Google page ranks = fail because of CAM

I am a student [in a health profession]. I have a patient with a subluxation of the shoulder. In stroke patients, this is a common ailment in the affected arm, as the weight of the arm is hanging without muscular support due to paralysis/weakness. We’re giving this patient daily movement therapy to increase range of motion, but eventually this patient will have to be discharged and will be on their own (although with family members who will be trained as well). In effect, this patient will be in charge of their own therapy other than outpatient or home visits for professional therapy. So in order to provide something for this patient to help them do some stretching etc on their own, I go to Google with the search “treatment shoulder subluxation” and the first page I get is this.

A CAM page.

Sigh.

This particular piece of sketchy treatment is called “prolotherapy“. And for something Wikipedia describes as having “conflicting evidence about its effectiveness”, the website should probably not be saying things like: “Prolotherapy offers the most curative results in treating chronic pain” [emphasis added] and “Nearly all pain conditions can be successfully treated with Prolotherapy” following a pack of lies about other treatments for pain. Let’s examine these statements shall we?

1. Traditional modern medical treatment for shoulder subluxation or instability involves rotator cuff strengthening exercises, specifically of the supraspinatus muscle, which is the primary muscle responsible for the external rotation of the shoulder. Although rotator cuff strengthening exercises help strengthen shoulder muscles, they usually do not cure the underlying problem, ligament laxity, and, thus, do not alleviate the chronic pain that people with this condition may experience.

First, the term “traditional medicine” is already condescending and sets a tone that what they have to offer is more innovative and cutting-edge. Well, the fact is: evidence is evidence. If you have it, your treatment wins. If you don’t, I’m not using it on a patient when I have other methods that are evidence-based. If there’s no evidence either way, I’ll try something low risk, but in this case there are effective evidence-based alternatives. So, fail.

Second, ligament laxity is symptom not an “underlying cause”. The cause of a subluxed shoulder is usually paralysis or injury. Furthermore, the pain they are describing is usually associated with bursitis, with the gleno-humeral joint being compressed, stretched, or twisted oddly due to improper movements with the humeral head out of position (a result of subluxation). So their description is a little misleading.

Third, I think they are describing the wrong muscle. While supraspinatus is involved in rotator cuff stability, it is actually an abductor of the shoulder, not an external rotator. External rotators are deltoid, infraspinatus, and teres minor. Unless they are referring to abduction as external rotation, which is just bizarre. Also, therapy works on all the shoulder muscles, not just the one on top of your scapula.

All that aside, I would not recommend an invasive treatment for shoulder subluxation unless a patient is not responding to non-invasive treatments and precautions.

2. Another standard practice of modern medicine is to inject steroids or to prescribe anti-inflammatory medications. However, in the long run, these treatments do more damage than good. Although cortisone shots and anti-inflammatory drugs have been shown to produce short-term pain benefit, both result in long-term loss of function and even more chronic pain by actually inhibiting the healing process of soft tissues and accelerating cartilage degeneration. Plus, long-term use of these drugs can lead to other sources of chronic pain, allergies and leaky gut syndrome.

No. This uncited statement is dubious at best. The “risks” of these treatments are typically the same as with any injection: infection, temporary discomfort at the injection site, damage caused by improper injection, and allergic reaction. Their statement that these treatments worsen symptoms is false. As for so-called “leaky gut syndrome“, that’s a partially made-up CAM ailment, so draw your own conclusion (hint: it’s theoretical nebulousness not deserving of such absolute statements against effective treatments).

3. When all else fails, patients who experience chronic pain as a result of shoulder subluxation may be referred to a surgeon. Unfortunately, surgery often makes the problem worse. Surgeons will use x-ray technology as a diagnostic tool, which does not always properly diagnose the pain source.

Wow. So you could go to a surgeon, but they’ll bust you up. So, good luck!

Where do I even start… Surgery is a last resort, not because it’s ineffective, but because it’s 1) invasive (read: risky) and 2) expensive. While true that X-rays do not often catch the problem (for example, soft tissue damage), such damage can be imaged through other methods such as MRI and ultrasound. So that statement is misleading and disingenuous. Finally, surgeons don’t just cut people up for the sake of it because they aren’t sure and they might as well try something. They perform surgeries when surgery is indicated on a case by case basis.

4. A better approach is to strengthen the ligamentous and shoulder capsular structures with Prolotherapy. In fact, shoulder subluxation or instability is one of the easiest conditions to treat with Prolotherapy.

Better? Really? Let’s see. This therapy involves deliberately irritating a part of the body to increase the body’s defenses in that area to accelerate the rate of tissue repair. Now while there may be something to this, the jury (i.e., rigorous peer review) is still out on the effectiveness of this treatment – a Cochrane review of 4 available studies showed conflicting results – and the possibility of effectiveness absolutely does not justify misleading people about other available therapies.

Also, an injection to affect a ligament would have to be very specific because they are frigging tiny, relatively speaking. There is a great possibility that this process would be activated (if it works) in surrounding tissues which may actually compound the problem. For example: since prolotherapy evidence is mostly back pain research, I would encourage extreme caution in using it for shoulder pain particularly in stroke patients where spasticity is a common post-stroke ailment.

Chronic pain is most commonly due to either to cartilage deterioration, tendon weakness or ligament weakness, as is the case with shoulder subluxation.

Again they are sort of describing symptoms as though they are causes. I’ll clarify. Shoulder subluxation (the problem) is defined by weakened tendons, ligaments, and muscles (the symptoms). This is usually painful. Subluxation is due to trauma, stroke, or previous injuries (the causes).

This basic lack of clarity does not bode well for me taking them at all seriously (although they lost that privilege several ignorant sentences ago).

The safest and most effective natural medicine treatment for repairing tendon, ligament and cartilage damage is Prolotherapy. In simple terms, Prolotherapy stimulates the body to repair painful areas. It does so by inducing a mild inflammatory reaction in the weakened ligaments and cartilage. Since the body heals by inflammation, Prolotherapy stimulates healing.

In theory. Get some more evidence and then you can make such bold statements. Safest? Most effective? MOST? Funny how that never came up in my schooling…or any journals I’ve looked at…or any reputable medical websites I’ve consulted… I would think that the treatment that is MOST effective would have been mentioned, I dunno, EVER.

Prolotherapy offers the most curative results in treating chronic pain. It effectively eliminates pain because it attacks the source: the fibro-osseous junction, an area rich in sensory nerves. What’s more, the tissue strengthening and pain relief stimulated by Prolotherapy is permanent!

Most curative…see above for my thoughts on their undeserving “most” statements.

Nearly all pain conditions can be successfully treated with Prolotherapy, including:
Osteoarthritis, Tendonitis, Migraines, Sports Injuries, Loose Joints (Hypermobility), Fibromyalgia, RSD Pain, Temporomandibular Joint Syndrome (TMJ), Sciatica, Herniated Discs, Degenerated Discs, Degenerated Joints, Chondromalacia Patellae, Osgood-Schlatter Disease, Carpal Tunnel Syndrome, Ligament Sprains, Plantar Fasciitis…and Back, Hip, Neck, Shoulder, Knee, Elbow, Foot, Ankle, Hand, Wrist, Finger and Toe Pain

This is a CAM favorite. “Our treatment is clearly better because it treats everything under the sun.” Except for a few things I noticed that don’t belong: Carpal Tunnel Syndrome and TMJ (to name just 2). If the effect is to tighten tendons and ligaments, this treatment would worsen Carpal Tunnel Syndrome by further compressing the nerve and worsen TMJ by further tightening the joint. So, I say WTF to that.

To read how a young athlete with shoulder pain benefited from Prolotherapy, click here.

I find it telling that, rather than provide a list of peer-reviewed references to support their statements, they link to an case report of one 13 year-old girl.

The treatment regimens suggested here are based on the experience Caring Medical. They do not apply to every case or condition. A person using these recommendations without the aid of a personal physician does so at their own risk. This information is provided for informational purposes only. It is essential to have your condition evaluated by your own personal physician.

There is is. “We can get away with saying all of the above, misleading you into thinking this is a great therapy and therefore priming you to evaluate information on it in a positive way, because – hey – we’re just providing harmless information. It’s your responsibility to listen to a doctor.”

That’s really good advice, actually. Go to a doctor.

But what about people like me who are looking up information for a patient in order to devise a treatment? It annoys me to no end that I have to sift through this garbage to get to information of any substance. CAM hurts people by wasting my time as a health care practitioner.

If prolotherapy has weight to it, fine, but websites like this are not being honest about its true nature. They don’t say “this a new treatment that is currently gathering evidence that might work for you and here are our sources so far”, they say “traditional treatments will hurt you so you should do this”. They say all of the bad things (and sometimes they are completely made up) about “traditional” treatments, and all of the good things (also sometimes completely made up) about their therapy. Evidence? What’s that?

That is wrong. WRONG. W-R-O-N-G. Sweet merciful crap, I can’t emphasize enough how WRONG that is. And it comes up first on a Google search for the problem.

Thank you CAM, you just wasted my time and reduced my focus on a patient. Congratulations, assholes.

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2 responses to “Google page ranks = fail because of CAM

  1. Well written. I knew that as soon as I saw the word “subluxation” I would be in for a treat. A bitter, depressing, soul-stealing treat.

    My skeptic red-flag was a-wavin’ in the section where they describe the various things it cures. I may be stepping out of my non-medical depths here, but when a treatment claims to treat/cure ailments that have fundamentally different causes, its efficacy seems dubious at best.

    I may not have any of that fancy science-book-learnin’, but seriously…”Osteoarthritis, Tendonitis, Migraines…Sciatica”? I know enough that this is like claiming the cure for AIDS can also cure Hodgkin’s Disease, Liver cirrhosis and lymphoma. And if that wasn’t enough of a big umbrella, they can also treat anything that they missed, especially the oh-so-specifc “Back, Hip, Neck, Shoulder, Knee, Elbow, Foot, Ankle, Hand, Wrist, Finger and Toe Pain”

    Well I’m sorry, Monsignor, but that dog won’t hunt.

  2. The “treatment X cures all” statement is definitely a huge red flag and is very common in CAM. Though, my flags were already primed when they couldn’t even get the basic anatomy right…

    In fact in one of my anatomy books, it even goes on to specify that, of the rotator cuff muscles, supraspinatus is the only one that DOESN’T actually rotate the shoulder.