When the discussions about Chiropractic treatment for spinal pain are entertained there seems to always be a strong opinion. It is almost like having a discussion about religion or politics. Some people “swear” by Chiropractic treatment and others swear at Chiropractors.
Chiropractic treatment has become synonymous with Spinal Manipulative Therapy (SMT). The more accurate question would be, “Does Spinal Manipulative Therapy work?”. SMT is not the only therapy that Chiropractor’s perform.
For the purposes of this blog posting, the question, “Does Chiropractic Treatment Work,” is particularly in reference to SMT. I will not be giving a review of all the philosophies and practice of Chiropractic doctors in this article.
To make things still more confusing, Chiropractors are not the only medical professionals that perform SMT. Osteopathic physicians (medical initials D.O.), M.D.s, and Physical Therapists may all become trained in SMT.
The history of SMT dates back to 1872 when an M.D. physician by the name of Dr. Andrew Taylor Still set up the first school of Osteopathic Medicine in Kirksville, Missouri. He left the traditional field of medicine after his wife and 3 children died from spinal meningitis. His medical school changed the professional designation for its’ graduates from M.D. to D.O. (Doctor of Osteopathy).
Dr. Still originated many of the SMT techniques still in use today. He was a pioneer in understanding spinal anatomy and physiology. He was also very “forward thinking” with 50% of the first medical school class in Kirksville made up of women. This was unheard of for that period in American history. Many of the women were relatives of Dr. Still.
One of Dr. Still’s students was the founder of Chiropractic. In 1895, Daniel David Palmer set up the first school of Chiropractic Medicine. He had been a student with Dr. Still for only 6 weeks. The actual history about this is scant. Dr. Still is rarely mentioned in the history of Chiropractic Medicine.
It is because of this common origin that Osteopathy and Chiropractic have so many similarities. Yet and still, the degrees conferred by their respective schools are different and the training has several major differences.
What is Chiropractic Treatment ?
As I have already pointed out, for the purposes of this article, when I refer to Chiropractic treatment I am really talking about SMT. SMT is a therapy that attempts to “adjust” the spine and place it back into proper “alignment.” The proper alignment is thought to reduce spinal muscle spasm, joint pain, ligament tension, and tendon tension.
The actual maneuvers may cause a “pop” when the spine re-aligns. The “pop” is similar to the sound that is made when someone “cracks their knuckles.” A sense of relief is often felt by the patient after the “pop.”
The person receiving the SMT is usually laying on a special examining table that allows the doctor to have a mechanical advantage for the maneuver. The tables are usually lower and firmer than a conventional examination table.
The treatment itself may only take a few seconds. The doctor performing the treatment is required to rotate and bend the patient’s spine into what can seem several awkward positions. The process requires a certain physicality by the performing doctor. Large patients can prove difficult to align if the doctor is of a slight build.
How Does It Work ?
The actual mechanism for the “pop” sound and why patients feel relief is not actually known. The sound may be coming from within the small joints of the vertebrae called facet joints. Alternatively, the sound may be generated by the vibration of the small tendons and ligaments of the spine.
Each vertebra is surrounded by a microscopic network of nerves. When the vertebrae are misaligned (called “subluxations”) the stretch causes stimulation of the nerves and the generation of pain. The thinking is that the realignment removes this tension reducing pain.
Furthermore, the nerves that are stretched cause reflex muscle contraction (spasm) which may be the human body’s attempt to realign the spine itself. SMT reduces the muscle spasm by decreasing the nerve stretching around the vertebrae. Some patient’s obtain immediate muscle relaxation after SMT is applied.
What is it good for ?
Recent studies comparing SMT and other forms of physical therapy have shown symptomatic benefit for the patient. Every year in the U.S. 22 million Americans seek Chiropractic care. About 35% of these cases are for relief of back pain. People seek SMT for the following conditions:
The number of treatments and type of SMT is guided by a number of factors such as insurance coverage, severity of pain, and cause of pain. Generally, people will require more than one or 2 treatments. Multiple treatments over many weeks is the norm (as it would be with physical therapy or therapeutic exercises).
Is It Dangerous ?
There have been reports of serious spinal injury with SMT. A careful look at those case reports reveals that the Chiropractor should have been able to predict that a serious spinal abnormality was present. Most of the practitioners that utilize SMT today will only apply that form of therapy when the spine has been cleared of any dangerous conditions.
Most patients having SMT will have had X-Rays of the spine, a CT scan, or an MRI. When the proper diagnostic workup has been done, SMT is very safe. In fact, if all back therapies are compared, SMT is one of the safest therapies a person with spinal pain can receive.
Chiropractors practice a very low risk type of therapy. This is not only evidenced by the extremely low complication rate of SMT but is also evidenced by the cost of malpractice insurance for chiropractors. Chiropractors pay some of the lowest rates for their malpractice insurance.
If their therapies were risky the insurance companies would charge much higher rates. Most Americans understand how readily an insurance company will raise the cost of coverage for nearly any risk. The low rates reflect their confidence in the safe nature of SMT.
SMT is an effective form of treatment for certain types of spinal pain. It compares favorably with spinal physical therapy and can be used as an adjunct to a comprehensive spinal program. SMT certainly carries less risk than other more invasive back therapies (such as surgery). It seems to be a reasonable method of therapy to use in people with properly diagnosed spinal pain.