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  • Chiropractic: All it's Cracked Up to Be?

    First of all, a disclaimer. I am a DO, aka a Doctor of Osteopathic Medicine. What does that mean you might ask? Well, simply a DO, like a MD, is a fully trained physician who can perform surgery, write prescriptions, etc. There are some minor philosophical differences which really just amount to common sense and have little bearing in actual practice. There is one difference though that stands out to most people. DO’s are trained in osteopathic manipulation, which most patient’s perceive to be essentially the same thing as chiropractic. All DO’s are trained in manipulation, but less than 10% implement it in their daily practice. Over the past 100 years, manipulation has gone from essentially the only tool for treatment provided by DO’s to an also as DO education has evolved to incorporate the education necessary to function as a fully trained physician. I very rarely implement manipulation in my practice, but I do break it out on friends and family members when they complain of aches and pains and ask for a little help.

    Well, so what is a chiropractor? A DC (Doctor of Chiropractic) focuses solely on manipulation and other adjunctive care. They can’t write prescriptions, but often times they will also offer acupuncture, aroma therapy, reflexology, etc. along with manipulation, essentially extending their practice from straight manipulation to complementary and alternative medicine. Lots of alternative medicine has not been proven yet to be effective, but I’m not going to be too critical here. Lots of alternative medicine modalities are very difficult to create a blinded study for. It’s not like you can just use a placebo pill to test your treatment method, but I digress. The manipulation offered by both DO’s and chiropractors is pretty similar, but personally I think there are a few differences. I feel that DO’s tend to focus more on soft-tissue techniques, myofascial manipulation, etc. where DC’s tend to be more into “popping”, what we call high velocity low amplitude, or HVLA. I’m sure the DC’s that read this will disagree, but it’s just a personal opinion. The fact is, if you are interested in receiving manipulation to help with you aches and pains, the vast majority of the time you are going to go to a DC. Very few DO’s really advertise their manipulation services, and DC’s, naturally due to it being their primary treatment modality, have done a great job marketing themselves as the “go to guys” for this type of care.

    The real question is “Does it work?” The answer really depends on what you mean by “work”. This site and forum is dedicated to support athletes and body builders. This is a group prone to the types of injuries that would logically seem to benefit from a chiropractor’s services. Back strains, hip pointers, achy necks, etc. For that reason, I’m going to focus on chiropractic treatment of these types of issues, both in the acute phase and the chronic phase.

    Let’s start with the acute phase. When you have an acute injury, you first have to determine the severity of it. Is it just a strain, or did I tear something or break something? Before allowing anyone to “work” on you, you first have to be sure that either they or another health care professional has fully evaluated you and made sure there isn’t something more serious going on. Usually, you will know yourself, just because in the course of training you probably have hurt yourself in this same way before. Sometimes, there is just an acute strain, tight muscle, etc and all it needs is a little pressure in the right spot to get you back going faster. A lot of times, the treatment will make you feel better for a few hours, but then over time you get back where you are started. These are the types of injuries that really benefit from electrical stimulation (not very expensive to get your own TENS unit at home), alternating hot and cold, and a lot of rest and ibuprofen.

    What about chronic pain? Again chiropractic treatment often will make you feel better for a day or so, but over time you are right back where you started. You really have to decide whether the short term benefit is worth the cost in that regard. If going to the chiropractor weekly keeps you from popping multiple Percocet a day, I wholeheartedly encourage you to continue seeing the chiropractor. Interventional pain physicians, the ones who treat pain with nerve blocks and the like trying to avoid addictive medications, routinely refer their patient’s to chiropractors.

    Now time for me to be a little more critical of chiropractors. Medicine is a business first and foremost. Don’t ever think otherwise. However, chiropractic many times is a struggling business. Look around. There seems to be a chiropractor located in every strip mall. Over the past several years, there has been a glut of newly trained chiropractors, and the market is completely saturated. This is one of the reasons chiropractors try to sell treatment plans. They evaluate you, tell you you have a problem, and that it will take 22 visits to fix it. How does anyone know it will take 22 visits to fix? Where does that number come from? Well, if an insurance company is paying for it, that’s probably the number of visits they will pay for in a year. You may say, but I pop a ton every time I go, doesn’t that mean I have a problem? Here’s a secret, everybody pops, whether they have a problem or not. And no, just because your heel is “1/2 inch short on the left” you probably don’t need a heel lift either.

    I put manipulation in the same category as a nice massage. It feels great most of the time, and generally you feel better for awhile afterwards. But really there isn’t much long term benefit, you are going to be right where you were before in a few days. But if that benefit was worth the cost, proceed away. It’s not like I’m recommending narcotics and surgery, don’t get me wrong. Narcotics are the devil and will ruin your life, and surgery especially for back pain isn’t a cure either. Studies have shown that manipulation is helpful for low back pain, but that is about as far as any study will lead us. It’s just too hard to have “sham” manipulation treatments and impossible to have blinded study participants. One thing in closing, I strongly recommend against cervical HVLA. Vertebral artery compromise, stroke, etc. are possible complications, and I feel the risk is not worth the reward. The answer to the question posed at the start of this diatribe is a resounding, “Maybe?”

    James W. Stephens, DO
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