I appreciate the comments made by Dr. Siff. The comment about heat
dilating blood vessels is only try to about 2mm below the surface of the
skin--a moist hot back does not penetrate to near the depth to have any
direct effect on the dilation of blood vessels. Also, the research so
often quoted by chiropractors about "manipulation being beneficial for
acute back pain" were actually studies performed in England BY PTs using a
Maitland approach--NOT CHIROPRACTIC TYPE HIGH VELOCITY MANIPULATION.
Furthermore, studies by insurance companies have found patients to be more
satisfied by chiropractic care for the treatment of low back pain as
compared to seeing ONLY A MEDICAL DOCTOR--the highest satisfaction was with
physical therapy. But this is really not exactly fair. If I had a tumor, a
kidney infection, etc, that caused back pain, I am sure I would be more
satisfied with an MD. If I had a herniated disk unresponsive to
chiropractic care or physical therapy, I would be more satified with a
ortho or neuro surgeon. If I had "garden variety" low back pain, I would
be most satisfied with doing some home exercises and walking either with
instruction by a PT or a DC or an MD. Unfortunately (or maybe fortunately)
PTs are not as aggressive as chiropractors at "selling" their services.
The research will eventual point us all in the correct direction but it is
best to not "selectively" report only the part of the research most
beneficial to ones "cause". Two weeks ago the New England Journal found
that chiropractic manipulation offered no different relief than McKensie
exercises--and neither treatment was significantly better than the control
group, for non radicular low back pain. So, more research is the answer.
Thanks for your comments
Herb Silver
At 05:50 AM 2/22/99 EST, you wrote:
>Several public service items which appeared this week on the AOL (America On
>Line Internet Service Provider) Health News column are quoted below for your
>interest.
>
>ITEM 1 Comment: Though the advice about the use of ice in acute inflammatory
>conditions generally may be sound, its routine application to "back pain" in
>general, however harmless it may be, needs more adequate comment about its
>scope and limitations.
>
>Firstly, attribution of all acute back pain to inflammation is simplistic,
>especially since there are a multitude of causes of acute back pain, only
some
>of which are inflammatory or pathological. Moreover, back pain caused by
>protective muscular spasm may well be attenuated more effectively by warmth.
>
>The statement that "I have seen heat do more damage in acute injuries than
>anything else" is rather overdramatised and conjectural, because I doubt
if he
>has performed biopsies or carried out MRIs etc to clinically assess the
extent
>of damage before and after the application of heat.
>
>Possibly more noteworthy is the comment: "When in doubt, call your
>chiropractor for advice." Noting that AOL serves something like 12 million
>customers, this message reaches a huge audience and any medical columnist
>carrying out his duties objectively would rather have written "consult your
>doctor, physical therapist or chiropractor."
>
>ITEM 2 Comment: The quotation that "A recent Harris Poll survey found that
>patients with back problems were more satisfied with chiropractic treatment
>than other types of care" surely is intended to sell chiropractic more than
>to inform the public.
>
>The same AOL column gives advice from "kinesiologists" and Alexander
>Technicians, but nothing from physical therapists - apparently the latter
have
>nothing to do with back pain and disability. This type of biased journalism
>does AOL no credit whatsoever; nor does it do credit to the numebr of highly
>informed and comradely chiros who belong to this list. Health care is meant
>to involve all who can help the patient, not only those who want to capture
>the market or media headlines.
>
>Although I am not a physical therapist, I find this type of propaganda on AOL
>very distasteful and I hope that future Health News items present a far more
>balanced approach to medical topics.
>
>How do others feel about this issue?
>
>Mel Siff
>
>----------------------------------------------------
><< ITEM 1:
>
>Quick Relief for Back Pain
>by Dr. Malcolm Conway
>
>Let's review a few quick remedies to help you if you are presently
>experiencing acute low back pain.
>
>If the pain just came on, the rule of thumb is to use ice. Why ice? Because
>ice is a vasoconstrictor (reduces the size of the blood vessel) and will help
>keep the inflammation down to a minimum. By reducing the inflammation, you
>will reduce the amount of scar tissue coming into that area. Ice also
produces
>a temporary analgesic effect on the pain. With the proper use of the ice you
>can possibly decrease the use of medication.
>
>Heat on a new injury usually isn't good because it becomes a vasodilator
>(opens blood vessels) and will let more inflammation into the damaged
area. In
>my treating experience, I have seen heat do more damage in acute injuries
than
>anything else. If the injury is new, you're much better off using ice on a
new
>injury instead of heat. . . . . . .
>
>How long should you use ice?
>The textbooks say no more that 72 hours, but I have used ice successfully for
>over one week. How to use it with success all depends on the situation. When
>in doubt, call your chiropractor for advice.
>
>Remember, this is only a temporary solution to a possible injury that may
need
>professional assistance. If the pain continues, call your health professional
>for an appointment.
>
>Copyright 1999 Malcolm Conway
>
>Dr. Malcolm Conway is a practicing chiropractor in Pennsylvania. . . . >>
>
>-----------------------------------------------------------
>
>ITEM 2:
>
><<Spinal Manipulation
>by <A HREF="aol://4344:1679.AUTH_015.13642859.530311650">Jane Dusek, DC</A>
>
>After intensive study and evaluation, government researchers have concluded
>what millions of chiropractic patients have known for years: Spinal
>manipulation is a safe and effective form of initial treatment for one of the
>most common health complaints -- acute low back problems. For nearly a
>century, spinal manipulation has been what chiropractors do best. It provides
>relief from pain without drugs or surgery. . . . .
>
>A recent Harris Poll survey found that patients with back problems were more
>satisfied with chiropractic treatment than other types of care, and 70
percent
>of Americans surveyed believe that chiropractic should be included as a basic
>benefit in their health plans.
>
>In another study, the prestigious Rand Corporation concluded that spinal
>manipulation was an appropriate treatment for acute low back pain, and
>reported from its analysis that 94 percent of all manipulations are performed
>by doctors of chiropractic.>>
>--------------------------------------------------------
>
>Dr Mel C Siff
>Denver, USA
>[log in to unmask]
>
>
____________________________________________________________________________
___
Herb Silver
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