Alternatives to chiropractry.

September 19, 2008 2:59 AM

What alternatives are there to chiropractic manipulation? (Yes: I know, you are not a medical professional!)

My wife recently went to a chiropractor for a sore back (muscular - we're keeping a heat pack on it and it should be fine in a day or two). He also took an xray and showed her where her spine deviates from a healthy spine. Now he wants her to come back twice a week for manipulations, otherwise it WILL get worse. What alternatives are there to spinal manipulation?

I don't altogether trust chiropractors, and am not convinced that two (expensive) sessions a week are going to help "fix" my wife's spine.

I'm thinking yoga, pilates, dance classes etc, and a generally healthy lifestyle, and just being more aware of one's posture can help fix it.
Please give me your thoughts, ideas, criticisms.

posted by robotot to health & fitness (26 comments total)

>> What alternatives are there to spinal manipulation?

Physical therapy!!! (Someone with a PT or DPT, after his or her name.) Find someone who takes a history and explains the likely causes of your wife's back issues, tests for muscle weakness not just in her back, gives her a small set of well-explained exercises to do (and takes plenty of time to demonstrate them, make sure your wife understands, etc.), suggests how to adjust her daily activities, and what a possible timeline is for recovery. If he or she does all these things, you're probably in pretty good hands.

Chiropractic can't really solve anything permanently, because your muscles and daily activities will you take you right back to where you started. Plus, high-velocity manipulation is dangerous. Physical therapy done right changes underlying structure and muscle balance, as well as reeducates movement. It's a smarter, safer fix.

(in my not so humble yet amateurishly informed opinion)
posted by zeek321 at 3:38 AM on September 19, 2008 [3 favorites]

You are correct in suspecting an improved and more active lifestyle will promote less back pain. Chiropractic treatment offers an ongoing temporary relief which can cause people to focus more on their overall condition and what they themselves can do to improve it. I don't think there have ever been any truly scientific studies proving chiropractic treatment is any better than a proper diet and exercise program, perhaps at least directed by a physical therapist. Weight loss (you didn't state her Body Mass Index) could be a major benefit if she is overweight.
posted by OneCrayon at 3:45 AM on September 19, 2008

I prefer reality based treatment over faith based treatment. A good PT will give you reality based treatment.
posted by caddis at 4:07 AM on September 19, 2008

I don't altogether trust chiropractors, and am not convinced that two (expensive) sessions a week are going to help "fix" my wife's spine.

This is a wise sentiment, regardless of your opinion of chiropractors. Given the choice between palliative care and care that will try to seek out and address the underlying causes of your wife's back problems, it's pretty clear the latter is both a better financial investment, and a better option for her long-term health. Physical therapy, as mentioned above, does the latter... it'll be a tougher treatment regimen, but over any timeframe longer than "the length between twice-weekly chiropractor visits," it will result in better health.

(Disclaimer: I just started a PT regimen for a sore back, and am intensely distrustful of all things chiropractor... week 1 of therapy hurt like a bear, but if it prevents recurring injury, I'm there)
posted by Mayor West at 4:22 AM on September 19, 2008

Please see this previous comment of mine.
posted by dmd at 4:29 AM on September 19, 2008

There was an article a few years in Men's Health where a guy with back problems went to a variety of places for help. The only place that helped permanently was the orthopedic surgeon (who didn't operate.)

Manipulations twice a week for forever sounds like something more aimed at keeping the chiropractor's bottom line healthy than keeping your wife healthy.
posted by Comrade_robot at 4:29 AM on September 19, 2008

As someone who's been there and suffered through a broken back, laminectomy and discotomy - I can tell you this - there are no quick magical fixes. There is bed rest, there is surgery, there is GENTLE yoga and there is energetic healing. And that's just about it. You can work on the mind - via Sarno (google him) and you can go to the odd acupuncturist and change your lifestyle - but the crux of the matter still remains - how to remove the muscle and bone that's pressing on the nerve in the least obtrusive way. There are breakthroughs in micro-surgery - that's not flat out surgery - in/out 24 hours. You might want to research that avenue.
posted by watercarrier at 4:33 AM on September 19, 2008

Lifestyle changes and the services of a good physiotherapist can help you a lot. But, OTOH, I wouldn't absolutely rule out a chiropractor who knows their limits and who has some damn good techniques for soft tissue injuries under their belt, such as ART.

I was advised to see a specific chiropractor in Toronto for my stubborn shoulder pain. I am deeply skeptical of chiropractic claims, but I decided to try her anyway, prepared to refuse any suggestions that my neck or spine get manipulated or adjusted. The first session was intense, as was the second later that week, but by my third treatment the following week, the combination of two quick and simple stretches at home and the 10-15 minute treatments had reduced my pain a lot and given me near-perfect range of motion. She then told me to go away for three weeks and to continue stretching at home, where I continue to improve.

So there are some chiropractors who won't turn you into a crunchy little cash cow, and you can get effective treatment from them, but there are obviously a hell of a lot of greedy quacks out there, too. If you are not aware of any chiropractors, like mine, who seem both knowledgeable and ethical, look for a reputable physiotherapy clinic with an eclectic but careful approach to soft tissue injuries.
posted by maudlin at 5:00 AM on September 19, 2008

I have my doubts about my chiropractor, but I did want to mention that she has provided me with stretches and exercises, as well as postural advice, to help promote the long term structural changes described re: physiotherapists above. She might still be a quake, but she's not a quake that just has me into her office to manipulate (pun intended) and bill me.

Also, I started out seeing her several times a week while I was in pain and that has gradually slacked off to every two weeks. Many of her patients see her less often than, and we're talking about dropping my schedule further. Ask your chiropractor how long 2 day a week visits are likely to last -- chances are, not very long.
posted by jacquilynne at 5:07 AM on September 19, 2008

I'm a fan of therapeutic massage. I pulled my back out weight lifting about a year ago and I went to a massages therapist that had a office next door.

He was able to identify which muscles were involved and give me some stretches and exercises that really helped. He worked the muscles and stretched me out during a half hour session and it only cost me about $45.
posted by wrnealis at 5:46 AM on September 19, 2008

Daily, proper, back-safe stretches are the single best way to keep back pain a thing of the past, and to relieve current flareups. Unfortunately, a lot of doctors - and physiotherapists - don't know which are the safest, and will often recommend exercises that may further strain your back.

I've had back problems since 1996 and suffered for years with it, including a four month stint I spent entirely on my back - rounds of chiros, physiotherapists, and doctors weren't able to do much for me.

But learning back-safe stretches and doing them daily, religiously, has left me nearly pain-free for going on two years now. The only time I have flareups now is when I slack and don't do my exercises religiously.

The exercises I use are in this really, really fabulous book: Healing Back Pain Naturally. Written by an MD, himself a longtime back pain sufferer, it focuses on relaxation, stress and pain management, and stretching. I seriously can't recommend it highly enough.
posted by twiki at 5:59 AM on September 19, 2008

I am a skeptic. Not just your average skeptic, but a militant, athiestic, take no prisoners, scientific method skeptic. No bullshit meridians, energy fields, shakras. I am an engineer and scientist.

I also visit a chiropractor periodically, always in response to an acute injury, normally due to a misguided bend and lift move. Happens perhaps once every two years or so. The two areas that this occurs in my body are upper neck and lower back. Normally, pain goes from 0 to perhaps 8 on a 1..10 scale and range of motion becomes assymetrical and limited.

Chiropractors reliably alleviate the problem in about 10 minutes, usually with a standard set of spinal adjustments. Normally, after I have done this sort of thing, I'll do a few more visits, over the next week or two, and observe my movements more closely to avoid whatever I did to cause the problem.

PT's, DO's and massage therapists would probably be able to help, too, but my preference is for instantaneous relief, and I have not been disappointed.

I do recognize that a lot of chiropractors are integrated with the 'mystical' stuff, which I find unfortunate, mostly because of those pesky double-blind experiments and all, but there is some rational explanation of why what they do works in certain situaions. They aren't all quacks, and frankly, not all allopaths (i.e., 'regular' doctors) are good healers. They fuck up frequently, and I'll simply point to malpractice insurance premiums for support on that front. (QED). (Two recent examples: current wife's misdiagnosed ance treated unsuccessfully for 5 years turned out to be rosacea, fixed in a few months. Friend whose cervical cancer missed after 20 gyno exams recently awarded a large sum of money for all those pesky internal organs that had to be removed. Old example: deceased wife's colon cancer missed by allopaths with 10 years of detailed treatment of her chronic fatigue symptoms. Please tell me more about how chiropractors are quacks! )

Admitedly, some are. Reasoning skills follow the normal distribution, though, and your basic allopath is just as likely to be barking up the wrong tree. These are the people, remember, who used to prescribe thalidomide for morning sickness, with unfortunate results.

The fundamental premise of the chiro is that skeletal structure impacts body function and it is demonstrable. Hence, their primary approach has some value; at least as much as the DO and PT. Good ones 'prescribe' exercises to strengthen problem areas. Alll the ones I ever met emphasize diet and weight control.

They are regulated health care providers in the states in which I have lived.
posted by FauxScot at 6:31 AM on September 19, 2008 [2 favorites]

Self treatment with myofascial trigger point therapy using Clair Davies' book
posted by Not Supplied at 6:47 AM on September 19, 2008

Doctor of Osteopathy.

I know there's a distinction between osteopaths in the US and UK, but don't know the situation in Australia. In the US, osteopaths have very similar training to allopaths except they have a tradition rooted in manipulation, massage, and general medicine. They have all proscribing privileges and accepted medical specialties. They are sometimes trained in and - if not - usually open to the benefits of less-traditional treatments.

I know one osteopathic orthopedic surgeon that does well by his patients by avoiding the knife if at all possible. You can't undo surgery.

Also, Bikram Yoga will kick your ass, but your back will quickly get in the best shape of your life.
posted by GPF at 6:50 AM on September 19, 2008

In situations like this I'd recommend The Egoscue Method. There are clinics throughout the country so you may find one near you, or you can seek treatment online by sending photographs.

What they do is analyze your posture then give you a "menu" of stretches/exercises to perform every day to get your body back into alignment. I've used them a couple of times for unrelated problems and couldn't be happier, and it's far cheaper than chiropractic care because once you have your list of stretches you'll never really need to see them again.
posted by PFL at 7:08 AM on September 19, 2008

Oops. That should have been The Egoscue Method.
posted by PFL at 7:09 AM on September 19, 2008

Definitely PT. Your insurance may cover it if you go to an Orthopedist first to have him prescribe it.
posted by radioamy at 8:02 AM on September 19, 2008

This summer, I had neck pain which was causing headaches. I went to a massage therapist, who insisted that I was "out" and that I needed to go downstairs to see her chiropractor friend right away. I have an intense distrust of chiropractors, especially our local ones. They run ads that state they can "cure" your allergies through spinal manipulation and another is telling all the parents in my town to not have their children immunized.

So, I called my doctor and asked her what she would recommend. She was pleased that I questioned the quacks and sent me to a physical therapist.

Physical therapy was great. It turned out that I wasn't "out," but had suffered some whiplash from a fall. My treatment included massage, exercises and retraining my body to maintain proper posture. It wasn't long before the headaches went away and I started to feel better in general. They were happy to see me "graduated" and unlike with a chiropractor, I likely won't be going back as long as I stay smart about my back muscles and posture.

In the end, I am really happy I didn't risk going to a chiropractor. I also had to drop my massage therapist. She had neither the right nor the skill to diagnose me. I found out later that she and the chiropractor downstairs are constantly trading business and recommending their patients to each other.

I'd like to point out that my PT encouraged the occasional spa/therapeutic massage, but only as a relaxation method and not as treatment. It was clear to me that the massage my PT practiced versus the massage I was used to was vastly different in both method and effect.

Finally, do check with your insurance first. Some insurance plans are PT friendly and others are not. It's a tricky situation. It will help if you get referred by your doctor.
posted by bristolcat at 8:25 AM on September 19, 2008

I've had good results with short-term chiropractic work to fix specific issues (shoulder pain in particular, but also resolving neck tension that substantially affected migraines - in both cases, covered by my health plan.)

That said: for general realignment work, I've known people who've had really good results with Alexander Technique or Feldenkrais Method work (and have done a little Alexander Technique work relating to music).

Both are focused on retraining you/your body to healthy and free function, rather than manipulative (in both cases, the trainer/therapist might lightly touch you to indicate where to focus, or to show you different kinds of movement, but they're not trying to manually realign you or anything.)
posted by modernhypatia at 8:47 AM on September 19, 2008

not convinced that two (expensive) sessions a week

Most chiropractors charge around $50 an adjustment. That doesn't seem that expensive to me but price value is relative to disposable income. Keep in mind, many insurance policies cover Chiropractic; so the expense may not be such an issue. Also, twice a week is recommended at the beginning of treatment. Typically, the frequency of visits decrease over time as the treatment progresses.
posted by aperture_priority at 8:50 AM on September 19, 2008

Generalizing about an entire occupation of people isn't generally accurate. I went to a chiropractor who approached things from a very medical perspective, explained what she was doing, explained what was going on with my musculature and how I could change particular habits that were causing the problem, and led me through some exercises that helped stretch the muscle as well. She helped me go from a situation where I was having day-long distracting, burning pain in a particular section of muscle of my back to a situation where I was feeling normal once more. She is a talented, intelligent, non-hoodoo person focused exclusively on the well-being of her patients, and, just on her behalf, I'm even (oddly enough) unexpectedly finding myself a little offended. Saying all chiropractors suck is like saying all people who participate on message forums on the Internet are slimy pasty-faced geeks living in their mother's basement without a life. Some chiropractors suck, just as some people actually fit that stereotype. But expanding it to everyone, in each of those cases, is just dumb.
posted by WCityMike at 9:35 AM on September 19, 2008 [1 favorite]

am not convinced that two (expensive) sessions a week are going to help "fix" my wife's spine.

physical therapy isn't cheap, either. see what's covered by your health plan.
posted by matteo at 10:10 AM on September 19, 2008

If her issues are related to tight/spasming muscles, I wholly recommend acupuncture. I know that's as hot of a button for some as is chiropractics, but I've found it to be immensely helpful. (If you google it you are going to find a lot of hippie information about body meridians and such, that you may find goofy.)
Anyway, she should look for someone who does the technique called "trigger point release" where the needles are inserted into the muscles and then agitated for about 10 seconds (little ouch-y, that part) until the muscle releases itself from the spasm or contraction. I have found this to be the only thing that fixes my back/neck/shoulders when they are so tight that there are spasms in my shoulder blades, or blinding headaches.

I found physical therapy always made my injuries worse, because they prescribed exercises that tightened the muscle and surrounding muscles, which made everything much worse. Acupuncture, yoga and sports-based/deep tissue massage were the only things that helped.

Once she finds relief, regular gentle yoga should be able to maintain the openness of the muscles. Memail me if you have any questions.
posted by 8dot3 at 11:23 AM on September 19, 2008

I like physical therapy and deep tissue massage. (Ask around for a highly competent LMT; their skills vary quite a bit.) And then have her ask the physical therapist about the right exercise to keep on with. In my case, yoga was fun but not maximally effective for my particular issues. Pilates, on the other hand, was brilliant for me. YMMV.

Pilates, like massage, is an endeavor in which it really pays to look hard for a brilliant practitioner/teacher. For a treatment-oriented pilates regimen, I'd recommend at least starting with private sessions with an instructor whose work is oriented toward rehab of injuries. It's not cheap, but it's worth it. Pilates is surprisingly subtle, not unlike some of the internal martial arts in certain ways. I wouldn't recommend that she start hitting the gym and doing pilates in a big class full of gym bunnies.

I'd also recommend getting a basic anatomy book and looking through it. Learning about how my bones fit together and having a good visual model of my musculoskeletal structure has helped me be more aware of my posture. It made my PT, yoga, and pilates practice stronger, too.
posted by sculpin at 1:37 PM on September 19, 2008

Oh, and a tip for finding a good Pilates studio? Find out where the ballet dancers go. Those people are hardcore, and many of them are fighting injuries.
posted by sculpin at 1:46 PM on September 19, 2008

I'm thinking yoga, pilates, dance classes etc, and a generally healthy lifestyle, and just being more aware of one's posture can help fix it.

Oh, that's nonsense. You need to actively lay hands on the spine for it to ever be healthy. Staying fit and active never helped anything.

Seriously, your chiro is fucking crazy. The only controlled studies on back pain suggest everything you said and none of the other stuff. Do more, not less.

If you ever see a cadaver and get to monkey with it's spine you'll see. The idea of moving shit around is like me telling you I'm gonna re-direct the golden gate bridge a wee bit by tugging on this here cable.
posted by docpops at 3:59 PM on September 19, 2008