the discipline called "applied kinesiology." I do not believe that the weight of available scientific evidence supports such clinical use. We are now in the process of making such procedures acceptable through the examination of scientific evidence and consensus methods such as nominal group and Delphi procedures. The recent Mercy Conference in California, which brought together opinion on standards of care from a wide range of chiropractors, was an important stop along the way. I hope that such work will ultimately lead to my profession's discarding any procedure unable to meet
basic scientific criteria. I sincerely hope that Waugh will not judge an entire profession by his experience with a single caregiver. We have our bad and our good. Rather than visit an acupuncturist when next your low-back pain flares up, please, see a good chiropractor.
chiropractic is partly due to the medical profession's failing to follow Paget's reasonable suggestion. Although Dr. Waugh's piece is amusing, the real joke - if any - is on the medical profession, which historically has ignored one facet of dealing with back pain: spinal manipulation. Michael Livingston, MD Richmond, BC
References 1. Livingston MCP: Spinal manipulation causing injury: a three year study. Clin
Orthop 1971; 81: 82-86 2. Paget J: Clinical lecture on cases that bone-setters cure. BMJ 1867; 1: 1-4
Dr. Waugh's article illustrates traditional medicine's lack of interest in the musculoskeletal system. It also shows the unfortunate ignorance of physicians that there is a group of well-trained family medical practitioners who make a point of dealing with the problems incurred in the musculoskeletal Dana J. Lawrence, DC system. These physicians are Editor knowledgeable in the art of maJournal ofManipulative and Physiological nipulation. Furthermore they are Therapeutics competent in several injection Lombard, Ill. techniques, such as nerve blocks, Reference trigger point injections and epidural blocks. Such physicians fill a 1. Shekelle PG, Adams AH, Chassin MR void between "practitioners of alet al: The Appropriateness of Spinal health care" and surManipulation for Low Back Pain, ternative RAND Corp, Santa Monica, Calif, gery, something that Waugh is obviously unaware of. 1991 It is high time that the tradiIt is true that chiropractic treat- tional medical training in Canment can be amusing and even adian universities included orthodangerous.' However, can we real- pedic medicine. This subject has ly be satisfied with the training of been included for a number of medical students in the examina- years in the curriculum of the tion and management of common faculty of medicine at the Univermusculoskeletal problems? sity of Rochester, Rochester, NY. A distinguished surgeon, It is taught by family physicians James Paget, suggested 125 years who are already certified or have ago that we "learn then to imitate obtained a fellowship in orthowhat is good and avoid what is pedic medicine according to the bad in the practice of bone-set- precepts developed by the late ters."2 The medical profession, ex- Dr. James Cyriax. To complement this, one may cept for a few people such as Cyriax, Mennell and Marlin, ig- attend an osteopathic school of nored this advice. The rise of medicine to acquire another di2136
CAN MED ASSOC J 1992; 146 (12)
mension in the art and science of manipulation. It is hoped that dissemination of this knowledge in the medical community will bring about better understanding of the sound principles of orthopedic medicine. Yvon Bourdeau, MD, CCFP Orleans, Ont.
I enjoyed the article by Dr. Waugh. The success of chiropractic manipulation is a fact well recognized by many practising orthopedic surgeons. My concern is that Waugh describes his problem as an extremely painful hip. From his description of the pain I suggest that what he was actually experiencing was severe pain in his buttock. Many patients are referred to orthopedic surgeons with "painful hips," and it becomes apparent after the first 10 seconds of history-taking that the the pain is in
the buttock, having nothing whatsoever to do with the hip joint. I propose that it is high time medical practitioners appreciated the more-than-subtle difference between hip pain and buttock pain. Hip pain originates from the hip joint or the proximal femur and classically is felt in the groin, anteriorly. Buttock pain, experienced posteriorly, invariably originates in the lumbosacral region. With our extensive training and knowledge in the field of anatomy I do not feel that it is too much to ask that physicians call a spade a spade. Hip is hip, but buttock is low back. Let's not forget it. Gerald P. Reardon, MD, FRCSC Assistant professor Division of Orthopaedic Surgery Dalhousie University Halifax, NS
[The author responds.] I am gratified that so many readers took the time to write about LE 15 JUIN 1992
basic scientific criteria. I sincerely hope that Waugh will not judge an entire profession by his experience with a single caregiver. We have our bad and our good. Rather than visit an acupuncturist when next your low-back pain flares up, please, see a good chiropractor.
chiropractic is partly due to the medical profession's failing to follow Paget's reasonable suggestion. Although Dr. Waugh's piece is amusing, the real joke - if any - is on the medical profession, which historically has ignored one facet of dealing with back pain: spinal manipulation. Michael Livingston, MD Richmond, BC
References 1. Livingston MCP: Spinal manipulation causing injury: a three year study. Clin
Orthop 1971; 81: 82-86 2. Paget J: Clinical lecture on cases that bone-setters cure. BMJ 1867; 1: 1-4
Dr. Waugh's article illustrates traditional medicine's lack of interest in the musculoskeletal system. It also shows the unfortunate ignorance of physicians that there is a group of well-trained family medical practitioners who make a point of dealing with the problems incurred in the musculoskeletal Dana J. Lawrence, DC system. These physicians are Editor knowledgeable in the art of maJournal ofManipulative and Physiological nipulation. Furthermore they are Therapeutics competent in several injection Lombard, Ill. techniques, such as nerve blocks, Reference trigger point injections and epidural blocks. Such physicians fill a 1. Shekelle PG, Adams AH, Chassin MR void between "practitioners of alet al: The Appropriateness of Spinal health care" and surManipulation for Low Back Pain, ternative RAND Corp, Santa Monica, Calif, gery, something that Waugh is obviously unaware of. 1991 It is high time that the tradiIt is true that chiropractic treat- tional medical training in Canment can be amusing and even adian universities included orthodangerous.' However, can we real- pedic medicine. This subject has ly be satisfied with the training of been included for a number of medical students in the examina- years in the curriculum of the tion and management of common faculty of medicine at the Univermusculoskeletal problems? sity of Rochester, Rochester, NY. A distinguished surgeon, It is taught by family physicians James Paget, suggested 125 years who are already certified or have ago that we "learn then to imitate obtained a fellowship in orthowhat is good and avoid what is pedic medicine according to the bad in the practice of bone-set- precepts developed by the late ters."2 The medical profession, ex- Dr. James Cyriax. To complement this, one may cept for a few people such as Cyriax, Mennell and Marlin, ig- attend an osteopathic school of nored this advice. The rise of medicine to acquire another di2136
CAN MED ASSOC J 1992; 146 (12)
mension in the art and science of manipulation. It is hoped that dissemination of this knowledge in the medical community will bring about better understanding of the sound principles of orthopedic medicine. Yvon Bourdeau, MD, CCFP Orleans, Ont.
I enjoyed the article by Dr. Waugh. The success of chiropractic manipulation is a fact well recognized by many practising orthopedic surgeons. My concern is that Waugh describes his problem as an extremely painful hip. From his description of the pain I suggest that what he was actually experiencing was severe pain in his buttock. Many patients are referred to orthopedic surgeons with "painful hips," and it becomes apparent after the first 10 seconds of history-taking that the the pain is in
the buttock, having nothing whatsoever to do with the hip joint. I propose that it is high time medical practitioners appreciated the more-than-subtle difference between hip pain and buttock pain. Hip pain originates from the hip joint or the proximal femur and classically is felt in the groin, anteriorly. Buttock pain, experienced posteriorly, invariably originates in the lumbosacral region. With our extensive training and knowledge in the field of anatomy I do not feel that it is too much to ask that physicians call a spade a spade. Hip is hip, but buttock is low back. Let's not forget it. Gerald P. Reardon, MD, FRCSC Assistant professor Division of Orthopaedic Surgery Dalhousie University Halifax, NS
[The author responds.] I am gratified that so many readers took the time to write about LE 15 JUIN 1992
