Frequently asked questions

Proprioceptive medicine and the Trevor McDonald Tonight programme

by Simon King, Chiropractor.

Main points (remembering that the show used 3 minutes of about an hours' filming)

  1. None of my comments are meant to replace advice from your current healthcare provider.
  2. Chiropractic is a primary health care profession that specialises in the diagnosis, treatment and overall management of conditions that are due to mechanical dysfunction of the joints, particularly those of the spine, and their effects on the nervous system. The profession has statutory regulation.
  3. All conventional treatments (including but not limited to chiropractic, physiotherapy, acupuncture, massage, medication and surgery) are still necessary and useful in many cases.
  4. It would be wise to try all conventional treatments before considering unconventional.
  5. The clinical opinion I gave to Jonathan Maitland was based on my own hypotheses and observations gained over 20 years of practice. Many of these observations are published and publically available on this website and on YouTube.
  6. The examination for irritation to the flexor withdrawal reflex is only ever done as part of a full consultation, neurological and orthopaedic examination. Referral to appropriate medical care is always carried out as necessary.
  7. My theories and recommendations are not representative of chiropractic theory or chiropractors generally. I am not representing any group or organisation.
  8. None of my recommendations can cause any clinical harm for patients.
  9. All patients are subject to long-term follow-up.

And now the questions:

  • I don't believe it!
    Well good for you! I have no ability or desire to change your belief systems. The observations I have will only be useful for people who have discovered that their existing belief systems don't have all the answers. If your beliefs are different to mine, that is the nature of the human experience. Fortunately, we are all entitled to our opinion and I totally respect your right to hold yours.
  • You're pushing harder!
    Maybe - but the videos I have posted online would suggest otherwise. Unfortunately, the important part of injury prevention is the reactive strength of muscles, not the ability to lift weights. Reactive strength relies on reflex reactions, and right now there is no objective test available for this. Whenever possible, I use objective measures like lifting weights but this is not as sensitive as manual muscle testing and is not strictly testing the most important component of robustness.
  • All your results are based on placebo, psychology or patient belief.
    Jonathan Maitland certainly arrived with that belief system and it is a convenient one for him to hold onto because he didn't want to go to the dentist. I can tell you that no placebo response lasts 8 years (which was the length of time since I treated one of the patients he interviewed). At most, placebos last 2-4 weeks. Lesley had already had back surgery. Most of the things I ask of people are extremely unpopular and most patients are as skeptical as Jonathan. Fortunately, most get better anyway. If Jonathan ever does get his filling changed, it will be interesting to see how he reacts to the accusation that his improvement is all in his mind!
  • Jonathan spent £3000 on treatments that didn't really work, but he wouldn't spend £120 (maximum) on a treatment that would make a permanent change to his proprioception, was not destined to make me any money at all (no conflict of interest) and one which I demonstrated would make him stronger instantly (and therefore had a good chance of curing his pain).
  • Can you help me?
    I do take on a limited number of patients at my clinic in Berkhamsted, and I have trained about 200 chiropractors and health professionals in the UK whom I am happy to refer you to. I cannot tell whether or not I can help you based on your symptoms or your history, and I cannot give advice via the Internet or e-mail. The only way any practitioner can give advice is by accepting you as a patient.
  • How can I learn more about proprioception?
    My book 'Live Without Pain: What's Really Wrong With You, and How to Fix It' (www.live-without-pain.com) is out at the end of October 2008, which has as much detail as I can muster. If you leave your e-mail address here:
  • Where's your evidence?
    When I asked Jonathan Maitland what evidence he would need to have his filling removed, he said "An article in The Lancet".
    I write about the limitations of medical research in my book but the main points are:
  1. Randomised Clinical Trials (RCTs) prove statistical significance, not clinical significance (this would be a good example)
  2. RCTs and published evidence do not provide truth or wisdom (otherwise why would there be a need for further evidence or trials?).
  3. It is possible that clinical trials don't actually change clinician attitudes or behaviour in any significant way (using this drug instead of that drug is not a significant change).
  4. There are some things that cannot be tested with an RCT - gravity and evolution spring to mind. Artificial vs natural might be another of those untestables.
  5. RCTs average results over populations. Unless there is 100% cure with the treatment and 100% failure by the placebo, then the relevance of the population average to any individual patient is nil. So, no matter what the results of a trial published in The Lancet, Jonathan would still have no clue as to whether it would work for him at all, because no individual represents the average.
  • How does any clinician know whether the results of any trial are relevant to them or their patients?
    The first stage of scientific inquiry is good observation. My observations are recorded on video and are available for all scientists to investigate.
  • The only evidence that matters to me is the evidence of the patients, but collection of that evidence should be made as objectively as possible. This I do with the Record Your Results service, which objectively measures patient outcomes (all of them, not just selected patient samples with selected patients and selected practitioners). Any practitioner can join this service and measure their outcomes, and in time, we can compare results between practitioners and professions.
  • Having said all this, I do intend to bow to the general insanity of medical research and produce the RCTs that are so universally respected in spite of their expense and general lack of potency. You can help by taking part in either of our two current research projects:
  1. The Jewellery Experiment
  2. The Half-Lever Experiment
  • How can I find a practitioner of proprioceptive medicine?
    A list of trained chiropractors exists here, it will soon be replaced by a more comprehensive website.
  • Where can I learn more about proprioceptive medicine?
    The Institute of Proprioceptive Medicine is set up to provide membership for chiropractors, osteopaths, dentists and doctors interested in education and research into the clinical effects of proprioception. Their website is www.proprioception.org.uk (unfortunately this website was not completed by the time of programme broadcast).