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Is an Osteopath (DO) the same as a Chriopractor?

Answered on August 19, 2014
Created March 31, 2011 at 6:33 PM

I'm trying to find a decent doctor in my area who isn't a drug pusher. From what I read and Osteopath is the same as a medical doctor who "can" write prescriptions but I don't want a crazy shaman with the crystals etc. Anyone with some experience with an osteopath or know what to expect?

9f9fa49265e03ddd2bf2bba5477a556b

(3184)

on April 01, 2011
at 08:39 PM

Also, that article is ridiculous. DO's claim improved outcomes during the 1918 pandemic. Not, gee, only 1 patient out 1600 died. That is absurd. Increasing lymphatic flow and respiration is going to help (not cure) a bed ridden influenza patient with a secondary URI. Doing spinal HVLA on that patient will not cure, nor probably even help that patient. Oh wait, that's right, HVLA would actually be contraindicated on a patient with severe influenza and pneumonia.

9f9fa49265e03ddd2bf2bba5477a556b

(3184)

on April 01, 2011
at 08:24 PM

I don't believe 95% of the spinal adjusting is not done by chiropractors. Internationally trained osteopaths ONLY do manual medicine, unlike their American counterparts. And Chinese medicine docs also do similar techniques. And every DO FP doc I know does some spinal manipulation. But yeah, chiros are more apt to do spinal HVLA than anyone else even when it isn't the best treatment, so maybe you're right. And you are trained to care for the nervous system? So chiros are doing neurology residencies now?

21fd060d0796fdb8a4a990441e08eae7

(24543)

on April 01, 2011
at 06:28 PM

Jae- yeah, I think the page that we are collectively on is the "logical page". Active release technique, trigger point release, nutritional advice, and mobility exercises I got from chiro and the internet were miles ahead of anything I heard from a physiatrist and rheumotologist. But until there is evidence for some of the widely-held claims of some chiros, I'll choose to stick to MDs (or DOs) for things other than soft-tissue complaints. I don't think we should comment on the same threads anymore, because our opinions are too similar, and redudancy is inefficient :)

77732bf6bf2b8a360f523ef87c3b7523

(6157)

on April 01, 2011
at 06:15 PM

Thanks for your responses, Kamal. I think you and I are on the same page, but you articulated several points better than I could have. @Dr. R: No offense, but I am a little skeptical of asking a chiro to defend his own profession. I don't have anything against individuals who are chiropractors; I've seen one who had quite amazing hands. I couldn't care less whether he had an MD or DC or DPT. But I wouldn't go to him for advice if I had, say, an infection.

21fd060d0796fdb8a4a990441e08eae7

(24543)

on April 01, 2011
at 05:41 PM

Note that "urine therapy" (drinking your own urine) would have been a better treatment for brain cancer than going to an MD, in the early 1900s. That's because it wouldn't harm you, whereas MD care for brain cancer back then was (I think) no so advanced because of lack of pharma research and basic science knowledge.

21fd060d0796fdb8a4a990441e08eae7

(24543)

on April 01, 2011
at 05:40 PM

That article, originating from "Planet Chiropractic", suffers from so many selection biases it's almost funny. The reason you don't look at cohort data for things like influenza and chiro is that if you're really sick, you may well have chosen an MD over a chiro, and you die under the care of an MD. That is only one of the many logical pitfalls with correlating influenza death with MD care. There are many others, such as a lack of effective treatment in the early 1900's. If they had tamiflu back then, the numbers would be crazy different!

21fd060d0796fdb8a4a990441e08eae7

(24543)

on April 01, 2011
at 05:21 PM

And lastly, I do not disagree with you about finding the root of disease rather than throwing pills at it. It's just that the causes of disease seem to lie in the nutrition/toxin area, not in the misaligned-vertabra-throwing-off-nervous-system area. The chiros I've been to know an amazing amount about posture and kinesiology. But the best ones (in my limited experience) have focuses on that, not on disease from poorly aligned vertabra. That's why I would much rather go to a chiro about back pain than my PCP or physiatrist, but not for most other health concerns.

21fd060d0796fdb8a4a990441e08eae7

(24543)

on April 01, 2011
at 05:17 PM

Here is the link to the 2010 Cochrane report...http://www2.cochrane.org/reviews/en/ab005427.html

21fd060d0796fdb8a4a990441e08eae7

(24543)

on April 01, 2011
at 05:15 PM

The most comprehensive review of chiro is the latest Cochrane review. There is a small benefit from chiro in the short/medium run, and no benefit in the long run. Chiro was shown to have significantly more side effects than other treatments. Studies had a high risk of bias because of poor methadology. That is the evidence base for chiro. When combining the low evidence base, plus the murky biological plausability, it is something to definitely question. No doubt, chiro works great for certain people, but on a population wide basis, there is not good evidence.

21fd060d0796fdb8a4a990441e08eae7

(24543)

on April 01, 2011
at 05:12 PM

Also, I am admittedly not an expert at all on chiropractic. I still go to chiropractors, so I obviously have nothing major against it as a profession, and do not harbor ill will from a bad experience. But my day job is analyzing clinical trials in evidence based medicine. From that, I can critically compare evidence for different treatments. The controlled trials you cited do not show chiro is better, for the most part. Several trials have more methadologic concerns than average (e.g. no Bonferonni correction for multiple comparisons, etc).

21fd060d0796fdb8a4a990441e08eae7

(24543)

on April 01, 2011
at 05:05 PM

Dr. Ryan- You misphrased what I said. I said "Chiros do not know as much about physiology or disease" compared to MDs. From every MD and chiro I've ever talked to, that is true. To take board exams requires quite an array of knowledge, which reinforces what MDs learn from both class and rotations and residency.

E8022f05c250e19a65b92207dd1630ca

(851)

on April 01, 2011
at 04:19 PM

@ Jae if you look at chiropractic school websites they will show you the curriculum of their doctorate program. I did 4 years undergraduate studies and 4 years of chiropractic school (year round) to complete my DC. If you want facts I suggest doing some research rather than asking someone who does not have a qualified opinion.

E8022f05c250e19a65b92207dd1630ca

(851)

on April 01, 2011
at 04:14 PM

And I gave you references of controlled trials, please take the time to look at them.

E8022f05c250e19a65b92207dd1630ca

(851)

on April 01, 2011
at 04:12 PM

Diagnosing a symptom and drugging it or cutting out pathology from someone's body does not make you scientific. It's more scientific in my opinion to find the cause of adaptive physiology (or pathology as the medical profession calls it) and allow the body to function properly. Having high cholesterol for example is an intelligent adaptation by the body to a stressor. Giving someone a drug to artificially lower the cholesterol does not remove the stress and we falsely assume that we improved this person's health. Why not find the cause of the stress and correct it and actually improve health?

E8022f05c250e19a65b92207dd1630ca

(851)

on April 01, 2011
at 04:05 PM

Kamal, you contradict yourself by saying that you don't say things in a biased way but then you continue with your unfortunate experience with a chiro. I admit that just like most professions, not all chiro's are great. That does not give you permission to make false statements like "chiros do not know much about physiology". I would say that I know more about physiology than most medical professionals.

21fd060d0796fdb8a4a990441e08eae7

(24543)

on April 01, 2011
at 03:13 PM

Like I went to this really nice and well-qualified chiro, who noted that my shoulders were hypermobile as well as knees, ankles, etc. He proceeded to adjust me. Then I went home and read an peer-reviewed article saying that no-one should ever do adjustments on hypermobile folk (later turned out I had a connective tissue disorder). My back hurt for about a year from that. And even that guy couldn't give a good reason why he could somehow detect subluxations in my spine, when it was not medically apparent.

21fd060d0796fdb8a4a990441e08eae7

(24543)

on April 01, 2011
at 03:10 PM

Dr. Ryan- the large majority of chiro studies are uncontrolled. Uncontrolled trials of vegetarian diets also show benefits. That is why comparitive trials are important--you do not know if the treatment works, or if it's just nice getting your back cracked and it spurs you to have healthier habits.

21fd060d0796fdb8a4a990441e08eae7

(24543)

on April 01, 2011
at 03:09 PM

Jae- While I obviously know much less about chiro than Dr. Ryan, I would be hesitent to classify MDs, DOs, and chiros all as doctors. MDs and DOs have very standardized curriculums that are very science-based. Other than temporary back pain benefits, the benefits of adjustment are not well studied enough to make it into a curriculum. So when my uncle and his family use a chiro as their primary care doc, it make me very uncomfortable. Chiros do not know as much about physiology or disease, plain and simple. Scapular stability? Sure! Early signs of multiple myeloma? No.

21fd060d0796fdb8a4a990441e08eae7

(24543)

on April 01, 2011
at 03:05 PM

Also, the use of adjustments for things other than back pain has very little evidence, comparative to claims that are made about "nervous system benefits".

21fd060d0796fdb8a4a990441e08eae7

(24543)

on April 01, 2011
at 03:04 PM

Dr. Ryan- By "Evidence Based Medicine", I do not just mean published studies. EBM is the use of systematic reviews and meta-analysis to get pooled estimates of effect size. Chiropractic does not fit the bill. At best, it has shown a modest effect size in uncontrolled studies. Obviously, randomized controlled trials are difficult with such a practice. But most everything else that is physical (e.g. intensive physical therapy) has shown better comparative results. I'm not saying this in any biased way-- I've gone for adjustments and directly compared evidence.

77732bf6bf2b8a360f523ef87c3b7523

(6157)

on April 01, 2011
at 02:34 PM

Kamal: would you say it's misleading to call chiros "doctors"?

E8022f05c250e19a65b92207dd1630ca

(851)

on April 01, 2011
at 02:16 PM

You are incorrect again about chiropractic not having evidence based research to support the practice. Here are some studies if you actually want to have a qualified opinion: Spine July 15, 2003;28(14):1490-1502 (effectiveness of chiro), Journal of Manip & Phys Ther Jan 2005, Vol 28, #1 (effectiveness again), Check out the journal of Injury 1996 (93% of chronic whiplash improved with chiro that were failed MD & PT tretments), Journal of Hypertension, 2007 (chiropractic lowers blood pressure), International Tinnitus Jour, 2007 (chiro and Meniere's disease)

E8022f05c250e19a65b92207dd1630ca

(851)

on April 01, 2011
at 02:05 PM

Kamal, if you're not comfortable with allopathic, then I'll use the term conventional medicine. And as for the classroom thing, there is nothing there that talks about reviewing adjustments. This talks about basic minimum classroom studies for a health care practitioner. Just as chiropractors do not do rounds in hospitals and perform crisis intervention, MD's do not spend clinical hours studying adjustments and chiropractic technique.

E8022f05c250e19a65b92207dd1630ca

(851)

on April 01, 2011
at 01:57 PM

Matthew, not all health care professionals are trained to search for the cause of disease. Docs who use meds or surgery to try to correct problems due to the lack of exercise, poor nutrition, or stress are only treating symptoms and not addressing the cause. Chiropractors are not exempt from this either, there are plenty of chiropractors who treat symptoms of poor lifestyle with adjustments.

E8022f05c250e19a65b92207dd1630ca

(851)

on April 01, 2011
at 01:53 PM

PS- http://www.associatedcontent.com/article/1733660/chiropractic_care_during_1918_influenza.html?cat=68

E8022f05c250e19a65b92207dd1630ca

(851)

on April 01, 2011
at 01:52 PM

Since 95% of the world's spinal adjusting is done by chiropractors, I don't see why you would choose a DO to do something they so rarely do. Your opinions of Chiropractors are misleading, we do not treat cancer or any disease for that matter. We are trained to aid the body function optimally by caring for the human frame and nervous system. We are also skilled in PDx and identifying pathology if other treatments or referrals were needed. The chiropractic profession prides itself on not using medication or surgery to help heal the sick.

34a367e60db77270bd7096dc04270fdc

(4171)

on April 01, 2011
at 02:59 AM

Thank you for such a detailed answer, I appreciate the time it must have taken to post all of that & it helped me a lot!

21fd060d0796fdb8a4a990441e08eae7

(24543)

on April 01, 2011
at 01:14 AM

This is really great info, straight from the horse's mouth. Although you really should be studying rather than writing thorough answers!

6fa48935d439390e223b9a053a62c981

(1676)

on April 01, 2011
at 12:52 AM

This is the most complete answer I have ever seen on paleohacks! And interesting, too. Thanks. +1

21fd060d0796fdb8a4a990441e08eae7

(24543)

on April 01, 2011
at 12:47 AM

Also, only one of these two professions is substantially affected by the tenets of evidence-based medicine. Hundreds of millions of dollars are spent doing systematic reviews to hone the stats covering different treatments. While chiros are interested in several worthwhile topics, studies have shows that different chiros can't even agree on identifying a spinal subluxation in x-rays. In my opinion, chiros are good to talk to because they keep up on non-adjustment therapies and keep an open mind, as well as spend time with you.

21fd060d0796fdb8a4a990441e08eae7

(24543)

on April 01, 2011
at 12:46 AM

Also, only one of these two professions is substantially affected by the tenets of evidence-based medicine. Hundreds of millions of dollars are spent doing systematic reviews to hone the stats covering different treatments. While chiros are interested in several worthwhile topics, studies have shows that different chiros can't even agree on what a spinal subluxation is. In my opinion, chiros are good to talk to because they keep up on non-adjustment therapies.

21fd060d0796fdb8a4a990441e08eae7

(24543)

on April 01, 2011
at 12:18 AM

That being said, I've been to many chiropractors for soft tissue issues. Because chiros know a lot about physical activity and health, they are up on posture, foam rolling, active release, etc. But that is not something that is necessarily from the profession. Physical therapists do similar things, at times, but are more constrained by their working relationship with hospitals and doctors.

21fd060d0796fdb8a4a990441e08eae7

(24543)

on April 01, 2011
at 12:15 AM

This seems misleading to me. Doctors (MDs) spend lots of time during their training (classes, rotations, residency, fellowship) looking for the cause of disease. Whether they pursue similar aims in practice is up to them and their battles with time management and insurance hassles. Allopathic also is an outdated term, in my opinion (my sister is a naturopath). There is no allo- and naturo- in reality...there are only mechanisms of disease. I've seen the "minimum classroom hours thing" many times, and that is also misleading. MDs spend no time reviewing adjustments.

0bc6cbb653cdc5e82400f6da920f11eb

(19245)

on March 31, 2011
at 09:09 PM

"...trained to search for the cause of dis-ease rather than treating symptoms" So regular doctors don't search for the cause of disease then?

918ecd2369c4e8cd6a2d66846c20137c

(285)

on March 31, 2011
at 08:24 PM

Alfredo nailed it. DO = MD, with slightly different training. Over the years five of my docs have been DO’s, two of which were excellent - in other words: I find DO’s to be just as hit and miss as MD’s.

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6 Answers

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9f9fa49265e03ddd2bf2bba5477a556b

(3184)

on March 31, 2011
at 08:58 PM

Well seeing as I'm a DO student, I think I can field this question...

Osteopathic medicine was developed by an M.D., A.T. Still. Chiropractic medicine was developed by a student of Still's, B.J. Palmer. Dr. Still, frustrated with the state of medicine in the mid-1800s, developed a number of manual manipulative techniques to treat conditions that, at the time, were not really curable with conventional (a.k.a. allopathic) medicine. To give you an example, one all osteopathic students are taught, during the 1918 influenza outbreak, patients under osteopathic care had much higher survival rates (there were neither antivirals or antibiotics for secondary bacterial infections at the time). Osteopathic physician achieved better outcomes through techniques like rib articulatory techniques (these are where the physician helps improve movement in the rib cage) and lymphatic techniques (these are where the physician, essentially manually "pumps" or "milks" the lymphatic ducts to facilitate movement in the lymphatics). None of this is rocket science really--it is well established that patients who are supine for extended periods of time (as they would have been with a nasty case of influenza) and have poor respiration are prone to things like opportunistic bacterial infections (and, death). So just by manually helping the ribs move a little better and getting improved respiration and get lymph moving again, you can (potentially) improve a patients condition (of course, we don't have any real studies on the 1918 results, it is just anecdote--but these two techniques have subsequently been demonstrated to have some efficacy).

One of the other things Still developed (or re-discovered, these techniques are pretty old) is the High Velocity, Low Amplitude thrusting techniques that chiropractors are famous (or infamous) for. This is what everyone imagines when they hear the word chiropractor--"cracking" the cervical or other spinal vertebrae. So Palmer essentially took HVLA and other manual techniques from Still et al. and ran with them, to the exclusion of other forms of medicine.

Now, let me add here, both chiropractors and, at least traditionally, osteopaths both viewed somatic dysfunctions as being a root cause of a lot of disease states. Chiropractors, or at least some fraction of them, probably obsessively focused on spinal dysfunction, whereas osteopathic physicians would take the entire body into consideration. Let me define somatic dysfunction, at least from an osteopathic standpoint. So we can start with the spine (since that is where chiropractors start). I can take any person, literally, and go up and down your spinous processes (the horizontal parts projecting from the body of your vertebrae) and find they're not aligned. No body is perfect, not a surprise. But what that means is that over the length of your spine, you're kind of rotating a little to the right in your neck, maybe a little to the left in your upper thoracics, back to the right in your lumbars. Almost everyone is twisted about the axis of their spine. Everything is connected to the spine, so that means if you're chronically (or even acutely) rotated off center, all the muscles attaching around that region of the spine are going to be put into contraction (maybe just mild). Then those muscles attach somewhere, they're going to be pulling on another group of muscles, etc. So eventually what started as a mild rotation of one vertebrae has put a number of muscles into strained positions and caused postural problems. Now the body is very robust, so this may or may not be a big deal. We kind of adapt to this and we're used to being all contorted. But you don't have to be all contorted, and, osteopathic physicians and chiropractors have techniques to "uncontort" bodies. At least some fraction of chiropractors like to address this with HVLA (e.g. the dramatic neck cracking), but osteopathic doctors (and some chiropractors) have gentler techniques (some are basically massage techniques, others more like physical therapy techniques) to get things aligned and reduce hypertonic muscles and other postural issues.

Now, there are both DO's and DC's who feel that you can treat many (most/all) illnesses through these manual manipulative techniques. The theory, at least from the osteopathic world, is that the entire body is connected (it is, literally), and local inflammation in one region (say from hypertonic muscles in spasm because of the aforementioned spinal rotation) are a drain on the bodies resources and can lead to decreased immune function or things like that. That isn't too crazy. It is physically plausible. Some DO's/DC's also think that you can effect the sympathetic and parasympathetic nervous system through spinal or other manipulations. We're getting into fuzzier ground here. And then osteopaths have things like cranial techniques, wherein we can supposedly influence the body by manipulating the cranial bones with very, very tiny movements. I will be diplomatic and say there isn't good evidence for that, nor do I see how that is possible from what we presently know about anatomy today. Which is to say there's certainly some DO's who peddle medicine that is a little on the mystical side and not so evidenced based. Of course, I feel that way about a lot of what MD's do. It is just that manipulating the fused bones of the skull sounds a lot more crazy than we're going to give a compound that we spent 10 years working on in the lab to you but we really don't know what receptors it is effecting. But it beats a placebo by 0.01%. Both magic tricks. But I digress...

So that all said, most DO's do not use manual manipulative techniques anymore. We go through more or less the same basic science and clinical training as MD students, except we get classes in manual manipulative medicine (and we may or may not get a more patient centered, wholistic approach to clinical medicine than MDs, depending on the school). We then go on to do the same residencies as MDs (we can either literally go into MD residencies, or, there is an alternate track for DOs to do DO residencies, which are more or less the same training, often in the same hospitals as MD residencies, except they might encourage you to use your osteopathic techniques). Functionally, outside of family practice, most DOs will be indistinguishable from MDs. They practice the same kind of medicine. Family practice DOs are more apt to maintain and use osteopathic manipulative techniques (especially since they can bill those). And there are also residencies for DOs in Neuromuscular Medicine/Osteopathic Manipulation, and those DOs will then go on to specialize in manual medicine (so they'd functionally be similar to a chiropractor, except they can prescribe medications if need be, and have a better background in clinical medicine). There are some studies that show that DOs are, on average, better listeners and have better bedside manner. Not a big difference, but a statistically significant one. Listening to patients has been drilled into us from day 1 (and, at least at my school, we've been doing patient encounters since the 1st week of school...so we get lots and lots of training in listening and interacting with patients).

I certainly think there is some definite utility to many of the osteopathic techniques (or I wouldn't be in a DO school to begin with). But, when it comes down to day to day practice, most DOs and MDs practice the same kind of medicine. Like I said, there are some institutional/cultural differences, and those are measurable over large enough samples. Between one MD and one DO, it is probably a wash, especially for specialties and sub-specialties. As for a DO vs a DC (the original point here), no offense to the chiropractors, but I'd rather see a DO who specialized in manual manipulative medicine. They've gone through hospital rotations, know all about conventional medicine and they know (or should know) when you should be sent to a hospital or a specialist (as opposed to trying to cure your cancer by popping your back). But I'm sure some MD will jump in and say they get better training than us (although, since we do the same residencies and often have the same lecturers--there's a couple big state schools where the MD and DO classes literally take all the same classes together--except for the osteopathic manipulation classes).

So to answer the question: by and large you can expect a routine office visit with a DO except for an FP or maybe an internist who might be able to do some manual techniques on you (if you want and it is indicated for your condition). Yes, there are some shamany-witch doctor DOs out there. There are some weirdo, woo woo MDs too (anyone from the Andrew Weil lineage, for example--I do believe he actually started a couple residencies now in complementary medicine or something like that). But those folks will often advertise as being non-mainstream or whatnot.

Lastly, you all probably want to know are DOs more or less likely to be open to your crazy Paleo ways? Out of a class of 200+ students, there are a handful of Paleo eating, Crossfitin', Vibram wearing freaks. Maybe 2-3% of the class. So the answer, again, is that your DO is probably going to be just like your MD (which is probably why there is a movement afoot to just combine the 2 and have one degree). Now, back to studying...

6fa48935d439390e223b9a053a62c981

(1676)

on April 01, 2011
at 12:52 AM

This is the most complete answer I have ever seen on paleohacks! And interesting, too. Thanks. +1

E8022f05c250e19a65b92207dd1630ca

(851)

on April 01, 2011
at 01:53 PM

PS- http://www.associatedcontent.com/article/1733660/chiropractic_care_during_1918_influenza.html?cat=68

9f9fa49265e03ddd2bf2bba5477a556b

(3184)

on April 01, 2011
at 08:39 PM

Also, that article is ridiculous. DO's claim improved outcomes during the 1918 pandemic. Not, gee, only 1 patient out 1600 died. That is absurd. Increasing lymphatic flow and respiration is going to help (not cure) a bed ridden influenza patient with a secondary URI. Doing spinal HVLA on that patient will not cure, nor probably even help that patient. Oh wait, that's right, HVLA would actually be contraindicated on a patient with severe influenza and pneumonia.

34a367e60db77270bd7096dc04270fdc

(4171)

on April 01, 2011
at 02:59 AM

Thank you for such a detailed answer, I appreciate the time it must have taken to post all of that & it helped me a lot!

21fd060d0796fdb8a4a990441e08eae7

(24543)

on April 01, 2011
at 05:41 PM

Note that "urine therapy" (drinking your own urine) would have been a better treatment for brain cancer than going to an MD, in the early 1900s. That's because it wouldn't harm you, whereas MD care for brain cancer back then was (I think) no so advanced because of lack of pharma research and basic science knowledge.

21fd060d0796fdb8a4a990441e08eae7

(24543)

on April 01, 2011
at 05:40 PM

That article, originating from "Planet Chiropractic", suffers from so many selection biases it's almost funny. The reason you don't look at cohort data for things like influenza and chiro is that if you're really sick, you may well have chosen an MD over a chiro, and you die under the care of an MD. That is only one of the many logical pitfalls with correlating influenza death with MD care. There are many others, such as a lack of effective treatment in the early 1900's. If they had tamiflu back then, the numbers would be crazy different!

21fd060d0796fdb8a4a990441e08eae7

(24543)

on April 01, 2011
at 01:14 AM

This is really great info, straight from the horse's mouth. Although you really should be studying rather than writing thorough answers!

E8022f05c250e19a65b92207dd1630ca

(851)

on April 01, 2011
at 01:52 PM

Since 95% of the world's spinal adjusting is done by chiropractors, I don't see why you would choose a DO to do something they so rarely do. Your opinions of Chiropractors are misleading, we do not treat cancer or any disease for that matter. We are trained to aid the body function optimally by caring for the human frame and nervous system. We are also skilled in PDx and identifying pathology if other treatments or referrals were needed. The chiropractic profession prides itself on not using medication or surgery to help heal the sick.

9f9fa49265e03ddd2bf2bba5477a556b

(3184)

on April 01, 2011
at 08:24 PM

I don't believe 95% of the spinal adjusting is not done by chiropractors. Internationally trained osteopaths ONLY do manual medicine, unlike their American counterparts. And Chinese medicine docs also do similar techniques. And every DO FP doc I know does some spinal manipulation. But yeah, chiros are more apt to do spinal HVLA than anyone else even when it isn't the best treatment, so maybe you're right. And you are trained to care for the nervous system? So chiros are doing neurology residencies now?

2
77877f762c40637911396daa19b53094

(78467)

on March 31, 2011
at 07:00 PM

A doctor of osteopathy is more similar to an MD than a chiropractor. Both go on to specialize, practice, and obtain hospital priveledges. The things that differentiate a DO is usually an emphasis on holistic medicine, body adjustment, and the fact that DO schools are generally easier to gain admission to. Many DOs never perform adjustments in their practice, but finding one who does can be a godsend, if you're into that sort of thing.

Long story short, most DOs are not distinguishable from MDs.

918ecd2369c4e8cd6a2d66846c20137c

(285)

on March 31, 2011
at 08:24 PM

Alfredo nailed it. DO = MD, with slightly different training. Over the years five of my docs have been DO’s, two of which were excellent - in other words: I find DO’s to be just as hit and miss as MD’s.

1
E8022f05c250e19a65b92207dd1630ca

on March 31, 2011
at 08:32 PM

Great question. As a chiropractor, I can tell you that we are two separate and distinct professions. As others mentioned, DO's are practicing allopathic physicians who have prescribing abilities and are schooled much the same as an MD's. Chiropractors actually have more minimum required classroom hours than MD's and are more educated in terms of lifestyle modifications and trained to search for the cause of dis-ease rather than treating symptoms. What makes chiropractic unique is that we perform more than 95% of spinal adjustments to relieve spinal restrictions and nervous system interference that plague most of our sedentary world. There are several different specializations in the chiropractic profession though, one being more focused on musculo-skeletal symptom relief, and the other is corrective and more wellness oriented. (Note: edited to be less self-promotional. For more information on Dr. Ryan, please see his profile.)

21fd060d0796fdb8a4a990441e08eae7

(24543)

on April 01, 2011
at 03:10 PM

Dr. Ryan- the large majority of chiro studies are uncontrolled. Uncontrolled trials of vegetarian diets also show benefits. That is why comparitive trials are important--you do not know if the treatment works, or if it's just nice getting your back cracked and it spurs you to have healthier habits.

21fd060d0796fdb8a4a990441e08eae7

(24543)

on April 01, 2011
at 12:47 AM

Also, only one of these two professions is substantially affected by the tenets of evidence-based medicine. Hundreds of millions of dollars are spent doing systematic reviews to hone the stats covering different treatments. While chiros are interested in several worthwhile topics, studies have shows that different chiros can't even agree on identifying a spinal subluxation in x-rays. In my opinion, chiros are good to talk to because they keep up on non-adjustment therapies and keep an open mind, as well as spend time with you.

77732bf6bf2b8a360f523ef87c3b7523

(6157)

on April 01, 2011
at 02:34 PM

Kamal: would you say it's misleading to call chiros "doctors"?

21fd060d0796fdb8a4a990441e08eae7

(24543)

on April 01, 2011
at 12:15 AM

This seems misleading to me. Doctors (MDs) spend lots of time during their training (classes, rotations, residency, fellowship) looking for the cause of disease. Whether they pursue similar aims in practice is up to them and their battles with time management and insurance hassles. Allopathic also is an outdated term, in my opinion (my sister is a naturopath). There is no allo- and naturo- in reality...there are only mechanisms of disease. I've seen the "minimum classroom hours thing" many times, and that is also misleading. MDs spend no time reviewing adjustments.

0bc6cbb653cdc5e82400f6da920f11eb

(19245)

on March 31, 2011
at 09:09 PM

"...trained to search for the cause of dis-ease rather than treating symptoms" So regular doctors don't search for the cause of disease then?

21fd060d0796fdb8a4a990441e08eae7

(24543)

on April 01, 2011
at 12:46 AM

Also, only one of these two professions is substantially affected by the tenets of evidence-based medicine. Hundreds of millions of dollars are spent doing systematic reviews to hone the stats covering different treatments. While chiros are interested in several worthwhile topics, studies have shows that different chiros can't even agree on what a spinal subluxation is. In my opinion, chiros are good to talk to because they keep up on non-adjustment therapies.

E8022f05c250e19a65b92207dd1630ca

(851)

on April 01, 2011
at 04:19 PM

@ Jae if you look at chiropractic school websites they will show you the curriculum of their doctorate program. I did 4 years undergraduate studies and 4 years of chiropractic school (year round) to complete my DC. If you want facts I suggest doing some research rather than asking someone who does not have a qualified opinion.

21fd060d0796fdb8a4a990441e08eae7

(24543)

on April 01, 2011
at 05:17 PM

Here is the link to the 2010 Cochrane report...http://www2.cochrane.org/reviews/en/ab005427.html

E8022f05c250e19a65b92207dd1630ca

(851)

on April 01, 2011
at 01:57 PM

Matthew, not all health care professionals are trained to search for the cause of disease. Docs who use meds or surgery to try to correct problems due to the lack of exercise, poor nutrition, or stress are only treating symptoms and not addressing the cause. Chiropractors are not exempt from this either, there are plenty of chiropractors who treat symptoms of poor lifestyle with adjustments.

21fd060d0796fdb8a4a990441e08eae7

(24543)

on April 01, 2011
at 12:18 AM

That being said, I've been to many chiropractors for soft tissue issues. Because chiros know a lot about physical activity and health, they are up on posture, foam rolling, active release, etc. But that is not something that is necessarily from the profession. Physical therapists do similar things, at times, but are more constrained by their working relationship with hospitals and doctors.

E8022f05c250e19a65b92207dd1630ca

(851)

on April 01, 2011
at 04:14 PM

And I gave you references of controlled trials, please take the time to look at them.

21fd060d0796fdb8a4a990441e08eae7

(24543)

on April 01, 2011
at 05:21 PM

And lastly, I do not disagree with you about finding the root of disease rather than throwing pills at it. It's just that the causes of disease seem to lie in the nutrition/toxin area, not in the misaligned-vertabra-throwing-off-nervous-system area. The chiros I've been to know an amazing amount about posture and kinesiology. But the best ones (in my limited experience) have focuses on that, not on disease from poorly aligned vertabra. That's why I would much rather go to a chiro about back pain than my PCP or physiatrist, but not for most other health concerns.

21fd060d0796fdb8a4a990441e08eae7

(24543)

on April 01, 2011
at 05:15 PM

The most comprehensive review of chiro is the latest Cochrane review. There is a small benefit from chiro in the short/medium run, and no benefit in the long run. Chiro was shown to have significantly more side effects than other treatments. Studies had a high risk of bias because of poor methadology. That is the evidence base for chiro. When combining the low evidence base, plus the murky biological plausability, it is something to definitely question. No doubt, chiro works great for certain people, but on a population wide basis, there is not good evidence.

E8022f05c250e19a65b92207dd1630ca

(851)

on April 01, 2011
at 02:05 PM

Kamal, if you're not comfortable with allopathic, then I'll use the term conventional medicine. And as for the classroom thing, there is nothing there that talks about reviewing adjustments. This talks about basic minimum classroom studies for a health care practitioner. Just as chiropractors do not do rounds in hospitals and perform crisis intervention, MD's do not spend clinical hours studying adjustments and chiropractic technique.

21fd060d0796fdb8a4a990441e08eae7

(24543)

on April 01, 2011
at 03:04 PM

Dr. Ryan- By "Evidence Based Medicine", I do not just mean published studies. EBM is the use of systematic reviews and meta-analysis to get pooled estimates of effect size. Chiropractic does not fit the bill. At best, it has shown a modest effect size in uncontrolled studies. Obviously, randomized controlled trials are difficult with such a practice. But most everything else that is physical (e.g. intensive physical therapy) has shown better comparative results. I'm not saying this in any biased way-- I've gone for adjustments and directly compared evidence.

21fd060d0796fdb8a4a990441e08eae7

(24543)

on April 01, 2011
at 03:09 PM

Jae- While I obviously know much less about chiro than Dr. Ryan, I would be hesitent to classify MDs, DOs, and chiros all as doctors. MDs and DOs have very standardized curriculums that are very science-based. Other than temporary back pain benefits, the benefits of adjustment are not well studied enough to make it into a curriculum. So when my uncle and his family use a chiro as their primary care doc, it make me very uncomfortable. Chiros do not know as much about physiology or disease, plain and simple. Scapular stability? Sure! Early signs of multiple myeloma? No.

E8022f05c250e19a65b92207dd1630ca

(851)

on April 01, 2011
at 04:05 PM

Kamal, you contradict yourself by saying that you don't say things in a biased way but then you continue with your unfortunate experience with a chiro. I admit that just like most professions, not all chiro's are great. That does not give you permission to make false statements like "chiros do not know much about physiology". I would say that I know more about physiology than most medical professionals.

77732bf6bf2b8a360f523ef87c3b7523

(6157)

on April 01, 2011
at 06:15 PM

Thanks for your responses, Kamal. I think you and I are on the same page, but you articulated several points better than I could have. @Dr. R: No offense, but I am a little skeptical of asking a chiro to defend his own profession. I don't have anything against individuals who are chiropractors; I've seen one who had quite amazing hands. I couldn't care less whether he had an MD or DC or DPT. But I wouldn't go to him for advice if I had, say, an infection.

21fd060d0796fdb8a4a990441e08eae7

(24543)

on April 01, 2011
at 05:05 PM

Dr. Ryan- You misphrased what I said. I said "Chiros do not know as much about physiology or disease" compared to MDs. From every MD and chiro I've ever talked to, that is true. To take board exams requires quite an array of knowledge, which reinforces what MDs learn from both class and rotations and residency.

21fd060d0796fdb8a4a990441e08eae7

(24543)

on April 01, 2011
at 03:05 PM

Also, the use of adjustments for things other than back pain has very little evidence, comparative to claims that are made about "nervous system benefits".

21fd060d0796fdb8a4a990441e08eae7

(24543)

on April 01, 2011
at 05:12 PM

Also, I am admittedly not an expert at all on chiropractic. I still go to chiropractors, so I obviously have nothing major against it as a profession, and do not harbor ill will from a bad experience. But my day job is analyzing clinical trials in evidence based medicine. From that, I can critically compare evidence for different treatments. The controlled trials you cited do not show chiro is better, for the most part. Several trials have more methadologic concerns than average (e.g. no Bonferonni correction for multiple comparisons, etc).

E8022f05c250e19a65b92207dd1630ca

(851)

on April 01, 2011
at 02:16 PM

You are incorrect again about chiropractic not having evidence based research to support the practice. Here are some studies if you actually want to have a qualified opinion: Spine July 15, 2003;28(14):1490-1502 (effectiveness of chiro), Journal of Manip & Phys Ther Jan 2005, Vol 28, #1 (effectiveness again), Check out the journal of Injury 1996 (93% of chronic whiplash improved with chiro that were failed MD & PT tretments), Journal of Hypertension, 2007 (chiropractic lowers blood pressure), International Tinnitus Jour, 2007 (chiro and Meniere's disease)

21fd060d0796fdb8a4a990441e08eae7

(24543)

on April 01, 2011
at 03:13 PM

Like I went to this really nice and well-qualified chiro, who noted that my shoulders were hypermobile as well as knees, ankles, etc. He proceeded to adjust me. Then I went home and read an peer-reviewed article saying that no-one should ever do adjustments on hypermobile folk (later turned out I had a connective tissue disorder). My back hurt for about a year from that. And even that guy couldn't give a good reason why he could somehow detect subluxations in my spine, when it was not medically apparent.

E8022f05c250e19a65b92207dd1630ca

(851)

on April 01, 2011
at 04:12 PM

Diagnosing a symptom and drugging it or cutting out pathology from someone's body does not make you scientific. It's more scientific in my opinion to find the cause of adaptive physiology (or pathology as the medical profession calls it) and allow the body to function properly. Having high cholesterol for example is an intelligent adaptation by the body to a stressor. Giving someone a drug to artificially lower the cholesterol does not remove the stress and we falsely assume that we improved this person's health. Why not find the cause of the stress and correct it and actually improve health?

21fd060d0796fdb8a4a990441e08eae7

(24543)

on April 01, 2011
at 06:28 PM

Jae- yeah, I think the page that we are collectively on is the "logical page". Active release technique, trigger point release, nutritional advice, and mobility exercises I got from chiro and the internet were miles ahead of anything I heard from a physiatrist and rheumotologist. But until there is evidence for some of the widely-held claims of some chiros, I'll choose to stick to MDs (or DOs) for things other than soft-tissue complaints. I don't think we should comment on the same threads anymore, because our opinions are too similar, and redudancy is inefficient :)

1
6fa48935d439390e223b9a053a62c981

(1676)

on March 31, 2011
at 07:44 PM

A DO is NOT the same as a chiropractor. A DO is the same as an MD.

1
Aead76beb5fc7b762a6b4ddc234f6051

(15239)

on March 31, 2011
at 07:29 PM

i saw a DO for internal medicine when i lived out in oregon and she was great. the only difference i could tell was that she treated my whole self and really listened to my complaints and took them seriously. she even asked about diet and exercise. she wasnt at all dismissive, condescending, paternalistic or rude like so many (read: all) MDs have been with me, but that could be all personality, too.

one of the docs on the floor of our local hospitals pedi inpatient units is a DO- when my daughter had an accident and was there for a few days, she was wonderful. spent a lot of time with us. when we were transferred down to boston to a high-level PICU, she was the only one who called us (US, not the treating docs) to check in. i appreciated that.

there were a few DOs at the hospital where i worked as a med/surg social worker, and they were all really wonderful- to their patients and the rest of the staff. i would see a DO for general medical care again in a heartbeat. it just so happens that i adore my current PCP (an MD) and my primary medical concern requires a neurological specialist.

0
1da74185531d6d4c7182fb9ee417f97f

on March 31, 2011
at 07:27 PM

I find most DO's are more holistic in their approach but there's very little about their formal training that would encourage that so it's still possible to find a very conventional DO.

My advice would be instead of a GP to find a "Family Doctor." They tend to be a lot less drug pushy. In fact my Family doctor who treats my husband, myself and my 4 month old is a MD and is delay/selective vax, WAPF/Paleo encouraging, anti-drug, unless it's an emergency won't prescribe antibiotics, doesn't use any of those hideous hand sanitizers, and even prescribes homeopathic remedies (I don't believe in homeopathy and he knows that but he works well for us on most other fronts.)

I don't know what your insurance is like but most family doctors are open to a phone interview if your insurance won't cover multiple "lets see how this works" visits.

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