Low back pain and the chiro (sorry, long post)

[Matt]

Hi all, I just wanted to give a short rendition of my story and a chiro I just started seeing and to get your feedback. I know most here have a dislike for chiros, or at least do not believe they are necessary, but I'd appreciate any advice that anyone has all the same.

Basically, I have had low back pain now and then for years. The first time was when I was 16. I played pretty high level tennis and one time I just did something to it on a shot and couldn't walk for a few days. Since then, somewhat off and on. As I got older I started weight training, and the incidences of pain became more frequent, with the lates injury being Tuesday of this week doing, of course, squats. (Not that I think squats cause injuries, but I am coming to realize that any safe movement can still cause issues if you are not in the proper shape to be doing it, i.e. lack of flexbility or weak abdominals which do not allow you to get into the proper position or stabilize...but I digress).

Before my appointment on Tuesday afternoon, I did alot of research online about low-back pain and basically came to the conclusion that alot of it had been caused over the years by (1) flexibility issues (2) strength issues in the abdominals, particularly transverse, pelvis stabilizing muscles and (3) my ridiculously flat feet and pronated ankles. Well I went to the chiropractor, really great guy, I am in NC and he works with the Duke, NC State and UNC athletic teams and he had some theories, took a quick couple of x-rays, and wow, not pretty. I may not be a doctor (lawyer actually) but I was pre-med and accepted to med school before changing my mind, so even though the MCAT days were a decade ago, I have some idea of what a spine should look like. And mine ain't it. I always knew I was not perfectly straight, but I pretty much have mild scoliosis looking curves all the way up and down, and some rougher, sharper ones in the lumbar region. But the more concerning x-ray was from the side, which showed that my L4-L5 and L5-S1 discs are quite narrow at the back and that my sacrum is titled WAY too far back. I knew I had that sort of butt and gut out shape, though I am in good shape so i don't have a "belly", but seeing the skeletal structure underneath was enlightening.

Anyway, bottom-line, his treatment plan is to do some adjustments the first few weeks, but mainly have me begin to do a variety of stretches for the hips, glutes and legs and exercises particularly for the lower abs to strengthen them so that they will start pulling the bones in the right directions and take the pressure off those discs, particularly the squeeze from the sacrum. He also thinks (and I did before i went in there) that I need to see someone about custom orthotics as my feet are, as I said, ridiculously flat. So far I have had two appointments, and he spent more time doing stretches than adjustments.

I've been to chiros before, never had a problem, though some were definitely better than others. Some focus more on just manipulating you, some on kinesiology type things and others, like this guy, on doing the manipulations, but focusing on letting my body fix the root of the problem.

So what do you guys think? I mean, I understand the aversion to chiros who want you in 3 times a week for 8 months to cure you, but I believe that adjustments do provide some benefits, even if they may be mostly pain relief. However, this guy, to me, is coming from the same angle as it seems Dean and most of you followers of RYB, which is that although various medical applications may have their benefits, in the end, the only thing that can fix all the bad things your body has done to your back is to start doing the good things and wait out however long it takes to pull those suckes back to some semblance of proper alignment. Perhaps he is coming fromt his angle because he does work with D-1 athletes, and adjusting them all them isn't going to cut it, they need rehab that will get them back on the field and hopefully prevent similar injuries.

Might have been a bit of a rambling post, but just wanted to get the whole story out there.

Thanks for listening...err...reading.

[Admin]

Hi Matt,

Thanks for telling us your story.

I assume you've read my articles on chiropractic and spinal manipulation, so there's no point in my going into it again. But let me ask you this; if chiropractors are able to bamboozle you or I, why is it such a stretch to understand that they can also bamboozle famous people?

Star athletes and corporate executives don't know any more about medicine than you or I do and aren't really "better than us." Hero worship should not play a part in making medical decisions.

Having said that, I'm glad your chiropractor is helping you rebuild your back. I wish more of them would wise-up and start doing the same.

Dean

[randolph]

Great post, Matt. What do I think? Three things come to mind.

First: the same principle you've described so well (that lack of flexibility and strength causes the problems associated with some exercises, like free-weight squats), appears to be behind the problems with some chiropractic manipulation. (My theory is) the doctor of chiropractic (DC) who hurt me did not understand this; during his 3 manipulations of my lower back, he forced my lower back beyond its flexibility limits and the strength of associated muscles ... and exacerbated my mild back pain into full-blown sciatica, just as any improperly done squat would do. Apparently, your DC understands that each body limits how far he can go with his manipulation, and he has experience enough to properly manipulate his patients without causing injury. My guess is, that with the great prevalence of "cookie-cutter" treatment plans that stripmall DCs slap on their customers, little effort is made to adjust their manipulations to the flexibility and strength limits of the customer. And thus, a problem with chiropractic.

Second, no spine is perfect ... and most don't need to be. Let's say your DC reports that you've got 3.5% lower lumbar scoliosis (I could have chosen at least a dozen different variations of spinal "imperfectness"). If you've got the money, you'll have prettier Xrays if you employ the DC to straighten out your back (which is a controversial notion in itself ... not going there) ... but is there really a problem with such minor scoliosis? The vast majority of us live satisfying lives, unaffected by such minor spinal variations. I suppose if you were a world-class tennis pro, such scoliosis would contribute to a muscle imbalance that could affect your serve and thus, your productivity ... but for most of us, there are more important bills to pay. My guess is that there are far too many DCs who are unethical enough to conveniently overlook the fact that the perfect spine they are sculpting for you is not necessary. Somehow, my GP seems to understand that all symptoms of variation from the mean do not need to be corrected. Of course, your flat-footedness may be a problem that really needs to be treated, but it would sure be nice if more DCs would approach abnormalities from cost/benefit considerations rather than "all abnormalities are bad" and thus need my care (and your money).

Third, a large part of the effectiveness of chiropractic treatment is placebo. It simply feels good to be touched, as they do, and to be talked to more than a GP would normally. So this comes down to another financial priority. If you've got the money (and time), and if you respond to the generally greater amount of touching and conversation available from a DC and his staff ... go for it. Whatever works. But some of us can't afford to spend our very limited medical dollars on feel-goods that are supposed to be actual medical treatment for conditions that need more than periodic placebo boosts.

Thanks again for the provocative post, Matt. What do you think?

Randolph

[Matt]

Thanks for the responses Dean and Randolph.

I agree with pretty much everything you have both said. And I don't want to give the wrong impression about this chiropractor and the straightening of my back, as he never said he would be able to do it and in fact told me he was not that concerned about the scoliosis. He said it was not pretty, but that what was of concern to him was the sacrum tilt and how it was putting so much pressure on that L5-S1 disk. I think any straightening of the scoliosis would just be an added benefit but not his or my goal.

To address your points Randolph, you are correct that this guy is very careful about adjustments and knowing at least my limits on flexibility. He adjusted that lumbar area both days and it was extremely gentle, just rocking it enough to get some movement. But I agree, some if not alot of chiros go way overboard and "force" adjustments that the body is not willing to accept, which is likely what happened to you. Having been involved with athletics most of my life and having seen a variety of medical personnel, this guy strikes me more like a physical therapist that also practices chiropractic.

To your second point, I think I answered that in the first paragraph. I think the main $$ I am going to have to spend is going to be for orthotics, and, interestingly enough this guy cautioned me to go elsewhere. He said they do them, but that I could most likely get them for less money by going somewhere else, he just suggests I do it soon.

And third, I agree, alot of chirpractic is placebo...but to me, that does not necessarily ditract from its usefulness. Many people think prayer is a placebo, but whatever its method, whether actual or psychological, there is no denying the apparent physiological gains that can be made. And if I gain some benefit from it, then I am not going to worry about whether it is placebo or really physically doing something. That being said, I am not going to spend my $$ on going in the number of times a week he is recommending. I will continue to see him, but much less often than he recommends as there is no need since I am already basically pain free, although now that I have gotten some feedback on my condition, I won't be running back to the gym to do squats! I've been stretching off and on all day watching football...going to be continuing this for the rest of my days it seems.

[Dean]

Matt,

Based on everything you've told us... including this statement:

"He adjusted that lumbar area both days and it was extremely gentle, just rocking it enough to get some movement."

It sounds like he's doing all the right things.

I would still want to go to a medical doctor for medical advice, but he sounds like a good physical therapist.

Keep us posted on your progress,
Dean

[Matt]

Dean,

I have thought about going to a medical doctor, but at this point, with the pain essentially gone, is there anything that an MD would be able to tell me that would be different and beneficial? I think we all agree that the problem is only going to stop once I have rebuilt those muscles and gained flexibility and strength in other areas, and I guess I am just reluctant to go to see a GP, as I am not sure that they will be able to tell me anything that I do not already know.

Appreciate the thoughts.

By the way Dean, I love these anti-bot questions. I have only ever seen the word verification, but this is good stuff.

Matt

[Dean]

Hey Matt,

No, I was speaking in general terms. I didn't mean to imply that you need to see a doctor.

As far as the anti-bot questions are concerned, they work great, but I think some of them are harder than they need to be. The nice thing is, if you register, you don't have to answer them anymore.

Dean

[randolph]

Help: what's an "anti-bot question"?

Thanks, Randolph

[Admin]

Hey Randolph,

He's referring to the anti-spambot questions that "guests" have to answer when they post to the forum. They are one of the ways I found to prevent machines from automatically posting spam in the forum.

Dean

[askthedoc]

Hi:
Just ran into this site yesterday. Seems like Chiro's aren't thought to much of. Well, I'm a Chiro and have been in practice for 42 years and I guess I can't blame you; however, not all of us practice with a cookie cutter program. People have to know what to look for. One of our problems is that we can't call ourselves specialists in any field. Look for Chiro's that have diplomat status and/or are affiliated with a Physiatrist. I agree with Dean that if you don't rehab your back you will never stabilize your spine. The body is a self correcting mechanism! These Doc's who want you to come to there clinic 2-3 times a week for 6 months are not doing you a favor - at best they will make you treatment dependent, that is only good for there bank account![/u]