Great response Chris. In this statement, I believe it is vital that we must differentiate that we are not replacing the primary care physician (the chiros have taken this route http://www.sciencebasedmedicine.org/index.php/chi... ). We simply need to identify ourselves to the public that we are the practitioner of choice for direct consultation for suspected neuromusculoskeletal conditions. We need to deliver a direct message to the public identifying us as more than an ancillary interventialist. Research has indicated that we do a good job of medical screening, recognizing a musculoskeletal diagnosis and treating that condition in a reasonable amount of time. We simply need to have a push to spread the word. I hope that #solvept will be a start for this movement.

My concern is that a medical professional has provided an intervention on national television TWICE without any mention of a formal examination or assessment. I am not sure what the standards of practice are before one performs an adjustment, but I do know that physical therapists are expected to perform an examination and assessment, rule out red flags, etc. before we perform a thrust (if necessary). The same procedure before a medical doctor prescribes a medication. I am not aware, but did this chiropractor perform within the normative standards of chiropractic practice?

JS,
Please watch the video and tell me the timeframe at which he said he said this. I would slam an MD the same way if he gave a patient medications on the air without at least acknowledging they were formally assessed. I would slam a PT the same way if they performed mobilizations, a thrust or any potentially harmful interventions without assessment. This intervention was provided without any support.

Ed,
The video is linked in this thread...The patient was selected out of the audience and there was no mention of examination by Oz or the chiro. This was not stated anywhere in this video, or a prior tv appearance by the duo a month earlier in which they presented in the same fashion. You can watch on my site: www.forwardthinkingpt.com If you still believe that there was a mention of examination or assessment, please let me know and I will stand corrected.

John,
I also posted this garbage on my page ( http://forwardthinkingpt.com/2012/04/13/dr-oz-is-... ) There are actually 2 different videos in which the all and powerful "Oz" and this chiro perform adjustments without any formal examination or assessment. I find this quite alarming and quite negligent (especially in an individual with self reports of a history of back pain). On my website, I made the comment that what if Dr. Oz gave this individual prescribed medications without any formal exam or assessment. Would the AMA condone this behavior? Would this be safe? At minimum, there are red flags which must be screened before a manip is performed.

This chiro also makes the statement, "Chiropractic looks for the root of the problem." I personally did not see him looking at anything prior to providing this intervention. I believe a formal retraction by Oz is appropriate and the ACA needs to have a talk with this chiro who is publicly manipulating without assessment (Im coining this as MWA) on national television.

Jay,
Why do some patients continue to have pain following a total knee or hip replacement? The joint has been cut out and replaced...and the metal/plastic prosthesis has no neural innervation. There was an article in the Journal of Pain last year that examined this. The authors found that expectations of pain relief and pain catastrophic thoughts pre-surgically predicted 1-year post surgical outcomes. So, I would argue that if the patient "thinks" the surgery will be effective, it will be effective. If the patient has doubt or has psychological variables such as pain catastrophizing, kinesiophobia, etc. they are more prone to having prolonged symptoms. I do not disagree that osteoarthritis is a contributory variable. I do disagree that it is the only variable that needs to be treated. And it appears that most surgeons only focus on one variable.

Nice follow up, John. As a profession, I think it's important that we critically re-examine what we know to be true, what we think to be true, and what we wish was true. Unfortunately, some of the techniques we were taught have been invalidated. We may wish they were still truths, because we spent alot of time (and money) trying to learn and perfect them, but sometimes we must just let go. I can understand hesitancy and resistance, but when an overwhelming amount of well-designed studies tell us something, we cannot ignore it.

I see alot of debate occuring in two major PT realms: Manual Therapy (the biomechanics vs. neurophysiology debate) and Education (the biomedical vs. biopsychosocial model debate). In this, we must understand that our brain is wired to disagree when presented with two sets of conflicting information. This is a natural response and the job of the anterior cingulate cortex, but we must all continue to work hard to attempt understand these new concepts because they will ultimately result in better practice patterns for our patients.

Maybe you could get some tips on how to respond to the phone calls from Jim Florentine: http://www.youtube.com/watch?v=2dy9lUJJGqI

We look at what we do know to be true and restructure what we do to be evidence-based...Despite having alot of things which have little to no evidence to support, we have alot of things that have significant evidence to support...We simply quit "beating around the bush", accept our limitations, and this will strengthen our overall practice...
We don't need alot of "tricks" to be effective clinicians...

Myths:
1. Abnormal biomechanics = pain
2. Bad weather = pain
3. We can reliably differentiate which type of tissue is causing our patients pain
4. We can reliably (inter-) determine endfeels and hyper/hypo-mobility
5. Ultrasound does anything
6. Cold laser does anything
7. We can isolate segments with grade 5 thrust manipulations
8. We can reliably determine vertebral rotations or an abnormally positioned SIJ through palpation and movement testing
9. The VBI test tells us reliable information about the vertebral artery
10. No pain, no gain