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I recently attended an info session at a local chiropractor office with my wife who is having some back and neck pains.

Long story short, I didn't have many expectations coming into that session, except to gather additional info, because this is my first time dealing with chiropractors but I came out of that session feeling like I just attended one of those Primerica seminars. This particular chiropractor was quite aggressive in soliciting business and while I have no doubt he knows what he is doing at the professional level, his approach certainly didn't leave me a good impression for folks in this field.

I just think that when your health-care providers worry more about the bottom line than the patients' well-being then it is a really sad world we are living in. I have done further research and advised my wife to see a physiotherapist instead which is more beneficial, IMO, from both a medical and financial perspective. The insurance coverage for physio is also better than chiro, for us anyway. Ultimately, my wife will have to make her own decision where she wants to go and what she wants to do but this experience really opens my own eyes.

Any idea why chiros need to *hustle* that bad? if you pardon my choice of word.
 

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I think it depends on the chiropractor. My stepdaughter went to one who also was aggressive and money-oriented (in order to have her treated, we had to provide a series of post-dated cheques in advance for six months of visits, we couldn't pay after each visit), but I have a friend who's a chiropractor and she's not that way at all.
 

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i'm a huge fan of the specialized physiotherapists who practice manual therapy, who treat muscle & joint disorders, and who are classed as orthopaedic specialists. Frequently the clinics where they practice focus on sports injuries, fresh fractures & sprains, all kinds of bad backs & necks, someting as small as a sprained thumb, and so on. In my experience these physios are expert in teaching highly specialized exercises, the like of which a patient could never learn in a gym. The patient will be expected to practice these exercises daily at home, followed by ice treatments at home.

again in my experience, the goal of these physios is to rehabilitate the patient ASAP, as opposed to chiros who are said to be looking for a repeat patient who will pay them forever. Especially with the sports physios, the objective is always to get the patient as close to full recovery as quickly as possible. In the very early stages of a fresh injury, the physio will do no more than minimally vibrate the afflicted zone in order to restore circulation, which in turn will promote healing. What the patient might perceive as a tiny barelyi-noticeable vibration, though, is the physio concentrating on certain muscles and tissues that she knows, from her studies in anatomy & physiology, to be crucial in repairing the injured joint or bone.

one has to question a physio clinic office manager in advance in order to learn the philosophy of the clinic. I for one would never go to a physio who puts her patients on machines, which is what the majority still do, unfortunately

in searching for these specialized physios, it's an excellent idea to first find out which clinic in your city is treating the prominent athletic teams and the national dance schools. Here you will find the greatest number of skilled joint injury/manual practice physios. My own experience has been fabulous. In the first instance my physio had led the physio team for the canadian national olympic ski team through no less than 4 olympic games. My most recent is an extraordinary young woman who is physio to both the national ski team & the national track & field team. She's out of town 2 weeks out of 4, training with the teams, so she's heavily booked up. The amazing thing is that these gifted & exceptional physiotherapists charge the standard rate, there's no surcharge for their genius.

turning back to chiropractors, i believe that there are documented cases where they have caused injury. A herniated disk should not be treated by chiropractic, for example. Spinal cord disorders in particular should be diagnosed by expert MDs first - orthopedic surgeons & neurologists - and should next present themselves to one of the aforementoned orthopaedic physiotherapists. As a longtime fan of sports physios, this is past being just an opinion. Like it's more my religion.
 

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+1 to Humble. I believe a lot of the ailments "treated" by chiropractors could be alleviated by building a stronger muscle cage for the body. I don't mean to diss chiropractors in particular; I just really, really believe in the importance of strength training (and all the other dimensions of being fit: endurance, flexibility, balance, speed, agility, etc.).

Humble we could have an interesting conversation about our sports and physio histories and experiences. :) (I hasten to add that I am but a lowly "ordinary" woman who nonetheless exercises 1-2 hours per day...right now all pretty much focussed on rehabing my knee after ACL repair.)
 

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i do hope you will be seeing a physio for your knee, MG. I don't know which clinics in toronto are treating the athletes, not to speak of the national ballet, but those are likely the physios to consider.

you are absolutely right. Training the muscles to protect the joints is numero uno.

i remember when i tore the meniscus in my right knee the physio (she was the olympics X 4 one) said that the overall approach is to strengthen the quads so they can shelter stress to the knees. She taught me some exercises which i did do. For me, ultrasound on the knee was a fabulous pain reliever, but apparently it has no effect on some patients and no one can predict what the reaction will be.

do you have your physio picked out ? what i have found is that the office managers in the manual-therapy-sports-injuries clilnics are highly competent & kindly women who can guide a patient to a more experienced physiotherapist selon le cas. (hint: you want the office manager, not just a person booking an appointment who may not yet have any knowledge of the field.) As a most ordinary person myself i've been lucky, twice being handed by a discerning office manager directly to the 2 outstanding physios that i described. And the fees were the same. The only prob is that the more experienced the physio is, the more booked up he or she will be. IMHO they are worth waiting for.

your surgeon should also have an excellent referral ... but a problem is that not all doctors routinely refer to physios, even when they should. (hint: if you haven't found your physio yet, please do think about beginning the search on monday morning.)

assuming the surgery went well, i don't think you'd have very many actual paid visits. Knees i believe are challenging in that the surgery is usually directed inside or beneath the kneecap, ie slightly less accessible for the physio. The bigger part will be the home exercise & ice routine.

wishing you all the best,
hum
 

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i remember when i tore the meniscus in my right knee the physio (she was the olympics X 4 one) said that the overall approach is to strengthen the quads so they can shelter stress to the knees.
Interesting. I tore the meniscus in my left knee last year; walking is excruciating but biking actually seems to help, which jibes with what you are saying above. I went to an orthopedist about it and he recommended not having surgery but just living with the pain (it's "useless pain," he said -- I'm not making the injury any worse by walking). Living with the pain is easier said than done, as once I go farther than half a kilometer it starts feeling like someone is digging a knife into my knee and twisting it with every step. But now that serious biking season is back and I'm out riding every day, I find I can walk a little farther without too much pain.

In general I'm skeptical of chiropractors, but when I was biking with my chiropractor friend about 12 years ago and I slipped off the shoulder of the road into the gravel and crashed (cracking my helmet and embedding quite a bit of gravel into the same knee that now is giving me trouble), she very effectively fixed the neck pain I was experiencing from slamming my head on the road through a quick adjustment back at her office -- I've had no problems since then.
 

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OK, let's talk knees.

I am going to the David L. McIntosh Sports Medicine Clinic at the U of T. David was (is) a pioneer in the area of ACL diagnosis and reconstruction. He performed the very first successful ACL repair in the world. (My office is on campus; I just walk over for physio.)

David was also my grandmother's first cousin; he repaired her hip in the 1950s and she lived with him during her recuperation.

My physio is one of the physios for the National Ballet (well, at least some of their members - I don't know all the details! I just know one of their dancers has appointments before me) and has travelled with different teams to various Oympics and Paralympics. My surgeon is the Raptors' surgeon; talk about an in-demand guy.

Brad - meniscus repair is very quick and easy; it's just arthroscopic. You risk (apparently) arthritis in the joint which will eventually require repair if you don't repair it now. I wonder if you might seek a second opinion - I am a lifelong cyclist and it would really bum me out if I felt pain while cycling.

I had total ACL reconstruction + meniscus repair in 3 places. (I got to read the surgical report, which was really amazing. But I just counted incisions to check how many arthroscopic repairs I got as opposed to the big incision on my knee.)
 

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Hum - I was at my first physio appointment 6 days after surgery. I have rented ice thing (a "cryocast") plus a rented TENS machine. I do an hour on the stationary bike (I can't make a full revolution yet, though) per day + 4 sets of squat exercises and leg presses (just pressing a yoga ball into the wall at this point...I'm still a month away from weighted leg presses.)
 

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brad, while waiting at least 6 weeks for my first appointment to see my 2nd angel physiotherapist (the one w the ski & track n field teams) i hobbled over to my local Y to see a volunteer physio for a brief consult. He turned out to be from the same clilnic where i was waiting for the angel. He knew her well. They'd graduated from McGill physio together, they were racing together on some ski team (not the national olympic, though.)

he started me off perfectly. I was to do tiny exercises at home. It was a serious injury, not my knee. When i finally got to the angel herself, she picked up seamlessly.

i thought he was an excellent physiotherapist. He later treated an elderly friend who had broken his shoulder. I hear that he presently directs a clinic for the same physio group in the cote-st-luc area. I don't know if he practices himself now, or whether he only administers. He'd be worth waiting for, imho, especially since your injury is fairly old but unfortunately remains far too severe. You probably also have a few habits in sitting & walking that a knowledgeable physio would seek to adjust.

i would imagine that bike riding spares putting weight on the knee, which is why you're more comfortable on a bike than afoot. But a knife in the knee after half a kilometre, one whole year after the injury, should surely be helped. Very sorry to hear about that.

if you'd like his name perhaps you might send me a message.

oh, and the reason i'm not suggesting the angel herself is that she's off on a year's maternity leave for an infant born just before Xmas.
 

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When I was younger I fell off a horse and almost broke my neck. I did end up with a nice bone chip in one of my neck vertebrae. I also had shooting pains going up and down my arms because of the nerve damage.

My mom brought me to the chiropractor and he refused to treat me before we got X-rays something my own Dr refused to do.

He was very good, but lots of chiropractors are pretty horrible. The guys who get you to pay for multiple treatments and those who tell you that chiropractors cure everything from heart burn to acne due to your spine imbalances are charlatans.

When I sprained my hip due to falling off another horse and getting dragged along for a while the chiropractor was also very helpful.

So they can help.....

As an aside after I had surgery it was recommended that I see an accupuncturist with very good results.
 

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OK, let's talk knees.
Brad - meniscus repair is very quick and easy; it's just arthroscopic. You risk (apparently) arthritis in the joint which will eventually require repair if you don't repair it now. I wonder if you might seek a second opinion - I am a lifelong cyclist and it would really bum me out if I felt pain while cycling.
Fortunately I don't feel any pain bicycling -- we did a 600 km tour last summer and the only pain I ever felt was when I was walking (well, climbing long hills with fully loaded panniers was painful, but that was muscles, not knees!).

Thanks for the advice (and to humble pie for advice and recommendations as well) -- I will bear it in mind. My brother had the meniscus surgery and it made the problem worse, and the orthopedist warned me that while it's a simple procedure it often leads to side effects later on. So I'd rather avoid it unless it really becomes necessary.

I'm a big believer in the body's ability to heal itself over time; my orthopedist has a torn meniscus himself but says the pain just gradually disappeared and now he hikes in the mountains on the weekends. It may take a few years and I'm willing to see how it goes. I've had a number of problems over the years that fixed themselves over time and/or with physical and posture therapy.

I had a serious repetitive strain injury (thoracic outlet syndrome) about 15 years ago that was so bad I had to quit my writing/editing job because I couldn't type for more than 5 minutes without my right hand going completely white and numb. After five years of physical therapy, massage therapy, weekly Alexander Technique lessons, and using voice recognition software instead of my hands, the injury was under control and I rarely feel symptoms anymore unless I use a mouse with my right hand. I'm hoping the same kind of approach will help with the meniscus but we'll see....
 

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I have a better opinion/experience of naturopaths (& homeopaths) than chiropractors (not the same profession, I know).
However, all types of alternative practitioners not covered by provincial health coverage (OHIP here in Ontario) need to depend on their self-marketing skills in order to survive in the profession.
Most employer sponsored extended health care coverages either don't cover them or cover a percentage (80% at best).
Therefore, unlike tradional health care professionals, these guys (and gals) can only depend upon their goodwill, references and marketing skills to keep the lights on.
Which may help explain why a lot of them come across as salespeople rather than health care practitioner.
And some of them are.
But there are good ones out there too.

When I was looking for a naturopath for our family, I called the College of Naturopathic Doctors as well as my insurance company for references.
So start with references and "word-of-mouth", call the association or college, etc.
Once you have a short-list, it is esp. important to check your insurance company for any complaints or bad claims against any of the ones you are considering.
 

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Unfortunately, there are "Bad Apples" in all professions. The best way to find any professional advice would be to ask friends or family members for a referral(s) to someone they trust. In my experience chiropractic, physiotherapy, as well as massage and acupuncture has helped me with many of my ailments. However, chiropractic has actually helped me the most. I've been to a few chiropractors and found that the ones who doesn't ask for payments for future treatments are the ones who are genuinely interested in getting you better.
 
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