Visiting A Chiropractor For Lower Back Pain?
Are You Thinking Of Visiting A Chiropractor? Make Sure You Know What To Expect...
Visiting A Chiropractor For Lower Back Pain? Chiropractors work by forcibly re-aligning your spine. Chiropractic care therefore is not for the fainthearted. You need to know the risks and the benefits before trying it.
In the article below, we review the evidence and ask ‘is visiting a chiropractor worth the risk?’
How Does A Chiropractor Work?
By definition, Chiropractors are health care professionals that train in using their hands to manipulate the human joints to achieve better alignment and aid physical recovery.
They do this by using enough physical force to correct potential misalignment in the your spine, with the main goal of ‘restoring’ your integral framework.
As pointed out in Forbes magazine (while reporting on an estimated $496m wasted on chiropractors), it is worth remembering that chiropractors are not actually qualified doctors.
The word ‘chiropractor’ itself literally means ‘hand-practical’ in Greek, but it is the level of practical manipulation that makes the idea of seeing a chiropractor for lower back pain so controversial.
Despite it’s effectiveness seemingly being proven in some patients beyond any doubt, chiropractic therapy continues to be considered as an ’alternative medicine’ – one that can be only complementary to the more traditional treatments.
This description however fails to do it justice as so many of the ‘alternative medicines’ are now considered pretty key by a range of doctors that have referred patients to them.
Chiropractors specialize by working on areas that can be improved through vigorous physical manipulation to ease muscle tension or align the joints better.
However, visiting a chiropractor for lower back pain is by far the most common reason for seeing one as, not only is lower back pain extremely common, but they are seen as being one source that specializes in musculoskeletal manipulation.
What Is The Difference Between A Chiropractor And A Physiotherapist?
Chiropractors can be seen as very similar to physiotherapists in their joint specialism around physical manipulation.
However, there are also very significant differences – principally that physiotherapists don’t seek to forcibly re-align the spine. Physiotherapy focuses on restoring mobility, independence and mental well-being.
Physiotherapists deal with a much wider range of conditions and are much more likely to use a full suite of treatments including hydrotherapy, exercise and electrotherapy in achieving their goals for you as a patient.
A Chiropractor for lower back pain is a very different story.
Chiropractors very much focus principally on spinal conditions only, although they will argue that neck/ shoulder and even leg pain may be related and therefore treated as well.
It is also worth noting that chiropractic therapy tends to involve much more aggressive, forceful manipulation, whereas a physio is more likely to fall back on more gentle massage and other treatments.
If you are frail or elderly, then a chiropractor almost certainly isn’t not for you.
What To Expect When You Visit A Chiropractor?
When you first visit a chiropractor for lower back pain, you can expect your first consultation to include the following 3 initial steps –
- Assessment. You’ll be asked what hurts, where it hurts and what makes the pain feel better or the pain feel worse.
- Your History. As well as your job, you may be asked about your family history, other injuries/ treatments that you’ve had and your diet.
- Physical Tests. You may be asked to perform a variety of movements so the chiropractor can assess the range of motions available to you and how stable you can perform them. They may even ask for an e-ray to be carried out, while they try to assess the true position of the vertebrae in your spine.
The purpose of this pre-assessment is to identify areas of the spine that may have moved fractionally (subluxation) and therefore require specific focus during the chiropractic adjustment.
Chiropractors in the 21st Century. As with so many areas of medicine, the need to treat patients (and also attract work), has led to somewhat of a watering down of the traditional model of chiropractic care.
Nowadays, it is not unusual for chiropractors to offer other less specialised treatments such as hot/ cold therapy, exercise advice and even massage.
Naturally, private chiropractors are businesses that survive on customers, so this moving across in to more gentle practices is perhaps not surprising, especially as the clinical benefits of pure chiropractic manipulation are still somewhat up for debate.
After-effects Of Chiropractic Treatment
Unfortunately after choosing a chiropractor for lower back pain and after receiving the physical adjustments felt necessary by your health professional, it is likely that you may experience even worse back pain in the short term.
One of the downsides of chiropractic care is that it is a very physical practice. Considerable force has to be applied to alter the alignment of your spine and, given that they are already working on an area of your body that is most likely inflamed and painful, then it is inevitable to a some extent that patients often wake up the next day stiff and in pain.
If however the chiropractic treatment has been successful, this short-term pain should soon subside and be replaced with greater spinal stability and much less discomfort.
How Effective Is A Chiropractor?
“.…the proven benefit of chiropractic spinal manipulation is far less certain than chiropractors tend to admit and its risks are not negligible” E.Ernst (BMJ)
This could be a whole debate in itself. The British Chiropractic Association claims that ‘95% of back pain is mechanical in origin, and can be treated by a chiropractor in a primary care setting’.
But this doesn’t actually state how effective such treatment might be.
Part of the problem is actually that there is very little direct clinical data to support or contradict such treatment and, one thing is for sure – if there is doubt amongst chiropractors as to how effective their manipulation can be, then future clinical studies will be very slow in being developed that may destroy their lucrative industry.
Currently, studies that actually focused specifically on chiropractic care (as opposed to trialing just ‘manipulation’ which could include other techniques such as physio/ massage etc) are few and far between.
Rather worryingly, the results of those that do exist and focus solely on chiropractic care largely found no clinical benefit whatsoever (‘The effectiveness of chiropractic for treatment of low back pain: an update and attempt at statistical pooling’)
However, simply not having conclusive data to prove it’s worth is one thing – the increasingly undeniable link to certain massive side effects is quite another.
As Rothwell DM, Bondy SJ and Williams SJ note in their study on chiropractic manipulation (‘chiropractic manipulation and stroke: a population based case-control study’)
“the anatomic explanation of how spinal manipulative therapy could cause a stroke is well documented”.
Furthermore, because early to mid-stage osteoporosis is not always straight forward to diagnose with a standard x-ray, a number of patients end up being mistreated with vigorous manipulation that severely risks fracturing their increasingly brittle bones. This is especially likely if the Chiropractor did not spot the early onset of osteoporosis.
There should be little doubt however that were it to be successfully diagnosed, osteoporosis should be contraindicated (in other words, sufferers should not receive Chiropractic manipulation).
However because it is fairly rare (approx. 1 in 15 pts with lower back pain) and chiropractic care is still fairly new, there is no official threshold at which treatment should not be given or guidance on what steps to rule out osteoporosis must be taken before treatment.
Then just to top it all off, there is the noted increase in cerebrovascular injuries as a result of chiropractors treating the upper back (often as part of a treatment plan for lower back pain) and accidentally damaging the vertebral artery.
This is the artery that runs up the spine and changes from a vertical route to a horizontal route just before it becomes the basilar artery and heads up to the brain.
The artery is open to potential damage where it changes course and, although there is no definitive answer as to how prevalent this is, there are a number of independent cases studies linking the chiropractic manipulation and vertebral artery damage in certain circumstances.
The Final Word –
All in all, while Chiropractors will undoubtedly defend their profession to the hilt (of course they would) and the General Chiropractic Council itself declared that all patients must give ‘informed consent’ before treatment, it is highly questionable exactly what risk/ benefit analysis can be performed and just how much they are likely to tell you that isn’t based around selling you their services.
Even the BMJ itself concluded ‘the proven benefit of chiropractic spinal manipulation is far less certain than chiropractors tend to admit and its risks are not negligible’ (‘Chiropractic spinal manipulation for back pain. E.Ernst.). Having taken time to collect and read many of the clinical studies around chiropractic care, could we recommend it?
Well, as an opinion, we couldn’t recommend it – a chiropractor for lower back pain is certainly not the best options in almost all circumstances.
Maybe as a last resort if treatments such as posture altering, massage therapy or physiotherapy have failed, then the more dramatic Chiropractic approach may be a final solution to try.
Frequently Asked Questions
Chiropractor’s are almost certain to say yes. However, given that chiropractic care is all about manipulation and realignment of the spine, rather than massaging muscles, the reasoned, independent answer would be no, they are not right for a strained back.
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References Used –
1. Salzberg, Steven (April 20, 2014). New Medicare Data Reveal Startling $496 Million Wasted On Chiropractors. Forbes.
2. E.Ernst (2003). Chiropractic spinal manipulation for back pain. British Medical Journal.
3. Assendelft WJ1, Koes BW, van der Heijden GJ, Bouter LM. (1996) The effectiveness of chiropractic for treatment of low back pain: an update and attempt at statistical pooling. Journal Of Manipulative And Psychological Therapeutics
4. Rothwell DM, Bondy SJ, Williams JI. (May 2001) Chiropractic manipulation and stroke: a population-based case-control study.
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