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

Shoulder Pain: Is Surgery Your Only Option?

In my experience, besides back pain, shoulder injuries and pain are some of the most common reasons a patient presents to our chiropractic office.  In fact, I have observed that most of my patients who suffer from chronic neck and upper back issues have at least a minor shoulder condition complicating their case.  The biggest fear with our shoulder pain patients is the dreaded ‘rotator cuff’ injury.  Why dreaded?  Because so many people have been trained to think that he only solution for rotator cuff problems is an invasive procedure.  Generally, the race to expensive, invasive interventions, in my opinion, is largely unnecessary overkill but can include pain management injections, which are generally only temporary and don’t really fix the cause of the pain, and surgery, which has a potential for risk, and recurrence of the condition. Surgery also limits additional future conservative care options in the likely event that the surgery fails.

Your shoulder can experience pain and dysfunction just like your back can.  Acute traumas and chronic stresses can lead to wear and tear on the joint just like they would in the low back.  It reasons then, if a patient can experience an excellent recovery with conservative care of their low back, conservative care of the shoulder is also a viable method of improvement.  So why, when you go to your doctor, do they so often immediately refer you to an orthopedic surgeon?  There are several reasons for this:

1.        Your doctor may not know or understand the nature of a shoulder injury.  The shoulder joint is a complex one with multiple muscular, tendonous, and neurological involvements that can affect areas other than the shoulder.

2.       A lack of understanding of how the body heals if the obstructions to the healing process are removed.

3.       A lack of understanding of the role conservative intervention can play, including chiropractic adjusting of the extremities, in helping the patient to heal themselves.

4.       Surgery is a perceived quick fix (despite the fact that surgery is not without its potential complications and failure rates).

So, you have shoulder pain…now what?  Shoulder pain is not as simple as just ‘rotator cuff damage.’  You have to understand what the mechanism of injury is, what tissues are involved, and whether there are other areas that may be contributing to or aggravating the shoulder region.  There are countless reasons a person can develop pain in the shoulder and rarely is the pain ‘just a shoulder problem.’

Your shoulder joint mechanism is an extremely complex one.  It allows for the largest range of motion of any joint complex of the body.  It has muscular attachments not only to the shoulder joint, but to the neck, rib cage, elbow, and even the low back.  The rotator cuff musculature represents only 4 of approximately 2 dozen muscles that affect shoulder function.  Did you know that the collar bone is the only one that directly attaches the bones of the entire arm to the rest of the skeleton?

In order to adequately diagnose a shoulder problem with the greatest level of accuracy, an MRI of the shoulder may be required.  While many will rely on plain film x-rays to diagnose a shoulder condition, x-rays alone don’t generally reveal the information necessary, especially for a chronic shoulder issue.  An MRI on the other hand will reveal information about all the soft tissues in and around the joint, including the cartilage.  It can even offer information as to whether the injury is acute and whether there is an active inflammatory response currently progressing.

Understanding how the shoulder functions is a key to helping it resolve.  Most injuries to the shoulder are either acute sprains or chronic overexertion injuries.  Either way, most shoulder conditions will improve with conservative care.  Now, many will argue that physical therapy is the best solution for a shoulder issue and I would agree to an extent.  Physical therapy is extremely effective at helping a shoulder condition to resolve.  However, to limit conservative care to only pain management and exercising the shoulder joint may prevent the patient from reaching full resolution of their condition.

Ideally, these factors need to be addressed when caring for a person with a shoulder injury:

1.       Misalignments of the shoulder joints need to be identified and corrected manually.  This requires the expertise of a chiropractor.  There are 3 true joints and 1 potential joint in the shoulder that must be corrected to restore full function before additional care can be rendered.  Exercising or stressing a deranged joint may actually aggravated it and slow your recovery.  The muscles, ligaments, and tendons of the joint rely on proper alignment for their proper function. Your soft tissues cannot function correctly if the skeleton is functioning incorrectly.    Only a chiropractor or, arguably, an osteopathic physician has the training and expertise to identify and correct misalignments in the shoulder with precision.

2.       Pain must be controlled.  While rendering care, there is the temptation to jump right into exercise to rehabilitate the area.  True, studies have shown that the earlier you introduce exercise, the better the long term recovery, but this has to be done within reason.  Applying stress to a guarded and deranged joint experiencing debilitating pain may aggravate the condition.  Additionally, the person is most likely not using the damaged tissue when they are in exercising the area and are, instead, recruiting other tissues to compensate for the loss.  Getting your pain under control is a critical step to rehabilitation.

3.       Exercise is critical.  Ultimately, you will have to add active exercise to strengthen the affected soft tissue damage.  Because your body lays down new tissue and builds up existing tissue according to the stress you place upon it, stressing the joints and soft tissues within reason is a critical component to resolving a shoulder issue.  It will be very difficult to expereince a full recovery without eventually adding a structured exercise regimen.

4.       Don’t ignore other associated areas.  Often, when you feel shoulder pain, you think it is necessarily only a shoulder problem.  In fact, it may not even be a shoulder problem at all.  Neck issues, upper back problems, postural issues, elbow dysfunction, and even low back pain can contribute to derangement in the shoulder.  They can both cause pin in the shoulder and aggravate a shoulder condition.  So, it’s critical that ALL these areas that interact with the shoulder also be addressed when helping you recover.

Conservative care for most mild to moderate shoulder conditions can be extremely effective.  When cared fro properly, I generally see a 90% recovery in our office in 90-120 days, depending on the type and nature of the shoulder injury.  The biggest detriment to a person’s improvement with conservative care, though, is their own impatience.  Healing takes time.  Conservative intervention for these types of shoulder injuries should at least be attempted before any invasive medical intervention is considered.