited medical training, so my question is: Is spinal manipulative therapy (SMT) a legitimate treatment/management option for lower back pain, or is it in the same realm of chiropractic woo and I should pass on the opportunity of joining the research team?
Thank you in advance.
You know the one I’m talking about. This is just idle curiosity, so feel free to ignore this question.
Like I’ve heard one chiropractor say, if it isn’t a specific adjustment, it isn’t chiropractic—and at the very least, based on my understanding of chiropractic as a patient, nothing is served by gross spinal traction compared to specific adjustments. Well, maybe the risk of hypermobilizing, to say nothing of what would seem to be the chance of a potentially serious spinal injury! (I winced the first time I saw it, and I’m far away from any medical profession.)
So, I realize that gross spinal traction doesn’t treat any specific issue, and who’s to say what kind of issues a given patient might have, so I’m fully aware that what I’m about to ask may be unanswerably vague: I’ve seen some practitioners say to the laity that they don’t do it because they would use specific adjustments instead.
I’m at a loss to what kinds of things those adjustments might be though, beyond traction to the neck (traction on the other parts of the spine is a bit harder.) Any chance you might take a guess?
So I've been a CA in Oregon for almost a year and right before I started, the office got a new office manager and she found nearly 100k worth of billing mistakes/negligence (and that is what she could prove). So needless to say we do our due diligence when it comes to verifying benefits and calling insurance companies now.
Since her take over, we do not drop any billing codes such as 98943 unless the doctor says to and we have found out something very disturbing: 98943 is classified as a "chiropractic code", but is falling under patients' Rehabilitation (PT) benefits. This has led to losing patients because they come in expecting to only pay their co-pay that they have for chiro care and then are stuck with another $20+ due to PT being subject to their deductible.
Calling into these companies and asking who/what/why/how/when this became a thing has resulted in more frustration due to the fact that the customer service reps aren't held responsible for what they say. I can be told 5 times by 5 different agents that 98943 in fact fall under the patient's chiro benefits, only to get an EOB a month later saying it falls under PT benefits.
I took this job as a CA to get some experience and see if chiropractics is where I really want to be, but between this and the bullshit you have to go through with Evicore for multiple insurance companies, I'm starting to think a career in chiropractics is going to be more hassle than it is worth.
So if anyone has any advice or links to help me figure this out, it would be greatly appreciated!
I work in insurance and just had to process a claim for a 24 day old newborn who received spinal manipulation. I couldn't believe it.
Then I had to adjust the claim for a month later when the child went back in for a check up spinal manipulation.
No question, just didn't really know who else to vent to. Absolutely sickening.
I keep telling myself, maybe the DC is one of those hucksters who kept a plastic bottle in his jacket and made the noise and didn't really do anything. It was early enough in the child's life that they didn't even have a name in the system. Just "Newborn".
Horrible.
Just curious about what PT's think of how chiropractors use SMT and how you (PT's) use it.
Do you think chiropractors tend to over-utilize it? How often do PT's utilize it? It is really as beneficial/important as chiropractors make it seem? When is SMT indicated, what can it treat? Are you taught SMT in school?
Any thoughts/opinions are appreciated.
https://circleofdocs.com/manipulation-of-dysfunctional-spinal-joints-affects-sensorimotor-integration-in-the-prefrontal-cortex-a-brain-source-localization-study/
Apologies if this was posted here before, but I thought it was a fascinating article that would interest all of us.
