From MSN ~
Wednesday, October 06, 1999
More than one in four people who see chiropractors are seeking relief from
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.
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 didnt
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 physicians
support, Levy began to see chiropractor Linda S. Squires,
president of Amethyst Chiropractic in Brookline, 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
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, Levys visits tapered off, and within a few
months she was able to enjoy a long-planned kayaking trip to
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.
Levys 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 theres 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 its 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
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
What are chiropractors?
And what do they do?
||Chiropractors specialize in the treatment of the
musculo-skeletal system. Classic chiropractic treatment involves manipulation of the bones and joints, primarily of the spine.
||They may also use massage or other techniques to loosen tight muscles.
||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.
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 youre not better
after four to six weeks, theres 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
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
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
| Choosing a
Haldeman, a clinical professor of neurology at the University of
California-Irvine and a specialist in spinal problems, offers
|||Be careful, as you would with
any physician, not to go to someone with claims that exceed
|||Expect a thorough physical
examination before treatment.
|||Expect a reasonable and
understandable explanation of what the chiropractor thinks is
wrong and what you can expect from the treatment.|
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
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
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 subacute 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,
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
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
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.
| Red flags|
|While there are
many benefits to manipulation, there are some situations in which
the technique should be avoided, such as if a patient has:
|||Acute severe injuries|
|||A tumor or softening of the
bone, unless cancer has been ruled out |
|||Severe spinal infection
Agency for Health Care Policy and Research; Dr. Scott
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.
Its 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,
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,
Although some chiropractors tout the
techniques 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
I think its 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
Susan Ince is a medical writer
based in Hawaii. She has contributed to many national
publications, including Glamour, American Health, Redbook and
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