Is It Worth It To Try Chiropractic First If I’m Told I Need Surgery?
Dr. Jeff Williams, a chiropractor in Amarillo, TX makes it clear
There are so many directions this information could go so let us just break it down step by step. This is definitely an 'educate yourself' kind of article.
I think the most important thing to say from the top is that I am not a chiropractor that is against surgery. I am not one that is against the medical profession. A family member of mine is a physical therapist. I work with the medical profession. Some of my patients are medical doctors. Some of my friends are surgeons. Many more of my friends and collaborators are nurse practitioners, physician assistants, RNs, LVNs, and we currently have a CNA working with us in my clinic.
You might say that I’m part of a team because, honestly, when practitioners of all kinds are working as a team, the winner every time is the patient. There is no doubt about that fact.
I wanted to get that out of the way because some of the things I say may be misconstrued as me being against surgery or the medical profession. That is simply not the truth. I am against surgery and shots taken out of the proper order in treatment recommendations and guidelines and I’m against shots and surgery for the wrong patients. That is more than fair and sensible in my view.
Now that we have covered that, a good place to begin is with the more recent recommendations by one of the largest medical groups, the American College of Physicians. In a guideline written by Qaseem et. al. in the Annals of Internal Medicine, the ACP now recommends the following be tried FIRST for back pain of any duration; long term and short term pain(Qaseem A 2017):
- Spinal Manipulative Therapy (Chiropractic)
- Low-Level Laser
- Cognitive Behavioral Therapy
- Yoga (but not all kinds are perfect - ask us first)
- Tai Chi
At our clinic, we do the first five I listed!
Thanks to this paper, we can now say that if you go to your doctor, whether it is in the ER, a family practice setting, or in a surgeon’s office and they are not looking at these techniques as the FIRST line therapies to try, then they are outside of current thinking, current research, and current guidelines. You MUST view it this way. It is vital to see things in this way because if you do not, you are at risk of an outdated doctor sending you down the path of unnecessary medications, unnecessary and risky shots, and potentially even surgery.
That sounds dramatic but a project from 2012 by Keeney et. al. demonstrated how hurt workers that visited a surgeon first had surgery 42.7% of the time while hurt workers that went to a chiropractor only had surgery 1.5% of the time(Keeney BJ 2013). BIG DIFFERENCE!! The fact is, if you go to a surgeon, many times, you're going to get surgery. When you have a hammer, most things look like a nail don't they?
It is not just the ACP saying these things either. This same sentiment is echoed by The White House Commission on Opioid Abuse(Mutikani L 2017), The Lancet Series on Low Back Pain(Buchbinder R 2018, Foster N 2018, Hartvigsen J 2018, Buchbinder R 2020), The Joint Commission(The Joint Commission Online 2014), and to an extent, even the Journal of the American Medical Association(Page N 2107).
Being able to advocate for yourself simply comes down to being educated as a patient. It is as much the patient’s responsibility as it is the doctor’s.
Following the failure of all of the techniques I mentioned, according to the ACP, a patient would then try low-grade medications. If they failed, then higher grade, riskier medication would be attempted. Assuming those failed to resolve the issue, then and only then, would shots and potentially surgery be considered.
We have an unfortunate culture where the table is flipped 180 degrees and surgery and shots are happening before going through the treatments in the correct order. This thinking has to stop immediately because patients are getting permanently altered surgically and that is simply unacceptable.
More recently, in 2020, a project was published in American Family Physician(Flynn D 2020) about chronic pain and the need for nonpharmacologic and noninvasive treatments. This project reiterated and backed up the recommendations made by the ACP saying that yes, spinal manipulative therapy, massage, exercise, acupuncture, and low-level laser fo provide relief for chronic pain. They even help in cases of fibromyalgia.
Now that I have demonstrated the fact that medical entities recommend alternative therapies be tried before surgery, let us talk about the surgeries themselves.
Most are not aware of the fact that a lumbar (low back) spinal fusion surgery costs about $60,000 for Medicare and up to $150,000 for regular insurance patients. I think we can agree on the fact that that is incredibly lucrative. But most do not understand that the most common surgeries done for musculoskeletal conditions are not backed by good research.
Let me explain; a paper from this year searched the research database to perform a systematic review(Harris IA 2020). A systematic review is at the very top of solid, well-backed research. They took 6,735 studies having to do with the most common musculoskeletal surgeries. Of these 6,735 studies, only about 1% of them, 64 to be exact, compared having the surgery to having no surgery at all. Here is the eye-opener though; of those 64 that actually compared surgery vs. no surgery, only 9 of them were actually favorable to having surgery.
Another very common surgery is shoulder surgery. I wonder what the number is for patients having surgery on a torn supraspinatus muscle in the shoulder would be when recent research has shown that 75% of these tears can be rehabilitated successfully without surgery(Boorman RS 2018)?
On top of that, epidural steroid injections come with their own set of dangers and risks. They have been shown to not be very effective at all and when they actually do help, the relief is short-term only and they can provide absolutely zero help in the long-term. It is like taking the batteries out of your smoke alarm during a fire because you don’t like the noise it’s making. Besides, these shots can put the integrity of your bones at risk.
As I have demonstrated, not only do the largest organizations in the medical industry recommend alternative therapies for back pain FIRST but now you understand the lack of research backing these incredibly invasive and risky shots and surgeries. Many of which are repeated several times trying to achieve some sort of effectiveness.
Then why is it that the medical professionals are not consistently filling up offices like mine with musculoskeletal pain patients? Though the relationship is exponentially better in 2020, the history of fighting between the chiropractic and the medical professions is long. Those in control of both professions have long memories as well. With that being said, there have been significant inroads in integrating and in collaborating and in becoming more of a team with the patients’ best interest at hand. It is getting better every year and the opioid crisis has picked up speed on the process. It has been like a snowball rolling downhill as a matter of fact considering that doctors of chiropractic can play such an integral role in helping patients reduce and ultimately eliminate pain medication when they are made a part of the team and a part of the process.
Some of the reasons medical professionals are slow to refer at this time are there is still a bit of a mistrust factor. The chiropractic profession is not well-standardized if I am being honest so it is hard for a medical professional to know exactly what kind of a chiropractor they would be sending their patients to and, at the end of the day, nobody wants to look like a fool for sending their patients to someone that is not on top of their game.
Also, many medical professionals simply do not know much about evidence-based, patient-centered chiropractic care like is found in my clinic. They do not know the research and many times, they are just too busy to go find it themselves. This is frustrating for practitioners like me but understandable.
To the original point of if one should try chiropractic before surgery, my answer would be that every condition is different so no firm declarations can be made in a social media article or video but, in general, for non-complicated neuromusculoskeletal pain, according to the medical field’s leading guidelines and thinkers, and considering the incredible risk and lack of evidence behind the most common shots and surgical procedures, one would be crazy to recommend shots and surgery first before doing what research tells us all to do.
Which is visit a clinic as we have here in Amarillo, TX where you will find chiropractic, massage, exercise, acupuncture, low-level laser, balance and proprioceptive training, and much much more. All geared to get patients back on their feet noninvasively, non pharmacologically, safely, and smartly. Based on research and guidelines.
That’s what we call evidence-based, patient-centered care. You should try it!
Dr. Jeff Williams, DC, FIANM is a Fellowship-trained Neuromusculoskeletal specialist and chiropractor in Amarillo, TX. As an Amarillo chiropractor, Dr. Williams treats chronic pain, disc pain, low back pain, neck pain, whiplash injuries, and more. Dr. Williams is also the host of The Chiropractic Forward Podcast (http://www.chiropracticforward.com). Through the podcast, Dr. Williams teaches fellow chiropractors and advocates weekly for evidence-based, patient-centered practice through current and relevant research. If you have any questions for Dr. Williams, feel free to email at [email protected] more about Dr. Williams and his practice at https://www.amarillochiropractor.com.
Dr. Williams was voted Best Chiropractor In Amarillo in the Best of Amarillo 2020. Dr. Williams's full-time Amarillo chiropractic practice is Creek Stone Integrated Care at 3501 SW 45th St., Ste. T, Amarillo, TX 79109. If you are searching for a chiropractor near me, Dr. Williams is your Amarillo Chiropractor.
Boorman RS, M. K., Lollinshead RM, (2018). "What happens to patients when we do not repair their cuff tears? Five-year rotator cuff quality-of-life index outcomes following nonoperative treatment of patients with full-thickness rotator cuff tears." J Shoulder Elbow Surg 27(3): 444-448.
Buchbinder R (2018). "Low back pain: a call for action." The Lancet 0(0).
Buchbinder R, U. M., Harvigsen J, Maher C, (2020). "The Lancet Series call to action to reduce low-value care for low back pain: an update." Pain 161: p 557-564.
Flynn D (2020). "Chronic Musculoskeletal Pain: Nonpharmacologic, Noninvasive Treatments." American Family Physician 102(8): 465-477.
Foster N (2018). "Prevention and treatment of low back pain: evidence, challenges, and promising directions." The Lancet 0(0).
Harris IA, S. V., Mittal R, Adie S, (2020). "Surgery for chronic musculoskeletal pain: the questions of evidence." Pain 161(9): S95-S103.
Hartvigsen J (2018). "What low back pain is and why we need to pay attention." The Lancet 0(0).
Keeney BJ (2013). "Early predictors of lumbar spine surgery after occupational back injury: results from a prospective study of workers in Washington State." Spine (Phila Pa 1976) May 15(38): 11.
Mutikani L. (2017). "Opioid crisis cost U.S. economy $504 billion in 2015: White House." from https://www.reuters.com/article/legal-us-usa-opioids-cost/opioid-crisis-cost-u-s-economy-504-billion-in-2015-white-house-idUSKBN1DL2Q0.
Page N (2107). "Association of Spinal Manipulative Therapy With Clinical Benefit and Harm for Acute Low Back Pain." Journal of American Medical Association (JAMA) 317(14): 1451-1460.
Qaseem A (2017). "Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain: A Clinical Practice Guideline From the American College of Physicians." Ann Intern Med 4(166): 514-530.
The Joint Commission Online (2014). "Revisions to pain management standard effective January 1, 2015 BrightStar Care recognized as Enterprise Champion for Quality for second year New on the Web." Joint Commission Online.
- chiropractor amarillo
- chiropractor amarilo
- chiropractor adjustment
- chiropractor in amarillo texas
- chiropractic care in amarillo
- chiropractic amarillo tx
- amarillo chiropractic offices
- amarillo acupuncturists
- amarillo chiropractors
- amarillo chiropractor
- amarillo chiropractic clinic
- amarillo disc herniation
- amarillo pain clinic
- dr brister amarillo
- dr daneshfar amarillo
- dr errington amarillo
- dr keister amarillo
- dr parker chiropractor amarillo
- dr paullus amarillo
- chiropractors in amarillo tx