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Cult? Unprofessional? Uneducated? Quackery? Philosophy? Subluxation? Ineffective? Unsafe? Addictive? Uncooperative? Cult? Unprofessional? A Doctor of Chiropractic (DC) specializes in physical medicine to treat those types of health problems which give you some of your worst case results - pain from non-pathological conditions. Uneducated? Chirpractic is the second largest primary health care profession in the western world. In the mid-1960s the profession began changing educational requirements to reflect the greater need for quality medical skills. In 1974 the U.S. Department of Education began accreditation for chiropractic education with minimal standards equivalent to a Doctor of Medicine's (MD) degree. DCs receive the same basic medical education as an MD does prior to his or her specialization (2 to 4 years pre-med plus 4 years medical training plus 1 year internship). Some state university systems are now teaching chiropractic education courses within their medical training system leading to DC degrees. Many private chiropractic interns are going on hospital rounds at local teaching hospitals. Specailty certification is available following from 1 to 4 years of extended study in the specialities of radiology, neurology, orthopedics, rehabilitation, sports medicine, and several others. Quackery? Several years ago, before the upgrade of chiropractic education, the AMA viewed chiropractic as a form of quackery and attempted to destroy it. Following a federal lawsuit in 1987, the AMA was found guilty of violating the Sherman Antitrust Laws by conspiring and attempting to destroy the chiropractic profession. Many of the examples of the AMAs accusations were found to be almost mythical and even conflicted with their own internal research findings. This is not an attempt to belittle nor cast dispersions on the AMA. It is only to point out that many of the untruths spread prior to 1987 are still abounding. Today, many MDs are pleasantly surprised at how it fits with what they do and the benefits to their patients. Philosophy? There are extremist in both professions. My basic philosophy is generally medical in nature. I approach patients from an understanding of anatomy and physiology. I work on the entire body - not just the spine. No responsible DC today claims to cure organic diseases through adjustments of the spine. Those conditions outside my expertise are referred to other specialists for the best benefit of the patient. If there is concurrent neuromusculosketal pain, chiropractic and physical medicine can help augment your treatment. Subluxation? A "subluxation" is a term many people disagree on. An adjustment or manipulation to fix a subluxation is just as misunderstood. Simply put, a subluxation is a joint that is stuck. It affects the normal movement of the joint, irritates the liagmentous tissues surrounding the joint, can cause the surrounding muscles to become hypertonic to help prevent painful movement and ultimately irritates the associated local nerves and reflexes close to that joint. Physical therapy to restore motion to the "stuck joint" is very important but best done when accompanied with manipulation of the joint itself. Only a DC with the 4 years of intensive training in adjusting techniques has sufficient training to do it safely and effectively. Ineffective? The U.S. Department of Health and Human Services recently completed a thorough and detailed analysis of care for acute low back pain in adults. Only 2 of the 23 doctors and specialists on the committee were DCs. Their conclusions were that bed rest, the use of NSAIDs, ice and manipulation were the only proven methods of care. However, bed rest should be limited to no more than 2 to 3 days. Other therapies including rehabilitation are more likely to give temporary relief or are more suited to long term care of chronic conditions. The number one injury in workers' compensation is non-surgical back pain. Wadell, Mooney and Burton, all prominent specialists in orthopedics have written in different research journals that mechanical (manual) therapy is the most rational and effective approach to most of these cases. Active manipulation coupled with rehabilitation is generally the best, most cost effective and quickest course of treatment. California, Utah, Florida, Oregon, Kansas, many other workers' compensation systems, U.S. government studies, and six formal international government studies have all reached the same conclusions - Chiropractic health care practiced by a modern DC is safe, effective, cost-effective and appropriate for those neuromusculoskeletal conditions generally treated by most DCs. Unsafe? The safety of manipulation is expressed in many research results. The specter of death or disability following manipulation of the spine, in particular the neck, is blown way out of proportion and was actually initiated by the AMA and brought out in their federal case. The actual incidence of such cases is less than .0002% or only 2 or 3 out of 1,000,000 treatments. One side light - does $3,179 sound like a reasonable annual premium for $1,000,000 malpractice insurance? The insurance companies know the real level of danger and reflect it in their low premium requirements for DCs. Addictive? Many people take vitamins and exercise to stay healthy and feel fit. When they stop they can tell the difference. That's the same with periodic chiropractic adjustments. People often feel better after they finish rehabilitative care than before they had their injury. For this reason many people choose to go periodically to a DC. It is by choice, not by prescription. Uncooperative? Today the AMA and the other health care organizations encourage cooperation between alternative health care professions. Just as in any particular profession there are bad apples, the same, also, holds true for DCs and MDs. The important issue is making sure you are comfortable referring your patients to a provider you know has the high level of expertise you would expect, generally agrees with the accepted model of health care you follow, and is effective in their treatment. Dr. Richman is such a provider. If you have comments regarding this column, please send them to Dr. Richman at comments@drrichman.org.
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MEDICAL
DOCTORS AND CHIROPRACTIC
