Adjust Your Thinking: Chiropractic First For Low Back Pain

Recently, I was doing some research on low back pain and common treatments for the condition.  What struck me as peculiar was how difficult it was to find accurate information on chiropractic care in the medical literature.  Having seen thousands of patients with back pain over the years and watching the vast majority of them improve with spinal adjusting, it seems to me to be inexcusable that chiropractic care is not the number one consideration when discussing caring for patients with back pain.

My search was rife with cautions and contraindications, most of which were inaccurate to say the least, and very few medical sites even referenced chiropractic spinal adjusting at all as a valid treatment for back pain.  Sure they’ll list about every other form of medical procedure from drugs to surgery, rarely mentioning known complications to those treatments, but chiropractic care is noticeably absent, ironic considering the success rate and safety record of chiropractic care versus traditional treatments for this condition.

According to WebMD, one of the foremost sources of health information on the internet, over 22 million Americans seek chiropractic care annually and over a third of those patients are seeking care for back pain.   Additionally, research confirms that chiropractic care is effective for the treatment of back pain, neck pain, and headaches.  Moreover, WebMD also reports that the satisfaction rate for patients seeking care in a chiropractic office is 95%.

So, why does the mainstream medical establishment still apparently have difficulty embracing chiropractic care as an effective valid option for patients with back pain?  I have spoken with many medical physicians over the years and their opinions are generally across the board.  Most, I have observed, really have no idea about how chiropractic works, why it is effective, or even what happens in a chiropractic office.  Essentially, I’ve inferred that they just think chiropractors ‘crack backs’ and the patient gets better either by magic or would have improved anyways.

Part of the reason for this misconception and poor understanding of the nature of spinal adjusting is that so many doctors, in my experience, have ever even been to a chiropractor.  Worse, with so much antiquated and disinformation prevalent from “respected” sources, it’s tough to sum up chiropractic care from a medical literature perspective.  I’ve seen, though, that those few medical doctors we’ve worked with in our office have a completely different opinion of chiropractic care once they become a patient.

When researching treatment options for low back pain, options such as lifestyle modification, physical therapy, oral medication, or even surgery are very common in searches.  Too often, unfortunately, chiropractic care is omitted altogether, though it may arguably be the most effective method of addressing the cause of the pain, rather than just covering the symptoms or offering temporary relief.  Even the National Institute of Health refers only briefly to ‘spinal manipulation’ and does not use the term ‘chiropractic’ at all when suggesting treatment options for back pain.  This is despite the fact that a 1992 government sponsored study by the RAND organization found chiropractic care to be more effective and less costly than medical care for the treatment of acute back pain.

Deepak Chopra, M.D. has said “instead of thinking outside of the box, get rid of the box.”  For too long, options for the treatment of back pain have been confined to limited ‘box thinking.’  Chiropractic care has been an established healthcare choice for over a century and its effectiveness for treating low back pain is well documented in the peer review literature.

Sites that offer back pain relief suggestions should be recommending chiropractic care as a first choice, especially given its effectiveness rate and safety when compared to medical care for comparable conditions.  Instead of burying ‘spinal manipulation’ in the second half of an article on back pain, the article should be saying, “If you have back pain, see a chiropractor first!”

It’s time to toss out the box that traditional methods are the only ‘solution’ for back pain.  Medication, for one, does nothing to address the cause of the pain and merely offers symptom relief.  It completely ignores the fact that pain occurs for a reason.  Surgery may directly address the cause of the back pain but comes with high procedural risk due to its invasiveness and relatively high potential for failure, not to mention limited options for care post-surgery, should the procedure fail.

Chiropractic care has a proven track record of safety and high effectiveness for low back pain.  Risk of complication from adjusting is also very low.  So, why then is chiropractic not the first choice in all instances for mild to moderate back pain?  The only answer can be fear.  Fear that more patients may choose chiropractic care over traditional medical care for one of the most common ailments in a doctor’s office.  Fear that patients may take fewer pharmaceuticals.  Fear that patients may actually get well and may not need expensive, invasive procedures.  Fear that maybe medicine doesn’t have all the answers.

There is a history of discrimination against chiropractors that goes back 100 years.  As recently as just a half century ago, chiropractors were still being jailed for “practicing medicine without a license.”  This changed in the 80’s, though.  In 1988 the American Medical Association was sued in a case many refer to as Wilk vs. AMA in which the AMA was found to be guilty of violating the Sherman Antitrust Act, essentially conspiring to restrain chiropractic care and guilty of working to prevent medical physician referral to chiropractors.  It also found the AMA guilty of preventing chiropractors from obtaining access to hospital diagnostic procedures and staff.  The effects of this discrimination against chiropractic however, are still being felt today.  While chiropractic care is certainly becoming more mainstream, it still appears as though many medical sites regard chiropractic care as a fringe alternative treatment method.

Fortunately, the art and science of chiropractic has moved ahead by laps and bounds despite the lack of recognition in medical circles.  Most insurance companies now cover chiropractic care and even Medicare will cover spinal adjusting.  An important question is, when will medicine get with the times?  With more and more people choosing alternative medicine every day, chiropractic care has become the wave of the future.

I once saw a quote that said that “research is proving every day what chiropractors have been saying for a hundred years.”  It’s so true.  Chiropractic care is a method whose time has come.  Is it a panacea for back pain?  Not by any means.  But chiropractors should be the gatekeepers for back pain, limiting access to more invasive medical interventions only if conservative care fails.  Who knows how many spines we may save, and how much of a difference we might make in the lifestyle and health of a patient if we adopt this approach?

Referrences:

http://www.acatoday.org/level2_css.cfm?T1ID=13&T2ID=68

http://www.webmd.com/pain-management/guide/chiropractic-pain-relief

http://openjurist.org/895/f2d/352/wilk-dc-dc-dc-dc-v-american-medical-association-a-wilk-dc-w-dc-b-dc-b-dc

http://www.onhealth.com/back_pain_health/page4.htm#low_back_pain_treatment

http://www.rand.org/pubs/research_briefs/RB4539/index1.html

http://pain-medicine.med.nyu.edu/patient-care/conditions-we-treat/failed-back-surgery-syndrome

http://backandneck.about.com/od/faqs/f/failedbackfbss.htm

http://www.ncbi.nlm.nih.gov/pubmed/21463472

The Exercise Paradox: Movement Is Not An Option

Movement is not an option.  It’s a requirement.  A common conundrum that I see on a regular basis in my office is whether or not to exercise when you have chronic pain.  The correct answer is you should always be exercising.  Now, that doesn’t mean that every exercise is meant for every person and doing the wrong ones, based on your condition, may even have a negative effect on your health.  That being said, incorporating some form of exercise into your regimen is critical to maintaining your health and there is always some for of activity you can do regardless of your current health status.

Unfortunately, many people make the mistake of assuming they cannot exercise because of some form of ailment.  Generally they report that exercise “aggravates my knees” or “hurts my back.”  The problem is that the ‘no exercise’ solution really does nothing to improve that person’s health and may even be making it worse.  Your body is designed to move and the ‘use it or lose it’ rule really is directly tied to your health,

The World Health Organization has said that “sedentary lifestyle is more harmful than smoking.”  This is a fact that often does not occur to those stricken by pain or where exercise is more of a burden than a benefit.  To be honest, we’ve become a sedentary society where convenience is the rule.   It seems that every aspect of our lifestyle from computers to mobile phones is designed for convenience.  Of the thousands of patients I’ve seen in my office, I’ve noticed that being sedentary for large portions of the day can do more to aggravate a chronic pain issue than even some traumas.  Further, most exercise physiology research confirms that the sooner you can return a person to exercise, the better the long term recovery.

The reasoning for lack of exercise that many patients make is “the more I exercise, the more it hurts.”  The paradox is that the less you exercise, the more it will continue to hurt.  Worse, the less exercise you get, the more deconditioned you will become and the more your condition will advance.  You have to understand that your body is a sensory input and motor output machine.  It requires constant sensory and motor stimulation to stay healthy.  While it may “feel good” to not exercise, it is well known and accepted that prolonged immobility leads to muscle weakness, poor circulation in the extremities, increased risk of cardiovascular disease, respiratory problems, and can contribute to neurological symptoms.

For most people, a better solution is not that they can’t exercise, it’s that they need to exercise smartly.  For example, you can’t expect a person with severe arthritis in the knees to begin a walking regimen.  However, pool exercises may be a good place to start, then transitioning to a recumbent exercise bike.   Likewise, arm exercises using weights may also be a viable option to help maintain skeletal muscle tone and improve circulation to the extremities.  Either way, not exercising is not an option.

From heart disease to degenerative arthritis, exercise is possible and even necessary to maintain or restore health.  The question becomes then, what exercise is best for you when establishing an exercise regimen?  Many people just don’t know where to start when they are in pain and looking to rehabilitate themselves.  I will generally advise my patients to begin as easily as possible, exercising in a pain free zone.  While there is a temptation to work through the soreness, exercising while in pain can often aggravate the affected area and does little to rehabilitate it because the targeted muscles are guarded, your body compensating with other muscle groups.  Begin at the beginning.  Ease into any new regimen and exercise in a pain free range of motion.

Once you find a regimen you are comfortable with, begin building on that foundation.  Avoid those motions and movements that may aggravate your condition, focusing instead on the movements you are able to do well.  Over time, increase the amount of time, reps, and resistance as the exercise becomes easier.  Ultimately, you will begin rehabilitating yourself, improving your strength and range of motion via your own physical work.

Besides pain, exercise is a fundamental requirement for the person looking to become healthy and stay healthy.  In fact, your body depends on small amounts of stress in order to more adequately heal.  Movement improves circulation to the tissues which brings in oxygen and nutrients to help keep muscles, ligaments, tendons, cartilage, and even organs healthy.  Movement also stimulates nerve firing to help improve nervous system function, decreasing pain, improving muscle tone, and improving balance and coordination.  Movement against gravity will help strengthen your core and improve your posture.  Increased heart rate will also help keep your heart, lungs, and blood vessels healthy.

There is a solution for just about anyone.  Of course, the best exercise anyone can do is the one they are actually consistent with on a regular basis.  Excellent exercise habits will produce excellent results.  If you are only hit or miss with your regimen, expect corresponding results.  If you neglect exercise all together, expect illness to be an eventuality for you.

Including Chiropractic: Don’t Skip the Most Important Step to a Healthier You

Why should you see a chiropractor?  After all you really don’t have any back pain, right?  As a chiropractic physician, one of the biggest misconceptions I see in our office on a near daily basis is the assumption that chiropractic care is just for back pain.  This erroneous myth is perpetuated by the amazing success that chiropractors have with caring for patients with back pain in our office.  It’s also the result of a reactive ‘disease management’ system that only treats people after they’re already sick.

To be honest, for a chiropractor, most cases of back pain are fairly straightforward.  Making a difference in the patient’s health and moving them away from ‘crisis management’ thinking is a lot more difficult.  Seeking chiropractic care for just back pain is like thinking about going to the dentist just for cavities.  There’s more to it than that.  The big difference is that you can replace your teeth but you only get one chance to take care of your spine and nervous system.  There’s no such thing as a spinal transplant.

Did you know that the first documented chiropractic adjustment was not for back pain at all?  It was for a case of hearing loss.  Unfortunately, this is a history lesson that is even lost on some of my own colleagues. In 1895, the founder of chiropractic care, D.D. Palmer performed a spinal mobilization on a deaf janitor named Harvey Lillard.  Mr. Lillard claimed to have been deaf for years and believed it began when he felt something shift in his upper back.  Reasoning that if a bone shifting out of place could lead to hearing loss then moving the bone back should restore it, Palmer mobilized the vertebra in Harvey Lillard’s upper back, ultimately restoring his hearing.

In the past 100 years, chiropractic care has established a reputation as an alternative option to traditional medicine.  Today, there are over 60,000 chiropractors in every state in the country.  Chiropractors are so intertwined with treating back pain because that condition produces such a rapid improvement with little residual as to be astounding in many cases.  If you read the research, though, you’ll find that chiropractic care has been shown to be effective for everything from headaches to digestive problems.  It’s even effective for pediatric conditions such as colic and asthma.

Most people regularly accept the importance of diet and exercise in maintaining a healthy lifestyle.  Few however, other than a chiropractor, really teach about the importance of maintaining healthy nervous system function to maintain health and ward off disease.  In fact, less than 10% of the population has even been to a chiropractor before.

Not many people could argue against eating well and getting regular exercise as important to health, but my experience has shown me that most physicians will actually discourage chiropractic care unless the patient has a back pain symptom.  While this approach is in line with treating disease, this is not a ‘healthcare’ approach.  To treat back pain only after it occurs does nothing to prevent the condition in the first place, minimize the risk of back injury, or maintain healthy nervous system function.

To be truly healthy, you have to reject the ‘disease management’ model that is reactive when it comes to health.  To be truly well, you need to take proactive steps to prevent pain and illness from happening in the first place.  I would argue that chiropractic care is most effective when the patient has little to no pain, essentially when the body is not in acute distress and can accept the adjustment and hold it.

We are constantly bombarded by physical and mental stresses.  These stresses can be disastrous to the the body if left unchecked.  How many stresses do you endure on a daily basis that your body has to respond, adapt, and deal with?  Disease ensues when your body is no longer able to counter the stresses in a healthy way.  Chiropractic care helps improve your body’s ability to adapt to stress by decreasing the physical load on the body and removing pressure from the nervous system.

To be truly healthy, you must include all aspects of a healthy lifestyle.  That includes eating well, exercising, and maintaining your body’s nervous, muscular, and skeletal system.  If you want to be at your best, just like regular diet and exercise, you need spinal adjusting on a regular basis.