Knee pain after chiro appointment?

[ausrandoman]

its not so much about realigning - its about neurology and proprioceptive balance. the "pop" doesnt matter so much - hence why low force chiro still works without the cavitation. each speed of adjustment has a different neurological signature. it just so happens that when you get the pop that signature has been shown to have different effects than without the "pop" (which is just a gas bubble anyway).

(sorry for making it non technical but i figure that would be easier to understand than if i start talking about 1a afferents and brain stem function - which i can if youd prefer)

(when i said the tibia could be rotated - i was using layman speak. its more likely that its neutral zone larger or smaller than normal and its instantaneous axis of rotation is not ideal creating aberrant muscle loading and the resultant pain pattern.)

There are pretty much 2 schools of chiro the old and the new. the old talk about bone out of place and that the bone puts pressure on the nerve and the adjustment restores innate. which was great in the 19th century when they didnt have the understanding we have now. the newer school is concerned more with neurological function and midline stability as controlled through the brainstem and follows more the evidence based practice model.

you are correct - with the exception of ribs, bones dont move out of place to the extent that most people imagine or that some practitioners would have you believe.

i will speak for myself now and say that what i look for is resistance to spring on palpation - if a joint feels "jammed" then there is too much gain in the system and it is not functioning correctly neurologically. the adjustment fires a specific neuron which feeds into the brainstem which effectively acts as a reset switch and restores the natural gain to that the joint can move to the extent it was designed to.

that is an over simplified version but i hope it might help to give you a greater understanding. without writing an essay and using examples it gives you the basic idea but is by no means the complete picture.

sorry for the hijack.

Would you please explain what you mean by "proprioceptive balance." Do you mean that there is some problem with proprioception that causes loss of balance? Do you mean that there is an abnormality in the proprioceptors?

What is the neurological signature? Can you point me to reports of the action potentials recorded by electrodes within the nerve cells?

What is the "neutral zone" of the tibia? Is this related to the engineering useage of "neutral zone", which is the part of a beam at which the strain is zero?

What is the "evidence based practice model"? Can you refer to a Cochrane review?

What is the "gain in the system"? What is the amplifier, what is the input, what is the output?

[drubie]

Quackery plain and simple. They can't show scientific studies that explain how it works because there aren't any. Anecdotes are not science.

[hiflange]

Quackery plain and simple. They can't show scientific studies that explain how it works because there aren't any. Anecdotes are not science.

Anecdotes may not be science but for many sufferers of pain results are proof enough, and as jpgibson pointed out, even placebos produce results. The history of scientific discovery is littered with stories of the science orthodoxy rejecting "outlandish" theories for decades - tectonic plate theory was still considered quackery when my Mum was at Uni!

I'm about as skeptical as they come however I went to a chiro with an open mind in an effort to resolve a major issue with my left knee. I'd suffered with pain behind the knee during my mid teens and was treated with repeated cortisone injections - thank you western medicine! Severe pain returned in my late twenties and was resolved by the chiro without the radical manipulation they have a reputation for. A couple of decades on I still visit the chiro occasionally, still very happy with the treatment I receive there and I hope never to have cortisone again.

[vander]

Quackery plain and simple. They can't show scientific studies that explain how it works because there aren't any. Anecdotes are not science.

Anecdotes may not be science but for many sufferers of pain results are proof enough, and as jpgibson pointed out, even placebos produce results. The history of scientific discovery is littered with stories of the science orthodoxy rejecting "outlandish" theories for decades - tectonic plate theory was still considered quackery when my Mum was at Uni!

I'm about as skeptical as they come however I went to a chiro with an open mind in an effort to resolve a major issue with my left knee. I'd suffered with pain behind the knee during my mid teens and was treated with repeated cortisone injections - thank you western medicine! Severe pain returned in my late twenties and was resolved by the chiro without the radical manipulation they have a reputation for. A couple of decades on I still visit the chiro occasionally, still very happy with the treatment I receive there and I hope never to have cortisone again.

That would be a chiro never actually fix a problem need to keep going back and need to get it 'cracked' or 'adjusted'. Great business model, but lots of them (not all there are some good ones and some circumstances when it works) but most of it is BS.

[winstonw]

I've said it elsewhere on the forum, but here goes again.
I'm a physio, and studied undergrad science with chiro students who had to do a BSc before 2 years graduate Masters program at MacQuarie Uni in Sydney.

Firstly, there were some very bright students amongst them, and their anatomy, physiology, biochem, and microbiology ed was from the same depts that train physios, pharmacists, vets, dentists, doctors. Therefore, my view is Aussie chiros trained here since the mid 1990s, has good biological science training behind them. What happens in their 2 year post grad course I have a little insight into, and understand that overplaying the visceral influence of vertebral manipulation is not a feature anymore.

Secondly, yes there's overservicing BS in all manual therapy professions (physio, chiro, osteo). Physios on the whole overuse therapeutic ultrasound, interferential, massage)...and clients rarely comply with prescribed exercises. Let's face it, many are like Xplora, who think $80 ought to 'fix' things, at least for a few months...which is why many people pay more to see sports masseurs and feel good massage. Nevertheless, most chiros I've met (over 20) are not adept at diagnosing sports injuries. AFAIK, they do not get the biomechanics training for it, unless they do comprehensive post grad study and work in the field for some time. As for osteopaths, I put their undergrad training in the same bag as chiros. However, their scientific objectivity can vary depending on what school they trained at.

Manipulating and mobilizing joints is referred to as manual therapy. Osteos, Chiros, and physios are all free to pursue post grad courses that specialize in this.
Therefore, all are potentially capable of dealing with joint issues time and cost effectively.
The problem is it can take sometimes 5 years of clinical experience before a manual therapist can do their craft really well. Manual techniques require lots of practice and the clinical insight on when to use more/less force. What works for one client may exceed another's pain thresholds, which is what makes working in either of the three professions fraught with risk of being criticized on internet forums!

As for subluxation, physios believe joints can become slightly incongruent, without being anatomically 'dislocated'...this kind of incongruence will not be picked up by Xray. What predisposes to subluxation is usually a combo of joint stiffness/looseness and muscle imbalance (intra or intermuscular length/tension).

Joint manipulation is able to 'free' many stuck joints and get the muscles to relax.
But it won't deal with the underlying causes - joint capsular thickening and shortening, muscle dysfunction.
Subluxation is more likely to occur in joints that are congenitally or pathologically somewhat incongruent or asymmetrical, and in joints that must move more during compound movement (movement requiring multiple joints).

So yes, jt manipulation and mobilization, and massage can be very effective in the short term.
In the long term, posture and exercises are generally essential to prevent recurrence.

The hardest task of manual therapists, is to educate clients out of their medical illiterate dogma, then convince them to take posture and exercise seriously.
Poor posture and diet, and sedentary lifestyle, are the primary causes of joint dysfunction in the general population.

[simonn]

tectonic plate theory was still considered quackery when my Mum was at Uni!

Because there was not enough evidence at that time, perhaps? It is now an accepted theory and a good example of how the scientific method works.

In even more time chiropractors have not come up with anything more than anecdote. Don't get me wrong, it would be pretty awesome if smallpox could be cured by a special massage, but the evidence is simply not there, ergo quackery.

"Do you know what they call alternative medicine that works? Medicine." - Tim Minchin.

[vander]

Solid post their Winston.

100% agree the underlying biomechanical issue is often ignored, too many physios ignore these issues also just treat the symptoms which can work but the big picture issues are sometimes lost.

[ausrandoman]

I've said it elsewhere on the forum, but here goes again.

snipped for brevity

Thanks. That was a clear explanation that helped me (a layman in anatomy) to understand what physios / osteos / chiros do.

My view, like any layman, is severely biased by personal experience. I have been helped quickly and effectively by physios on the few occasions I have seen one. The only chiro I have seen, 25 years ago, was a crank, a fraud and a charalatan.

about three years ago, when a science journalist wrote that the British Chiropractic Association (BCA) promoted "bogus" treatments (e.g. spinal manipulation to cure earache), the organisation responded not by providing evidence of the effectiveness of the treatments they endorsed but by suing him.

[Xplora]

Let's get well away from the "cracking your neck will stop your boner problems" brand of chiro. I'm interested in one thing alone - improved function. Depending on your hobbies and lifestyle, it's easy for some to severely misalign stuff - consider a 20-30 hour a week piano player. Hunched shoulders, sore lower back, bad neck. You just can't get away from it, because piano encourages poor posture at the longer timeframes. Snapping things back into place "reinvigorates" the limbs, and does help your body to start applying horsepower that it could not before, because it hurt. That stiff neck ensures you won't be able to stretch quite as well to the piano. Your joints work one way, and muscles can work against that. I feel that chiro is a reasonable response to "nonnatural" human effort. Joe Friel put it like this, when talking about diet, quite interestingly. I think there is a place for complex carbs because the endurance athlete is doing something that evolution didn't design us for. You weren't designed to ride a bike 12 hours a week. You weren't designed to even run that much. You WERE designed to move sparingly, and for scarce food environments.

Modern life takes us outside our original purpose. That's fine, and ok. We can handle it, but we can handle it "better" with a little help from massage people, chiros, supplements, coffee. If you are interested in performing outside your current abilities, then something like chiro may help you a lot, depending on your situation. If you don't, awesome. Chiro ain't cheap. Just remember that there is not ONE high performer these days that isn't doing something extra, beyond working harder, in any field.

Earaches? WT? Not every chiro is a quack, just as not all bankers are thieves