I started going to a chiropractor about 6 weeks ago to see what chiropractic treatment was all about. I spend 10-15 minutes on a table that rubs my back and then my chiropractor does about 5-10 minutes of uiltrasound and then about 2 minutes of adjusting. I can’t say that I feel any different after 6 weeks. I’m really disappointed that the only real therapy that I’m getting lasts 2 minutes. For those of you that go to chiropractors regularly or for those of you who are chiropractors, is this the standard treatment? Is there more to this practice that I’m missing out on? I’ve never really had any problems with my back but I thought I’d try and get “aligned” before I start training for next season. I’ve looked at some of the other posts regarding this topic and now I’m curious about ART. It seems to me that this technique inlcudes more therapy and hands on treatment than chiropractic therapy. Any suggestions? By the way, I’m a firm believer in regular message treatment (1/month at least) and I think I’m going to drop the chiropractic treatment and stick with messages.
I’ve seen a real advancement in my health over the last three years of consistant chiro visits. 1-2 minutes sounds right unless you have seriously screwed something up.
There’s no science behind chiropractry. No one has ever been able to prove that it works - all the evidence is anecdotal. A big study last year showed that, for the treatment of back pain, it’s no better than using ibuprofen (Advil/Motrin). In addition, the spine really can’t be “adjusted.” Nonetheless, some people swear by it.
A word of warning: chiropractic adjustment of the neck has been associated with vertebral artery dissection and stroke, with an incidence as high as 1 in 3000. You don’t want that. It’s bad. Very.
1: It’s chiropractic, not chiropractry.
2: If it’s as effective as an NSAID, that may be worth something; NSAIDs are not entirely benign, and do have a significant complication rate, including death.
3: Efficacy of spinal manipulation and mobilization for low back pain and neck pain: a systematic review and best evidence synthesis.
Source Spine Journal: Official Journal of the North American Spine Society. 4(3):335-56, 2004 May-Jun.** ******
RESULTS: Acute** LBP:** There is moderate evidence that SMT provides more short-term pain relief than MOB and detuned diathermy, and limited evidence of faster recovery than a commonly used physical therapy treatment strategy. Chronic** LBP:** There is moderate evidence that SMT has an effect similar to an efficacious prescription nonsteroidal anti-inflammatory drug, SMT/MOB is effective in the short term when compared with placebo and general practitioner care, and in the long term compared to physical therapy. There is limited to moderate evidence that SMT is better than physical therapy and home back exercise in both the short and long term. There is limited evidence that SMT is superior to sham SMT in the short term and superior to chemonucleolysis for disc herniation in the short term.
4: ****Spinal manipulation: current state of research and its indications.
**Source **Neurologic Clinics. 17(1):91-111, 1999 Feb. **Abstract **Based on the most recent and comprehensive systematic reviews, there is moderate evidence of short-term efficacy for spinal manipulation in the treatment of both acute and chronic low back pain. There is insufficient data available to draw conclusions regarding the efficacy for lumbar radiculopathy. The evidence is also not conclusive for the long-term efficacy of spinal manipulation for any type of low back pain.
The evidence is not “all anecdotal”. There are a number of RCTs which demonstrate superiority above placebo / sham manipulation. I don’t personally understand how it works, and would even agree that the terminology is misleading, but that doesn’t mean it doesn’t work. “Conventional” medical treatment like NSAIDs have not been shown to be superior in management of back disorders - can you improve most of the back pain in your practice? Come to the dark side, young (OK, I don’t know that you’re young) orthopod, and embrace your chiropractic colleagues - they often want to see the patients that you don’t.
And, no, I’m not a chiropractor.
Deke
OK, my reply above doesn’t mean it helps everyone, and I know of no clear evidence that it helps athletic performance if you’re not already in pain. If it’s not helping you, move on. It does help quite a number of folks though.
Deke
el guapo wrote: chiropractic adjustment of the neck has been associated with vertebral artery dissection and stroke, with an incidence as high as 1 in 3000
Where did you get this statistic? There would be a lot of people hauled off from the chiropractor’s offices in ambulances going straight to the ER if this were true. I’ve never seen nor heard of a single incidence, and I’ve worked in hospitals for over 25 years.
Some Chiropractors don’t use the quick rotary motions associated with such injuries just to be “safer”. At least, that’s what they’ve told me. The ones that choose to use the quick rotary motions, of course, pooh-pooh the risk, saying it just isn’t as risky as some have tried to make it sound. Still, I prefer the lateral-flexion style on my neck…seems to work just as well to relieve the muscle spasms and associated numbness in my neck/shoulders that I get if I don’t go every once in a while. Ibuprofen by itself doesn’t seem to touch those spasms/numbness, and chiropractic treatment works great for this, for me. No way would I have been able to ride enough on the bike to successfully do an Iron distance race without going to a chiropractor periodically. I actually tried to go without it for a good while when I moved last year. Just couldn’t cope with the neck pain from muscle spasms that gradually worsened when I didn’t go. I also get painful upper rib problems if I don’t go periodically.
Can chiropractic treatment help to re-establish more normal mobility in a vertebral joint, with decrease in pain associated with the previously relatively immobile vertebra? Yep, if you have that problem to begin with. But, those that say they can “cure” asthma, liver disease, etc., I don’t buy it.
Love the name “el guapo”! They used it in the Three Amigos, right?
All I’ll say is that I find it’s like getting a bike fit - quality of practitioners varies. It took me 3 years to find a good one and I swear by it. If you release stuff early enough it cuts down on massage and is incredibly proactive to injury reduction if you find the right practitioner. Yes a lot of it is anecdotal but i’ve used virtually every type of injury treatment and this for me is the most effective along with a good core stability gym program.
I swear by a once a month visit. Incidentally Lance has one as well…
Simplistically explained, and as we all know…
…the spinal chord houses the central nervous system of the body (apart from the brain)…from which all the nerves spread out to all parts of the body…hence the numb leg associated with sciatic problems etc etc…this is because the nerves leading to that part of the leg is being pinched, for example.
If you have misaligned verterbrae then these nerves are not functioning properly and hence you get other symptons you would not even associate with missalignment of verterbrae.
Blurred vision is a symptom if your cervicals (neck verterbrae) are out of wack…as has happened to me. What would most people do…go to the optician and treat the symptoms rather than the cause.
As a graphic designer I sit on my arse all day…well, a lot of the day…so I have issues with my neck, mid back and lower back…the verterbrae get compressed from bad posture you don’t even notice and hence the problems we are all familiar with.
So…the solution to me is mechanical!!! Put those verterbrae back where they should be over a course of treatment if they are particularly bad.
The issue with chiropractors is the money you pay for what seems like a few minutes treatment…THAT’S THE ISSUE. IF IT COST $5 PER VISIT THEN EVERYONE WOULD GO AND EVERYONE WOULD RAVE ABOUT IT.
Chiropractice(?) works and works well. I would be in bad shape were in not for my regular visits over the year. To drop treatment and just have massages is not enough.
Like I said - some people swear by it. As I tell my patients: if it works for you, then have at it.
Thanks for the responses. Didn’t mean to inflame.
I am a chiropractor and a triathlete. My profession can make a vast difference in the way you perform but I can tell you, your results will definately vary from practioner to practioner. Like any occupation, there are those who take the time to research and practice sound techniques and there are those who just manipulate (crack, pop see ya later). As far as the bullshit remark about vertebral artery dissection…the studies are across the board but the incidence is roughly once in 2.5 million adjustments. I once read it happens one time in 38 chiropractic careers! Let’s just say, I know a heck of a lot of chiropractors and have well over 500,000 adjustments under my belt and strokes have never occured in my office or anyone’s office I know of.
Just to let you know, if you dont get results in my office after three weeks of care (even the worse people) something else is probably wrong with you and we refer out.
Like other people said, FIND THE RIGHT ONE! I went to one in Dec/Jan, and she basically crippled me. I had an SI joint problem that was being maintained by my PT, tried the chiro, and it was awful. I was bent over most of the day. I went back to my PT who got me in working order again, through several months of training, then started with a different chiro mid-summer, who made my back feel better than ever. He was also a pretty serious runner, which helped. However, it didn’t really help my IT band, so I’m back to the PT for that.
I am a Radiologist. I have had 7 patients with severe strokes from vertebral artery dissection from chiropractic manipulation of the neck. These were all young healthy people who are now faced with lifelong severe dissability. One of those people was an ER doc in our hospital. Her sister is a chiropracter and talked her into an “adjustment”. Anybody undergoing chiropractic care should understand the risks and weight them against the percieved benefits which have yet to be established in well constructed, double blinded, controlled scientific study. A well done study in The American Journal of Medicine a few years ago showed that chiropractic care resulted in no additional benefit compared to patients who were given pamphlets on back stretching exercises.
Like El Guapo said, there are people who swear by chiropractic but the hard evidence just isn’t there. If your only tool is a hammer, every job looks like a nail.
“Blurred vision is a symptom if your cervicals (neck verterbrae) are out of wack…as has happened to me. What would most people do…go to the optician and treat the symptoms rather than the cause.”
This is exactly the kind of total BS that is given to patients from all too many chiropracters. The optic nerve and oculomotor nerves are CRANIAL NERVES, meaning they originate directly from the brain and proceed to their ultimate destination via foramen (holes) in the skull. The spinal cord is in no way involved. The so called “adjustments” will have no affect on vision. People swallow this quackery and pay through the nose for it every day.
The most comprehensive study of low back pain that I am aware of was the Manga Report which was unbiased since it was commissioned by the Ontario Government and hired outside consultants. It came out very much in favor of chiroprctic. Traditionally AMA studies of chiropractic were no more than propaganda against chiropractic, hence the AMA losing in court under American anti-trust laws for deliberately deceiving the public. I strongly suggest you read the book “Chiropractic, History and Evolution of a New Profession” by Walter Wardell for more of this. Wardell is a medical sociologist at Cornell who has studied chiropractic vs medicine in great deal.
The Magna Report is here http://www.chiropractic.on.ca/Main.html
The incidence of stroke by neck manipulation is 1 in 2.5 million. Your claim of seeing 7 young stroke patients caused by chiropractic is very questionable. No doubt you’ve published this finding in a peer reviewed journal?
I gotta agree with cerveloguy, that is a pretty unusual number of patients, unless you’re the tertiary referral radiologist that a class action lawyer sends people to. If your typical radiologist had numbers like that, patients would be dropping like flies.
The other issue is that we have been talking about chiropractic as if it is a single treatment for a single problem. Personally, I don’t think I would want a neck manipulation - but for acute low back pain, there seems to be virtually no down side beside cost. There are studies like the one you refer to which demonstrate only minimal benefit, but as the meta analyses I posted above suggest, there are quite a few RCTs which do show a moderate benefit. I would suggest that there are a whole lot of things that we physicians do that have no benefit, potential harm and are not supported by RCTs - for example prescribing NSAIDs for undiagnosed MSK problems. How many people does that practice kill a year from GI bleeds?
We get hostile about chiropractors because the whole alignment explanation for what they do doesn’t make sense to physicians, but that doesn’t mean it doesn’t help a significant number of people for whom we don’t have particularly effective treatment.
Deke
Doc slick, I have no reason not to believe you. However, seven is a big number for one radiologist to see, you’ve apparently got something very bad going on in your area, it should be stopped before they kill/cripple someone again. I assume you’ve exhausted all the available local medical media sources to get the word out about the problem you have seen in your community. That number is substantial, and the reasons should be investigated and exposed for the sake of community health.
Any way, that’s why I like the lateral flexion neck movement, not the rotary. Lateral flexion is much slower and doesn’t have the potential shearing effect, so I’m assuming (I know it could be a mistake to assume) it has less potential for vertebral artery avulsion. Heck, I can mimick the lateral flexion movement myself as long as it’s on a loose-muscle day…it’s when those neck muscles spasm that my neck is too stiff for me to move it through that range of motion, and the chiropractor does it for me. I’ve never had it not relieve the spasms.
That’s a great comment about the hammer and nail. The Chiropractor I go to works out of a Western-style medical office, and they seem to cross-refer patients easily. Perhaps that is one reason mine is not one of those that claims to be able to cure everything, he actually sounds much like a physical therapist in his statements. It’s along the lines of, “Got a physical problem with some joints that can be helped with a little movement that you can’t do on your own? Maybe I can help.” Interestingly, he works on every member of the entire western medical office, including each of the doctors.
I’ve heard some chiropractors referring to Western medicine as the “evil empire”. I think many really believe that. While it may be true that Western medicine does a poor job overall in adequately stressing the importance of preventative lifestyle choices, that doesn’t make it the evil empire. This failure partly reflects the mindset of much of the population: “Let me do what I want, when I want to do it, and if it causes me some discomfort, give me a pill to fix it so I can keep on doing what I want, when I want to do it.” Neither chiropractors nor MD’s can fix that attitude.
For me, chiropractic felt good, as long as I kept going. When I stopped I was dying. After a while, I was fine again. Maybe it’s great for some - even necessary. But I think the bulk of it out there is just a racket that tries to hook you like a crack dealer.
Deke,
I won’t deny there is a possibility of risk with cervical manipulation but we have to keep it in perspective that the risk is very low and less risky than most accepted medical procedures. It is an area that does need more study.
Last year we went through the Lewis Inquirey in Ontario that was a well publicized inquest into the death of a chiropractic patient by a stroke. It was the first one ever reported in Ontario yet it provided a field day for the popular press. The negative publicity was so much that the average chiropractic office reported a drop of 50% in the month immediately following the investigation. It took several months for most offices to return to normal. Of course deaths by medical procedures never are reported by the mass media, and certainly not with the sensationalism of the Lewis Inquirey.
Now it appears that chiropractic is about to become delisted off the Ontario health plan, which is about one third of our incomes. This despite several studies recommending that OHIP would actually save money if they increased funding, not decreased or eliminated it.
I might be either selling orthopaedic supplies for a living or moving out of Ontario if delisting occurs. We’ll just have to see what happens.
HA! I was just about to post the exact same thing! Any 1st year student in basic anatomy would have figured that out. Unfortunately the general public thinks that all nerves come directly from the spinal cord and bad chiropractors know this (and are likely even taught this in their marketing seminars).
I think many really believe that.
I would say SOME older chiropractors believe that. They are from the days when chiros and MD’s fought tooth and nail over insurance coverage, validity, etc. It was ugly.
Today, IMO, the climate is much different. Both are covered by insurance, both get their money and respect (most of the time), many seem to work together. I went to college to become a DO at the request of my dad (a DC). My dad think’s DO’s are “the doctors of the future”. My dad crossed the line and had a best friend that was an ERMD. I think both guys taught each other a lot and erased a lot of misconceptions.
If you can get both sides to let their guard down, I think you’ll find that each will talk about benefits of of both.
I went to a chiropractic facility in KC where the #1 objective seemed to be “use up this guy’s insurance coverage as quickly as possible”, and then I went to another in KC whose philosophy was “come back and see us when you need and we’ll get ya feeling better” (awesome father and son team … son was also a physical therapists).
My dad was the chirporactor for all of the junior college’s sports teams. staying healhy and pain-free helps performance.
A “bad chiro” is akin to the MD that prescribes antibiotics for everything from a viral infection to knee pain. There aren’t as many of them as there seems to be … but the negative stereotype overshadows clusters of positive perceptions.