Chiropractics

Why do all the chiropractors I’ve been to and all the ones my clients go to still cross you over and hold down your shoulder while jumping on your leg to see how many cracks they can get in and effort to fix your alignment?

1. My understanding is that there are 2 camps of chiropractors: Traditional and Non-Traditional. The traditional chiropractor is of the belief that reducing subluxations in the spine can fix anything. Non-traditional chiropractors are still trained with that in mind, but they are not attached to manipulating the spine will cure cancer approach. Neither of these categories speaks to the ethical boundaries that we often see chiropractors cross, but without a doubt, physical therapists, physicians, strength coaches, and trainers also cross these boundaries. My opinion is that the traditional clinicians cross boundaries just as much as chiropractors, but because the general public typically think they understand what those clinicians are doing, so it is not thought of as an awful act when a PT charges for an hour of wasting your time, or a D1 strength coach programming crunches after crunches. All specialties are on the hook for not following contemporary trends or science.

2. In regards to manipulation techniques, these are not isolated to chiropractors. They are well taught and practiced by physical therapists and osteopathic physicians as well. Some very prominent physical therapy programs such as McKenzie’s, Maitland’s and Paris’ continuums both teach the same manipulations you see typically from chiros. Maitland would call it a Grade 5 mobilization.

3. The physical therapy literature also has a very solid set of articles that support the use of manipulation in the presence of back and neck back. A recent trend (5-7 years) in rehab literature is the development of clinical prediction rules (CPR). These rules are evidence-based programs that give the clinician a roadmap that if you see xyz, and you do B, you will get desired response. In fact, manipulation in flexion/rotation if performed with a certain presentation of acute low back pain will increase a valid outcome measure by at least 50%. Manipulation is very efficacious in some populations.

4. Something else to consider is that where much manual therapy has its genesis is in New Zealand and Australia. I am told that they are very few “chiropractors” or “physical therapists” in those countries. They are all collectively known as “physios,” and they do what you would expect a combination of the two to do with their patients.

5. Lastly, the notion of segmentally mobility should not be dismissed. I would trust that there are few members of this Website that speak louder against training outside of a neutral core. I have 3 slides in my Advanced Joint by Joint presentation that lists as many problems that can go wrong when you train mobility in the lumbar spine. It is wrong and unacceptable. However, by means of what many have heard me coin as the Core Pendulum Theory, it is also quite mandatory that lumbar vertebrae have the 12-15 degrees rotation and 30-40 degrees of flexion that is kin to the normal spine. If you don’t have that inherent mobility, there is a potential loss of proprioception needed to reflexively stabilize the spine. Now I am not suggesting these wackadoo clinicians are evaluating and correcting with this in mind; they probably aren’t. But mobilization of the spine to access segmental mobility is a very important link in ultimate performance in my opinion. Keep in mind manipulation is just 1 way to get it, and I am not of the belief that I need a battering ram to break through a locked door. There are other ways, but the original posts’ concern about adding spinal mobility is the topic at hand. It’s okay to get it, and great core training that 95% of the sportsrehabexerpt.com Website supports is how you keep it.

  • March 30, 2010

Leave a Reply 2 comments

Andy Malkin Reply

Awesome post here, you know, I never really given it much thought how critical it is to maintain in shape and raring to go. There’s no difference if it’s for events of troubling times and good health will help pull yourself and the other person through, or if it’s in common, everyday living when preparedness is essential for general health and wellbeing. I say, exercise, do core training, and you’ll be ready for anything. That’s for sure!

Michael Tancredi Reply

Hi Charlie,
I am updating my website and wanted to check your’s out to link to; then I ran across this, so couldn’t keep quiet. I see that my comments to you, when I was treating you in my office, held some weight. Since no one else was present; thought I would comment.

In all of my years of school; no one system convinced me they had all the answers, and could explain every compensatory change occurring in a single spinal segment, let alone an entire spine or human body. That is why I tend to base my treatment protocols on clinical results; and then turn to people like you (unfortuantely there aren’t very many) to rehabilitate (get stronger and more functional) my patients. I think the reason we all “try to see how many cracks we can get”; for one simple reason – it is clinically effective.

In chiropractic school they call that move a “million dollar roll”, because if you can do it effectively you’ll fix so many people, you’ll make a million dollars. I think I do it effectively (still waiting on the million dollar part – ha) and it does work, mainly because we restore facet mobility.

Very simply, facets are joints and joints are meant to move! If they don’t; a big (and painful) cycle sets up shop – directly behind a large nerve root and very close to a spinal cord! Any joint that doesn’t move, typically due to surrounding muscle spasm, becomes inflammed. That is why epiduals are frequently effective, the steroid injected removes inflammation.

Inflammation of a facet increases hydrostatic pressure on the adjacent nerve roots causing pain. When we are in pain, the surrounding muscles frequently go into spasm, thus the “cycle”. Spasm fixates facet joints, those joints inflame, the inflammation put pressure on the nerve, that causes more pain which your body recognizes as a problem and goes into more spasm.

I know you know that; it was just for your readers.

If anyone has a perfect system of analyzing the spine and associated compensatory changes when injured; I haven’t seen it yet. That is not to say we don’t have some very good research; or we should stop trying, but it is just most of it seems “to have some holes in it”.

I also think that some in my profession are so caught up with “improving their rep” and proving themselves; they sometimes rely on sketchy research, rather than to just say, “I don’t know”. They don’t realize that so much of what is done in standardized medicine, isn’t backed by great research either, but we know clinically it works so the physician uses his tools.

So chiro’s, like most of us who want to help our patients, “go with what works”.

Sometimes it seems, “the more I learn, the more I realize how little we really know”.

Hope you are doing well with your move down South!

Your Friend,

Mike

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