quick science-check

[sebastienne]

Oh dear, I've become terribly confused by Ben Goldacre! I know that chiropractors are charlatans.. but are they the same thing as osteopaths, or is there a difference?

My upper back is painfully stiff. It's becoming difficult to find a comfortable position to sit in, and dancing at rehearsals is.. interesting?

Last time this was a major issue for me, I was living at home, and my parents paid for me to visit an osteopath, who seemed to clear the problem up. Was this the placebo effect, or the natural course of the pain - or should I be considering spending a not-insignificant amount of money on similar treatment this week? (Or should I just be popping ibuprofen and having lots of hot baths?)

Comments

[lollardy.livejournal.com]

As far as I know, osteopathy isn't particularly reputable? My friend is a physiotherapist, and says that osteopaths are not taught about the scientific basis for anything that they do (I don't think this is due to some sort of time-honoured rivalry between physios and osteopaths; she's not saying it in a sneery way). I dunno if this makes them charlatans though.

[apotropaios.livejournal.com]

Proper osteopaths are made of magic. They're definitely worth the money.

[anotherusedpage.livejournal.com]

I think you're being a bit all-or-nothing in your thinking, lovely. Some chiropractic treatments are stupid and clearly based on Bad Science. Chiropracty is not going to cure your digestive issues, your painful periods, or your baby's asthma. However, it might just help with problems with your spine. Not all chiropractic practitioners claim to be able to do anything other than help back pain. If you have back pain, chiropracty or osteopathy may be able to help.

If you don't want to try anything connected with alternative practice, try finding somewhere that offers sports massage. That might help.

[darthfox.livejournal.com]

They're different, as you know, because of the spelling.

I don't know how it is on your side, but over here there are some (I might venture to say most) chiropractors who are charlatans or sincere practitioners of nonsense or what have you, but others who are aware of some science behind what they're doing - it's just that because they're essentially unregulated it can be hard to tell, which is why a lot of us just avoid them wholesale. We don't tend to use "osteopath".

No matter whom you see, it's likely I suspect that they'd be able to get you some short-term relief, but not actually solve the underlying problem. Which you can do just as well by taking ibuprofen and hot baths. Do you have electric heating pads over there? (I can't remember.) Put one of those behind your shoulders - tie it on with a scarf or something even. And make sure your bra fits.

Good luck!

[forgiveninasong.livejournal.com]

My mum has misaligned vertebrae in her lower spine. She's been seeing a chiropractor for about a year and a half now. Her walking is much improved, as is the pain, which is almost non-existant, unless she inadvertently knocks it out of place. Mum doesn't like taking ibuprofen because it just masks the pain and you can actually end up doing more damage.

I would recommend chiropractors!

[forgiveninasong.livejournal.com]

I agree with this! Chiropracty is only good if you have something actually physically wrong with you (my Mum had x-rays and everything and was actually referred to a chiropractor for her spine).

[the-whybird.livejournal.com]

Some quick resources:

Quackwatch on osteopaths (http://www.quackwatch.com/04ConsumerEducation/QA/osteo.html) is pretty damning.

[liminereid.livejournal.com]

Ah my friend is a certified osteopath from Royal School and she had to learn every muscle and bone in the body to graduate. Among other things. I'd go to the Royal School and look for some one they recommend. Osteos are better than Chiropracters but in my friend's words 'some of us realise we just deal with bones and muscles and we manipulate them to help people. Soem of us are weird and believe they can feel psychic energy and heal pretty much everythign via moving you.' Those ones are dangerous and charlatans.

[liminereid.livejournal.com]

My trained British Osteopath friend who has a practice in Edinburgh has described pretty much all of those proceedures as rubbish. it's not the be all and end all of osteopathy.

[liminereid.livejournal.com]

http://www.bso.ac.uk/
British School not Royal.

[beornwulf-saxon.livejournal.com]

this is a good point, as I had a series of chiropracty sessions for my spine problems a bit over a year ago, and they worked wonders. I would have doubts about them managing to affect anything else, but for spinal issues they can be good :)

[the-whybird.livejournal.com]

Mum doesn't like taking ibuprofen because it just masks the pain and you can actually end up doing more damage.

YMMV, of course, and I don't know enough about spinal pain to speak specifically about what happened to your mum, but my understanding of back pain is that studies have shown (http://www.mja.com.au/public/issues/175_09_051101/buchbinder/buchbinder.html) that the best answer is to carry on with your normal life, keep exercising, and avoid resting for long periods. The point of taking ibuprofen for back pain is to make things painless enough for you to do that (and then for you to stop when the pain's no longer chronic), not to be a permanent solution.

[forgiveninasong.livejournal.com]

Yes yes. She carries on as normally as possible, but before she had treatment at the chiropractor, it was nigh-on impossible for her to do anything, as the spine was trapping all the nerves and she was getting so many shooting pains down her legs and arms. Realignment at the chiropractor means that, whilst her back is not how it should be (like everyone else's), the realignment pushes the vertebrae back into a more comfortable place, therefore releasing the trapped nerves and reducing the amount of pain she was in before this. She was at the point where she was taking allsorts of painkillers just so she could go to work, but she very rarely needs to take anything. If her back does shoot out of place, she has been told what she should do and has the luxury of being able to use her chiropractor as a drop-in if anything serious does happen.

[mejoff.livejournal.com]

It's pretty easy to become confused by Goldacre, given his propensity for unexpectedly egregious generalisation and dogmatic conclusion jumping.

Don't get me wrong, he's often useful, but he's also often nearly as bad as some of the people he's at war with.

[half-of-monty.livejournal.com]

Why go for either and not physiotherapy, which is the proper bona fide version?

When my back started stiffening up, and being painful a reasonable proportion of the time, I went to my doctor. I was hoping to get a physiotherapist appointment in which I could learn the right exercises to strengthen and heal it. Doctor agreed that was the right approach, but said I'd be waiting ages for the physio and I'd get the same effect (and more or less the same exercises) by taking up pilates.

3 years on, I never have back pain, and my posture is considerably better.

Pilates got a bit of a clouting in the informationisbeautiful graphic on alternative therapy, but some pilates instructers (like my one at the uni club) are qualified physiotherapists - so my doctor's assessment that you get the same sort of stuff from either seems perfectly fair.

[the-whybird.livejournal.com]

It's more likely that I'm communicating poorly and/or don't understand the specifics of misaligned vertebrae. My understanding is that the best treatment for a lot of back pain (which might not necessarily include misaligned vertebrae) is to remain physically active; the point of popping those painkillers to is reduce the pain enough that you can do this until things get better, rather than to be a permanent solution.

I'm certainly not advising that people take painkillers as an alternative to treatment.

[vampire-kitten.livejournal.com]

One thing to try for quick/cheap relief - the aromatherapy place on the high used to do very cheap 1/2 hour back massages - talking about the £10/£15 mark. Made mine much more comfortable, could be worth trying?

[queerpup.livejournal.com]

Sadly this seems to be true. Plus he's a whiny git that needs to grow up!

[totherme.livejournal.com]

Seconded. I have had personal very good experience with physio (though in my case for a knee injury), and know several people who have benefited a great deal (all these cases being back pain issues) from pilates.

The thing with either of those options though, is that you have to put some work in. A physio can sometimes give you a short term benefit without any effort on your part (through massage), but for long term benefit you need to regularly do the exercises you're given. To get any benefit at all from pilates, you need to regularly do the exercises you're given.

I like to think that I get a good deal of pilates-like benefit from the taichi I do, but I am aware that there are an enormous number of dodgy taichi schools out there. If you go looking for something long-term, I'd suggest you go looking for pilates.

[frank-snow.livejournal.com]

Got any examples of this?

[frank-snow.livejournal.com]

It's worth noting that the evidence is still conflicted in the area of back pain. There's some evidence that it Chiropractic can be useful for lower back pain, but there's little to no evidence that it helps with neck pain, and what little evidence there is is typically negative or inconclusive.

None of which is to necessarily say that someone should or shouldn't use them, but I've noticed recently that the received wisdom is that Chiropractic is okay if it's just back pain, but I think it's still more complicated than that.

[mejoff.livejournal.com]

I beleive we've discussed the real standout example before. The accupuncture thing, where they did the test on people wit similar chronic pain.

No treatment predictably helped in no way,
Placebo pills helped in something like10% of cases,
real painkillers in 75%,
traditional accupuncture in around 55%
careful but ad-hoc accupuncture without the ritual forms in roughly 50%.

(I may be misremembering the exact numbers, but they are representative)

Goldacre's conclusion: not that accupuncture is somewhat effective but it's the needles in the skin rather than the lore based technique that does it, but that all accupuncture is bogus and any relief the subjects may have felt was placebo.

[frank-snow.livejournal.com]

I think I've found the article (http://www.badscience.net/2007/09/542/) you're referring to, but I can't say I agree with your interpretation. His conclusion is clearly that the causes of back pain are complex and include social factors, and that it shouldn't be treated with reductive medicalisation (to wit: "a wonder pill or a course of acupuncture will solve all your problems").

[queerpup.livejournal.com]

Important thing is to work out the cause of the stiffness, and then not do that again!

Advice to take painkillers and keep moving is *generally* a good thing. If you're getting tingling or numbness in your limbs, get to a GP / walk-in centre.

Muscle stiffness from a bit of overuse just needs a nice warm bath / shower, anti-inflammatories, and gentle regular movement, and time.

[brightlywoven.livejournal.com]

I wouldn't be completely against seeing a well qualified osteopath who was honest about their treatment for lower back or thoracic spinal pain. Having seen a stroke caused by neck manipulation, I wouldn't let ANYBODY manipulate my neck.
Physiotherapy is, I think, a very good long term option (and one I had success with for lower back pain), in terms of helping me understand how I was moving wrong, and how to stretch and strengthen my muscles to prevent it. But if you need instant relief, a massage might be the way to go?
Hope you're feeling better soon!

[eurynome1967.livejournal.com]

I think that the big pink ibuprofen are pretty miraculous. What tends to happen with upper back/shoulder/neck pain is that you start to hold yourself and move in restricted ways which can perpetuate the pain. The big pink ones cut out the pain and enable you to free up. Three days of those, taken carefully with food, and you will know whether it is just unaccustomed exercise aggravated by lack of sleep, or something that needs treatment. I have never yet used either a cheiro or an osteo, but I know people who have had miraculous experiences with one or the other (DJMC and a slipped disc, for instance) ...

[deepbluemermaid.livejournal.com]

I saw an osteopath in Oxford, on and off, for my chronic back pain (I have a severely curved lower back which causes me a lot of trouble). So I'd recommend the fantastic guy, Tom, at the St Clements Osteopathy clinic. Here's their website:

http://www.51stclements.co.uk/

[black-rider.livejournal.com]

Osteopaths here are qualified medical doctors as well... I rather prefer them. It may not be hard science, but having my bones put back into proper alignment makes me *feel* better, and that's all I really give a damn about. Painkillers and hot baths help too. ;)

[grignoter.livejournal.com]

There is some truth in this - apparently if you don't move enough then the muscles in your spine can spasm and heal more slowly. It's a rule of thumb not the right solution for every single problem, so of course medical input still needed, but often the advice is to take painkillers and keep moving a bit (although probably avoiding hardcore work outs and lifting!)

[the-whybird.livejournal.com]

any relief the subjects may have felt was placebo

I think you're confusing "placebo" with "not real". All that placebo means is "not attributable to the medicene". If you take a placebo and it makes you feel better, then in the case of something where it's the symptoms you want to treat (like the common cold, lower back pain*, hayfever, or depression) that doesn't mean that the illness was all in your mind.

Placebo is not necessarily a derogatory term (and Goldacre is very clear on this (http://www.badscience.net/2008/03/all-bow-before-the-might-of-the-placebo-effect-it-is-the-coolest-strangest-thing-in-medicine/)) unless you're claiming that your medicene isn't a placebo. If you undergo a treatment and it makes you better, then that treatment is a good treatment -- it doesn't matter whether the treatment was placebo or not.

There are two dangers with placebo treatments. One is the possibility that the people administering them forget that they're placebos, and start placing more and more importance on the (noneffective) part of the treatment. You end up paying £50 for a $1 pill in a $49 box. That's a very inefficient way to get well.

The other possibility is when the people administering them don't twig that you have a condition which requires a non-placebo treatment: for example, if you went to acupuncture clinic with misaligned vertebrae, then having pins stuck into you might make you feel better, but you'd have a medical condition that was getting worse and ought to be treated.

[mejoff.livejournal.com]

James, I've been feeling for some time that the extent to which you patronise me is upsetting, is it simply that you have a dgree and I don't, or am I less intelligent than you in real terms?

I know exactly waht I'm saying, and I don't really care what 'Goldacre is very clear on'. Through the genuinely useful process of debunking dishonest and anccurate scientific practice, he has accrued around himself a cult of personality which makes it social anathema to question him, and into which he appears to be buying to a dangerous extent himself, and I feel this has made him unreliable.

[the-whybird.livejournal.com]

Okay.

I'm the first to admit that I can be a patronising bastard when I'm explaining stuff, but that's only ever been out of a desire to make my point clear; I'm not good at arguing using rhetoric and I try to avoid that whole messy area by ladling out great big dollops of explanation.

I do not, not have I ever, made value judgements on people because of their education and I'm actually kind of shocked that you think I do. If I have ever done this, then please let me know when I've done it, because I was wrong to do so and I need to stop.

But fundamentally that's not important. Whether or not it's been a deliberate act on my part, what matters is that something I've done has upset you, and I'm sorry for doing that.

[sebastienne.livejournal.com]

I find this response inspiring.

[ninda-sarrik.livejournal.com]

I whole-heartedly second this suggestion - Tom was recommended to us by a neighbour, and he's helped several people I know in Oxford who've got back pain and other problems like that. I'm going to enter the debate about what technique is good/bad/disreputable/medical, I'm just going to stick with this specific recommendation for this specific person :)

Chiropractic Care

[walkerville01.livejournal.com]

Typically, chiropractic studies are focused on spinal function and its relationship to not only the nervous systems, but to overall health and wellbeing.
Looking for Chiropractors in Adelaide? Visit us at walkervillechiropractic.com.au for more info about Back Pain (http://walkervillechiropractic.com.au/).