Chiropractic
Consider This Therapy For
The "hands-on" joint manipulation known as chiropractic is considered
particularly valuable for relief of acute (temporary) pain in the lower back.
This type of pain usually subsides on its own within 3 months, but chiropractic
treatment can often bring it to an end immediately. (See also the entry on
osteopathic medicine.)
In many cases, chiropractic can also ease pain--due to either a temporary
condition or aggravation of a chronic problem--in areas such as the mid-back,
neck, or joints. Additionally, it is sometimes used to relieve the pain of
headaches, muscle spasms, and nerve inflammation. Its effectiveness for relief
of sciatica (pain or numbness along the sciatic nerve, generally in the back,
buttocks, hips, or adjacent parts) remains controversial.
After the common cold, low back pain is the most common reason for doctor
visits. It's an especially frustrating problem because there's frequently no
simple medical explanation for it--and therefore no easy cure. However, there's
now mounting evidence that spinal manipulation can be a genuine source of
relief. In 1994, the Agency for Health Care Policy and Research (AHCPR) released
its Guidelines on Acute Low Back Problems in Adults. This report identified
manipulation (defined as certain specific techniques used to re-align or
re-adjust a joint) as the preferred method of treatment for relief of acute back
pain. Traction, bed rest, corsets, or drug therapies were not recommended.
Similarly, a report from the RAND Corporation published in the prestigious Annals
of Internal Medicine found manipulation effective for the relief of acute
low back pain. (It was not, however, deemed as successful in the treatment of
chronic or recurrent low back pain, sciatica, asthma, high blood pressure, or
pain caused by neurological conditions.) Chiropractors, RAND pointed out,
perform 94 percent of spinal manipulations (though not necessarily with the same
techniques employed in the study).
To date, there's no scientific confirmation of chiropractic's effectiveness for
anything other than low back pain. However, in a few years we should know more.
In early 1998, the National Institutes of Health's Office of Alternative
Medicine, and the National Institute of Arthritis and Musculoskeletal and Skin
Diseases awarded a research grant to support the first federally funded Center
for Chiropractic Research.
How Treatments are Done
Although the back is the primary focus of chiropractic, the manipulations can be
applied to any muscle or joint in the body. Techniques vary among practitioners.
Typically, after preparation and proper positioning, the chiropractor creates
tension around the offending joint, then applies pressure to return it to its
proper position. A popping sound is often heard--and sometimes felt--following
this maneuver. The noise is similar to the one you hear when cracking your
knuckles. It results from the sudden release of built-up pressure in the joint,
and is generally painless. As the joint snaps into place, pain is relieved and
proper function is restored. Other techniques you may encounter include soft
tissue manipulation, trigger-point manipulation, or deep tissue massage.
On your first visit to a chiropractor, you'll probably be asked to complete a
questionnaire about your personal and family medical history. Be sure to discuss
any illnesses that run in the family. Although chiropractors are not prepared to
diagnose the full gamut of disease, they are trained to perform physical
examinations in much the same way as a general medical practitioner. For
example, you may be given a blood test to rule out infection and a reflex test
to rule out neurological problems. Your blood pressure, pulse, and respiration
will also be measured.
Once these general readings have been taken, the examination will begin to zero
in on your musculoskeletal system--the muscles and bones in your body--with
particular attention to your spine. The chiropractor will also analyze your
posture, and will probably perform some orthopedic tests as he examines your
articulations (a chiropractic term for joints). These tests usually involve
moving a particular limb in search of joints that are "fixated" (not
moving) or moving with impaired range.
If the chiropractor identifies a fixated joint, he will then attempt to
determine whether there is any risk involved to restoring normal movement to the
joint and what other parts of the musculoskeletal system have been affected by
the joint's dysfunction. It is common for a "healthy" joint to
overcompensate by moving excessively when another joint is not working
correctly. The healthy, hyperactive joint might be near the fixated joint or in
an entirely different part of the musculoskeletal system. Overcompensation can
result in new, incorrect structural configurations that cause discomfort or
pain.
To rule out any conditions that would preclude treatment, chiropractors usually
take an x-ray of the region causing your pain before beginning the
manipulations. Some chiropractors also take x-rays to locate subluxations
(partial dislocations). Most chiropractors have basic x-ray equipment on-site
and all chiropractors are trained to read x-ray images. If a specialized view is
required, you may be referred to a center that has advanced technology, such as
magnetic resonance imaging (MRI) equipment, or other equipment that provides a
comprehensive image.
About 90 percent of chiropractors use x-rays. However, full-spinal x-rays in
search of subluxations are considered controversial by many practitioners, and
constitute less than 17 percent of all x-rays performed by chiropractors,
according to the American Chiropractic Association. Many practitioners,
chiropractic and otherwise, believe that full-spinal x-rays yield little if any
useful information, and thus expose patients to radiation needlessly.
The chiropractor will also examine your muscles to determine if they are
balanced. Just as healthy joints compensate for injuries in other structures,
muscles may also exhibit "compensated distortion." When one muscle or
group of muscles is contracted, for example, those on the other side may be
abnormally relaxed.
Once the chiropractor has all the information he needs, treatment will proceed.
Therapeutic equipment common to virtually all chiropractors is a specialized
table designed to conform to a patient's body. The table has mechanized parts
that can be adjusted in accordance with the patient's size and the region of the
body that requires treatment. For example, the surfaces where the face, pelvis,
and other body structures lie will yield independently as the chiropractor
applies controlled force to these areas during treatment.
According to the American Chiropractic Association, more than 90 percent of
chiropractors use techniques common to physical therapy, especially in
preparation for manipulation. Your practitioner may use a broad, pad-like
vibrator to relax your back muscles. He may apply hot or cold compresses to
increase circulation and relax painful muscle spasms, or use traction to ease
pressure. Ultrasound is often used as a "micro massage" to stimulate
circulation and remove fluid from the area around a damaged joint and nearby
tissues.
Some chiropractors also recommend and teach relaxation techniques as a way to
prevent future strain, and prescribe rehabilitative exercises as part of an
extended treatment plan. Some also prescribe and sell dietary supplements and
herbs, although such products fall outside the realm of chiropractic.
Treatment Time: The initial visit typically lasts at least 1 hour.
Subsequent visits usually take between 10 and 30 minutes.
Treatment Duration: On average, a course of treatment involves 3 to 5
visits per week for 2 weeks. Several studies have noted that consumers using
chiropractic care are more satisfied with treatment than patients who receive
medical care. Chiropractors are perceived as spending more time face-to-face
with the patient, although no studies have been done to verify this.
What Treatment Hopes to Accomplish
The primary goals of chiropractic therapy are relief of musculoskeletal pain and
restoration of mobility. However, many consumers use (or misuse) chiropractors
for a wide variety of unrelated ailments. In a 1993 survey of more than 5,000
chiropractors, musculoskeletal complaints did in fact dominate the list of
conditions they treated, but respondents also reported "routinely"
seeing patients with headaches, and "often" seeing patients with high
blood pressure problems, allergies, or obesity. Seen less frequently were
patients with nutritional disorders, menstrual irregularities, asthma, and
diabetes.
Chiropractic has long drawn criticism from the medical world for its failure to
provide valid proof of its effectiveness, and for the exaggerated claims of some
practitioners, who have touted spinal adjustment as a cure for everything from
chronic pain to sinus infections. Indeed, until 1980 the American Medical
Association (AMA) labeled as unethical the referral of patients to
chiropractors, only lifting the prohibition when challenged in a successful
antitrust suit.
Lately, with growing proof of spinal manipulation's effectiveness for low back
pain, chiropractic has gained new-found respectability. Collaboration between
medical specialists and chiropractors is on the increase, and some managed care
plans have begun covering chiropractic treatments. Still, critics say there is
little evidence that chiropractic relieves anything other than acute back pain.
Few reliable studies support chiropractic for the treatment of chronic
musculoskeletal disorders, although some studies of chiropractic treatment for
headache show promising results.
The version of chiropractic currently gaining medical favor is far different
from the original discipline. Developed by Daniel David Palmer in Davenport,
Iowa, in 1895, chiropractic started out as a natural healing method freighted
with a variety of spiritual and metaphysical concepts. Palmer's theory suggested
that an Innate Intelligence flows through the nervous system and can be
obstructed by a "subluxation"--or misalignment--of one or more of the
24 joints in the vertebral column, thus interfering with the blood supply and
the body's full expression of healthy functioning. Palmer believed that, because
all parts of the body are connected through the nervous system, all diseases
were caused by one or more subluxations. Thus, any disease could be cured by
manipulating or realigning the vertebrae in order to allow the body to heal
itself.
A significant misalignment of the vertebrae is rare--and, as in scoliosis, is
usually quite noticeable. Conversely, many people have asymmetrical spines with
slight imperfections in alignment, yet suffer no adverse effects on their
health. Many contemporary chiropractors therefore have begun to discuss
subluxation less in terms of misalignment and more in terms of loss of function,
since even a joint in perfect alignment may fail to work properly and tend to
cause pain.
Over the years, different branches of chiropractic developed that emphasized one
or more principles of Palmer's original theories to greater or lesser degrees.
Historically, chiropractors categorized themselves as "straights" or
"mixers" to describe how closely they adhered to Palmer's philosophy.
"Straights" were purists, using only manipulation and focusing
exclusively on the spine; "mixers" supplemented manipulation with
other forms of treatment, such as nutritional counseling and physiotherapy, and
acknowledged that diseases were caused by problems other than subluxations.
Chiropractic schools and professional associations developed along these lines.
Today, these distinctions are breaking down. According to a 1997 report from the
Agency for Health Care Policy and Research, more than two-thirds of
chiropractors use techniques other than manipulation, such as exercise,
nutritional counseling, and physiotherapy, although 93 percent retain spinal
adjustment as their primary approach to treatment.
Who Should Avoid This Therapy
Chiropractic is not recommended for disorders of other than musculoskeletal
origin, and should be avoided for certain musculoskelatal problems as well. For
instance, it is not recommended for osteoporosis, bone or joint infections, bone
cancer, acute rheumatoid arthritis, and diseases of the spinal chord or bone
marrow. It should also be avoided in an area that has been operated on, such as
a spinal fusion, and near acute fractures and dislocations or healed fractures
and dislocations with signs of ligament damage. Chiropractors do not treat
fractures.
Scoliosis, a condition in which the spine curves to the side, is generally
considered a target for chiropractic therapy. However, idiopathic
scoliosis, which develops over time instead of being present at birth
(congenital scoliosis), is not appropriate for treatment by a chiropractor.
What Side Effects May Occur?
Serious side effects from spinal manipulation appear to be rare. Strokes have
been reported following manipulation of the neck, presumably as a result of
damage to one of the arteries supplying blood to the brain. However, the
incidence of adverse events from manipulation of the neck region is estimated to
be 1 in 1 million procedures, according to the Agency for Health Care Policy and
Research. Likewise, the Agency pegs the risk of a serious side effect from
manipulation of the lower back at 1 case in 100 million manipulations.
Minor side effects of spinal manipulation have not been systematically analyzed.
The adverse reactions reported by one study, such as headache, radiating
discomfort, and fatigue following manipulation were not clearly shown to be a
result of the treatment.
How to Choose A Therapist
Choose a chiropractor as you would any other health care professional. Discuss
your condition with him and clearly establish the type of treatment he plans to
provide, its expected outcome, how long it will last, and how much it will cost.
Ask about his training and treatment philosophy, bearing in mind that
chiropractic is generally considered effective only for temporary back and joint
pain. Find out whether the chiropractor is part of a team of health care
providers, and see whether he will provide referrals if necessary. Be suspicious
of a practitioner who attempts to sell you expensive nutritional supplements or
devices that purport to improve your health.
There are approximately 50,000 chiropractors in the United States. They are
licensed in every state and must pass an examination with the National Board of
Chiropractic Examiners. Restrictions on the procedures they may perform vary
from state to state. To be admitted to a managed care plan, they must often pass
additional tests.
The 16 chiropractic colleges in the U.S. are accredited by the Council on
Chiropractic Education, a federally recognized accrediting agency. Typical
academic training and clinical internships include four years of training at an
accredited institution after a minimum of two years of college; more than 2,000
study hours of biological and clinical sciences; more than 1,000 study hours of
chiropractic sciences, including body mechanics, spinal analysis and
adjustments, diagnostic imaging, and x-ray interpretation; internships in
clinical radiology and interpretation; and at least 900 hours of clinical
practice and patient care. Some chiropractors have additional postgraduate or
continuing education in the fields of sports injuries, occupational health,
orthopedics, or neurology.
When Should Treatment Stop?
In many cases, relief is immediate. If pain persists, allow some time for
improvement to appear--2 weeks is generally sufficient in cases of acute
low-back pain. If there's still no change, or if the condition becomes worse,
stop the treatments and seek alternative therapy. Many chiropractors refer
patients to specialists for further evaluation when a condition persists.
See a Conventional Doctor If...
Despite chiropractic's original contention that all health problems stem from
subluxation, your wisest course is to check with an M.D. if the problem isn't
clearly related to the back or joints. Likewise, if a chiropractor discovers any
dangerous problems that need immediate medical attention, he's likely to refer
you to a medical specialist without delay. Tumors, fractures, or other
suspicious findings viewed on an x-ray are common reasons for immediate
referral.
Resources
ORGANIZATIONS
The American Chiropractic Association
1701 Clarendon Blvd.
Arlington, VA 22209
Phone: 703-276-8800 or 800-986-4636
Web: http://www.amerchiro.org
The International Chiropractors Association
1110 North Glebe Rd., Suite 1000
Arlington, VA 2201
Phone: 703-528-5000
Web: http://www.chiropractic.org
FURTHER READING
The American Holistic Health Association Complete Guide to Alternative
Medicine. William Collinge, MPH, PhD. New York: Warner Books, 1987.
Chiropractic: The Victim's Perspective. George Magner. Amherst, NY:
Prometheus Books, 1995.
The Alternative Health & Medicine Encyclopedia. James E. Marti.
Detroit: Visible Ink Press, 1995.
Quackwatch.
Website at http://www.quackwatch.com
Dr. Rosenfield's' Guide to Alternative Medicine. Isadore Rosenfield, MD.
New York: Random House, 1997.
The New Wellness Encyclopedia. The editors of the University of
California at Berkeley Wellness Letter. New York: Houghton Mifflin Company,
1995.
Understanding Acute Low Back Problems, Consumer Version. Clinical
Practice Guideline No. 14, U.S. Department of Health and Human Services, Public
Health Service, Agency for Health Care Policy and Research, Publication No.
95-0644, December 1994. Write: ACHPR Publications Clearinghouse, P.O. Box 8547,
Silver Spring, MD 20907; Call: 1-800-358-9295.
Back
to Alternatives <--