Thursday, July 23, 2009

Good Weekend

On a boltbus up to Boston (as a Yankee fan and New Yorker this trip always feels wrong). The mobile blogging is harder with my 1.5 year old treo 755p... need to upgrade to palm pre or switch to iphone (darn at&t for being so expensive - I pay fairly low rates with sprint).
Making this trip to attend a biomechanics course on the foot given by Brian Hoke of 'when the feet hit the ground' fame. It's a 1 day workshop tomorrow. After that I get to catch up with my godson which is long overdue. Hope everyone has a dry weekend - why is it chilly and pouring down rain at the end of July?

Saturday, July 18, 2009


A patient of mine asked about prolotherapy so I did some information gathering. In my blog reader which is actually a useful adjunct to more formal types of literature I found 7 entries dating back to 2007. There was a NYTimes article from 08/07/07 that touted the promises of this intervention. An entry in the CAM report from 01/06/08 had an interesting review/summary of the following article: The Spine Journal, Volume 8, Issue 1, January-February 2008, Pages 203-212 Simon Dagenais, John Mayer, Scott Haldeman and Joanne Borg-Stein.
the authors concluded, it’s not possible to separate the benefits of prolotherapy from the other treatments because “there is no evidence of efficacy for prolotherapy injections alone without cointerventions.”

The best was this youtube video, the part on prolotherapy is towards the end:
Nothing too concrete... so I went to pubmed where there were 59 search results to the term "prolotherapy" including a Cochrane review article from 2007 (highest level of research) that concluded
There is conflicting evidence regarding the efficacy of prolotherapy injections for patients with chronic low-back pain. When used alone, prolotherapy is not an effective treatment for chronic low-back pain. When combined with spinal manipulation, exercise, and other co-interventions, prolotherapy may improve chronic low-back pain and disability. Conclusions are confounded by clinical heterogeneity amongst studies and by the presence of co-interventions.

I doubt I will (within the confines of my practice act) recommend it to others based on the current literature out there but do any of you have any experiences with this form of treatment, please share in the comments and have a nice day, it is gorgeous here in NYC.

Addendum: Platelet-rich plasma injections seem to be the wave of the future here. We are seeing a lot more of them in NY. I am sure there will be posts coming soon on this topic.

Saturday, July 4, 2009

Safety of chiropractic interventions: a systematic review

^^Interesting story to go with the above picture^^

Please note, this is far from an attack on the chiropractic profession. I know and respect a number of chiro's and look forward to the positive interplay between our two professions through my career.

McMaster Plus has a great FREE service called Rehab+ where you can subscribe to topics of interest. The interaction and unique relationship between Physical Therapists and chiropractors is one that appears very often especially in outpatient therapy practices. This systematic review throws out a pretty significant statistic that made me cringe a little when reading it:
The frequency of adverse events varied between 33% and 60.9%, and the frequency of serious adverse events varied between 5 strokes/100,000 manipulations to 1.46 serious adverse events/10,000,000 manipulations and 2.68 deaths/10,000,000 manipulations.

Physical Therapy on the other hand has been shown to be much more cost-effective and safer than many alternatives including chiropractic. One example of this is how much malpractice insurance I receive for the low amount I pay... are you ready for this... $3 million in coverage for about $175.00 a year. Some (if not most) doctors pay 6 figures a year. I wonder how much Chiropractors pay?

Addendum to original post: I also stumbled upon this website:

100th post, what not to do

I came across this picture in Ski magazine discussing injury risk (click on pic for clearer version). I went ahead and added lines to the thighs and highlighted that the foot is compensating by the outside of it lifting off the ground. This picture is what you should not be doing! The magazine was in fact trying to point this out and offers the following solution if you display this increased hip adduction with squatting: Link Here.