Back spasms/sciatica

[NotoriousREV]

The last entry there might need expanding upon there!

Don’t worry, I’ll be sure to keep you updated.

[Rich B]

The difference is that Chiropractic claims to use spinal manipulation to treat a variety of health issues, including asthma, colic, period pains, autism and other stuff, whereas physio will use it when there’s a problem with the spine.

yep, this is still a thread specifically about back issues...

[NotoriousREV]

The difference is that Chiropractic claims to use spinal manipulation to treat a variety of health issues, including asthma, colic, period pains, autism and other stuff, whereas physio will use it when there’s a problem with the spine.

yep, this is still a thread specifically about back issues...

And chiropractors are still quacks.

[Simon]

I'm glad everyone's agreed now.

[NotoriousREV]

Rich should probably go back to his chiropractor to get his period pains sorted

[Rich B]

Rich should probably go back to his chiropractor to get his period pains sorted

When you can’t find the evidence to support your claims, just go for the good old fashioned insult instead!

[NotoriousREV]

Rich should probably go back to his chiropractor to get his period pains sorted

When you can’t find the evidence to support your claims, just go for the good old fashioned insult instead!

You mean like called me a nob twice, and saying I wank off dogs in 2 threads, without having posted a single shred of evidence to support your own argument? Yeah, fuck off

[Rich B]

Rich should probably go back to his chiropractor to get his period pains sorted

When you can’t find the evidence to support your claims, just go for the good old fashioned insult instead!

You mean like called me a nob twice, and saying I wank off dogs in 2 threads, without having posted a single shred of evidence to support your own argument? Yeah, fuck off

You were being a nob though. I’m genuinely interested in seeing the scientific evidence you’ve bleated on about that Chiropractic doesn’t work compared to physio for back pain, but you seem to be back pedalling on it.

[NotoriousREV]

I’ve laid out my argument, I’ve backed up everything I’ve said with sources. I haven’t resorted to childish insults, other than making a joke about period pains, which if you find that offensive you need to grow a pair.

Can I link you to a single study that compares all 3 techniques directly? No, it doesn’t look like anyone has carried out that study, at least that I can find with the minimal effort I’m willing to put in. But given that the studies I have linked to have compared against the same baselines (a control of doing nothing and a placebo of sham manipulation), they are comparable, which is why they design their experiments that way.

And for clarity, yet again, I have never said “doesn’t work”, I have repeatedly said “is less effective than”.

[Explosive Newt]

This is the problem with a lot of medical areas - they are evidence free zones and you rely on ‘expert consensus’ (which, given a lack of evidence is really no better than ‘what some bloke reckons’).

As the medical establishment currently doesn’t know who should take a preventative aspirin every day or the best way to resuscitate someone who is dying of sepsis it’s going to be even harder to find research on stuff like back pain.

Especially if people stand to lose if their treatment turns out to be rubbish.

[Nefarious]

OK, if the game is, "Let's find random papers on NCBI that support our case", here we go:

https://www.ncbi.nlm.nih.gov/pubmed/23026869
Spinal high-velocity low amplitude manipulation in acute nonspecific low back pain: a double-blinded randomized controlled trial in comparison with diclofenac and placebo.
Abstract
STUDY DESIGN: A randomized, double-blinded, placebo-controlled, parallel trial with 3 arms.

OBJECTIVE: To investigate in acute nonspecific low back pain (LBP) the effectiveness of spinal high-velocity low-amplitude (HVLA) manipulation compared with the nonsteroidal anti-inflammatory drug diclofenac and with placebo.

SUMMARY OF BACKGROUND DATA: LBP is an important economical factor in all industrialized countries. Few studies have evaluated the effectiveness of spinal manipulation in comparison to nonsteroidal anti-inflammatory drugs or placebo regarding satisfaction and function of the patient, off-work time, and rescue medication.

METHODS: A total of 101 patients with acute LBP (for <48 hr) were recruited from 5 outpatient practices, exclusion criteria were numerous and strict. The subjects were randomized to 3 groups: (1) spinal manipulation and placebo-diclofenac; (2) sham manipulation and diclofenac; (3) sham manipulation and placebo-diclofenac. Outcomes registered by a second and blinded investigator included self-rated physical disability, function (SF-12), off-work time, and rescue medication between baseline and 12 weeks after randomization.

RESULTS: Thirty-seven subjects received spinal manipulation, 38 diclofenac, and 25 no active treatment. The placebo group with a high number of dropouts for unsustainable pain was closed praecox. Comparing the 2 active arms with the placebo group the intervention groups were significantly superior to the control group. Ninety subjects were analyzed in the collective intention to treat. Comparing the 2 intervention groups, the manipulation group was significantly better than the diclofenac group (Mann-Whitney test: P = 0.0134). No adverse effects or harm was registered.

CONCLUSION: In a subgroup of patients with acute nonspecific LBP, spinal manipulation was significantly better than nonsteroidal anti-inflammatory drug diclofenac and clinically superior to placebo.

https://www.ncbi.nlm.nih.gov/pubmed/23372389
A randomized, controlled trial of osteopathic manipulative treatment for acute low back pain in active duty military personnel.
Abstract
OBJECTIVE: Acute low back pain (ALBP) may limit mobility and impose functional limitations in active duty military personnel. Although some manual therapies have been reported effective for ALBP in military personnel, there have been no published randomized controlled trials (RCTs) of osteopathic manipulative treatment (OMT) in the military. Furthermore, current military ALBP guidelines do not specifically include OMT.

METHODS: This RCT examined the efficacy of OMT in relieving ALBP and improving functioning in military personnel at Fort Lewis, Washington. Sixty-three male and female soldiers ages 18 to 35 were randomly assigned to a group receiving OMT plus usual care or a group receiving usual care only (UCO).

RESULTS: The primary outcome measures were pain on the quadruple visual analog scale, and functioning on the Roland Morris Disability Questionnaire. Outcomes were measured immediately preceding each of four treatment sessions and at four weeks post-trial. Intention to treat analysis found significantly greater post-trial improvement in 'Pain Now' for OMT compared to UCO (P = 0·026). Furthermore, the OMT group reported less 'Pain Now' and 'Pain Typical' at all visits (P = 0·025 and P = 0·020 respectively). Osteopathic manipulative treatment subjects also tended to achieve a clinically meaningful improvement from baseline on 'Pain at Best' sooner than the UCO subjects. With similar baseline expectations, OMT subjects reported significantly greater satisfaction with treatment and overall self-reported improvement (P<0·01).

CONCLUSION: This study supports the effectiveness of OMT in reducing ALBP pain in active duty military personnel.

https://www.ncbi.nlm.nih.gov/pubmed/15556955
United Kingdom back pain exercise and manipulation (UK BEAM) randomised trial: effectiveness of physical treatments for back pain in primary care.
Abstract
OBJECTIVE: To estimate the effect of adding exercise classes, spinal manipulation delivered in NHS or private premises, or manipulation followed by exercise to "best care" in general practice for patients consulting with back pain. [See figure].

DESIGN: Pragmatic randomised trial with factorial design.

SETTING: 181 general practices in Medical Research Council General Practice Research Framework; 63 community settings around 14 centres across the United Kingdom.

PARTICIPANTS: 1334 patients consulting their general practices about low back pain.

MAIN OUTCOME MEASURES: Scores on the Roland Morris disability questionnaire at three and 12 months, adjusted for centre and baseline scores.

RESULTS: All groups improved over time. Exercise improved mean disability questionnaire scores at three months by 1.4 (95% confidence interval 0.6 to 2.1) more than "best care." For manipulation the additional improvement was 1.6 (0.8 to 2.3) at three months and 1.0 (0.2 to 1.8) at 12 months. For manipulation followed by exercise the additional improvement was 1.9 (1.2 to 2.6) at three months and 1.3 (0.5 to 2.1) at 12 months. No significant differences in outcome occurred between manipulation in NHS premises and in private premises. No serious adverse events occurred.

CONCLUSIONS: Relative to "best care" in general practice, manipulation followed by exercise achieved a moderate benefit at three months and a small benefit at 12 months; spinal manipulation achieved a small to moderate benefit at three months and a small benefit at 12 months; and exercise achieved a small benefit at three months but not 12 months.

https://www.ncbi.nlm.nih.gov/pubmed/25175885
Osteopathic manipulative treatment for nonspecific low back pain: a systematic review and meta-analysis
Abstract
BACKGROUND: Nonspecific back pain is common, disabling, and costly. Therefore, we assessed effectiveness of osteopathic manipulative treatment (OMT) in the management of nonspecific low back pain (LBP) regarding pain and functional status.

METHODS: A systematic literature search unrestricted by language was performed in October 2013 in electronic and ongoing trials databases. Searches of reference lists and personal communications identified additional studies. Only randomized clinical trials were included; specific back pain or single treatment techniques studies were excluded. Outcomes were pain and functional status. Studies were independently reviewed using a standardized form. The mean difference (MD) or standard mean difference (SMD) with 95% confidence intervals (CIs) and overall effect size were calculated at 3 months posttreatment. GRADE was used to assess quality of evidence.

RESULTS: We identified 307 studies. Thirty-one were evaluated and 16 excluded. Of the 15 studies reviewed, 10 investigated effectiveness of OMT for nonspecific LBP, 3 effect of OMT for LBP in pregnant women, and 2 effect of OMT for LBP in postpartum women. Twelve had a low risk of bias. Moderate-quality evidence suggested OMT had a significant effect on pain relief (MD, -12.91; 95% CI, -20.00 to -5.82) and functional status (SMD, -0.36; 95% CI, -0.58 to -0.14) in acute and chronic nonspecific LBP. In chronic nonspecific LBP, moderate-quality evidence suggested a significant difference in favour of OMT regarding pain (MD, -14.93; 95% CI, -25.18 to -4.68) and functional status (SMD, -0.32; 95% CI, -0.58 to -0.07). For nonspecific LBP in pregnancy, low-quality evidence suggested a significant difference in favour of OMT for pain (MD, -23.01; 95% CI, -44.13 to -1.88) and functional status (SMD, -0.80; 95% CI, -1.36 to -0.23), whereas moderate-quality evidence suggested a significant difference in favour of OMT for pain (MD, -41.85; 95% CI, -49.43 to -34.27) and functional status (SMD, -1.78; 95% CI, -2.21 to -1.35) in nonspecific LBP postpartum.

CONCLUSION: Clinically relevant effects of OMT were found for reducing pain and improving functional status in patients with acute and chronic nonspecific LBP and for LBP in pregnant and postpartum women at 3 months posttreatment. However, larger, high-quality randomized controlled trials with robust comparison groups are recommended.

I could go on, but TBH, this cut and paste game is boring.

Can we settle on the fact that chiropractors are quacks, but there is still significant medical debate over Oesteopathy?

[Rich B]

And for clarity, yet again, I have never said “doesn’t work”, I have repeatedly said “is less effective than”.

Quackery. You need a physiotherapist.

it doesn't really work at all.

Far from it. Just amazed at people who are normally rational and logical being suckered into the alternative therapies nonsense.

[NotoriousREV]

https://journals.plos.org/plosone/artic ... ne.0178621

Exercise Therapy

Strength of evidence: On the basis of medium to large summary effects sizes from high quality reviews, and clinical guidelines, the strength of evidence for the effectiveness of exercise therapy for pain, function, and quality of life for patients with musculoskeletal pain, was graded as strong.

Bottom line: Current evidence shows significant positive effects in favour of exercise on pain, function, quality of life and work related outcomes in the short and long-term for all the musculoskeletal pain presentations (compared to no exercise or other control) but the evidence regarding optimal content or delivery of exercise in each case is inconclusive.

Manual Therapy

Strength of evidence: Despite several high quality reviews examining the effects of manual therapy on pain and function for neck, shoulder and back pain, current evidence generally shows small summary effect sizes or concludes no clinical effectiveness of manual therapy compared to sham or other active treatments. Overall strength of evidence was graded as limited.

Bottom line: Current evidence regarding manual therapy is beset by heterogeneity across clinical trials. Due to paucity of high quality evidence, it is uncertain if the efficacy of manual therapy might be different for different patient subgroups or influenced by the type and experience of professional delivering the therapy. On the whole, available evidence suggests that manual therapy may offer some beneficial effect on pain and function but it may not be superior to other non-pharmacological treatments (e.g. exercise) for patients with acute or chronic musculoskeletal pain.

[NotoriousREV]

Can we settle on the fact that chiropractors are quacks, but there is still significant medical debate over Oesteopathy?

100% with you on chiropractors. If there’s significant medical debate over osteopathy but not over physiotherapy, what does that suggest? After all, osteopathy is still considered (even by the majority of its practitioners) as Complementary/Alternative. Why is that?

[Nefarious]

After all, osteopathy is still considered (even by the majority of its practitioners) as Complementary/Alternative. Why is that?

Perhaps because it doesn't involve lots of expensive drugs, and so large pharma companies have little incentive to go through the trials and lobbying processes to get it recognised as such?

I'm broadly with you on "herbal" medicine, but there are effective drugs out there that are classed as "herbal" simply because of the commercial interests of pharma companies (non-synthesised melatonin, for example).

[McSwede]

From the age of 13 to approx 40 I continued to suffer frequent episodes of back problems. The doctor prescribed physio & heat treatment which did SFA for the pain and immobility in my back/neck. My parents ended up taking me to an osteopath who sorted me out and restored my mobility. Over the following years every time my back/neck "went" I sought out the help of an osteopath who would fix me over one or more treatments. I have gone in struggling to move and in pain then come out after one session of manipulations like a different person, free of restrictions and pain. I would and do recommend them to people with back issues.

I have been fortunate enough to not need the services of an osteopath for a few years now and this is due to a Physio For as much as osteopaths have fixed me when I have been broken, not one of them has done anything for my continued well being. I forget for the life of me why I ended up at the physio but they offered me advice regarding certain exercise for building up muscles in my back which could prevent the issues I had suffered over many years. Since following their advice I have yet to suffer a single event of any kind.

Osteopaths were superb at fixing me when broken but a physio made me not need one again for quite sometime.

[nuttinnew]

I blame the weather for the way this thread has gone.

[Ascender]

Sciatica is the devil's work and the pain that comes with it is utterly unpleasant in a way that no other pain I've experienced seems to be. Very hard to describe it though.

[Marv]

Sciatica is the devil's work and the pain that comes with it is utterly unpleasant in a way that no other pain I've experienced seems to be. Very hard to describe it though.

Who would be able to describe the pain better, an osteopath or a physiotherapist?

[Mike1215]

I blame the weather for the way this thread has gone.

Back to square one...