Current Research: Chiropractic, Medicine or Surgery?
When is it time to see a chiropractic physician, as opposed to taking medicine or seeing a surgeon? There is growing support for chiropractic or joint manipulation for problems ranging from lumbar disc herniation and chronic neck pain to knee arthritis. But how do we decide when its time to try chiropractic as opposed to medicine or surgery?
What’s the diagnosis, and does it matter? This sounds so simple as to
seem stupid to discuss, but the first problem is that different doctors
will give you totally different answers as to why you are hurting, that
can make you actually wonder whether they all live on the same planet.
Chiropractors will refer to a “bone out of place,” and a radiologist will
report your back x-rays as normal. Neurosurgeons will read an MRI of your
back and speak about “herniated discs” while therapists will refer to “tight
muscles.” Finally, your primary care doctor may say your back is “in spasm”
and prescribe muscle relaxants and non-steroidal anti-inflammatory drugs,
or even steroids. Sort of makes you wonder whom to believe? The truth is
that unless doctors identify cancer, a cyst or a tumor, we don’t really
know the absolute cause of most back and joint pain. However, we think
that it usually involves inflammation secondary to abnormal postures, occasional
accidents, and aging, and as long as you get well after a trial of care,
the exact diagnosis may not matter.
A trial of chiropractic?
Ok, so how do we know whether to try chiropractic, chiropractic and medicine, or surgery? Based on initial tests by your doctor or chiropractor, including imaging such as x-rays or MRI, and by taking a careful history, we can have a good idea up front whether the patient is a candidate for chiropractic care, or chiropractic and medical co-management, as opposed to surgical care.
So-called “Red Flags” such as unexplained
fever, arm or leg pain that is worse than neck or back pain, unexplained
fatigue or weakness, severe neurologic signs such as dizziness, imbalance,
loss of bowel or bladder function, and tingling, numbness, or weakness
in an arm or leg, are examples of signs that must be fully considered and
monitored by your physician or chiropractor. Even with some of these symptoms,
such as in the case of MRI confirmed “herniated disc” with leg pain and
foot numbness, you may still be a good candidate for a trial of chiropractic
care, (for example, 4 weeks of 3 adjustments per week, combined with in
home restrictions, therapy and exercises). However, in such cases your
chiropractic physician will carefully monitor your findings and refer you
for medical co-management or even surgical consultation, if after a suitable
time period your symptoms and clinical signs are not improved.
Why not just see a surgeon and get it “fixed”?
There is a common notion that surgery for back, neck and joint problems will “fix” them, so that despite the increased costs and risks, the outcome may be better. Unfortunately, studies of patients with herniated discs and knee arthritis have shown that in terms of two-year outcomes, surgery is no more helpful than exercise. It appears that being active, exercising some, and losing weight when necessary are important to making long term gains regardless of whether a patient does or does not get surgery.
Scientists concluded that conservative care should be tried first, and surgery reserved for cases that fail to be managed by conservative care such as exercise and chiropractic, in the only Federal guidelines ever developed for low back pain treatment. Those same scientists recommend a conservative approach for back pain that includes such over the counter medicines as Tylenol and ibuprofen, ice packs, and spinal manipulation (chiropractic adjustment), as being safe and effective.
There appears to be more support now than ever before for following the time honored chiropractic wellness approach that includes chiropractic first, medicine or medical co-management second, and surgery last. Unless there are red flags for serious disease or complications, chiropractic should be your first option rather than your last.
Sincerely,
Dr. Robert Leach
Further Reading:
- Research review on chiropractic for chronic back and even leg pain
- Latest research on manipulation as opposed to placebo for knee arthritis
- Recent research on chiropractic for chronic neck pain
- Surgery for chronic knee arthritis is not significantly better than exercise and medicine
- Surgery for disc herniation is not significantly better than exercise
- Read the only U.S. Federal guidelines ever written on back pain treatment: