Into the Fray of the Chiropractic Debate

Whale Spine

A whale spine, as found in the Galapagos in 2008.

In the film Amazon Women on the Moon, there is a segment called, “BULLSHIT OR NOT?” (…or “Baloney or Not?” if you saw the film on broadcast TV). In the segment, Henry Silva asks, “Was Jack the Ripper in fact a sixty-foot sea serpent from Scotland? Did I take this job to make a quick buck? We may never know the answers to these questions.”

I sometimes feel like I’m in the dead center of a BULLSHIT OR NOT debate, albeit one with far fewer sea serpents. See, I’m a skeptic, which means I’m one of those people who advocates for good science and asking lots of questions and educating the general public. I’ve also been known to go to a chiropractor.

THE DEBATE

If those two statements made you go, “…uh, where’s the problem?” you’re probably not running within the skeptic or medical circles, so I’ll fill you in.

To the general public (at least, here in the USA), chiropractic medicine is seen as a fairly benign alternative medical treatment. It works off the idea that many medical ailments branch from misalignment of the skeleton, and that adjusting everything back into order will give relief without the administration of drugs or invasive techniques. Sounds pretty good in a holistic sense, right?

On the other side of the equation, we have the skeptics, who are pointing out that chiropractic medicine hasn’t really been shown to do anything in controlled scientific tests. Furthermore, crazier alternative therapies and other general quackery tends to run rampant in chiropractic offices. And beyond that, some chiropractic treatments can be actively harmful. The Skeptic’s Dictionary has a fairly thorough article about the arguments against chiropractic therapy.

A DISCLAIMER

Now, the story I’m about to launch into is a personal testimony. Personal testimonies are not science. I’m not advocating any sort of medical treatment here, except the type of medical treatment that is well-researched. More than anything, I’m writing things out so I can digest what’s in my head. I’m writing things out because I think it might be useful to peek into the grey areas of the debate.

THE STORY OF MY KNEES AND BACK

I spent many of my teen years walking with a cane.

I was a pretty healthy kid, except for the part where my knees were just plain rickety. I was a rather sedentary kid anyway, preferring books and computers over being outdoors, so having bad knees just further encouraged me toward non-moving pursuits. I especially dreaded stairs, because it was very painful to climb them. In fact, I remember paging through a magazine one day and having a mild jump of panic over a photo of a flight of stairs.

Oh, and my knees, even today, make genuinely horrible crunching noises when fully extended. If you need a good gross-out and see me at a party, ask me to straighten my knees for you.

Anyway, I never really pursued what was wrong with me with a doctor, because I just kind of figured that’s the way things were. One doctor did look at my knees and thought it might be “runner’s knee” (which is a laugh, because I couldn’t really run at all), and put me on a prescription of ibuprofen… at 3,000 mg per day. My stomach lining didn’t like that at all, and my knees never improved, so I soon stopped the medication.

Then, somewhere in my early 20s, my car got rear-ended with me inside, and I was gifted with a case of whiplash. From there, my back and neck went bad, too. I couldn’t turn my head in one direction at all, and turning my head in the other created more horrible crunching noises from my body. There was also, predictably, more pain.

THE TREATMENT

By this time in my life, my dad had remarried, and I gained an aunt who was a chiropractor. My stepmother suggested I talk to her to see if she could do anything about my myriad body problems.

It turned out that my new aunt was just plain a pretty nifty person, and we got along well as family and friends. Soon, I decided to give her practice a try, and I started visiting her office once a week for treatment of my neck. I started regaining motion, and the pain started to lessen. Eventually, she also started working with my knees as well, mostly by aligning my back and keeping pain at bay. (More on that statement later.)

After recovering from that accident, I’d wind up seeing her maybe once or twice per year, whenever I’d throw my back out by slipping on some ice or whatnot.

THE RESULT

Here’s the thing: my neck and back did get better. So did my knees.

In fact, by the time I was 23, I able to walk up the side of a mountain in Colorado. Soon after, I spent a month in the Arctic Circle, and I traveled 180 miles by hiking and kayaking. Last summer, I was walking about 4 miles per day, just as an afternoon break from my desk. Hell, I even work at a standing desk.

Today, my knees very occasionally give me a twinge, and they still make horrible noises, but I can fucking walk without a cane. If I believed in a god, I’d say it was a damned miracle.

WHY IT WORKED

Now, here’s the thing…

I know I wouldn’t be able to walk normally today if I hadn’t had my aunt’s help. What I don’t know is how much that help had anything to do with chiropractic medicine.

Looking back, I think my knee problems probably were a combination of injury and atrophy. I injured my knees at some early point (or they had some sort of minor cartilaginous defect, explaining the crunching noise), and the resulting minor pain caused me to simply avoid anything that would involve moving my knees. Thus, without exercise, the muscles would weaken, thus making it very easy to re-injure my knees, which would make me even more ginger. In other words, I was probably in a vicious cycle.

The neck problems, though, were definitely whiplash. X-rays taken of my neck showed soft tissue damage from the car accident.

So, what we essentially have here are two muscle-related problems. From a chiropractic standpoint, the theory is that, if the chiropractor can realign the bones properly, the muscles would unwind and the pain would go away. Well, I don’t think that’s quite what happened during my successful treatment.

(What are below are just my personal theories. I am not a doctor of any stripe.)

Theory #1: Perhaps relaxation does help. I think that we can all agree that tightened-up muscles hurt. When we’re stressed out or when we over-exert ourselves, the muscles tense up and it hurts. Chiropractic treatment is relaxing, kind of in the way a back massage is relaxing. Someone is pressing on all the hurting bits that you can’t reach, and you unwind a bit. The muscles unclench a bit, and the pain abates. Even if this effect is just temporary, having a reprieve from the pain means that your stress level goes down, which means your general relaxation level helps prevent the tenseness from stress from coming back. In terms of my knees, getting the pain to go away even temporarily meant that I could walk… meaning I could exercise those muscles… meaning those muscles could eventually support my knees and prevent future injury.

Theory #2: The Placebo Effect. The Placebo Effect is an amazing phenomenon. Just the fact that someone with medical training knew I was in pain and was helping me was pretty potent stuff. I can fully see a scenario where a simple attitude adjustment within me made me invested in getting better, and thus I improved. In any case, I’m fascinated by the Placebo Effect, in that even though the treatment itself is fake, it does have very real results. Hell, placebos even work when patients know they’re getting a fake treatment.

Theory #3: Perhaps there’s something to holistic treatment of muscular pain. I’m pretty sure aligning bones won’t cure most medical ailments, because why would it? I can, however, see where, say, a dislocated rib would cause muscular pain because it’s out-of-place. I can also see where muscular back pain could be caused by, say, a foot injury, where you alter your walking to favor one leg, causing the muscles on one side of your back to strain because they are compensating for balance. If my aunt got enough of my pain to go away so I could stand up straight and walk without hunching over a cane, my guess is that correcting my posture would prevent the pain from coming back in the future.

Theory #4: Time heals all wounds. It’s entirely possible that my whiplash injury, given enough time to heal, would have done so perfectly fine on its own. Same with my knees, even though they had given me problems for years. After all, I’d just crossed from my teenage years into adulthood, which meant that my body was probably adjusting to a new norm in all sorts of ways.

Theory #5: All of the above and other vague things.

Now, those theories are all about effects immediately after treatment. They do not address why I remained better after I stopped seeing my aunt every week. I have only one theory about that:

Exercise is awesome. Once I stopped hurting, I could move around, and boy, that was awesome. I did a lot of moving around. And you know what? Human bodies were meant to move around. Exercise meant muscle tone. Muscle tone meant my muscles could keep my bones in place, and I could stop injuring myself so easily. Muscle tone meant I could build flexibility.

A QUICK ASIDE ABOUT ACUPUNCTURE

I’ll admit, my aunt also had a couple of alternative treatments in her office aside from chiropractic medicine. It wasn’t nearly as strange as some of the weird quackery I hear coming out of that profession, but there were a couple. It seemed to me that she used them a couple of times, then stopped using them altogether in later years.

One that stuck around was acupuncture.

Now, my position on acupuncture is that it’s mostly useless as a medical treatment, but it’s not entirely without value. It has been shown clinically that acupuncture releases endorphins, and endorphins are awesome. I don’t for a second believe that a well-placed acupuncture needle can cure heart problems or warts or personality problems, but they do feel great. I’m serious. Some of the most relaxed I’ve ever been was while my back was full of acupuncture needles.

It’s possible this relaxing effect is partly due to both endorphins and the fact that having needles in my back forces me to sit still for ten minutes. But hey, if you’re in the business of getting people’s back pain to go away, I can see how acupuncture needles can be useful.

AND YET HERE’S THE THING

I mentioned in earlier that I occasionally visited my aunt after my knees and neck stopped misbehaving. One of the complaints about chiropractic medicine is that there is something that smells like a scam, in that people often have to keep visiting a chiropractor to maintain their treatment. In my case, meaning my specific relationship with my aunt, I don’t think that was really a factor. If the real treatment you get from a chiropractor is relaxation / Placebo Effect / etc., I can see why it might take a couple visits for treatment to take hold, but honestly, I’d only show up once or twice per year, almost always after a new injury that I’d inflicted upon my own clumsy self. There was one day she popped a dislocated rib back into place.

But there was this one time I didn’t go to see her.

Back in March 2011, I fell off my bike. I dislocated my right shoulder, bruised my hip, and did pretty horrible things to my back by falling on my side. I was in incredible pain for months. I couldn’t lift my arm above my shoulder until about three months later. I couldn’t even lift my camera. I couldn’t sit in a chair for more than 5-10 minutes at a time. It was bad.

My treatment that time involved TRIA (an excellent local medical center that specializes in sports medicine) and a physical therapist. One of the MRI scans I received at TRIA revealed that I had Level 1 spondylolisthesis on the L5 vertebra. In regular English, it means the vertebra immediately above my tailbone is actually shifted slightly out of the column. If any of you out there remember Finger Pops, imagine the L5 vertebra is the Finger Pop, and the vertebra above it and the tailbone below it are the fingers. The Level 1 designation means that the misalignment is very slight; the range of deformity is L1 to L5.

In my case, spondylolisthesis is a birth defect. In my case, it’s also externally visible. My lower back doesn’t curve like most people’s; it has a corner.

It’s been like that for as long as I can remember, though I never really thought much about it until TRIA identified it. The fact that I have it explains a lot of things. Hyperextending my back has always felt creepy to me, because I always thought my spine felt “slippery,” as if the bones would slide apart. It turns out that my lower back pain, which came and went through the years and which I assumed was the result of the usual damage I do to myself, was actually coming from that rogue vertebra. It wasn’t pressing on nerves or anything; it was just poorly attached to the tailbone, easily causing strains in the muscles around it.

My aunt did comment on the corner in my spine once, but never brought it up again. Isn’t that… odd? If you were working on someone’s back pain and you saw their spine didn’t really curve right, wouldn’t you investigate?

I’m not blaming my aunt for passing over this detail, mind you. I was 36 years old before any doctor of any stripe said, “Hey, that spine thing is actually a thing.” Everyone missed it until they took an MRI.

So if you’re looking for proof that chiropractic medicine can’t find and treat everything, including certain back problems, there’s your proof.

WHAT WORKED BETTER THAN CHIROPRACTIC TREATMENT

Well, I recovered from the bike accident. I recovered quite well, in fact. It took a long time and a lot of physical therapy, but I did it.

Recovery meant lifting tiny weights for maddening amounts of time. It meant slowly stretching my shoulder so it wouldn’t lock up. It meant carefully using my left arm to lift my right arm above my head, until my right arm could shakily do so by itself. It meant a couple very long afternoons, spent doing nothing except icing my back and watching movies.

But the biggest part of my recovery was this: I had to keep moving.

I learned from physical therapy that the worst thing you can do (most of the time) for an injured back is to lay around and do nothing. Bad backs stop spasming when you start moving. Bad backs stop going bad when you strengthen your core stomach muscles and low back muscles.

In other words, I had to do the same thing to my back that I did with my knees. I had to stop hurting and start exercising.

Since I now knew I had a birth defect that predisposed me to back injuries, I knew I had to change my life to accommodate it. Not exercising was not an option. Sitting for long hours of the day was not an option. I switched to standing desks at home and at work. I ramped up my exercise schedule. I stopped sleeping on my stomach, so my back wouldn’t hyperextend itself during the night.

And do you know what?

I haven’t had back problems since.

5 Thoughts on “Into the Fray of the Chiropractic Debate

  1. And you have just explained in different words why I am going to the gym and seeing a trainer right now. I went to the doctor sure that there was something wrong with my knees (regular pain, crunching noises, etc), and after taking x-rays and examining them, he told me that my knees were just fine — it was the muscles around them that were hopeless. I went to PT for a couple of months, which had some effect, but it only dealt with my knees. Now I’m doing weights, and liking it…which is a bizarre thing to think about.

  2. I have recurring problems with my jaw muscles tensing involuntarily, once to the point that my GP at the time had to inject an intramuscular relaxant to get me unknotted. I’ve found that anything that focuses my attention on what my body is actually doing – exercise, soto zen meditation, massage – can help calm the sensory-motor feedback that is causing the problem. So yes, probably theory #5 above, and your recent rehab & exercise regime is the answer. Any practice that improves the awareness of the kinesthetic sense and encourages good body dynamics helps reduce the potential for bad feedback loops.

  3. The concept of Chiropractic is semi-sound… the thing is, just adjusting the bones back to their “correct” point isn’t enough. (Thus all the follow ups.) Frequently you also have to retrain the muscles that they don’t have to cramp up anymore and hold the bones in the correct position again…so there should be an exercise component that is FREQUENTLY ignored by chiropractors. I’ll never forget the Chiro I had when I was younger who told me that once my spine was properly re-aligned (herniated discs) and that the muscles were retrained… I’d probably not have to see him more than once a year, if at all, as long as I kept doing the therapeutic exercises.

    Its being aware of the body as a whole system: correctly aligned bones, properly trained/cared for muscles, ability to relax to de-stress… and self-awareness when something is ‘off.’

  4. The best chiropractors are those who work to fix the problem, and don’t expect you to keep coming back forever. Melissa’s aunt is one of those. She explained to me last time I was there that the reason she does ultrasound and accupuncture before the adjustments is because once you’re loosened up and relaxed, the adjustments “take” better.

  5. BetsyL on February 14, 2013 at 20:36 said:

    I think the theory behind it is crap. But I also know that my hip is screwed up because I have bad knees, and that the first non narcotic thing that ever helped it was a tiny chiropractor leaping on it with all her body weight.

    The second thing that ever helped it was massage, so I’m with you on the relaxation part. But when my hip went CLICK and then didn’t hurt for months- there’s a fair amount of someone trying to blow sunshine up my ass that I will put up with for that.

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