Is this about me?
In my 25 years of practice, there is one phenomenon in the “politics” of health care that has never failed to baffle me. It is the bias of a family physician, therapist, or specialist that cautions the established chiropractic patient against spinal manipulation. As I pause for a moment, and reflect upon that notion, what would happen if I had advised a patient with painful cavities in their molars, against fillings? I think a patient’s response would be obvious. I consider this as I have faced this question of ethics several times in the last month or so. The first case is with a long standing patient who has had numerous structural problems over the years as well as a number of orthopedic surgeries: right shoulder, neck (cervical spine), and right knee (meniscus). Due to the most recent surgery (knee), the patient had been walking with a profound limp. Over a period of weeks, these altered gait had caused considerable back pain. She had been seen in my office occasionally for the pain. I had adjusted her as needed and recommended warm compresses of moist heat. I carefully warned her to moderate her activities, advise her orthopedist about her knee, and realize that she may deal with this issue until the limp abates. She followed my direction and informed her orthopedist of her condition, who in turn, advised her to stop chiropractic care until the pain subsides! In the state of Michigan, not only is this advice illegal, but is entirely unethical. Upon questioning the patient, I attempted to uncover why she was directed in this direction. I found that the orthopedist did not explain why he wanted her to rest, he did not give her a diagnosis or explanation of the problem, did not inquire as to her history of chiropractic care, did not recommend a treatment plan, nor offer any treatment other than a prescription of NSAIDs. The patient was confused when I explained that she needed the spine adjusted to maintain stability and wavered in this contradiction, despite years of dedicated and successful chiropractic care. So I raise the question , “Whom does this advice serve?” It is well understood that chiropractic exists in the shadow of modern medicine, but chiropractic is not attempting to compete. It is attempting to supply a niche where medicine is falling short. Failed spinal surgery syndrome patients make-up a sizable portion of my patient population. Many specialists give advice from conviction, but some from ignorance. No, not of their craft, but of c hiropractic. Most physicians today (at least those of my patients) support their patient’s chiropractic care and endorse its use. This is a progressive change in the overall mindset of allopathic physicians.
Most recently, (this last weekend), a middle-aged patient had exhibited moderate pain in the low back, abdominal pain, and pain in the low (right) pelvis. Due to varying circumstances, she went to a local hospital ER where she was examined: imaging studies of her abdomen, where they subsequently gave her a plethora of pain killers, muscle relaxers, and NSAIDs. They sent her home and instructed her to make an appointment with a neurologist. She came to my office with an imaging study report and a generic handout on Lumbar Radicular Pain that the hospital had given to her. I noted two things: The imaging study noted only a cyst on the liver (which did not correlate with the patient’s pain), and a diagnosis of lumbar radicular pain (a pinched nerve). Nowhere was the spinal level indicated, nor was there any correlation with her symptoms. There were no test results, nor imaging studies of the spine indicated. What was indicated near the end of the handout, was the statement: “spinal manipulation is not recommended. It can increase the degree of disc protrusion.” Not only was this an absurd statement, it bordered legal and ethical boundaries. Every study that I have read in my career (without exception) that considers the etiology of disc derangement, spinal manipulation was not only the treatment of choice (where surgery was not indicated), it had the best long term recovery of any option. Also, when patients seek spinal manipulation for non-disc issues, there are usually indications that such procedures should still be performed in their presence:
Lewit, K. Manipulative Therapy in Rehabilitation of the Motor System. 1985
“Many of the questions frequently asked can be answered easily: what about spondylosis, disc prolapse, scoliosis, juvenile osteochondrosis, spondylolisthesis, osteoporosis, or ankylosing spondylitis? The answer is straight forward: these conditions do not form the basis for manipulative therapy. Nevertheless, if in such conditions movement restriction (blockage) is found and considered harmful, then it should be treated with adequate manipulative techniques.”
In short, an adjustment (spinal manipulations) should be performed where ever it is warranted, and though studies may be manipulated to say whatever the researcher wants it to say, spinal manipulation is a safe, effective measure against disc herniation. We need to ask the question to ourselves as patients, and to our physicians as treaters: what is best for my health? Always be wary of a physician or establishment that discourages other options and opinions, and do not accept the written word merely because it is written.
Remember, this is indeed about you.