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Can chiropractic care relieve
… my back pain?
… my neck pain?
… my headache?
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Probably. Chiropractic treatment is often effective in relieving pain associated with mechanical neck or back conditions. Most people with spine-related pain have what is now called mechanical back pain. That is, the pain is not caused by a disease process such as infection or tumor. Rather, it is what medical physicians have for years been referring to as "garden variety back pain." This term implies that it is common, relatively trivial, and would be expected to resolve within a few weeks with or without treatment.
But back pain is not trivial to someone in the throws of an acute episode or to someone who must live with chronic pain every day. And recent studies have caused doctors to question the assumption that most episodes of back pain resolve within a few weeks, with or without treatment.
Mechanical back pain (and much of what is said here also applies to the neck as well as to headaches caused by neck problems) means that the pain is produced by the distortion or dysfunction of the muscles, ligaments, or joints due either to injury, overuse, or postural stresses. (Notice that we did not say "bad" posture.) Its causes include excessive sitting, being overweight, and lack of exercise. Ultimately, mechanical back pain may result in degenerative disease of the spinal joints (arthritis) and degeneration of the spinal discs. Sometimes, a ruptured or herniated disc can result from prolonged mechanical strain.
Mechanical back pain does not include diseases of the bones or pain referred to the back by diseases in other organs. These causes of back pain occur in only a small percent of people with back pain. Chiropractors evaluate patients for such conditions prior to beginning treatment.
Over the past ten years there has been a growing recognition of the effectiveness of SMT (spinal manipulative therapy or manipulation) in relieving pain. Treatment guidelines in several countries including the U.S. and England now recognize the important role of SMT in treating acute back pain. Furthermore, there is also a growing body of research demonstrating the efficacy of SMT for chronic back pain.
Many neck problems and headaches are also relieved by chiropractic treatments, and there is a growing body of research to confirm this.
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What health problems do chiropractors treat?
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Our primary focus is on the diagnosis and treatment of musculoskeletal and associated neurological problems such as neck and back pain, joint pain, headaches, and muscle pain. While some chiropractors have claimed that spinal adjustments relieve a variety of illnesses, SpineCare chiropractors concentrate on treatments proven to be effective for spinal and other musculoskeletal complaints. The following conditions are often improved by chiropractic treatment:
- Low back pain
- Headache
- Neck pain
- Pain in joints
- Pulled muscles
- Whiplash
- Sports injuries
- On-the-job injuries
- Auto accident related injuries
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What kinds of treatments do chiropractors use?
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Spinal manipulation (or adjustments) is the most common treatment used. Manipulation helps restore normal movement and function to spinal joints. Manipulation is rarely painful. It is performed by positioning the spine in such a way that specifically directed movements of the chiropractor's hands correct vertebral joint dysfunction. Adjustments are mainly a manual type of therapy, but sometimes the treatment may be facilitated by the use of a special type of adjusting table or other mechanical device. Other therapies may include ice, heat, massage, ultrasound, and electric muscle stimulation. Exercises are often prescribed for patients to perform at home to improve upon gains made by in-office treatment. Another advantage of an exercise prescription is that progress is usually faster and fewer chiropractic treatments are required.
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Are spinal adjustments
painful?
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To be perfectly honest, the answer is no ... and yes. Many people experience momentary discomfort. A few people feel pain, but it is rare for the pain to last more than 30 to 60 seconds. The amount of pain one feels from the adjustment usually has nothing to do with how much pain the patient was in prior to the treatment. You might think that someone with an acutely painful low back or neck would find spinal adjustments more painful, but far more often it is just the opposite.
In acute conditions, there is usually muscle spasm and inflamed tissues. SpineCare chiropractors administer therapies to reduce pain, swelling, and spasm prior to adjusting the spine. The actual adjustment is performed so quickly that it is over before the patient's muscles can react.
Occasionally patients have muscle soreness or experience milder pain in another area for a day or two after the treatment as the body accommodates to the adjustments. Depending on your particular condition, you may be instructed to apply ice or heat at home, perform stretching exercises, or be given other home-care instructions to alleviate post-treatment discomfort.
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How safe are chiropractic
treatments?
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Chiropractic care is one of the safest treatments available. Side effects, other than mild soreness, are extremely rare. Adverse results from common pain medications such as Advil, Aleve, Motrin, Orudis, even aspirin are far more common. A recently published study reported one death for every 9,210 prescriptions of such drugs, mainly related to gastrointestinal bleeding and perforation.
A good chiropractor knows when to adjust and when not to. That is one reason why a history and physical exam are performed at the first visit, to check for health problems in which spinal manipulation should not be performed. Chiropractic treatment is so safe, especially since no drugs are used, that even children and pregnant women routinely benefit from it. Extremely rare side effects from manipulation can include fracture, disc herniation, and stroke. The risk of stroke from cervical manipulation has been estimated to be anywhere from one in a million to one in ten million. Perhaps the greatest risk is getting adjusted too frequently over a long period of time. SpineCare chiropractors avoid over-treatment that can lead to loose ligaments, hypermobile joints, and over dependence upon chiropractic care.
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What happens at
the first visit?
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During your first visit to a SpineCare clinic, the doctor will ask questions about your symptoms and take a general medical history. You will then have a physical examination directed specifically to the areas of complaint. This will include orthopedic and/or neurological tests commonly used by physicians. In addition, attention will be focused on your posture and the structure and function of your spine, including muscles, bones, and joints. X-rays or other tests may be ordered but are not routinely required by SpineCare chiropractors. At this point the chiropractor will explain the nature of your condition and whether you can be helped by chiropractic treatment. If your problem is one that is outside the scope of chiropractic, or if the doctor thinks that a second opinion is necessary, you will be referred to the appropriate health care professional. Most patients will receive a treatment at the first visit. But before you agree to go ahead with the recommended care, you will receive a complete explanation of the proposed treatment plan, its benefits and potential risks, if any, and your questions will be answered.
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X-rays are not routinely ordered at SpineCare clinics. Chiropractors have traditionally relied on spinal x-rays to help determine which bones are "out of place." But x-rays cannot demonstrate which vertebrae are fixated or hypermobile, no more than a photograph can tell you if a door is stuck closed or is freely movable. Modern chiropractic and medicine agree that there is little to be gained by taking x-rays of common spinal complaints. X-ray is usually reserved to evaluate suspected fractures, pathology, and congenital (birth) defects. If your SpineCare doctor suspects a condition that could be diagnosed more accurately with x-ray or other imaging techniques such as CT or MRI, then a study would be recommended.
No one knows for sure if there is a dose of radiation so low that it is completely safe. We do know that radiation's effects are cumulative. X-ray exposure adds up during our lives. Thus, even "low" doses of "safe" x-rays may add up over the years, producing undesirable health consequences. The risk of not taking x-rays must outweigh the risk of the x-rays themselves to warrant their use.
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Do I need a referral
from my M.D?
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No, in most cases you do not. If your insurance covers chiropractic care, it is unusual for M.D. referral to be required. (In workers compensation, continuing chiropractic treatment after 12 visits may require a referral, depending upon your employer's plan.) A growing number of physicians recognize the value of chiropractic treatment. The AMA no longer prohibits medical doctors from referring patients to chiropractors, and it is becoming more common for physicians to recommend chiropractic care to those patients who would benefit from it.
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How long do I have to
keep going?
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Some people have had the experience that once you start going to a chiropractor, there seems to be no end to the treatments. At SpineCare our goals are to relieve your pain as quickly as possible with the fewest number of appointments, and to help you get well and stay well without being dependent upon ongoing care.
In most cases, four to six treatments over a two week period is sufficient to determine if chiropractic care is going to help. Some people require more treatments over a longer period, but most experience considerable relief in a short time.
Some chiropractors advocate life-long chiropractic care: You need to receive regular chiropractic adjustments if you want to continue to feel good. SpineCare chiropractors are proponents of patient empowerment. We teach our patients how to keep their spines in good shape, much like dentists educate their patients about oral hygiene through regular brushing and flossing. We teach stretching and strengthening exercises and give advice on how to sit, stand, and perform your normal daily activities properly so you maintain improvements gained from chiropractic treatments. Several medical journals have published studies showing that patients with back pain benefit from spinal manipulation combined with exercises, but those patients who continued to do the prescribed exercises were far more likely to maintain their improvement after treatment was discontinued.
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What is the popping noise?
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The pop or crack often heard with an adjustment or manipulation is caused by the sudden movement of fluid and gas within a joint. This is called cavitation. But the noise is not therapeutic in itself. Research suggests that cavitation releases adhesions, thus improving motion. The purpose of an adjustment is to help restore normal motion in a joint. When you break a bone it should be put in a cast so it can heal. But when a joint is injured (even a muscle strain can impair joint movement), normal motion must be restored for proper healing to occur. An adjustment has a specifically applied force and direction to correct restrictions and fixations.
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Does chiropractic really work?
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There are now more than 36 controlled clinical trials published in medical journals, many of which report favorable results from chiropractic treatment. The AHCPR, an agency of the federal government, has endorsed spinal manipulation as a treatment of choice for back pain. Manipulation is also recommended by the Royal College of General Practitioners (Great Britain). In the U.S., chiropractors are the most highly trained providers of spinal manipulation. Over 90 percent of all spinal manipulation is performed by chiropractors. Surveys have consistently demonstrated high patient satisfaction with chiropractic treatment.
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Will my health insurance
cover the cost?
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Many managed care plans cover chiropractic care to some extent since it is in such high demand and offers a cost-effective way of achieving relief. Most HMOs in Oregon allow members to access chiropractors directly, even when they must get a referral from their M.D. for other types of specialized care. Many other health insurance plans include coverage for chiropractic services, too. If you are hurt at work or in an automobile collision, your insurance will cover 100 percent of your chiropractic care in most cases. Medicare provides limited coverage for chiropractic treatment.
SpineCare chiropractors are providers on most HMO and managed care plans. To find out if your health insurance covers chiropractic care—and to find out if a SpineCare chiropractor is a participating provider—call us at (503) 443-2273.
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Are chiropractors
"real doctors?"
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Chiropractic education and licensing are similar to that of medical doctors, and the D.C. degree (Doctor of Chiropractic) is recognized as a doctoral degree by the U.S. Office of Education. Chiropractors are not trained to prescribe drugs and, except for a few chiropractors in Oregon who are specially qualified to do minor surgical procedures, chiropractors do not perform surgery. Chiropractors receive four years of education in basic and clinical sciences at a chiropractic college, credentialed by the Council on Chiropractic Education, an agency recognized by the U.S. Office of Education. Many of the courses are identical to those taught in medical schools. In fact, chiropractors must take a far greater number of hours in subjects such as orthopedics and x-ray interpretation than are required for medical students.
Chiropractors must pass rigorous national and state board examinations to earn a license and the privilege of administering health care to the public. Chiropractors do not normally treat the wide range of medical conditions seen by general practitioners and medical specialists, but we are trained to recognize ailments more appropriately treated by other health care providers and refer patients to appropriate specialists.
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Is chiropractic treatment safe for people with osteoporosis?
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Osteoporosis is a relative contraindication for spinal manipulation. A treatment is contraindicated for a condition when the treatment is likely to make the condition worse or cause additional problems. When a condition is an absolute contraindication for a particular treatment, then the risk of harming the patient far outweighs any possible benefit from the treatment. If the treatment is only relatively contraindicated, as is the case with chiropractic adjustments and osteoporosis, then the decision to use spinal manipulation must be made on a case by case basis.
The most important rule for chiropractors when treating patients with osteoporosis is to be gentle. Fractures can result from manipulation that is too forceful. The spine is particularly susceptible to osteoporotic fracture. Those who are at high risk for osteoporosis, including people with a history of long-term steroid use, should discuss potential dangers of chiropractic treatment with their chiropractor. Of course, a good chiropractor will discover when taking a medical history if someone has or is at risk for osteoporosis and proceed accordingly.
For more information, see the brief summary, Compression fractures in patients treated with spinal manipulation.
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My concern is that my chiropractor who has taken excellent care of my neck is now insisting I come far more often than I was originally told.
Once my neck was repositioned properly, I was told 12 years ago that I would just need to come in for maintenance about 4 times a year. I did that and was told I was doing great because of taking care of myself and told I had no sign of arthritis. Now I am told to come once a month for manipulation and I have done that for several months but go in feeling great and then I ache for days afterward. When I stated that I wanted to return to the original plan of 4 visits per year, I was told I must come once a month to keep the arthritis under control. I said I thought I did not have arthritis and was doing all this so I would not get it. I have never had any back pain until after the recent treatments and I worry that these regular poundings are causing more damage than help. I play tennis twice a week, work out 2-3 times a week, yoga once a week and have not slowed down - have no problem running or doing any of the things I did when young. I am 66 and depressed now that I've been told I have the arthritis which I was going to the chiropractor to avoid. I do not think I have much arthritis because I have no pain except after these manipulations. I am afraid too harsh of manipulations are causing me more problems than preventing. I want to stop going so much but still be accepted as a patient when I do need help.
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First, let's consider what you are referring to as arthritis. Most likely you are talking about degenerative or "wear-and-tear" changes that normally develop in everyone's spines as we age. Other terms for this type of arthritis are osteoarthritis, degenerative joint disease or sometimes degenerative disc disease, and spondylosis. This is a normal occurrence as people age and it is not necessarily associated with pain and stiffness. The reason it is normal is that the discs - the cartilagenous pads between the vertebrae - lose their blood supply by the time we are 25 years old. After that, discs absorb fluid from the body much like a sponge. This is not as good as a blood supply, however, so over time the discs start to dry out, become thinner, and form small cracks. Along with changes in the discs, the vertebrae beginning forming spurs and other bony growth. These changes can be seen on x-rays of people over age 35 in most cases, whether or not there are symptoms.
There are several other types of arthritis which are more serious and are associated with diseases affecting other areas and systems of the body such as rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis, etc. I suspect you have none of these conditions.
As I said, osteoarthritis is a normal, natural occurrence in the spine. Being active can slow this process to some extent, but I'm unaware of any research studies that demonstrate chiropractic treatments will prevent or even slow this process. There are a few studies in which animal vertebrae have been externally fixated (that is, using metal devices to keep the vertebrae from moving). In these studies the animals developed arthritis in the immobile vertebrae in a matter of weeks. But this does not suggest that regular chiropractic treatments will prevent arthritis, only that fixation promotes it.
So, my question to you is this: How do you know you have arthritis, or for that matter that you had no sign of arthritis for the 12 years you were receiving 4 time a year treatment? The only way to determine the presence or absence of degenerative changes is with some form of diagnostic imaging, usually x-ray. Were you having regular x-rays? Has there been an x-ray study recently which, compared to past studies, shows changes in the spine consistent with osteoarthritis? If you were being x-rayed regularly during the 12 years you were "doing great," then you were being exposed unnecessarily. If you have not had recent x-rays (and from what you've told me there would appear to be no reason to do so), then there is no basis upon which to say that there is arthritis which must be kept under control with regular adjustments.
The fact that you now feel worse following each treatment should be telling you something. The traditional chiropractic philosophy is about removing interference to the nervous system so that the body can heal itself. If you are feeling worse now that you are getting more frequent adjustments, shouldn't you be listening to your body?
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