#51  
Old 06-15-2017, 05:45 PM
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Originally Posted by Siiimmons View Post
Its therapeutic exercise or something else then. Not PT.
Was trying to paint a simple picture of what we do. Could have said physiotherapy, therapeutic modalities, therapeutic exercises, etc. Most chiropractors receive a board certification in Physiotherapy (and many states require that) along with additional certifications down the road.
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  #52  
Old 06-15-2017, 06:39 PM
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Originally Posted by ToddL View Post
Yet your website says you treat children's ear infections, ADD, and bedwetting, among others, with chiropractic treatments. If you're not evidence based in that portion of your practice, it makes me skeptical about the simple "PT-esque" treatments.
Thought we rewrote all the pages but must have missed a few. You should see what these pre-built websites say with all the default text! I actually started this thread for the free website audit so let me know if you find anything else weird on there!

"Chiropractic care" encompasses nutrition and lifestyle changes in the eyes of the content management/marketing companies so there's a grey area to a lot of claims as far as marketing goes. This has actually been a pretty interesting controversy over in Europe, I think in England specifically but I'd have to look it up, about what can and can't be claimed as far as marketing and advertising goes.

Anyway, here's where a lot of pediatric chiropractic research gets pulled from. It's mostly case studies because there aren't enough big corporations to fund chiropractic research and not enough chiropractors (cash practices) use outcome measures consistently enough to gather a large pool of data. Maybe the upcoming insurance changes and Meaningful Use will help to change that. I'm not generally a fan of relying on case studies for evidence because of the bias implied, but for now we have to balance the limited available evidence with patient preference and personal experience. Some of the conditions have biological or neurological processes that are more plausible to be influenced. Research studies generally begin with biologic plausibility (is there a mechanism to effect and can we effect it) and progress towards human trials from there. To briefly respond to the three you picked,

Ear infections - Children's Eustachian tubes are smaller and more horizontal because their heads have not developed and elongated yet. If you can improve drainage and emptying of fluid in the ears, you could theoretically improve the symptoms or prevent ear infections from happening. Say a child has Torticollis from birth trauma, they're SCM will be spasmed and the lymphatic chain underneath the SCM may be impeded. Address the musculoskeletal factors and see if anything else improves with it.Ear infections have some decent research but again no overwhelming evidence to say this is the first treatment option. We refer to the child's pediatrician for anything that fits the qualifications for need to seek interventions such as antibiotics or ear tubes.

ADD & Bedwetting are both thought to be influenced by an imbalance of the parasympathetic and sympathetic nervous systems. Medications for both are focused on stimulating or slowing down neurological/neurotransmitter activity. Research has shown that spinal adjustments can influence neurotransmitter production and result in pain relief, changes in soft tissue function, immune production, substance P and cytokine production etc. so the big question is if an adjustment also stimulates other neurological processes to result in a change. That can't be said definitively one way or the other yet, but hopefully more research is done on these topics. Especially since Osteopathic Medicine and Physical Therapists are starting to provide more manual therapy and spinal manipulation services!

I wouldn't seek out trying to treat these conditions specifically, but if a child had headaches or neck pain and also happened to have ADD, it'd be interesting to see if it improved at all after the headaches and neck pain were resolved. Health insurance companies pay for children's chiropractic care for musculoskeletal complaints so there's enough efficacy and risk/reward there for them to decide it's worth paying for.

Does that help at all or did I just muddy the waters even more?
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Old 06-15-2017, 06:59 PM
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Originally Posted by sidewinder22 View Post
Not really clinical evidence, but personal experience with a similar issue. Years ago I was having pain in the piriformis area and ended up taking six months off to help heal it, felt great starting back up and within two weeks back started having the same pain happen again. I figured it can't be from overuse and after self-analyzing I found that two related things were causing the pain, one was keeping the head down which lead to the other thing trying to push off the back leg too late through the brace and jamming things up. After I got my head up dynamically balanced and stacked and started getting back off my rear leg before bracing on the front leg again, it was like a miracle and instant relief. This is why I hate the advice of "keep your head down".
Did you notice any improvement in your play along with relief of symptoms? Or any other related symptom relief as your form improved? Less elbow/shoulder/back pain as well? I'm always curious on people's personal experience with their form impacting their play vs form impacting injuries.
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Old 06-15-2017, 07:03 PM
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My major issue would be not figuring out exactly how to keep the front knee bent through out the process. My right leg would stay straight and my right knee will lock straight at the hit and follow through. Had a doctor look at it and he was surprised I had no knee problems. Since the issues started with my piriformis there are times where my plant foot hardly turns at all. After looking at older videos of myself I never had that issue. I'm thinking that when this injury surfaced I started to shift my weight too far forward so that the pain from bracing fully would go away. Either way now my timing and bracing is a mess. When I go back to old habits I can throw well, but the pain and numbness is too much to bare so I compensate therefore my game suffers.
Pain and numbness is a big enough reason to seek some sort of intervention! Couldn't hurt to video tape a couple of throws of your new habits vs your old habits and have the guys in form/technique check it out. I think there's a lot of overlap between throwing form and injuries, with follow through being one of the most important to prevent repetitive stress injuries.
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  #55  
Old 06-15-2017, 07:06 PM
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I believe the proper place here for this thread would be under 'Ask me anything' in the 'water cooler'
My bad, I'll stop responding to this thread and start up another one over there at some point.
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  #56  
Old 06-15-2017, 08:09 PM
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Siiimmons Siiimmons is offline
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Originally Posted by Doctor Disc Golf View Post

Does that help at all or did I just muddy the waters even more?
The research presented is laughable. There is MUCH more research that shows that manipulations are good for acute back pain, and thats about it. Please stop sharing this information, and stop billing for it. Unnecessary treatments you provide for these other issues are the opposite of evidence based, and are a burden on the healthcare system.

I dont know why anyone would take medical advice from somene who uses this "research" to manipulate for thise pediatric conditions.

Please dont take advice from chiropractors. They are salesmen first and "healthcare professionals" second.

Even this post is a marketing tool first, and offering help second.
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Old 06-15-2017, 10:58 PM
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Originally Posted by Siiimmons View Post
The research presented is laughable. There is MUCH more research that shows that manipulations are good for acute back pain, and thats about it. Please stop sharing this information, and stop billing for it. Unnecessary treatments you provide for these other issues are the opposite of evidence based, and are a burden on the healthcare system.

I dont know why anyone would take medical advice from somene who uses this "research" to manipulate for thise pediatric conditions.

Please dont take advice from chiropractors. They are salesmen first and "healthcare professionals" second.

Even this post is a marketing tool first, and offering help second.
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Originally Posted by Doctor Disc Golf View Post
I wouldn't seek out trying to treat these conditions specifically.....Health insurance companies pay for children's chiropractic care for musculoskeletal complaints
I apologize for the misunderstanding. I stated that I wouldn't seek to treat those conditions and instead treat the muscoluskeletal complaints that kids come in with. Research for back pain is great, I was just trying to explain where some of the other claims come from (pretty limited research for a lot of other conditions). Funny thing about health insurance companies is that they are actually pushing harder for chiropractic utilization than anyone else right now! Optum released some data a few years back showing the cost-effectiveness of different providers and the treatment pathways resulting from the initial visit. "Data from OptumHealth indicate that a more efficient treatment path typically begins with a patient consulting a chiropractor. This path tends to lead to interventions that are more closely aligned with recommended treatment guidelines and ultimately more favorable solutions at more reasonable costs." New FDA guidelines also suggest to use chiropractic (and acupuncture believe it or not) to reduce the use of Opioids and amount of drug interaction adverse events. Anyway, the previous post was supposed to read as:

1) Research is very limited and there are almost no high quality randomized controlled trials. This is due to many factors such as limited corporate money, difficulty in designing studies with placebo/sham treatments, and the difficulty in organizing outcome measures for many small clinics that all operate as separate businesses. Hopefully Meaningful Use and insurance reimbursement changes help gather more data surrounding outcome measures etc. Research studies involving children are usually retrospective and limited anyway due to the ethics and morals surrounding child studies.

2) Research usually follows the path 1) determine a biological mechanism and develop a treatment/medication to influence that mechanism. 2) progress to animal trials then human trials etc. Here's a semi-plausible biological mechanism for which treatment could be effective, and that's where some people will make claims beyond the current research. I was more-so trying to pose a question or explain where some of the claims come from. If a spinal adjustment can affect parasympathetic or sympathetic activity, can that cause a cholinergic or anti-cholinergic response in a synapse to influence neurological activity? Marketing people will take that and run with it and make claims surrounding any parasympathetic or sympathetic activity in the body, which turns out to be a pretty wide set of conditions. Many of the medications aimed at certain conditions like bedwetting work through an anti-cholinergic effect. That's where some of those claims come from but there hasn't been enough research to back up a lot of those claims. That's why any marketing materials you see will say something like "MAY improve", and that was part of the marketing legal issues over in Europe. Interesting stuff!

3) I stated that I wouldn't seek to treat those conditions specifically. Treat the musculoskeletal issues and if anything else resolves, great! Take asthma/respiratory issues for example. Those claims above would say the adjustment stimulated a sympathetic response and helped the lungs dilate etc etc. (School nurses learn thoracic percussion to help kids during asthma attacks so there might be something there) That may or may not have an influence, but I would say that mobilizing the thoracic spine, ribs, and accessory breathing muscles allows the rib cage to open up more and allow for easier breathing, which will probably give some relief to asthma symptoms in effect. I wasn't trying to treat asthma, I was treating the back pain and rib pain that someone with asthma came in with. If we get symptom relief in another condition, that's just a bonus. Is that fair? Does that make sense? I'm not trying to say we can treat everything and I would never go outside my scope of practice and tell anyone not to take medications etc.

This isn't a marketing post. We aren't going to profit in any way from this post. We just want to provide people with helpful materials to prevent injury in a sport we all love to play. "More than 81% of respondents stated that they had sustained an injury playing disc golf" with about 1 in 8 needing surgery. If some of those could be prevented, I think that would be pretty great! If you'd like to help someone profit from disc golf workouts and exercise, check out Disc Golf Strong. The only video of his I've watched about mobility vs stability in certain joints was pretty good! Watching the rest of them is definitely on my to-do list.

Anyway, I came on here to see what people would find interesting and useful, not to start a big debate, so I think it's time to let this thread die. Someone suggested I set something up in another forum so I'll post again once we have some disc golf content to share with everyone. Good luck out on the course!

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  #58  
Old 06-16-2017, 12:51 AM
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Originally Posted by Doctor Disc Golf View Post
I apologize for the misunderstanding. I stated that I wouldn't seek to treat those conditions and instead treat the muscoluskeletal complaints that kids come in with. Research for back pain is great, I was just trying to explain where some of the other claims come from (pretty limited research for a lot of other conditions). Funny thing about health insurance companies is that they are actually pushing harder for chiropractic utilization than anyone else right now! Optum released some data a few years back showing the cost-effectiveness of different providers and the treatment pathways resulting from the initial visit. "Data from OptumHealth indicate that a more efficient treatment path typically begins with a patient consulting a chiropractor. This path tends to lead to interventions that are more closely aligned with recommended treatment guidelines and ultimately more favorable solutions at more reasonable costs." New FDA guidelines also suggest to use chiropractic (and acupuncture believe it or not) to reduce the use of Opioids and amount of drug interaction adverse events. Anyway, the previous post was supposed to read as:

1) Research is very limited and there are almost no high quality randomized controlled trials. This is due to many factors such as limited corporate money, difficulty in designing studies with placebo/sham treatments, and the difficulty in organizing outcome measures for many small clinics that all operate as separate businesses. Hopefully Meaningful Use and insurance reimbursement changes help gather more data surrounding outcome measures etc. Research studies involving children are usually retrospective and limited anyway due to the ethics and morals surrounding child studies.

2) Research usually follows the path 1) determine a biological mechanism and develop a treatment/medication to influence that mechanism. 2) progress to animal trials then human trials etc. Here's a semi-plausible biological mechanism for which treatment could be effective, and that's where some people will make claims beyond the current research. I was more-so trying to pose a question or explain where some of the claims come from. If a spinal adjustment can affect parasympathetic or sympathetic activity, can that cause a cholinergic or anti-cholinergic response in a synapse to influence neurological activity? Marketing people will take that and run with it and make claims surrounding any parasympathetic or sympathetic activity in the body, which turns out to be a pretty wide set of conditions. Many of the medications aimed at certain conditions like bedwetting work through an anti-cholinergic effect. That's where some of those claims come from but there hasn't been enough research to back up a lot of those claims. That's why any marketing materials you see will say something like "MAY improve", and that was part of the marketing legal issues over in Europe. Interesting stuff!

3) I stated that I wouldn't seek to treat those conditions specifically. Treat the musculoskeletal issues and if anything else resolves, great! Take asthma/respiratory issues for example. Those claims above would say the adjustment stimulated a sympathetic response and helped the lungs dilate etc etc. (School nurses learn thoracic percussion to help kids during asthma attacks so there might be something there) That may or may not have an influence, but I would say that mobilizing the thoracic spine, ribs, and accessory breathing muscles allows the rib cage to open up more and allow for easier breathing, which will probably give some relief to asthma symptoms in effect. I wasn't trying to treat asthma, I was treating the back pain and rib pain that someone with asthma came in with. If we get symptom relief in another condition, that's just a bonus. Is that fair? Does that make sense? I'm not trying to say we can treat everything and I would never go outside my scope of practice and tell anyone not to take medications etc.

This isn't a marketing post. We aren't going to profit in any way from this post. We just want to provide people with helpful materials to prevent injury in a sport we all love to play. "More than 81% of respondents stated that they had sustained an injury playing disc golf" with about 1 in 8 needing surgery. If some of those could be prevented, I think that would be pretty great! If you'd like to help someone profit from disc golf workouts and exercise, check out Disc Golf Strong. The only video of his I've watched about mobility vs stability in certain joints was pretty good! Watching the rest of them is definitely on my to-do list.

Anyway, I came on here to see what people would find interesting and useful, not to start a big debate, so I think it's time to let this thread die. Someone suggested I set something up in another forum so I'll post again once we have some disc golf content to share with everyone. Good luck out on the course!
This is going too far off topic, so I will continue to respond via PM. However,asthma is an obstructive disease process, not restrictive. This means that working on the rib cage and spine to open up the thoracic cavity will not change the fact that the person with asthma has an issue with the airways, not the amount of expansion. In addition, quick research shows that manual therapy (aka chiropractic's go-to), does not change pulmonary function testing. In fact, children with asthma are more apt to be hypermobile in these segments. Why mobilize something that is more likely to be hypermobile?

This guy can continue to use words like sympathetic and cholinergic to sound smart, but this is all baseline medical stuff and doesnt have a lot to do with disc golf injuries asked about in this topic. But it looks really good on the pamphlet in the lobby.

To keep it on track, if you have a disc golf injury and go to someone and need to stay for longer than 6-8 weeks (unless you are post-surgery), find someone else. They just need your money and are just treating the symptoms rather than the pathology.

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  #59  
Old 06-16-2017, 04:07 AM
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"1) Research is very limited and there are almost no high quality randomized controlled trials."

I'd just like to point out that there are RCT studies in the literature and they are not flattering toward the field of chiro. I understand why OP would not want to discuss them, and likely genuinely believes them to be faulty in some way.

I've got parents who spend so much money on treatments that have been shown to be as effective as taking an NSAID per day. If/when the research actually does come in favorably, I'm happy to change my mind. Until then, I don't want to see so much money wasted on inefficient remedy.

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  #60  
Old 06-16-2017, 07:01 AM
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Stuff I've observed in 3 years playing PDGA tournaments:

1) Alot of injuries due to play being allowed on slippery tees, grass, etc. I've seen people slip, fall, sprain ankles, torque knees, etc, etc. This game is simply dangerous on slippery footing.

2) So many people have a sticky foot when they plant. Rotate on either heel or toe, but people...you gotta rotate that foot otherwise your knee WILL eventually have problems.

3) Tennis, golf elbow, etc. Can vastly be improved by just following through with your throw. The idea of "stopping your arm or hand" like you snap a towel is a recipe for long term problems. Even Ricky's statue of liberty follow through looks like it could cause problems as he ages.

4) And yes...so many peeps don't stretch before or after they play. I used to be one of them. And my knees and arms have paid the price.
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