Thursday, July 2, 2009

The healing joke to end all healing jokes

With apologies to Joel Grus and his brilliant religious joke to end all religious jokes. I wanted to make a specific point to my class and stole his format...

A Doctor of Osteopathy (DO), a chiropractor, a physical therapist, a massage therapist, an accupuncturist, a macrobiotic, an herbalist, a medieval court physician, a therapeutic touch practitioner, a scientologist, a Navaho medicine man, a homeopath, a podiatrist, a Christian scientist, a Catholic exorcist, a surgeon, and a physiologist walk into a bar. They overhear a man telling the bartender that his son's lungs are full of phlegm making it difficult to breath and the lungs are chronically infected. The child was also not growing well and had developed distal intestinal obstruction syndrome. Finally, the child is missing his vas deferens and his sweat is very salty.

All the healers thought about the cause of such an odd assortment of symptoms and being betting men, they decided to bet. The DO said "I bet a dollar he has dysfunctional cranial rhythm", and the chiropractor said "I bet a dollar it's a vertebral subluxation", and the physical therapist said "I bet a dollar it's an imbalance between right and lift hip abductor strength”, and the massage therapist said “I bet a dollar it’s a myofascial trigger point”, and the acupuncturist said “I bet a dollar he’s disrupted the circulation of qi along his meridians”, and the macrobiotic said “I bet a dollar the child’s body is in decay because he’s living out of balance with nature and the cosmos”, and the herbalist said “I bet a dollar the kid’s yin and yang are out of balance”, and the medieval court physician said “I bet a dollar he has an imbalance in his four humours”, and the therapeutic touch practitioner said “I bet a dollar that his aura is out of tune” and the scientologist said “I bet a dollar it’s the body thetans”, and the Navaho medicine man said “I bet a dollar the child has a disrupted nilch’i hwii’siziinii”, and the homeopath said “I bet a dollar that the boy has a tubercular miasm”, and the podiatrist said “I bet a dollar the boy has excessive overpronation” , and the Christian scientist said “I bet a dollar the child is full of fear, ignorance, and sin”, and the Catholic exorcist said, “I bet a dollar an evil spirit has invaded the boy’s body”, and the surgeon said, “I don't know the cause but I bet a dollar I can remove the lungs and hook the child up to a lung machine and he'll be alright”, and the physiologist said “I bet a dollar the boy has a mutation in his CFTR gene.”

So they went to the boy to search for dysfunctional cranial rhythms, and subluxed vertebrae, and hip muscle imbalances, and myofacial trigger points, and disrupted qi, and bodies out of balance with nature and the cosmos, and yin and yang, and the four humours, and an out of tune aura, and body thetans, and disrupted nilch’I hwii’siziinii, and tubercular miasms, and excessive overpronation, and fear, ignorance, and sin, and evil spirits but none could convince all the others that their prediction was true. Except the physiologist who correctly predicted the boy would have a mutated CFTR gene. She won $16 that day.

Do naturopaths wear eyeglasses?


Wednesday, July 1, 2009

Dr. Rob Rinaldi on how to reduce running injuries

The Andrew Wakefield golden ass award goes to Dr. Rob Rinaldi, DPM, for making the claim that 85% of all running injuries could be prevented if we'd only run in the right shoes (that is matching our foot kinematics with the shoe). Where did mr. Rinaldi get the 85% figure? Not from any research because there isn't any that would support this claim. But alot of the beginning of his article talks about his gut feeling, so most likely, he pulled it from where he felt it.

Although there are zero papers showing that correctly matched running shoes reduce injury rate, there is a single paper, published in 2006 and available to Rinaldi when he did his 10 months of research for the article, showing that runners fit by the Sports Science Institute of South Africa Sports Medicine running shoe clinic had an equal frequency of injuries in the year following shoe purchase to matched runners that had not been to the clinic. Since some of the control group (those that had not been to the clinic) were getting professional advice on shoe fit, we might expect the difference in injury rate to be small. Indeed, if all of the control runners were getting professional advice, we expect the injury difference to be zero (assuming the advice was the same).

So maybe both groups were just getting good advice and the frequency of injury in both groups was low? The authors do not report the percentage of runners who were injured in the year following running shoe purchase, only the raw number of total injuries. The shoe-clinic group had 93 injuries and 94 runners. The control group had 115 injuries and 83 runners (note that the control group ran more and the frequency of injury/running day were very close). Clearly some runners had multiple injuries. Regardless, these must reflect high injury rates (typical statistics are something like 50-80% or runners are injure per year). So there is no evidence from this one study that correctly matching foot kinematics to running shoe will reduce injury rates at all much less 85%.

Schwellnus, MP and G Stubbs (2006). Does running shoe prescription alter the risk of developing a running injury? International SportMed Journal, Vol.7, pp. 138-153.