If chiropractors are frauds, what do doctors do for bad backs?

August 30, 2005 7:38 AM

We've all heard that chiropractors are quacks. What is mainstream medicine's answer to recurring back problems? Has anyone here had success with these methods?

Six minutes of googling and browsing quackwatch.org/chirobase.org hasn't given me an answer to this question...

My wife has had back problems for a long time. A trip to the chiropractor usually makes her feel better for at least a few days, sometimes up to a month. Then her back goes "out" again, and she's back at the chiro. This (along with the danger of the methods) is one of the criticisms I've heard of chiropractic care.

If chiropractic methods are dangerous, what would a traditional MD recommend for someone whose back is always "out"? I always assumed they'd just recommend surgery or something. Do they send you to physical therapy? Has anyone here had success with this kind of treatment?

Yes, yes, go see a doctor. Well Mister Smarty Pants, your answer may help convince my wife to do just that.

posted by agropyron to health & fitness (33 comments total)

The problem is, "back problems" covers an awful lot of ground. What a doctor does about it depends on what, exactly, the problem is -- scoliosis, herniated discs, arthritis, muscle spasms, whatever. It needs to be more specific than "out".
posted by mcwetboy at 7:53 AM on August 30, 2005

Hmmm. Well, she has a rib that the chiro keeps adjusting. I guess it would have to be more specific than that too, eh?
posted by agropyron at 7:56 AM on August 30, 2005

I've never had back problems, am not a doctor, don't know anyone successfully cured, etc. But I did hear a sports medicine doctor (on the radio) say that the main cause of back problems was that the musculature of the back was not doing its job. He claimed that the discs were the last defense against the vertebrae touching and that your weight should normally be carried by your muscles. Thus, exercise and physical therapy were recommended over chiro and surgery.
posted by 445supermag at 8:03 AM on August 30, 2005

See a DO, Doctor of Osteopathy. Some general info here and some back pain specific info here.

One time I went to the emergency room becuase I'd been having crippling migrane headaches and I just couldn't take it anymore. I just wanted to walk out of there with an Rx. The doctor on duty happened to be a DO. He asked me a few questions, determined that I didn't have migranes I have tension headaches, he cracked my neck, gave me a glass of water, and my headache was gone in a matter of minutes never to return.

I guess the deal is that a DO is essentially a chiropractor, but beyond that is a licensed physician as well.
posted by TurkishGolds at 8:07 AM on August 30, 2005

Has she tried going to a message therapist at all? My dad has chronic back problems (from old age and fused disks and other stuff) and the only thing that keeps it bearable is a combination of a chiropractor and a message therapist. He goes every week or every other week. Thing is, it is not uncommon for someone to have to go repeatedly to keep their back in line. A chiropractor is not always a permanent solution and continued visits are necessary. Think of it as braces- they can align her back all they want, but it is going to go back to its original, painful format in time.
As for your fears of using one, I can't blame you. My dad will not use a chiropractor actually moves his bones because my mom won't allow it (she was a nurse on a neurosurgeon floor and saw too many people paralyzed from chiropractor). Instead, they use some kind of electrical impulse that helps him out a lot and even allows him to play tennis again.
posted by jmd82 at 8:08 AM on August 30, 2005

While many chiropractors might be quacks, not all are. And it was my experience that once I found a good one, it made all the difference in the world. However, a couple of times I tried going to the 'real' doctor about my back too, and the answer was just a bottle of muscle relaxers. Fun for awhile, sure, but not a great way to go in the long run. All of the above, though, have always suggested back excercises too, so I think that supports 445's point. Also, lack of minerals can cause back pain, so if she sweats a lot or drinks a lot, have her take a multivitamin with minerals. And maybe try getting regular massages. Doesn't do a thing for me, but helps my wife considerably.
posted by spilon at 8:12 AM on August 30, 2005

All chiropractors are not quacks. The ones to watch out for are the ones who tell you that they can help with things that are not related to spinal alignment. (I've seen chiros who claim that chiro can help with everything from glaucoma to allergies to ingrown toenails. Those are the quacks.)

If her back is repeatedly and frequently "going out", there's something wrong that the chiro isn't fixing.

Go see a doctor. Really. GP is fine. Tell the doc what's going on. Doc will probably recommend physical therapy first, depending on what the problem seems to be. PT will help, unless she's already got good abdominal and back muscle strength. The doc may also prescribe a good back brace, if her back is in really bad condition.

A good PT will also be able to help with mechanisms for dealing with/preventing the "going out". Standing/sitting/lifting properly will make a big difference in the amount of stress on the back, and may reduce/eliminate the recurrence of "going out". A good PT may do the same kinds of realignment that a chiro does, but will also have ideas on how to prevent the misalgnment in the first place.

A good doc will not recommend surgery unless and until it is absolutely necessary.

FWIW, I managed to postpone surgery for a ruptured disk for 20+ years by lifting/carrying/standing properly and doing a daily routine of exercises as recommended by an athletic trainer and a PT.
posted by jlkr at 8:14 AM on August 30, 2005

It is not necessarily conventional, but I know ALOT of people who will testify to the effectiveness of this: Ceragem Master.

There is one in Bellevue, WA.
posted by mic stand at 8:23 AM on August 30, 2005

There was an article in The New Yorker in 2002(?) about medical interventions for bad backs. It, and subsequent research I've read, suggested that such interventions frequently don't do enough helping to justify the radical intervention.

I really think that exercises to strengthen the back are key to getting better. Your wife should go see a PT and start on a program to strenghten things back there.
posted by OmieWise at 8:25 AM on August 30, 2005

Oh, FWIW, I do go to a chiro for some back problems on occasion and have been helped. The most imporant thing is the exercises I get, though.
posted by OmieWise at 8:26 AM on August 30, 2005

See the thread from the other day.
You've got an...um.....interesting attitude in the way you've framed your question agropyron.

What's a Doctor likely to do?

Physical examination and any imaging (xray, CT, MRI) +/- blood tests to establish a diagnosis; prescribe pills or local injections to combat inflammation if that's part of the problem; prescribe exercises; advise what physical limitations such a condition requires; provide instructions to physical therapist or chiro or osteo so that they can assist most efficiently; advise surgery as a last ditch possibility. It all depends, as others are saying, on what is actually wrong.
posted by peacay at 8:29 AM on August 30, 2005

Exercise -- try swimming backstroke.
posted by footnote at 8:33 AM on August 30, 2005

Thanks to everyone who has posted informative answers without snarking. peacay, that doesn't include you.
posted by agropyron at 8:37 AM on August 30, 2005

Speaking as a thoroughgoing sceptic, I do not agree with those who say chiropractic is bunk. I was first introduced to it some eighteen years ago, via my ex-wife who had a recurring problem with a once-ruptured disc in her lower back. She absolutely swore by chiropractic and it was hard to argue with the results. The first time her back "went" after I knew her was three days before we were due to fly out for a long backpacking holiday in Greece. She was virtually immobile. She couldn't bend at all. She was in huge pain. She insisted on getting to her chiropractor and, after three emergency treatments, we managed to get on the plane and make our trip. By that time she was moving somewhat gingerly but largely out of pain and fairly mobile. Two days later she hiked the Samaria Gorge with me.

A few years later I casually heaved my Vox AC30 out of the back seat of my car and felt a blistering agony shoot up my spine from coccyx to neck. I couldn't straighten up. It was excruciating. After one visit to the chiro I was standing straight and walking carefully. After three I felt right as rain. I have had occasional, far lesser recurrences of pain from this injury (i basically twisted a vertebra out of alignment) and a few visits to the chiro have always put me straight. Literally.

If you read up a bit about what chiropractic manipulation actually seeks to do, it makes some sense. Yes, there are dodgy practitioners out there who lump it in with obvious bollocks like magnetic therapy and so on. Yes, by its very nature there's a risk that a ham-fisted practitioner might screw your back up. You simply need to avoid the cowboys. Get a personal recommendation, always. But all "alternative therapies" are not equal. They're not even remotely similar, in many cases. At the out-and-out bonkers end you have nonsense like homeopathy. Chiropractic is something else and I always recommend people with back problems give it a try. I've probably recommended it to five friends over the years and all have found it a revelation and been very satisfied. Even those who are as instinctively sceptical as I am.
posted by Decani at 8:43 AM on August 30, 2005

When I was in higschool I put out my back pretty badly, and my mom didn't do anything for a couple months. Some friends of mine told me I needed to see a chiropracter, but my mom wanted to take me to a doctor first. We went, and the doc just said I should see a chiropracter. (or I could get surgery).

It took a while to get me 'straight', but it did work. I've had back problems since then, but doing ajustments has definetly releaved the problems whenver they've shown up.

The general medical solution is surgery, as far as I know.
posted by delmoi at 9:06 AM on August 30, 2005

A surgeon I know sends them to yoga before resulting to invasive proceedures.
posted by jmgorman at 9:11 AM on August 30, 2005

I'll tell you my experience as a way to have your wife get checked out. I had recurring back pain, i.e. it went out regularly, that was helped but not fixed by NSAID medication.

Upon the recommendation of a co-worker, I went to a chiropracter, who took x-rays, did some massage therapy and joint manipulation. She diagnosed my problem as alignment difficulties and the after effects of a 10 year old car accident. Ten treatment sessions certainly left my back feeling better, mainly the massage, and so I chalked it up to good care.

Fast forward five years and I am back at the doctor for something else when I mention my hand hurts too. A referral to a rheumatologist and I discover alignment difficulties and the after effects of a 10 year old car accident were in fact ankylosing spondylitis (AS) and psoriatic arthritis (PSA). Both clearly visible on the x-ray the rheumatologist takes.

I get a copy of the x-ray from the chiropracter of five years past and my doctor points out it was clearly visible then too.

Both AS and PSA are degenerative, irreversable diseases. Once the joints are damaged, there is no way to repair. Earlier medical treatment rather than chiropractic care could have prevented the permanent damage I have now. My moral of the story is see a rheumatologist BEFORE a chiropracter to rule out the bad stuff.

More info: Anklyosing Spondylitis and Psoriatic Arthritis. Also our own mcwetboy has a great blog on AS here.
posted by karmaville at 9:13 AM on August 30, 2005

What Decanti said. Chriros are not necessarily quacks; they simply are not doctors. Ones who claim to deal with things beyond their scope should be viewed with suspicion if not scorn. My understanding is that the dangers of chiropractic treatment is limited to high-speed adjustments (which have killed and paralyzed people) and listening to them about things they have no business positing on.

As far as "what would a traditional MD recommend" that's way too big a field to address. It depends on what the basis of the pain is. Collapsed disc pressing on the spine? Muscular inadequacy? Gout? The adjustment of "a rib" sounds fishy to me but IANAD.

And I prefer Mr Intelligent Trousers, thank you. Could you be more pre-emptively defensive and snippy somehow?
posted by phearlez at 9:16 AM on August 30, 2005

I really think that exercises to strengthen the back are key to getting better

One point that is often overlooked: weak abdomen muscles can easily lead to back problems. Doing abdominal crunches (NOT SITUPS) every other day doesn't take much time, and requires no special equipment, but can make a large amount of difference.
posted by WestCoaster at 9:44 AM on August 30, 2005

Most back pain goes away in 6 to 11 weeks no matter what you do. Here's what Consumer Reports recommends:

Though most back pain goes away by itself eventually, back pain can occasionally be the symptom of a more serious condition. See a doctor if your back pain is accompanied by any of these symptoms:

Leg numbness and weakness. These severe neurologic symptoms are a sign that a spinal nerve is being compressed. Without treatment loss of function could be permanent.

Intense pain for more than two weeks. While most back pain gradually improves, unremitting severe pain could signal a serious condition such as cancer or a blood vessel aneurysm.

Recent fall or accident. A fractured spine can produce permanent neurologic damage and needs immediate treatment.

Fever or chills. In combination with back pain, this could signal an infection in the spine, kidneys, or surrounding tissues.

Numbness in the groin and both legs. These can be symptoms of cauda equina syndrome, an uncommon condition in which a bundle of nerves in the lower spine is compressed by disease, frequently cancer.
posted by Faze at 9:53 AM on August 30, 2005

WestCoaster: my chiropractor stresses that exact point. He gave me a whole bunch of back and abdominal exercises to do to assist my recovery and help prevent recurrence.
posted by Decani at 9:56 AM on August 30, 2005

http://www.mybacksolution.com/

Although peppered with google ads, this looks fairly straightforward and useful.
posted by craniac at 10:11 AM on August 30, 2005

I have to chime in here and offer my own personal experience, which is with a NUCCA practitioner. These people are not "back crackers," they are engineers.

I was a forceps baby and have had trouble with the left side of my body since I can remember: terrible earaches as a child, walking pigeon-toed, growing pains, and then as an adult increasingly severe headaches and tingling and numbness in my left arm and leg.

My practitioner X-rayed my skull and neck, determined the precise angle of my misalignment, and adjusted me. Immediately, I was able to stand straight up for the first time in my life. My pigeon-toed gait was completely gone. The headaches and tingling faded away over the course of a month, never to return. This was three years ago.

Here's a link to the national NUCCA website. They can help you find someone in your area if your wife wants to give it a shot.
posted by macinchik at 10:50 AM on August 30, 2005

Mainstream medicine would probably refer you to a physiatrist. They specialize in pain treatment and rehabilitation.
posted by greatgefilte at 10:52 AM on August 30, 2005

im 22 and have had some MAJOR back issues over the last year or two. i shoveled 11+ tons of asphalt a day for my town as a summer job, herniated a disc and was basically unable to walk for about a year. i was doing the chiropractor thing but that would only help for about a day or two after the adjustment. i then moved to philly and heard about this thing called vax-d. basically its traction with a twist. i now have almost zero back pain, just some slight discomfort every now and then. just google 'vax-d' for more info. basically it causes a vacuum effect and the disc gets "sucked" back into place. im quite pleased w/ the results (i can now walk and bang w/o any pain, and thats all that REALLY matters, right?)

oh, and vax-d is a non-invasive solution, takes about 1 hour each day, 5 days a week for 1-3 months. i also got a massage/stim/ultrasound every day as well.

good luck to anyone w/ severe back problems, it really sucks.
posted by hummercash at 10:53 AM on August 30, 2005

I've had a back problem for nearly 30 years. First tried my GP, then chiropracters (helped, but didn't hold) then finally found a physiatrist (Also called Physical Medicine and Rehabilitation doctor) who diagnosed an old injury, gave me excercises I still do EVERY DAY, and a brace I wore for 8 months till the muscles got stronger. That said, other doctors saw nothing on the X-ray (he saw a narrowing of vertebrae).

Lately, I think yoga is helping my back (can sit without special cushions more often). It takes time.

It's like a lot of other things, there are better and not so good docs, chiros, etc. and also, it depends a lot on what you have. More recently I developed arm problems from computer use, and after the docs were no help, I wound up seeing a wonderful chiropractor who diagnosed Pronator Teres Syndrome, and treated it. Plus stretches (also every day - what a drag). He is both a chiro and a physical therapist, and has also helped with other stuff the docs couldn't . I call him my wizard, and he's helped a lot of my friends. So, if you live in the Twin cities (Mpls/St. Paul) email me and I'll tell you about him.

Good luck - there's a lot of good advice here, you need to be persistent.
posted by judybxxx at 11:36 AM on August 30, 2005

No, don't strengthen your stomach, strengthen your back

I've mentioned it before, I'm a big fan of Medx - but it's because I saw it's use for almost ten years in a clincal setting (as well as the past president of the American College of Orthopaedes endose it.)

Oh, and hummercash, were you in my FCP class last week?
posted by filmgeek at 12:41 PM on August 30, 2005

I don't know about Quacks, but I do know that after Karate training turned a Snowboarding injury into agony, and made it almost impossible to walk, or sleep, or really anything - one day after my first treatment I was up and around again, and it never returned. (Though my back still feels weak.)

He took xrays, showed me the problem (it was actually obvious on the film, one side of my pelvis was bent when I took a real hard fall on my arse), told me what he was going to do to help, and told me that the very best thing to do long term was to walk more.

I never got any weird feelings about strange claims, but after a little while I did get a feeling that I was on a production line, and when my accident compensation ran out, I stopped going.

My family doctor, however, freaked me the hell out - I called and asked the receptionist if they had any recommendations on a good chiro in the area, she said I'd have to go in as no chiro would take me without a referral, I then called a chiro out of the phone book and they didn't know what the hell she'd been talking about.
posted by The Monkey at 6:01 PM on August 30, 2005

The best advice I ever got about my back was someone who swore that if you had a muscle spasm, you shouldn't put heat on it, you use cold packs. If you think there's a chance there might be a muscle spasm going on, you could try a cold pack on it a couple of times and see if it helps.

Obviously, this needs medical attention, but if cold packs provide some minor symptomatic relief, it doesn't sound like something that would hurt you.

IANAD, YMMV. The Ace people (the same ones who make roller bandages) make a gel freezer pack in two sizes, the larger one will hold the cold longer, and being gel, they conform to the body well. If it doesn't seem to make the back more comfortable, it's always a good thing to have in the freezer for minor bruises and such. Available at most pharmacies.
posted by unrepentanthippie at 7:50 PM on August 30, 2005

I don't think it's accurate to characterize all or even many chiropractors as quacks. Most of them are competent in their specialty and are hard-working, decent practitioners.

One of the problems with asking traditional MD's about chiropractic is that the two specialties don't speak the same language. We use an entirely different set of jargon. When a chiropractor views an x-ray next to me, they say words, and the words make them decide on a treatment plan, but that process is pretty opaque to your typical MD - much as our own process is opaque to folks who haven't studied medicine, I suppose.

I have two specific criticisms about the chiropractic. First, high velocity neck manipulations are dangerous to people with underlying vascular disease; they can sometimes cause vertebral dissection, which can be fatal or severely debilitating. Second, chiropractors should not be performing or interpreting EMGs, as their scope of practice does not enable them to recognize or treat what they find. Most chiro's don't; the ones that do are after money, I think.

As far as back pain goes, it's estimated to be the most costly illness in terms of productive work time lost every year in the USA. I don't think traditional medicine, chiropractic, or anything else is particularly good at dealing with it. If there is a reason for this, it is probably the way human backs are built, not that doctors or chiropractors are evil.

The OP's question can't be answered in any kind of meaningful way. It's not specific enough.
posted by ikkyu2 at 7:52 AM on August 31, 2005

Oh, and hummercash, were you in my FCP class last week?

yup, thats me...
posted by hummercash at 8:39 AM on August 31, 2005

Second, chiropractors should not be performing or interpreting EMGs

Pardon my ingorance, but does EMG=X-ray?
posted by recurve at 7:51 PM on September 7, 2005

No, an EMG is an electrophysiologic study that examines nerve and muscle function.
posted by ikkyu2 at 11:11 PM on September 13, 2005