eMJA Management of chronic low back pain

[Guest guest]

Interesting article. Suggest some of our political people may be able to use this?

M. Thille http://www.mja.com.au/public/issues/180_02_190104/bog10461_fm.html

[Guest guest]

I have heard that Nikolai Bogduk is not a friend

of “mechanical therapy”. This gives me cause to ponder his position.

What body of research does he quote to

make these statements?

(Who did the manipulation, what type was

it, muscle energy, long lever, high velocity, nonspecific by a PT, how often

was it done, for what diagnosis and with what intent)

Why does he quote (in this article) one

meta-analysis so strongly as if it were gold?

He indicates by this articles sole

inclusion that it is a gold standard and supports the position that

manipulation is only slightly more effective than sham therapy.

Anyone have the inside scoop on this

one?

He references (10)

10. Assendelft WJJ, Morton SC, Yu EI, et al. Spinal

manipulative therapy for low back pain. A meta-analysis of effectiveness

relative to other therapies. Ann Intern Med 2003;

138: 871-881.

This states that:

“Spinal manipulative therapy had no statistically or clinically

significant advantage over general practitioner care, analgesics, physical

therapy, exercises, or back school. Results for patients with chronic low back

pain were similar. Radiation of pain, study quality, profession of manipulator,

and use of manipulation alone or in combination with other therapies did not

affect these results. CONCLUSIONS: There is no evidence that spinal

manipulative therapy is superior to other standard treatments for patients with

acute or chronic low back pain.”

Perhaps we as a profession could spend more time trying to help each

other so we have more resources to address those who misdirect and obfuscate in

their own best interest.

It’s just my opinion that professional unity would be beneficial,

but as we have heard before, of course this is all just a business decision.

I lapsed into an editorial Dr. Abrahamson must be rubbing off on

me. Does anyone have insight into what the drivers are that cause Bogduk’s

position relative to manipulation?

Larry Lubcke, DC, DABCO

eMJA

Management of chronic low back pain

Interesting article. Suggest some of

our political people may be able to use this?

M. Thille

http://www.mja.com.au/public/issues/180_02_190104/bog10461_fm.html

OregonDCs

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[Guest guest]

Nik is very dogmatic; he is therapeutic nihilist because he is a scientist rather than a clinician, and figures that no one should get treatment just because it is effective, safe, and people want it, but that it should also be proven in rigorous controlled study. This is one of the reasons his nickname is "Double-blind Nik." He is quite brilliant in his area though, and I have found him personally charming and very interesting to chat with. I don't think his proclamations that all treatment should be stopped until it is proven is taken too seriously.

D Freeman Mailing address: 1165 Union Street NE, Suite 300Salem, Oregon 97301ph 503 586-0127 fax 503 763-3581cell 503 871-0715 drmfreeman@...

eMJA Management of chronic low back pain

Interesting article. Suggest some of our political people may be able to use this?

M. Thille

http://www.mja.com.au/public/issues/180_02_190104/bog10461_fm.html OregonDCs rules:1. Keep correspondence professional; the purpose of the listserve is to foster communication and collegiality. No personal attacks on listserve members will be tolerated.2. Always sign your e-mails with your first and last name.3. The listserve is not secure; your e-mail could end up anywhere. However, it is against the rules of the listserve to copy, print, forward, or otherwise distribute correspondence written by another member without his or her consent, unless all personal identifiers have been removed.

OregonDCs rules:1. Keep correspondence professional; the purpose of the listserve is to foster communication and collegiality. No personal attacks on listserve members will be tolerated.2. Always sign your e-mails with your first and last name.3. The listserve is not secure; your e-mail could end up anywhere. However, it is against the rules of the listserve to copy, print, forward, or otherwise distribute correspondence written by another member without his or her consent, unless all personal identifiers have been removed.

[Guest guest]

I suppose then there is a logical corellary which would demand there be no human complaint allowed (or at least, 'acknowleged') unless or until there is a related therapeutic remedy.....

J. Pedersen DC