[Paleopsych] Chirobase: What a Rational Chiropractor Can Do for You
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Thu Mar 31 19:51:46 UTC 2005
What a Rational Chiropractor Can Do for You
[Mr. Mencken praise chiropractioners many times, on the grounds that a
visit to one would mean one less radio fan. He saw this as the Darwinian
selection process at work.]
Samuel Homola, D.C.
Spinal manipulation can relieve some types of back and neck pain and
other conditions related to tightness and loss of mobility, such as
tension headache or aching in muscles and joints. We also know that
massage may be as effective as cervical manipulation in relieving
tension headache. And physical therapy techniques may be as effective
as spinal manipulation in long-term relief of back pain. Rational
chiropractors can offer all of these modalities, when appropriate, and
thus provide patients with a choice. They may also offer basic advice
about nutrition, weight loss, exercise, ergonomics, relaxation
techniques, body mechanics, home care (such as use of hot or cold
packs), massage, and other self-help measures that might help relieve
or prevent aches and pains.
Science-based chiropractors make appropriate judgments about the
nature of their patients' problems, determine whether these problems
lie within their scope, and make appropriate referrals for problems
that do not. If you can find one who uses manipulation and physical
therapy appropriately and who is willing to coordinate with your
personal physician, you can benefit from the best that both have to
While some types of back pain can benefit from spinal manipulation,
not every patient who sees a chiropractor needs it. Proper diagnosis
should precede treatment of any type. This is why, if you consult a
chiropractor, it is crucial to choose one who can make an appropriate
diagnosis, uses spinal manipulation only when indicated, does not
order unnecessary x-rays, and refers to an appropriate physician when
needed. Chiropractors whose practice is not based on subluxation
theory are in the best position to judge whether your problem requires
medical treatment. Never rely upon the diagnosis of a straight
chiropractor or one who "specializes" in such fields as internal
medicine, neurology, or pediatrics.
Back-pain sufferers who have been diagnosed with musculoskeletal pain
and have reservations about spinal manipulation should ask their
physician whether a referral for physical therapy is appropriate for
their condition. (Actually, many chiropractors offer physical therapy
modalities as well as manipulation.) A study published in 1998 in The
New England Journal of Medicine found that the long-term effectiveness
of chiropractic manipulation was no better than the McKenzie method of
physical therapy (an exercise program) . However, many patients
have told me that manipulation was more effective in providing
Manipulation vs. Mobilization
Manipulation and mobilization are used primarily in the treatment of
conditions related to mechanical-type problems in joints and muscles.
Manipulation is a hands-on procedure used to restore normal movement
by loosening joints and stretching tight muscles. In some cases,
manipulation will restore normal movement by unlocking a joint or by
breaking down adhesions. A popping sound often occurs when a spinal
joint is stretched a little beyond its normal range of motion.
Mobilization simply stretches soft tissues by moving joints through a
full range of movement. Mobilization can increase the range of motion
of the arms, legs, and shoulders, but manipulation may be more
effective in relieving pain and restoring normal movement in the
Any portion of the spine that is tight, stiff, or painful on movement
might benefit from appropriate manipulation. Different methods are
used in different portions of the spine, since joint structure and the
direction of movement in the neck and upper back differ from those of
the lower back. For example: neck manipulation might be done while the
patient sits on a stool; upper-back manipulation might be done while
the patient lies facedown; and lower-back manipulation might be done
while the patient lies on one side. Dozens of manipulative techniques
can be used to meet the special needs of patients who must be
positioned one way or another. Tables with specially designed cushions
are used to support patients in certain postures.
Manipulation may improve the mobility of a cervical spine that has
been stiffened by osteoarthritis or by scar tissue from an old injury.
Disc degeneration caused by wear and tear or by injury is a common
cause of loss of range of motion in the cervical spine and can often
benefit from manipulation. Neck manipulation or mobilization may
improve range of motion and provide relief for neck pain and
muscle-tension headache. But remember that benefit must be weighed
against risk. Neck manipulation should not be used unless symptoms
indicate a specific need for it. It should be done gently with care to
avoid excessive rotation that could damage the patient's vertebral
artery. Neck manipulation should not be done immediately after an
injury that causes acute neck pain. When the acute pain subsides,
usually after a few days, manipulation may be useful to relieve
fixations and restore normal joint mobility. Once the patient is
symptom-free, it should be discontinued. A small percentage of
chiropractors advocate neck manipulation to "balance" or "realign" the
spine no matter where the patient's problem is located. I recommend
avoiding such chiropractors.
Neck manipulation is safest when neck rotation does not exceed 50
degrees. When rotation is not indicated or appropriate, special
techniques can be used with the patient in a face-down position so
that manipulative traction can be applied or there can be thumb
contact with specific spinal segments.
Patients who have pain caused by acute inflammation, as in rheumatoid
arthritis or spondylitis, will rarely benefit from neck manipulation.
Damage to upper cervical connective tissues in rheumatoid arthritis
can also be a contraindication. When in doubt about whether you should
undergo neck manipulation, check with an orthopedist. A competent
chiropractor should not object to your seeing a specialist for a
Tension headaches, often called muscle-contraction headaches, may
benefit from manipulation that loosens joints and stretches tight neck
muscles. Some chiropractic case reports suggest that migraine headache
can be relieved with cervical manipulation. However, true migraine is
unlikely to be relieved by neck manipulation.
Any kind of persistent headache should be brought to the attention of
your family physician or a neurologist. And so should any headache
accompanied by fever, vomiting, weakness, a change in speech or
vision, or any other unexplained symptoms. Severe headaches may
require medical attention for pain relief.
Before submitting to the risk of cervical manipulation for the
treatment of headache, it is essential to determine whether the
problem might be caused by a sinus infection, food sensitivity, a
brain tumor, or another cause unrelated to the cervical spine.
Fortunately, most headaches are of the simple tension or
muscle-contraction variety. So there is a good chance that simple
massage or stretching of neck muscles will relieve them.
A study published in 1998 in the Journal of the American Medical
Association found that cervical manipulation may be no more effective
than massage in the treatment of episodic or recurring tension
headache . Thus people with frequent tension headaches might want
to first try massage rather than risk injury from cervical
Up and Down the Back
Pain in the upper and lower portions of the spine can often be treated
successfully with manipulation and physical therapy. Low-back pain is
more common, is usually more serious, and deserves more attention.
Herniated discs are rarely a problem in the upper back or thoracic
spine, for example, while a herniated disc in the lower back or lumbar
spine can pinch spinal nerves and cause weakness and loss of sensation
in the legs or encroach upon the spinal canal to impair bladder or
bowel function (cauda equina syndrome). This is why the Agency for
Health Care Policy and Research (AHCPR) guidelines for treating
low-back pain caution against manipulating the lumbar spine when there
is leg pain caused by nerve-root involvement .
Except when the thoracic vertebrae have been softened by disease or by
aging, appropriate thoracic spine manipulation is rarely harmful and
often can relieve backache related to fatigue, postural strain,
arthritis, myofacitis, or other problems involving muscles and joints.
Many people undergo thoracic spine manipulation simply for the
relaxing effect that results from "popping the back."
Other Joints and Muscles
Uncomplicated mechanical-type problems of the muscles or joints of the
shoulder, elbow, wrist, knee, ankle, and foot can often be helped by a
competent chiropractor who uses physical therapy. Most chiropractors
learn manipulative techniques for treatment of extremity joints, but
these joints often benefit as much from mobilization as from
manipulation. And they are often best treated by a physical therapist
or an orthopedist. While chiropractors who have additional
postgraduate training in orthopedics or sports medicine can be
expected to have more extensive knowledge of injuries involving the
extremities, few can do more than the average chiropractor, since none
of them can prescribe pain medication, reduce a dislocated joint, set
a broken bone, drain a swollen knee, or perform injections or invasive
diagnostic procedures. Thus, a chiropractor with a diplomate in
orthopedics or sports medicine cannot do much more than a physical
therapist other than manipulate the spine. Although some physical
therapists are now manipulating the spine, most are using mobilization
Severe or prolonged problems with extremity joints should always be
brought to the attention of an orthopedist. As with back pain,
diagnosis is essential. When a condition under chiropractic care has
not improved after two to four weeks, a specialist should be consulted
for a second opinion. On the other hand, there are many situations
where home care can be effective once the diagnosis has been made and
acute symptoms have subsided. A rational chiropractor will be able to
advise when cost-saving self-care can be substituted for office
treatment. It is rarely necessary to continue any form of chiropractic
office treatment month after month.
Pain in other joints is not often as ominous as shoulder pain that
might occur as a result of a problem with the heart or the lungs or
because of a disc herniation in the neck. But it is always necessary
to rule out bone tumors, advanced forms of arthritis, and other
problems before beginning long-course treatment of any kind.
Tips on Choosing a Chiropractor
If you decide to consult a chiropractor, try to find one whose
practice is limited to conservative treatment of musculoskeletal
problems. Ask your family doctor for the names of chiropractors who
fit this description and who appear to be competent and trustworthy.
If your doctor cannot provide a name, ask other people and, if they
recommend one, be sure to ask what conditions the chiropractor treats.
If the chiropractor claims to treat infections or a wide range of
other diseases, look elsewhere. But don't depend upon the Yellow
Pages. You should avoid chiropractors who make extravagant claims or
who advertise extensively.
When you have selected a chiropractor, go for a consultation or
conduct a telephone interview to find out how he or she practices. If
the chiropractor treats infants, offers spinal adjustments as a
treatment for visceral disease or infection or as a method of
preventing ill health, requires that every patient be x-rayed, or
requires payments in advance for a long course of treatments, call
another chiropractor. The Chirobase Guidelines provide additional
tips about what to avoid. Chiropractors who follow these guidelines
have been invited to post their names in the Chirobase Referral
Remember that diagnosis is critical to the establishment of proper
treatment. Some chiropractors are competent in diagnosis, and some are
not. For example, "straight" chiropractors who examine only the spine
and who believe that "subluxated" vertebrae are the primary cause of
illness may "analyze" the spine rather than offer a diagnosis. Such
chiropractors may be unable to determine when chiropractic treatment
should not be used. Since evaluating some chiropractors may be
difficult, it might be wise to look for one who is willing to work
with your family physician by exchanging office notes. This would
offer the additional safeguard of assuring a second opinion.
Once you have found a rational chiropractor, you may find effective
relief for some types of back and neck pain as well as for various
other musculoskeletal problems. You may also benefit from the
comforting effect of a hands-on treatment that provides a pleasurable
way of relieving the aches and pains of everyday stress and strain.
Physical therapists, osteopaths, and a few physicians also offer
manipulative therapy. Chiropractors can sometimes be found working
with these practitioners in back-pain clinics. As the benefits of
spinal manipulation become better known as a result of scientific
research, such treatment will become more available from physical
therapists and other practitioners, as well as well as from properly
About the Author
Dr. Homola, who lives in Panama City, Florida, retired in 1998 after
practicing chiropractic for 43 years. His 12 books include
Bonesetting, Chiropractic, and Cultism; Backache: Home Treatment
and Prevention; and Muscle Training for Athletes. He has also written
many articles for magazines and journals, ranging from Cosmopolitan
and Scholastic Coach to Chiropractic Technique and Archives of Family
Medicine. This article is adapted from Inside Chiropractic: A
Patient's Guide (Prometheus Books, June 1999).
1. Cherkin DC and others. A comparison of physical therapy,
chiropractic manipulation, and provision of an educational booklet
for the treatment of patients with low back pain. New England
Journal of Medicine 339:1021-1029, 1998.
2. Bove G, Nilsson N. Spinal manipulation in the treatment of
episodic tension-type headache: A randomized controlled trial.
JAMA 280:1576-1579, 1998.
3. Bigos S and others. Acute Low Back Problems in Adults. Rockville,
MD: Agency for Health Care Policy and Research, 1994. AHCPR
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This article was revised on May 19, 1999.
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