Comments (0) I’ll be the first to admit it– I don’t think this was a good idea but it seemed fun a few years ago. I’m probably the only chiropractor in San Francisco who dressed up. Here I am with my favorite patient Monica Levin. Thanks to Monica for providing the picture.
The NYTimes recently published a column on the resistance to use of the best evidence in health care. They report that one of the biggest problems in getting good health care is the resistance of health care providers to changing the voodoo that they do to treatment that actually works.
This article references the Agency for Health Care Policy and Research’s guidelines on treating lower back pain. Spine surgeons were so upset that it excluded their favorite treatment – surgery – that they tried to kill the agency and they did quite a good job. The Times article reports the reason that surgery was not recommended: research didn’t show it was effective but it did show that spinal manipulation was effective (Chiropractic).
Personally I have to practice evidence based care to be able to sleep at night, it only makes sense and it’s best for patients.
For months we have been walking by the empty shell of the former Rick’s on Taraval. It was great to see last week the Parkside Tavern open. Not only does it look good on the outside but the inside has been re-vamped as well. I had a chance to speak with the owner for a few minutes and he seemed very committed to offering quality food and beverage.
Consumer Reports released the results of a large survey with regards to what helps people with their back pain. Not surprisingly The highest rated treatment was chiropractic care. Here’s a video from CBS’ Early Show discussing the article.
The Chicago Tribune recently published an article on chiropractic with some great recommendations for choosing a chiropractor.
-Be wary of those who say spinal manipulation can cure whatever ails you
-Ask whether exercise is part of the program.
-Ask friends and relatives for recommendations.
-Get more than an adjustment
-Shop around
Great recommendations for finding a chiropractor in San Francisco or anywhere else.
The UK’s National Institute for Clinical Excellence in May released guidelines for treating lower back pain.
The first recommendation is to promote self-management. This means to suggest to patients with LBP to exercise and try to continuing doing ones normal activity, as much as possible. The next one is pain medication – first acetaminophen (unfortunately this has also been proven to increase the risk of cardiovascular events). The final recommendation is exercise or manual therapy (i.e. spinal manipulation) or acupuncture.
Another interesting feature is what the guidelines proscribe. All of the following are treatments/diagnostic tests that are NOT allowed (because they either don’t work or aren’t needed):
Medical/Surgical treatments
SSRIs for pain management
Facet injections
Radiofrequency facet joint denervation
IDET (Intradiscal Electrothermal Annuloplasty)
PIRFT (Percutaneous Intradiscal Radiofrequency Thermocoagulation)
Diagnostic tests:
Plain film x-ray under any circumstances
MRI to be offered only to rule out red flags or for surgical referral.
People always call our office and ask if they should see their doctor first before consulting me. Unfortunately it is very likely that your health care provider will ignore these and all other guidelines and do what they have always done, even if the scientific evidence indicate it is not effective.
Maia James DC, Chiropractor in San Francisco and President of the California Chiropractic Association.
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