Can a Chiropractor confirm no disk herniation?

Discussion in 'Health & Fitness' started by tennisenthusiast, Nov 6, 2012.

  1. tennisenthusiast

    tennisenthusiast Hall of Fame

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    I mean, based on X-rays, how reliable is Chiropractor's diagnosis of no disk herniation detected? No offense intended to Chiropractors.
     
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  2. Itagaki

    Itagaki Semi-Pro

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    Probably very low. Unless the herniation is so severe it causes the vertebrae to be noticeably displaced, no one is going to be able to tell based on an xray

    MRI's are needed to diagnose it
     
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  3. ollinger

    ollinger Legend

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    A chiropractor tell you that you DON'T have a particular problem!!!
     
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  4. LuckyR

    LuckyR Legend

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    The more important question is: regardless of their training, even if someone can make the diagnosis of disc herniation, can they tell you with certainty that it is causing the symptoms that made you go see them in the first place?
     
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  5. PrimeChoice

    PrimeChoice New User

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    In my opinion, chiropractors are not real doctors. They beleive that ALL disease and illness comes from back problems. Well maybe they don't all beleive that but that's what "their" journal of medecine teaches them.

    I WOULD NEVER TRUST A CHIROPRACTOR'S ADVICE OR DIAGNOSIS.

    It's all hocus pocus 4 them.

    Go to a Orthopedist who specalizes in backs. They are the only ones' who can help. Also, get an MRI done. You'll probably need one of thoes.
     
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  6. tennis_tater

    tennis_tater Semi-Pro

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    Well, I think it depends on what the symptoms are that the patient is complaining of, but I think if an ortho or neuro is treating a patient for complaints of leg pain/leg weakness, then obtains an MRI that confirms the existance of a disc herniation and the probability of nerve impingment , and then does further neurological testing (i.e., EMG) that shows specific irregularities with the nerve whose nerve root is adjacent to the level where the disc herniated is located and where the nerve is believed to be impinged based upon a review of the MRI, then I think that individual can be fairly certain in opining that the disc herniation is the cause of the lower leg issues.
     
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  7. tennis_tater

    tennis_tater Semi-Pro

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    As others have said, completely unreliable. An MRI is needed.
     
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  8. junbumkim

    junbumkim Professional

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    It depends on the chiropractor, but my experience has been very good with them.

    What are your symptoms? I have had back problems for about 3 years, and no doctors thought X-Ray or MRI was necessary because the symptoms weren't consistent with herniated disc and a scan was more likely to show findings that weren't causing any problems...My chiropractor who was the last professional I saw thought the same...

    If you want to be more definitive, try seeing a sports medicine doctor if not an orthopedist.
     
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  9. LuckyR

    LuckyR Legend

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    Makes sense, but given the high rate of MRI confirmed "disc herniation" in the general population, the presence of it is not highly correlated with causation.

    From the groundbreaking (but by no means only) study of it's type that all show basically the same thing:

    "We performed magnetic resonance imaging on sixty-seven individuals who had never had low-back pain, sciatica, or neurogenic claudication. The scans were interpreted independently by three neuro-radiologists who had no knowledge about the presence or absence of clinical symptoms in the subjects. About one-third of the subjects were found to have a substantial abnormality. Of those who were less than sixty years old, 20 per cent had a herniated nucleus pulposus and one had spinal stenosis. In the group that was sixty years old or older, the findings were abnormal on about 57 per cent of the scans: 36 per cent of the subjects had a herniated nucleus pulposus and 21 per cent had spinal stenosis. There was degeneration or bulging of a disc at at least one lumbar level in 35 per cent of the subjects between twenty and thirty-nine years old and in all but one of the sixty to eighty-year-old subjects. In view of these findings in asymptomatic subjects, we concluded that abnormalities on magnetic resonance images must be strictly correlated with age and any clinical signs and symptoms before operative treatment is contemplated."
     
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  10. El Diablo

    El Diablo Hall of Fame

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    ^^ The conclusion here is obvious and reflects standard treatment. Nobody operates on asymptomatic patients. In fact, hardly anyone operates on symptomatic patients unless the herniation is quite severe and has not responded to other therapies. (A flaw in this "groundbreaking" study, unless you've left out important information, is that there's no mention of the SEVERITY of the herniations in these asyptomatic patients; that asymptomatic persons can have trivial herniations has long been known.)
     
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  11. LuckyR

    LuckyR Legend

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    Human nature is also obvious and there are many incentives in a Fee for Service world to connect the dots in a patient sitting in your office with symptoms and an abnormal scan to perform a highly compensated procedure like back surgery, even if the findings of the scan are moderately abnormal (not severely so). Perhaps you missed the word: "substantial" in the citation.

    And yes these findings are "long known", since the first studies are from the early 90's.
     
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  12. El Diablo

    El Diablo Hall of Fame

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    ^^ Incentives are mostly the other direction. Patients with mild findings have a hard time finding someone to operate on them these days. Colleagues of mine are constantly turning away patients they don't feel are likely to benefit from surgery. Disappointed patients can be very litigious so doctors don't want to deal with someone they think won't improve. Managed care insurance companies also often won't approve payment for procedures without very significant findings. Starting next year hospitals' payments will in part be related to patient satisfaction surveys, yet another disincentive from doing too much surgery. In general these days, it's not so easy for someone with borderline findings to find someone to operate on him.
     
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  13. LuckyR

    LuckyR Legend

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    Isn't it interesting the different incentives between Managed Care (what you are speaking of) and Fee for Service (what I was refering to)?
     
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  14. junbumkim

    junbumkim Professional

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    That's why many doctors will not order scans unless the symptoms were severe enough (i.e.. extreme loss of strength in a leg, paralysis, etc). And, it's widely accepted among physicians that scans will lead to false findings that are not causing any problems.

    If a physician opts for surgery, it's because he's a orthopedic surgeon who believes surgery is the best solution. Perhaps there are few doctors who lick their chops and think "Yeah, surgery, more money." but it rarely works out like that.
     
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  15. LuckyR

    LuckyR Legend

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    As usual, real life is a lot more nuanced than black and white. For example: if you are convinced (as the surgeon) that back surgery, with all of the potential risk and hassle associated with it, has a 97% chance of curing the symptoms, or a 3% chance, you know what to do. OTOH, if you know that at this point, the surgery has a 60% chance of getting rid of pain, let's say, that is another way of saying that it has a 40% chance of being a useless surgery. Do you do the procedure?
     
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  16. junbumkim

    junbumkim Professional

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    Not sure if you are trying to say doctors will make decisions based on the money, but i will let you have the benefit of doubt.

    The answer is "it depends". If we are talking specifically about back surgery to relieve pain, the answer is probably "no" based on the evidence. However, there will be cases where surgery could provide significant pain relief.

    If a patient is experiencing growing weakness in legs and losing control of bladder / bowel function, then surgery may be worthy considering even with low success rate.

    Medicine itself is never an exact science. There are aways risks and chances that the procedure may not resolve any symptoms. And, it is always risk vs benefits and other variables.
     
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  17. ollinger

    ollinger Legend

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    Don't know how much time LackeyR spends in medical staff lounges, but I'm in one every day and talk to surgeons about this all the time. Two points stand out in my mind. One is that surgeons are generally not eager to operate on people with disk issues unless they feel it will be helpful. But the other vital point is that people with chronic and severe back pain are a desperate lot who suffer constantly and not infrequently become suicidal over their plight, not to mention addicted and abusive of opiates. The question posed about whether a surgeon should or would operate if he sees a 40% chance of benefit is naive; for comparison sake, should an oncologist administer chemo if he sees a 30% chance of cure? Most would say "of course" if the alternative is death. People with severe chronic debilitating back pain often feel the same way; they see their affliction as a death sentence and will beg surgeons to operate even if there is a less than even chance of benefit. Even in the non managed care setting, which still exists to some extent, people usually have to shop around to find a surgeon who will operate.
     
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  18. samarai

    samarai Rookie

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    Well let me shed some light. In the majority of the cases, for you to have a disc herniation, the bony contours ( what you see on the xray) will also have corresponding changes. Remember the disc is sandwiched between the two bone. I can take an xray and if the bony contours look all normal between the vertebral body and the disc space is equal throughout then more then likely I can ascertain that you don't have a disc herniation. I would never make that diagnosis without a MRI but you get the jest. Secondly, studies have shown that if you were to MRI the adult population, half of them would have positive changes for bulges and herniations.
     
    Last edited: Dec 21, 2012
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  19. floridatennisdude

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    X rays see bones, discs are not bones. If you haven't had an MRI, which sees tissue, you don't know if the disc is busted or not.

    Chiros treat symptoms, they don't fix problems. I'd rather be treated by a high school athletic trainer than a chiro. If a chiro makes you feel better, you could probably save a bunch of money by taking an anti inflam and stretching.
     
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  20. WildVolley

    WildVolley Legend

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    How much experience do you have with a Chiro?

    I went to a chiropractor after messing up my shoulder from serving too hard. My upper neck/back muscles were locked up, and I was in a state of constant discomfort. The adjustment caused an immediate analgesic effect that was much stronger than taking analgesic drugs, and range of movement was greatly improved.

    I don't want to claim I was in some way cured, but the chiropractor had me doing neck traction and posture and shoulder exercises. It took me about six months of rehab to get the shoulder fairly healthy.

    The main point is that chiropractor-type adjustment can sometimes have a huge and instantaneous reduction in pain. The immediate drop in pain and increase in range of movement was far greater than I was getting from drugs and without any sort of other unwanted side effects.

    I don't believe that all disease can be cured by adjusting the spine, but I now understand why chiropractors can stay in business. People who dismiss the pain reduction possible in some cases don't know what they are talking about.
     
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  21. srvnvly

    srvnvly Professional

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    I had back surgery for a ruptured disc back in 2008, after suffering thru BS advice from a chiropractor, including lots of paid visits, my frustration, and the chiropractor telling me I would have to change my lifestyle, after worsening back/ leg pain.

    I the finally went to my family doctor, who ordered an MRI, diagnosed the ruptured disc, and sent me to a specialist, and, eventually surgery. Best decision of my life go away from this particular chiropractor. I am playing more tennis now than ever, and at the competitive level I like.

    I had what I consider a bad experience and i know others have had good experiences with chiropractors, but I know what I will do if this ever happens again.
     
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  22. tennisenthusiast

    tennisenthusiast Hall of Fame

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    If you don't mind, can you give me your age group? 30-35? 40-45? etc..
     
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  23. ian2

    ian2 Semi-Pro

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    I could have written the above: it's the exact experience I had two and a half years ago, with one major difference.

    What started as moderate back pain had become back AND leg pain IMMEDIATELY following a chiropractor visit. I was stupid enough to go to the same chiropractor the next day, and to another one for a couple of weeks afterwards. Meanwhile, things were rapidly going from bad to worse: within days I was losing motor control of my right foot, to a point where my foot below the ankle was kind of just "flopping" around. Soon after my right hip "locked" and at that point I could only hobble a few steps before the pain become so bad that I had to stop and recover before taking the next few steps.

    MRI itself was torture... I could no longer straighten my leg enough to fit into the machine, nor could I remain in the same position for any period of time due to pain. Three herniated discs. I was scheduled for surgery within a week after the MRI, and pretty much resigned to going under the knife. Thankfully, my wife was not. She scheduled another appointment with our family doctor who suggested trying PT as the last resort before surgery, even though it was obvious that she (the family doctor) didn't believe it would help at that point. She's been and remains a great doctor for our family but this one time she was wrong.

    One of the two referrals she gave us was to a sports medicine place, and luckily they had an opening that same day - otherwise I'd have gone to the PT department in the hospital, and possibly with a very different outcome. My wife drove me to that appointment since I could no longer drive; even getting in and out of the car was a major ordeal. I literally crawled into that door, and this is where the horror story ends. My recovery started the minute Jeff (the PT office director) got me on his table. One hour later I walked (!) out of there on my own: still hobbling of course, but my hip mostly "unlocked" and the pain turned from unbearable to, well, bearable.

    Two months and a dozen PT sessions later I was back on the tennis court... 80% overall, but in some ways stronger than I was before. The PT office was one half of that outfit. The other department under the same roof was devoted to high-performance training for pro, college, and top junior athletes. My last few PT sessions were more like fairly intense cross-training than "traditional" PT.

    So obviously the major difference with srvnvly's story is that I didn't go under the knife but instead went for physical therapy. I'd like to say it was the best decision of my life but in reality I was lucky to consider that option, and to end up in that particular PT office. I urge everyone who might be in a situation similar to mine to find the best sports PT practitioner and the best facility you can find, before opting for surgery.

    To anticipate possible questions: I was 47 then, and in good shape aside from the whole ruptured discs/sciatica/nerve damage thing :) Haven't had problems with my back since.
     
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  24. LuckyR

    LuckyR Legend

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    A couple of things: Only the most naive would not acknowledge that compensation is a real life incentive. By stating that, I am not accusing the vast majority of surgeons (or anyone else for that matter) of practicing Bad Medicine or fraud (though, again only the most naive would not agree that there is such a thing as medical fraud, rare but real). Rather I am refering to the well established phenomenon of unconsciuous bias (hence the reason for double blinding in legitimate research). If there was no such thing as compensation bias, there would be no difference in care between insured and uninsured patients, yet there is.

    True there are other biases: fear of litigation, fear of poor patient satisfaction etc that may skew clinicians in the opposite direction than that of conpensation bias, but that doesn't mean that compensation bias does not exist.

    As to the strawman of oncologists doing chemo when the alternative is death, that I believe qualifies as the very lowest hanging of all fruit, hence it's use as your alternative example. Can't you address the more controversial example I posed: do you operate purely for pain relief, (not to save a life) with a procedure that has a moderately high risk of complications if it only has a 60% chance of working? Of course there is no "right" answer, that's why I used it to point out the nuances in Real Life medicine, which is much more complicated than this thread.

    You ponder how much time I speak to surgeons, I do speak to some between my cases.
     
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  25. srvnvly

    srvnvly Professional

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    I am 48 now, 43 at the time of my back issues. My back is holding up great, with with stretching and some cross-training (I did cross-training before, but I do more stretching now).
     
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