An Interview with Dr. Shawn Thistle
Dr. Sean Thistle is a practicing chiropractor, educator, international speaker and founder of RRS Education which provides evidence-based clinically applicable information for chiropractors and other manual therapists. He’s lectured as a part-time faculty member for the Canadian Memorial Chiropractic College in orthopedics. The initial way that I came across you is a video that you did about the common myths in chiropractic. Can you talk about those myths and give your perspective on how you think those myths are affecting the chiropractic profession?
Dr. Thistle: I’ll give back story on where that video came from. This was an introductory video to a much longer interview that I did with a group called functional media started by two recent graduated physiotherapists and their angle was to interview people in the manual therapy space.
I did an hour audio interview where we got into a lot of these things in detail and the video was done as a teaser for that the longer interview. Some of the context was lost in translation, but I mentioned a few things that bother me from an evidence perspective, patient management perspective and our cultural authority as a profession.
One thing I talked about was body shaming from little asymmetries that people may have, a low shoulder or another postural change and how some of our colleagues can frighten people into long-term care plans based on those findings. These findings may or may not be giving them symptoms.
Human bodies are wonderfully adaptable and we live with our own asymmetries and most humans aren’t symmetrical anyway. Making a patient focus on something that’s probably irrelevant to their general state and condition and whether or not they have neck pain and there’s so many other things that we can effectively educate patients about in terms of lifestyle and activity that having someone worry about one shoulder being lower than the other does not seem like good clinical time.
Language really matters in terms of what we say to people and I would respectfully argue that a lot of people who focus on posture are doing it with the ulterior motive to get the patient to commit to a program that may not affect their posture. I just don’t think that’s right. Posture can matter in certain conditions, but it doesn’t matter in every patient who has these slight asymmetries or variations. Unfortunately there is not a lot of evidence that spinal adjusting can change posture. Yes, repetitive training and postural awareness will help. There are a lot of patients that really need our help if we put our focus in the right place.
Noah: What’s another myth you presented?
Dr. Thistle: Serial x-raying of patients to monitor progress or changes in static posture. That’s one of the most unnecessary things that chiropractors do these days. CBP and the Harrison’s have published some things, but the reference list that’s provided doesn’t say what they’re telling you. Buyer beware and reader be educated. Regardless of the quality of their research does serial X-raying of patients change outcomes? The answer is no. We know that chiropractic is very helpful for a number of conditions, but the majority of chiropractors who successfully treat patients do not x-ray their patients.
I’m not suggesting that people that practice in those techniques don’t help their patients. I’m just saying if we back up for a second and look at the clinical guidelines for the conditions that we’re seeing serial imaging is not necessary to achieve good outcomes.
Noah: We’re the only profession that is using X-ray in that way. Everybody else is using x-ray to diagnose severe radiological conditions and to ensure you’re not going to harm anybody. That seems to be kind of the mainstream use of x-rays would you agree with that?
Dr. Sean Thistle: Yes and that falls in line with you know globally published clinical practice guidelines on spinal pain syndromes. Serial X-rays is a problematic approach that doesn’t necessarily lead to better patient outcomes. Many of these doctors could not x-ray the next 10 new patients and get exactly the same clinical results. We have to be team players to advance our profession forward. We have a big choice to make right now whether we want to be part of the healthcare realm. An approach like imaging everyone to look for things that no one else in the world looks for can be detrimental to the profession.
Noah: If we can lean into the current environment then we can get acceptance and then work to change things from the inside out. Once we’re accepted as part of that integrated whole there’s a lot more opportunity for innovation and collaboration?
Dr. Thistle: The nature of big data and projects like the global burden of disease that publishes on conditions that disable and kill human beings and cause problems is basically providing us with a roadmap for our profession.
There’s a spinal pain crisis around the world and neck pain and low back pain are the most disabling thing on earth. I think people who live on the fringes of our profession are missing that opportunity. In order to have a profession we have to solve societal problem and there’s one laid out right in front of us that we happen to be really good at. We provide a viable solution with exercise, manual therapy, and spinal manipulation.
This is our opportunity right now to take charge as spinal pain experts. There’s an opioid crisis and governments, insurance companies, and healthcare systems are looking for viable solutions and we have one.
There’s a problem that we can help with, the evidence to support us in helping with that problem and a public desire for a non-invasive non-pharmaceutical based treatment approach for that problem. It’s never been a better time to be a chiropractor.
Noah: With this great opportunity and with all this young blood coming into the profession motivated to make a difference how can we take this opportunity by the horns and steer the profession in a direction that’s going to ensure good livelihood for every student coming-out of chiropractic school?
Dr. Thistle: I’ll touch on couple of things that I think are important. The world doesn’t owe you anything. A lot of chiropractors tend to struggle because they’re unwilling to commit and stay the course and practice the way that they want to practice.
Growing a practice that will survive in the long term takes a lot of hard work so you have to be okay with the idea that your treatment style will evolve over time and your doctoring style should evolve over time You also have to be amazing with your ears and I think listening to patients is something that we fall short on. Taking a good history and being present and having a good conversation with people. The most common complaints people have about health care providers is that they didn’t listen. There’s a therapeutic benefit to having a patient tell you their story. Embrace the personal side of our profession. Be a good listener.
Noah: The words that you use with your patients is going to represent the profession as a whole.
Dr. Thistle: This ties in to our cultural authority and what people think of us. We can assist with that problem and the public desire is the key.
Noah: There’s nothing more motivating than having the person with this condition that I’ve studied and learned about in front of me.
Dr. Thistle: You’ll also realize that patients don’t read the books. They can come in with whatever they want and variability is the norm. It’s really nice when a patient comes in and checks all the diagnostic boxes for a specific thing, but patients are complicated. I’ve always enjoyed that diagnostic chase and getting to the right answer and figuring out what works for an individual. Every patient needs something different from you and the challenge as a good doctor is for you to figure out what that thing is.
See the full interview here: https://www.youtube.com/watch?V=sqptm-lfxrq