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Chiropractic: Does
it work?
Experts say yes
By Susan Ince
SPECIAL TO MSNBC
| Oct.
6 —
Despite
a spell of negative publicity for chiropractic medicine, the practice
has never been more popular: The number of chiropractic visits per
capita has doubled in the past 20 years. Do chiropractors offer more
than just a good back rub? Experts say yes. |
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For
lower back pain, would you seek the care of a chiropractor? |
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2584 responses |
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Yes
 72%
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No
20%
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Unsure
8%
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WITHOUT AN ACCIDENT or unusual exertion to explain it, two years
ago Debra Levy, then 32, suddenly found herself immobilized by
excruciating pain in her lower back. Muscle relaxants were prescribed
but didn’t help. A few days later the pain was so severe she was taken
from her home by ambulance and hospitalized overnight.
X-rays showed inflammation but no
bulging discs or other structural abnormalities, and physicians sent her
home with stronger painkillers and instructions to rest and wait for the
situation to improve. Levy spent most of the time flat on her back; when
she walked at all, her body was contorted into an L-shape.
Then, with her physician’s
support, Levy began to see chiropractor Linda S. Squires, president of
Amethyst Chiropractic in Somerville, Mass. There, Squires readjusted her
spine and pelvis, massaged the muscles to help release spasms and gave
Levy careful instructions on stretching her muscles and using her back
properly.
“Instead of waiting for the
inflammation to dissipate and the spasms to let go, we manually work the
muscles and adjust the spine and pelvis so there is a quicker recovery
time,” says Squires. “Then we lessen the frequency of treatments and
try to move people to independence.”
Levy says the approach got her out
of bed and quickly back to work as a youth manager for the AIDS Action
Committee of Boston.
“She took me from a crisis stage
— having this unknown painful awful problem — and explained what was
wrong. Learning small things, like how to sit and get up safely, made me
feel more in control of my healing,” says Levy. After about a month of
regular adjustments, Levy’s visits tapered off, and within a few
months she was able to enjoy a long-planned kayaking trip to Mexico.
Now, Levy recognizes early signs of
trouble and returns to Squires for occasional adjustments and advice —
most recently, after adopting a baby and having a back flare-up before
she learned the proper mechanics for lifting and changing the infant.
Levy’s experience illustrates why
chiropractic is so popular: It is usually used for neuromuscular
conditions where evidence is most solid and no treatment option works
perfectly. While there’s little evidence supporting the use of
chiropractic for conditions like asthma or stomach troubles, experts say
studies show the discipline does offer relief — especially to patients
with back pain, sore necks and headaches.
Though it’s unclear just how
chiropractic works, one theory holds that it mobilizes the spinal joints
to improve the function of the nerves exiting the spine at different
levels.
BAD BACKS
Several years ago, the U.S. Agency
for Health Care Policy and Research concluded that chiropractic care is
effective in the first month of low back symptoms.
And Americans are paying attention.
One in six U.S. adults uses chiropractic services, according to a survey
of 1,500 adults commissioned by Landmark Health, Inc., of Sacramento,
Calif. About 38 percent of these patients seek care for low back pain,
according to an American Chiropractic Association survey.
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| What
are chiropractors? |
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And
what do they do? |
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Chiropractors
specialize in the treatment of the musculo-skeletal
system. Classic chiropractic treatment involves
manipulation of the bones and joints, primarily of the
spine. |
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They
may also use massage or other techniques to loosen tight
muscles. |
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In
addition, chiropractors often suggest exercises or
educational materials on proper ergonomics to help a
patient safely return to normal activities as soon as
possible. |
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“The preponderance of the
evidence strongly suggests that for acute lower back pain, without
evidence of neurologic deficit, the treatment of choice is spinal
manipulation,” says John J. Triano, a chiropractor and co-director of
conservative medicine at the Texas Back Institute in Plano.
If low back pain is accompanied by
worsening leg weakness, spreading numbness or loss of bowel or bladder
control, however, patients should seek prompt evaluation by a physician,
says Triano.
“The other major consensus is
that if someone goes to a chiropractor and feels no better after 10 to
12 treatments, then additional treatment of the same time will probably
not be of great benefit. If you’re not better after four to six weeks,
there’s no point in flogging a dead horse and going with the same type
of treatment — and that is also true of acupuncture, medication or
whatever you decide to try,” says Dr. Scott Haldeman, a clinical
professor of neurology at the University of California-Irvine and a
specialist in spinal problems.
At the Texas Back Institute, having
a range of professionals working together makes it easier to identify
treatments that are failing and switch patients to something else, says
Triano, who receives five calls a month from orthopedists and
chiropractors hoping to establish similar relationships. However, Triano
cautions that a one-time cure for low back problems is unrealistic. Like
Levy, most people will experience a periodic return of symptoms — on
average having their second episode about seven months after the first.
“Studies are beginning to provide
strong evidence that manipulation can relieve symptoms and restore
function faster in people with chronic back problems. But probably the
most bang for the buck is for people with back problems to make
lifestyle changes and become very physically fit,” says Triano.
PAINS IN THE NECK
More than one in four people who
see chiropractors are seeking relief from neck pain, whether it stems
from an injury or from daily misuse and bad posture — say, sitting for
hours in front of a computer screen or using the neck to cradle the
telephone.
In general, the medical model has
not been successful in addressing neck pain, according to Triano.
“Whether you see a chiropractor,
an orthopedist or a neurologist, there is no good system to pinpoint the
specific pain-generating tissue and provide a specific treatment for
neck pain, unless there is severe trauma with obvious dislocations or
fractures,” says Triano. “At this point, the evidence shows that
manipulative procedures are worth the effort, but if you are not
responding well after two to four weeks, it is probably not the right
treatment.”
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| Choosing
a chiropractor |
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Dr.
Scott Haldeman, a clinical professor of neurology at the
University of California-Irvine and a specialist in spinal
problems, offers these tips: |
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Be careful,
as you would with any physician, not to go to someone with
claims that exceed logic.
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Expect a
thorough physical examination before treatment.
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Expect a
reasonable and understandable explanation of what the
chiropractor thinks is wrong and what you can expect from the
treatment.
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The most common acute cause of neck
pain is whiplash — the term used for the painful symptoms created when
a sudden insult, such as a rear-end collision, forces neck structures to
extend past their normal range of motion.
“The amount of data is not as
strong as for low back pain, but a recent coalition in Quebec felt that
chiropractic is a reasonable option in the treatment of whiplash,”
says Haldeman.
Immediately after a whiplash,
patients generally do better if they are encouraged to move their necks
gently and return to normal activities as quickly as their pain will
permit, says Triano, who reserves the use of collars to those patients
with severe bruising and soft-tissue damage.
Whether manipulation soon after an
injury helps is debatable. One study, described in a RAND corporation
analysis, found that manipulation resulted in immediate improvement. But
one week later, it was no better than encouraging patients to move their
necks.
“Manipulation is probably most
effective in sub acute neck pain, when the patient is over the initial
injury but the neck is still subject to muscle spasms, limited range of
motion and ‘locking up,’” comments Haldeman.
CAN MIGRAINE BE
MANIPULATED?
About 14 percent of chiropractic
patients are looking for headache relief, according to the American
Chiropractic Association.
Recently, researchers at the
Northwestern College of Chiropractic in Bloomington, Minn., compared the
use of spinal manipulation against daily treatment with amitriptyline
— a tricyclic antidepressant used in the preventive therapy of both
chronic tension and migraine headache. In their study of 218 patients
with frequent migraine (at least four episodes per month), scores
derived from patients’ daily headache pain diaries improved between 40
and 50 percent over the four-week treatment period, whether the
treatment was twice-weekly chiropractic adjustments, amitriptyline or
both.
However, four weeks after the
treatments were stopped, those in the chiropractic group retained the
benefits, while those in the amitriptyline and combined groups lost
about half of their improvement, according to a report in the Journal of
Manipulative and Physiological Therapeutics.
“The results were virtually
identical to a similar study, without the combination group, that we
conducted with tension headache,” says lead author Craig F. Nelson, a
chiropractic and clinical researcher at the Northwestern College of
Chiropractic.
“I would caution that
overaggressive manipulation of the neck can actually make migraine
worse. However, less vigorous manipulative techniques, especially when
combined with an active exercise program, can be beneficial for many
migraine sufferers,” says Frederick G. Freitag, a chiropractic and
associate director of the Diamond Headache Clinic in Chicago.
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| Red
flags |
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While
there are many benefits to manipulation, there are some
situations in which the technique should be avoided, such as if
a patient has: |
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Acute severe
injuries
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A fracture
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Cancer
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A tumor or
softening of the bone, unless cancer has been ruled out
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Severe
rheumatoid arthritis
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Tuberculosis
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Severe spinal
infection
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| The
Agency for Health Care Policy and Research; Dr. Scott Haldeman |
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Whatever treatments they use for
migraine, patients should work with health care providers to identify
the triggers that provoke their headaches, and avoid the daily or almost
daily use of pain relievers, which can result in rebound headaches, says
Nelson.
“It’s unrealistic that there
will ever be a single gold-standard treatment for chronic headaches.
There are probably several dozen treatments, including medication,
chiropractic and others, that can be effective — but for a given
individual it is not clear which is likely to be the best. Whatever the
treatment is, the patient should expect a good result. After four to six
weeks, move on if the results and the side effects are not
acceptable,” concludes Nelson.
“Some patients do have postural
or mechanical factors that contribute to their headache situation. In
that kind of patient, it can occasionally be useful to use manipulative
therapies such as chiropractic or physical therapy, along with exercise
conditioning programs or postural retraining programs to address the
underlying problem,” says Freitag.
Although some chiropractors tout
the technique’s benefit in asthma, menstrual distress, recurrent ear
infections and gastrointestinal symptoms, only a small percentage of its
patients are seeking treatment for conditions without a clear musculo-skeletal
component. Given the state of the existing research evidence, that makes
sense, says Nelson.
“I think it’s fair to say that
chiropractors are trained to evaluate and manage neuro-musculo-skeletal
disorders conservatively and to know when conservative treatment is no
longer appropriate,” Nelson says.
Susan Ince is a medical writer
based in Hawaii. She has contributed to many national publications,
including Glamour, American Health, Redbook and Good Housekeeping.
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