Pot-Pourri

[dcdanb]

Josh --

Could there be any other possible explanations for the improvement your patients experience, excluding the improved rom and strength?

I suppose. But I've been using this method with every patient for about 10 y now (around 20k patient visits), and it gets consistent, dependable, lasting results with about 90% of them. Maybe more than 90%. Like virtually all of them.

As long as surgery isn't the best fix for them, it works reliably.

And as long as they follow the HEP I give them, they stay well.

As far as other possible explanations for results on this scale...what else could it be? I'm open to ideas.

Can ROM and strength improve as a result of pain reduction?

Of course. If it hurts too much to exercise, you'll get weaker and less flexible. As pain goes away, your ability to exercise increases.

I'm sure the techniques you use are successful, the key question worth discussing is "why are they successful?"

My working conclusion as to why these techniques are so effective is that our bodies feel and function their best when they can move freely, and have the strength to support and protect themselves.

If you have limited ROM at a joint, that joint -- by definition -- can't move normally. Aberrant motion in a joint makes injury more likely.

If your muscles are weak, they are less able to protect your joints (or themselves), and therefore make injury more likely.

By the way, I use zero stim, US or traction. Those are "weak" treatment tools with no proven usefulness beyond limited palliative effects. I only use active therapies, myofascial work and stretching/manip, which are demonstrably more effective.

[Johnny_Nada]

dcdanb,

Your comments bring this to mind.

[Barrett Dorko]

dcdanb,

Your results are your defense?

That is pathetic.

I guess I'm through being nice.

[Josh]

Dan,
I don't want to get this wrong and misunderstand what you're saying......
Are you saying:
Stuck joints cause pain, your manipulations un-stick them, pain subsides.
Weak muscles cause pain, your hep strengthens them, pain subsides.

How can fused joints be painfree?
How can strong athletes have pain or weak people be pain-free?

How are mfr, manipulation and massage considered active?
Can treatments be effective, but not efficacious?

[dcdanb]

Barrett,

What defense do you have for your treatment methodology?

I'm always looking for more effective ways to help my patients. If you have a better treatment approach, I'm definitely interested in using your methods.

[dcdanb]

Johnny --

The Sagan standard is an aphorism which asserts that extraordinary claims require extraordinary evidence.

What better evidence than results?

Of course, they're my results, not yours. I understand.

I don't have a dog in this fight. Just found your thread, and wanted to share what's worked for me. If you guys aren't interested, that's completely fine.

But my offer still stands, if any of you are ever in Austin, feel free to stop by the clinic

[dcdanb]

Josh --

I don't want to get this wrong and misunderstand what you're saying......
Are you saying:
Stuck joints cause pain, your manipulations un-stick them, pain subsides.
Weak muscles cause pain, your hep strengthens them, pain subsides.

I pose that limited mobility (aberrant movement) increases risk of injury. Restoring normal movement reduces it.
I pose that weak support muscles make injury more likely. Strong support muscles protect better.
I pose that stronger, more flexible joints spread the daily workload across more "workers", meaning the injured part gets relative rest during recovery.

How can fused joints be painfree?

I'm not sure where you got this...

How can strong athletes have pain or weak people be pain-free?

An injury occurs when you ask a body part to do a job it can't handle, then something fails (i.e. jumping off a roof, and your leg fractures. You asked your bone to do a job it couldn't handle, and it failed). Anyone can get injured. But giving your body the environment it needs to heal (i.e., restoring normal ROM and support strength), spreads the workload of daily life over more workers, giving the injured part relative rest, and speeding healing.

How are mfr, manipulation and massage considered active?

They're not. Notice the commas between the words. Separating them as different things.

Can treatments be effective, but not efficacious?

Effective = works in real life. Efficacious = works in ideal lab conditions.
Sure, but all care about is real life.

[Josh]

Dan,
I can't help but notice all the responses linking injury to pain. Does a patient in pain always have injured tissue to find?

Last resort to treat painful arthritic joints is typically fusion and it has been shown to be effective, not to mention multiple joints that go through autogenic fusion and are painfree.

Sorry for the confusion regarding mfr, manips,stretching.....you said more effective and my brain went right to the reference to active techniques.

Effective vs efficacy..........if a technique "works" in real life but not in a lab with controlled variables.....doesn't that make you wonder why. If it's "what" you do, shouldn't it "work" in a lab and the real world?

I believe the British sports medicine group just published a paper showing FMS (strength,rom screens) cannot predict injury.

[dcdanb]

Josh --

I can't help but notice all the responses linking injury to pain. Does a patient in pain always have injured tissue to find?

Yes. But "injury" is a relative term. A bruise is an injury, as is an amputation. But they're very different in their severity. Pain is never normal -- it is a light on your dashboard alerting you that something is wrong. That thing may be big or small, simple or complex. The history/eval process tells you what it is, and dictates the fix.

Last resort to treat painful arthritic joints is typically fusion and it has been shown to be effective, not to mention multiple joints that go through autogenic fusion and are painfree.

Ah, I see. And by effective, you mean it can reduce pain? Hey, if the patient has less pain, they have less pain. If they prefer living with one less joint over the alternative, then that's the best thing for them.

Effective vs efficacy..........if a technique "works" in real life but not in a lab with controlled variables.....doesn't that make you wonder why. If it's "what" you do, shouldn't it "work" in a lab and the real world?

You'd think. Honestly, I don't follow research that much anymore. I used to, religiously. Then I realized that hardly anything that gets printed has a real life application that can help my patients. Or results are ambiguous..."the authors conclude that more research is needed" kind of bullshit.

All I care about is real life.

And you don't have to be a famous researcher to discover new things. Why not try them yourself? Who cares if research has "caught up" with what you're doing. If it gets consistent, measurable, functional results, quickly, why not use it.

God gave us ALL a brain, and that means he wants us to use it. If a particular treatment method doesn't make clear sense, and is easy to describe, reproduce and validate, I'm an instant skeptic.

I could go on and on about this...

I believe the British sports medicine group just published a paper showing FMS (strength,rom screens) cannot predict injury.

While I test strength and ROM, I don't use goniometers or dynamometers. I do simple movement screens. I know what a healthy person should be able to do. If they can't do it, I plug in the tool that fixes that thing, then they can. And then they feel better.

I don't know what all those researchers are doing...but I think they're making thing way more complicated than they need to be.

[dcdanb]

Josh -- that should be:

*ISN'T easy to describe, reproduce or validate

[FrustratedNewGrad]

Dan,
I don't want to get this wrong and misunderstand what you're saying......
Are you saying:
Stuck joints cause pain, your manipulations un-stick them, pain subsides.
Weak muscles cause pain, your hep strengthens them, pain subsides.

How can fused joints be painfree?
How can strong athletes have pain or weak people be pain-free?

How are mfr, manipulation and massage considered active?
Can treatments be effective, but not efficacious?

What about chronic stress on a weak muscle/tendon that doesn't have the load capacity? Wouldn't that be a case of weakness indirectly causing pain? Certainly tendonopathies respond to loading and increasing that load capacity.

I think there are numerous ways in which a weakness or lack of flexibility/mobility could cause altered movements that place stress on a structure that doesn't have the capacity to handle the stress placed upon it.

[dcdanb]

Barrett --

If you can't explain it simply, you don't understand it.

- Albert Einstein

[dancrofts]

Hi Dan,

Are you familiar with the phrase “extraordinary claims require extraordinary evidence”? So far you have presented many claims based on anecdotal evidence. Anecdotes are uncontrolled observations that are plagued by bias and confounding variables that can lead to unreliable conclusions. Anecdotes are a way of confirming patterns: remembering “hits” and forgetting “misses”. By favouring personal anecdotes (low-grade evidence) over scientific data (high-grade evidence) you are making yourself vulnerable to erroneous conclusions.

My first gripe with your hypothesis is that “there is a simple explanation for every MSK problem”. I can see why this is so appealing: we fear the unknown and prefer to feel in control; our desire for simplicity gives us more control over our environment (at least we think it does). However, reality is always more complicated than you think. The fact is that humans are complex biological organisms and the therapeutic encounter is infinitely complex. Reducing every MSK problem down to issues with mobility and stability is very linear, reductive thinking. Simple answers to complex problems are also a tenant of pseudoscience. What about individual variability? What about the psychosocial aspects? What about the (lack of) scientific evidence?

Second, regarding movement, how do you account for the bidirectional relationship between altered motor output and pain? What if “tight things” and “weak things” emerged as an adaptive threat response? Here we are faced with the chicken vs. the egg problem. The literature only demonstrates small, transient effects for stretching, massage and manipulation. Exercise has demonstrated more consistent effects, but is that because things have been strengthened, or because of improved self-efficacy? A patient will improve regardless of whether or not you give them helpful stuff (see: natural history of disease and regression to the mean). How can we attribute a meaningful outcome to a treatment effect? This is a classic example of the post hoc, ergo propter hoc logical fallacy.

The scientific method starts with existing evidence and moves forward from there. Pseudoscience tends to work backward from desired results (motivated reasoning) making evidence fit into preconceived notions. Unless you have made a concerted effort to prove your own theories wrong, your methodology is flawed and your results should be interpreted with caution.

If you don’t follow the research, you are doing a disservice to yourself and to your patients. If you feel that “hardly anything that gets printed has a real life application that can help my patients”, then I can’t help but feel that you must improve your scientific literacy and critical thinking skills. Of course results are ambiguous and more research is always needed; science is never black and white, only shades of grey. Uncertainty is an inherent aspect of medicine.

Don’t fall into the trap of practicing pseudoscience: basing core principles on single case/observations (weak evidence) vs. large bodies of scientific data (stronger/reliable evidence); endeavouring to prove your own theory correct and explaining away opposing evidence; shifting the burden of proof onto others; falling prey to confirmation bias; and offering simple answers to complex problems.

How can we know what a “healthy person” should be able to do with any degree of certainty? (Hint: can you account for genetics, age, race, ethnicity and the veritable slew of confounders that accompany any patient in the therapeutic encounter?)

How can we predict that a novel input to a complex biological organism will “make them feel better” with any degree of certainty? (Hint: complex systems do not follow linear pathways; outputs emerge that are spontaneous and variable).

I hope that some of these questions have sparked some curiosity. Many of them do not have “correct” answers. I’m sure most on this board have experienced the discomfort of cognitive dissonance when trying to figure out what exactly it is that we “do”. More power to you for laying out your premises and allowing scrutiny. At the end of the day we’re all here to help out our patients, but perhaps we should do so by basing our principles on prior plausibility and robust evidence. Good luck with the journey!

[Johnny_Nada]

Pain is never normal

Have you read or listened to Lorimer Moseley?

Honestly, I don't follow research that much anymore. I used to, religiously. Then I realized that hardly anything that gets printed has a real life application that can help my patients. Or results are ambiguous..."the authors conclude that more research is needed" kind of bullshit.

All I care about is real life.

...Then you will continue to find a lot of push back here...

And you don't have to be a famous researcher to discover new things. Why not try them yourself? Who cares if research has "caught up" with what you're doing. If it gets consistent, measurable, functional results, quickly, why not use it.

Do you feel the same about homeopathy and the knee menisectomy?

God gave us ALL a brain, and that means he wants us to use it. If a particular treatment method doesn't make clear sense, and is easy to describe, reproduce and validate, I'm an instant skeptic.

Hence our skepticism with your "methods"

[Barrett Dorko]

I'm sure dcdanb is "nice" to everyone. He (she or it?) is what happens when one adopts a "medieval mind" as I've been known to call it.

It would seem that this chiropractor (I assume) has read nothing other than this thread.