Today, I’d like to discuss something that has significant bearing on all chiropractic practices – the crack! The cracking noise associated with adjustments (or cavitation, as it is properly termed) is something that is  perceived as a required outcome for most patients. People regularly ask “Did that go?” or “Did that work?” if they don’t hear a cavitation following and adjustment.

A new study in JMPT found that an audible cavitation was not necessary in order to experience the benefits of the adjustment. The authors measured 2 different variables associated with pain relief, and found that the adjustment reduced pain equally regardless of whether there was an audible cavitation or not.

So, it is the actual mechanism of the adjustment, the high velocity low amplitude thrust, that results in pain relief. Whether or not it creates an audible cavitation means nothing.

Dr. Debbie Wright is a practicing Courtenay Chiropractor.

I am pleased to announce that I have joined the Comox Valley Community Way program. The details of this program can be found at www.communityway.ca.

In short, it is a form of community currency that can be used at various local merchants and services, but through the design of the program also helps out local charities and non-profits. If you live in the Comox Valley I encourage you to check out the program and to begin participating. Different businesses will offer various forms of community way payment, such as the ability to pay a percentage of the total in community dollars. I am offering my chiropractic and laser therapy services at 100% community dollars.

A list of local businesses that are participating can be found here.

Dr. Debbie Wright is a practicing Courtenay Chiropractor.

529 patients participated in the study. 56% of the participants reported an adverse event during the first 3 treatments, and only 13% graded it as “intense”. Muscle or joint pain events were the most common types reported, and none of the events were considered serious.

The researchers found that if someone reported an “intense” adverse event during any one of the first 3 visits, they were less likely to report recovery on the fourth visit. What is interesting about this is that they didn’t have significantly more neck pain or disability than those who didn’t experience an adverse event.

At a follow-up 3 months later, those who had “intense” adverse events experienced the same recovery and pain reduction as those who didn’t have any adverse events.

The bottom line here is that even if someone reports an adverse event or reaction after treatment, it did not negatively affect their outcomes or recovery at 3 months. Moreover, it was only those who had an “intense” adverse events that reported less recovery in the short term (13% of participants).

It is also important to note that out of 4,891 treatments, no serious adverse events occurred. This adds validity to the current view that “the benefits of chiropractic care for neck pain seem to outweigh the potential risks.”

Dr. Debbie Wright is a practicing Comox Valley Chiropractor.

Chiropractic is a safe and effective form of treatment for neuro-musculoskeletal complaints. Below is a 30-minute video produced by the BC Chiropractic Association detailing how chiropractic can help you. Whether its a workplace injury, motor vehicle accident or chronic headache, discover how your local chiropractor can get you back on the road to recovery.

Dr. Debbie Wright is a practicing Comox Valley Chiropractor.

Myth #4: Chiropractic treatment is dangerous.

A great synopsis of the risks associated with chiropractic treatment was recently published in the Journal of Manipulative and Physiological Therapeutics. While the full text article can be found at the bottom of this post, the summary is as follows:

This synopsis provides an overview of the benign and serious risks associated with chiropractic care for subjects with neck or low-back pain. Most adverse events associated with spinal manipulation are benign and self-limiting. The incidence of severe complications following chiropractic care and manipulation is extremely low. The best evidence suggests that chiropractic care is a useful therapy for subjects with neck or low-back pain for which the risks of serious adverse events should be considered negligible. (J Manipulative Physiol Ther 2008;31:461-464)

This synopsis references a previous study published in Spine which found that the risk of experiencing a stroke following a visit to a chiropractor was equal to the risk of experiencing a stroke following a visit to a family doctor. It led the authors to conclude that “The increased risks of VBA stroke associated with chiropractic and PCP (family doctor) visits is likely due to patients with headache and neck pain from VBA dissection seeking care before their stroke. We found no evidence of excess risk of VBA stroke associated chiropractic care compared to primary care.” So, people who are already having a stroke will experience neck pain and headaches, and will logically go and see either their chiropractor or their family doctor. It is not the treatment of either of these practitioners that causes the stroke to happen.

In summary, there are risks of adverse events with chiropractic treatment. These risks are small and self-limiting, and the risks of severe complications are very small. When compared to other common treatments such as taking medication or surgery, chiropractic is a very safe form of treatment for neck and low back pain.

Synopsis of Chiropractic Safety

Dr. Debbie Wright is a practicing Comox Valley Chiropractor.

Myth #3: There is no evidence to support that chiropractic works.

I don’t even know where to start with this one. The fact is that there is are so many studies done on spinal manipulation that a Medline search would be overwhelming. Instead of going through the many systematic reviews and meta-analyses that exist, I think the evidence is well summed up by an review exploring international low back pain guidelines. The review can be accessed here.

Over the last 10 years, 12 countries have done critical reviews of the scientific literature concerning low back pain. The international consensus is that the balance of the evidence shows that chiropractic spinal manipulation is effective in managing low back pain, and therefore is included in the recommendations. Here is a summary of their findings:

Clinical practice guidelines for the treatment of acute lower back pain

• Reassurance of the favourable natural history
• Advice to stay active
• Discourage bed rest
• Acetaminophen, p.r.n.
• Chiropractic spinal manipulative therapy
• Advice against passive physiotherapy modalities, prolonged bed rest or specific back exercises.

Essentially the investigators found that following these treatment guidelines (including chiropractic spinal manipulation) led to better outcomes than usual medical care. It is important to note that the guidelines don’t recommend chiropractic as a stand alone treatment, but as one component of a continuum of care.

One of the authors of the study then went on to launch the 2-part C.H.I.R.O study (Chiropractic Hospital-Based Interventions Research Outcome study). The first part pitted chiropractic care (along with the above guideline recommendations) versus usual medical care. The people who received chiropractic care showed better functional and quality of life improvements. The results of this study have been presented at Canadian Spine Society Meeting, the International Society for the Study of the Lumbar Spine, and the North American Spine Society and will be published in an upcoming edition of Spine. A summary of the results can be found here.

In the opinion of this Comox Valley Chiropractor, we are so far past establishing that there is evidence supporting chiropractic care. We are now heading in the direction of trying to establish how to best use this tool in the management of patients, or whether certain subsets of patients will respond more favourably. In the past 5 years, Chiropractic Research Chairs have been established at many universities across Canada in order to further chiropractic research.

Dr. Debbie Wright is a practicing Comox Valley Chiropractor.

Myth # 2: Chiropractors aren’t doctors, they have very little education compared to medical doctors.

This is a continuation of my post on the top 4 myths about chiropractic. Before I address the educational qualification of chiropractors, how about a refresher on what makes someone a doctor. In British Columbia, Chiropractic is regulated by our College under the Chiropractic Act.  The Act provides us this designation due to our right to diagnose. This means that we are able to determine a specific cause for a group of signs and symptoms with respect to spine and spine-related disorders. We have enough education and training to be able to come to a diagnosis, and more importantly, to determine when a condition is outside our scope of practice.

As stated by Canadian Memorial Chiropractic College (where I attended), “The chiropractic curriculum encompasses a diverse range of knowledge including anatomy, pathology, biomechanics, chiropractic principles, diagnosis, and adjustive techniques.” The 4-year program focuses on diagnosis and treatment of musculo-skeletal injuries, and includes 4232 hours of instruction in subjects such as Neurodiagnosis in Chiropractic Practice, Differential Diagnosis, Systems Pathology, Clinical Biomechanics and Radiographic Interpretation. The requirements for admission into an accredited chiropractic program include minimum 3 years undergraduate study (as with medicine) but most students have  completed an undergraduate degree. That works out to 8 years of post-secondary education.

Interestingly enough, a 2001 article in the Journal of Bone and Joint Surgery analyzed the curriculum of Canadian medical schools and discovered that on average only 2.26% of class time was devoted to musculo-skeletal injuries. This is surprising considering that in BC, one third of all visits to MDs are for spine and spine related conditions. The article concluded that “There is a marked discrepancy between the musculoskeletal knowledge and skill requirements of a primary care physician and the time devoted to musculoskeletal education in Canadian medical schools.”

So it begs the question – if you have a problem with your back, what kind of doctor do you want to see? In my opinion, the information above speaks for itself.

Day in and day out in my Comox Valley Chiropractic practice, I encounter new patients who confess that they didn’t try a chiropractor sooner due to hearing negative (and misleading) information. I spend a lot of my time explaining the true situations behind they myths they’ve heard. Over the next few weeks, I’ll expand upon my favourite 4 myths that I hear again and again. They are as follows:

Chiropractic is addictive – once you go, you have to keep going back for the rest of your life.

Chiropractors aren’t doctors, they have very little education compared to medical doctors.

There is no evidence to show that chiropractic works.

Chiropractic treatment is dangerous.

I will start with myth #1 – once you go to a chiropractor, you have to go over and over again, and keep going for the rest of your life. This one amuses me for many reasons, not the least is which its a perfect example of why people seem to measure chiropractic with a completely different yardstick than any other health profession.

I like to compare chiropractic to dentistry. Most of us are born with a beautiful and healthy mouth of teeth. Over our lifespan, we are encouraged to go to the dentist twice a year for check-ups, cleanings and the occasional cavity filling. If we are diligent with our prevention, hopefully we will never have to have a tooth pulled or a root canal performed.

Similarly, you are also born with a beautiful and healthy spine. Over our lifetime, our spine will also undergo stress and strain due to our relative inactivity, prolonged sitting and excessive amount of computer work (similar to too much candy and soda for the teeth). Just because you can’t see your spine every day in the mirror, doesn’t mean that stress doesn’t accumulate – just ask someone with bone spurs. Seeing a chiropractor for prevention, or treatment of small episodes of back pain, will help to avoid those major episodes which can lead to more invasive treatment such as surgery.

So, are you addicted to your dentist? What would happen if you didn’t go? You’d either have a horrible set of teeth, or you would be forced to go for major work when the pain became too unbearable. Also, more research is starting to surface between a healthy mouth and a decreased risk of heart disease.

What would happen if you didn’t go to a chiropractor? Your episodes of back pain would probably still resolve, albeit much slower and with more of an effect on your life. Its possible that the simple back strain you didn’t address would just keep coming back over and over, until it ended up becoming a chronic condition.

People don’t become addicted to chiropractic. They simply discover a simple and effective treatment to get rid of their aches and pains quickly, so that they don’t become major events. That being said, in my opinion a good chiropractor will also be providing home stretching and strengthening exercises that will help the patient to maintain as much self-sufficiency as possible. So why do we completely accept regular visits to the dentist, but scream bloody murder when a chiropractor suggests preventative care?

In my next post, I’ll discuss what is considered a normal treatment plan in my office and what I think is reasonable for preventative care. “How long until I get better?” is the most common question I have to answer in my office.