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The Medical Experts Now Say, “Try Chiropractic”

Chiropractic office in Amarillo, TX discusses the topic

 

I don’t think I’m giving away any secrets here when I share with you that for generations, the medical field has had a certain disdain for the chiropractic field. This disdain was returned over the years as chiropractors recommended not going to the medical doctors, recommended not taking pharmaceuticals and things of that nature. 

Although things have improved drastically over the years, certainly in the last ten years or so, let’s not kid ourselves; there are still some older medical doctors clinging to archaic beliefs and impressions of chiropractic and there are some chiropractors still advising against pharmaceuticals and vaccines. It’s a reality. 

Before we get too far here, I want to be clear. Many of the biggest medical groups are now recommending spinal manipulative therapy (the hallmark and cornerstone of chiropractic care) as first-line therapy for short-term as well as long-term back pain. While using spinal manipulative therapy first has been in the prestigious Lancet Medical Journal[1-5] several times, supported by recommendations from The Joint Commission[6] and The White House Report on Opioids[7], there are two very notable medical entities I want to recognize for following research and evidence. 

These two groups have not clung to archaic dogma and rhetoric. They talked the talk on research and now they are walking the walk by supporting spinal manipulative therapy for back pain of any duration before ever considering surgical intervention. 

The two groups are the American College of Physicians (ACP) [8] and American Family Physician (AFP) [9]. 

The AFP’s paper was released in their journal on October 15, 2020, and was called Chronic Musculoskeletal Pain, Nonpharmacologic, Noninvasive Treatments. Here are some of the best quotes from the paper:

  • Because no individual therapy has consistent benefits, a multimodal treatment approach to chronic musculoskeletal pain is recommended. 
  • Systematic reviews (top-notch research) and guidelines support the effectiveness of various forms of exercise in improving pain and function in patients with chronic pain. 
  • Spinal manipulation leads to a small benefit for chronic neck and low back pain. 
  • Acupuncture has a small to moderate benefit for low back pain and a small benefit for non-pain fibromyalgia symptoms. 
  • Massage or myofascial release yields a small improvement in low back pain, hip and knee osteoarthritis, and fibromyalgia. 
  • Low reactive level laser therapy (cold laser) may provide short-term relief of chronic neck and low back pain, and ultrasound may provide short-term pain relief for knee osteoarthritis. 
  • Multidisciplinary rehabilitation may be effective for short- and at least intermediate-term improvement in pain and function for chronic low back pain and fibromyalgia. 
  • Patients should be encouraged to engage in a variety of therapies aligned with their preferences and motivation. 

 

What they’re saying there is that there are no silver bullets so the recommendations are to hit the pain from all sides with a full-on attack. Here at my chiropractic clinic in Amarillo, TX, Creek Stone Integrated Care, we do just that. Here under one roof, we offer spinal manipulative therapy, exercise rehabilitation, massage, acupuncture, low-level laser, spinal decompression, and so much more. 

The ACP was the first out of the gates in promoting spinal manipulative therapy for back pain. In 2016 they released new recommendations guiding physicians to refer their patients for the following treatments FIRST, before anything else. The treatments recommended for first-line treatment of back pain are:

For acute or subacute back pain

    1. Spinal manipulative therapy
    2. Massage
    3. Acupuncture
    4. Heat

For chronic back pain

    1. Spinal Manipulative therapy 
    2. Exercise-Rehabilitation
    3. Acupuncture
    4. Low-level laser
    5. Cognitive-behavioral therapy
    6. Tai Chi
    7. Yoga
    8. Motor control exercise
    9. Progressive relaxation

 

Again, those recommendations are coming from MEDICAL researchers. Not chiropractors. If your doctor told you to try a chiropractor, would you do it? Essentially, they are telling you exactly that if you suffer from back pain. They have been telling doctors to send their back pain patients to evidence-based, patient-centered chiropractors for 4-5 years now. 

Now that we got that out of the way, let’s get back to the relationship between the chiropractic and the medical professions. Where do the majority of the practitioners in each field sit currently? To make more sense, it is helpful to break it down:

 

The Chiropractic Profession

There are really 3 main styles of chiropractors in practice these days. The style that most in the medical profession seem to have serious issues with, the vitalists, are estimated to make up only about 15% - 20% of the profession. 

The vitalists commonly recommend their patients take no pharmaceuticals and never vaccinate their children. They commonly hold onto beliefs put forth by the founder of the chiropractic profession in the late 1800s. Beliefs that spinal manipulative therapy (also called adjustments or alignments by vitalists) can cure disease, boost immunity, and prevent disease. Any disease at all really. 

They commonly do not interest the patient in exercise-rehabilitation and only use spinal manipulative therapy as their only treatment. They make very long-term plans for most of their patients, and most of them create a sense of dependency that keeps the patient coming back time and time again over the course of their lifetimes so they can continue, as the vitalist claims, to ward of disease after disease. 

It is easy to see how this may irritate those practitioners in the medical field. 

The other end of the chiropractic spectrum is populated by Evidence-based, patient-centered chiropractors. In the interest of full disclosure, this is the group I fall into. Chiropractors like me integrate and work well with medical practitioners. Many medical folks in my area are actually good friends of mine and they trust me to take good care of the patients they send to me and I have the same trust in them when I send a patient their way. 

I’m in no way against surgery for the right patient and as a last resort. But most of the time, spinal surgery should be preserved for those that have failed other attempts at conservative treatments. Treatments like spinal manipulative therapy, exercise, massage, acupuncture, and honestly….time. Sometimes things just take time to heal and in the absence of neurological disturbances like loss of muscle function or reflexes, surgery is usually not recommended. 

Evidence-based, patient-centered chiropractors see patients for short term schedules and try to teach them at-home exercise-rehabilitation and movement strategies for controlling their pain at home rather than depending on going to the chiropractor endlessly for a lifetime. Chiropractors in the evidence-based group steer clear of discussions about vaccines and understand very well that advising patients to take or to not take, medications is outside of their scope. Those are discussions better left to the patient and their medical physician. 

The third style of chiropractor is somewhere in the middle. I call them the chiropractic Agnostics. They try to keep an eye on some of the current research and guidelines that come out in the profession but are not ‘knee-deep’ in it. They feel that going to the chiropractor improves overall health but typically stop short of making many of the claims the vitalists in the profession would make. They are a mix you might say. 

 

The Medical Profession

I think most would agree that the medical profession falls into two categories. The conservative side and the pills, shot, surgery side. We have medical practitioners that do not stay current on research and guidelines as well. Even though research has been emerging showing the lack of effectiveness of lumbar fusion surgery and the lack of research backing the most common surgeries for musculoskeletal conditions, I promise you that there are folks right here in my town getting these surgeries right now, as I speak on this video. 

You can see how this might irritate most chiropractors. Certainly when we know how effective we are for most of the conditions surgeons are performing so many surgeries for. 

You have more modern, forward-thinking medical providers that understand and are aware of new recommendations and research. They are happy to throw away old, archaic dogma and look at referring to evidence-based, patient-centered chiropractors. Then you have those that keep on trucking down the old path and ignoring anything that might put a dent in their financial prosperity and financial future. 

A perfect example of a patient that got the wrong end of a surgical knife is one that went under for low back fusion surgery. Again, pain is not a reason for surgery, research is clear that few benefit from low back fusion, most have to be repeated, low back fusion has to be repeated many times, and only about 5% of the 56 million back pain sufferers actually, truly require surgery. 

So, I was already not a fan of what this patient was sharing with me but it got worse. He went on to tell me that the pain medicine from the low back fusion caused nausea. One day, not too long after the surgery, he got sick and was throwing up. He said he threw up with so much intensity that he felt a pop in his neck and started having neck pain from that point. 

The neck pain did not clear up so guess what? The surgeon went in and fused segments of the neck only a few weeks after the low back fusion. Understand that this patient probably should not have had to endure the first surgery and certainly was not given enough opportunity to recover and avoid the neck surgery. 

This was pure foolishness. Pure dangerous and life-threatening and life-altering foolishness on the part of a surgeon that should have known better. But he either was ignorant or didn’t care and I’m not sure which is worse. 

Another excellent study[10] showed that workers that injured their backs had a 42.7% chance of having surgery if they consulted with a surgeon first vs. having surgery only 1.5% of the times when they consulted a chiropractor first. It’s true that when all you have is a hammer, then everything looks like a nail. 

So, you see, my point is that there are two sides to each coin. The best way of treating patients in the current day with the best information and guidelines available to us based on the best research is a multimodal, integrated, team approach. That means the medical field and the chiropractic field working together.

When a treatment plan is built on a good foundation like this with effective team members in place like this, the winner is the patient and the loser is unnecessary pain, unnecessary surgery, and unnecessary suffering. 

______________________________________________________

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 (https://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] Learn 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.

 

Bibliography

1. Buchbinder R, Low back pain: a call for action. Lancet, 2018. 0(0).

2. Foster N, Prevention and treatment of low back pain: evidence, challenges, and promising directions. The Lancet, 2018. 0(0).

3. French S, Low back pain: a major global problem for which the chiropractic profession needs to take more care. Chiropr Man Therap, 2018. 26(28).

4. Hartvigsen J, What low back pain is and why we need to pay attention. The Lancet, 2018. 0(0).

5. Buchbinder R, U.M., Harvigsen J, Maher C,, The Lancet Series call to action to reduce low value care for low back pain: an update. Pain, 2020. 161: p. p 557-564.

6. The Joint Commission Online, 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, 2014.

7. Mutikani L. Opioid crisis cost U.S. economy $504 billion in 2015: White House. 2017; Available from: https://www.reuters.com/article/legal-us-usa-opioids-cost/opioid-crisis-cost-u-s-economy-504-billion-in-2015-white-house-idUSKBN1DL2Q0.

8. Qaseem A, Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain: A Clinical Practice Guideline From the American College of Physicians. Ann Intern Med, 2017. 4(166): p. 514-530.

9. Flynn D, Chronic Musculoskeletal Pain: Nonpharmacologic, Noninvasive Treatments. American Family Physician, 2020. 102(8): p. 465-477.

10. Keeney BJ, Early predictors of lumbar spine surgery after occupational back injury: results from a prospective study of workers in Washington State. Spine (Phila Pa 1976), 2013. May 15(38): p. 11.