Today I am going to tell you 5 reasons why you do not need a chiropractor to treat your back pain.
[video of explosion and war]
And if you give me a second to explain after you have heard that, I will also tell you why you
don’t need an orthopedic surgeon either. Stick around to the end to find out exactly what I
do think that you need to deal with your back pain. And trust me, it isn’t drugs or surgery.
If you type chiropractic into the search bar on YouTube, you will find a myriad of
chiropractors of all types on this platform. For whatever reason, chiropractic therapy is
very popular on YouTube and there are quite a number of famous chiropractors that do very well
with their content. Several of you have sent videos to me for review, and I have created
content that critiques the techniques that I have seen, or that discusses the relationship between
chiropractic therapy and orthopedic surgery. But that is all rather general in nature. Today,
I want to tell you why the average person does not need a chiropractor
or at least chiropractic manipulation, despite what they might tell you, to treat their back
pain. Now don’t get me wrong, I am not telling you NOT to go to a chiropractor. That’s your business.
But after listening to this video, I hope that if you go to a chiropractor for spinal manipulation,
you will understand that you were just as capable of addressing the back pain
on your own without manipulation, as you were when you went to have them crack you.
Having said that,
here are five reasons why you do not need to see a chiropractor to treat your back pain.
Chiropractic manipulation is a form of symptom management. In other words,
chiropractic manipulation treats the symptoms and not the pathology. It is
like taking a Tylenol or having a hot shower. It speaks to the manifestation of the problem,
the pain, but not the thing that caused the pain itself. This is why you feel
good after leaving the chiropractor, but then shortly afterward, your symptoms return…making
it necessary for you to return to the chiropractor for additional treatment. Had the pathology or
problem been addressed by the treatment in the first place, then repeat treatment would not be
necessary. Now I know that chiropractors will say that they are correcting “subluxations”
of the spinal column which lead to all sorts of problems. But the concept of spinal subluxations
as used by chiropractors is an outdated concept that has not been proven or confirmed by study.
And before you get all hot and bothered that I simply don’t know what I am talking about,
let me say this. Science is the tool that we use to confirm or deny that what we think is
true is actually true. If chiropractors think that “subluxations” are actually
a thing of consequence, the onus is on them to show that it is that with adequately designed,
peer reviewed study. They have not done this so far, and the medical community is still waiting.
Now, if you discount the idea of subluxations as a form of pathology, then what exactly are
the manipulations treating? The vast majority of back pain is what physicians call mechanical
back pain. This term refers to pain that does not have a structural or a neurologic cause.
This basically means your back isn’t broken or dislocated, or you don’t have a spinal tumor
or infection, or you don’t have a pinched spinal nerve, or a compressed spinal cord.
It refers to back pain that is associated with muscle spasm, muscle imbalance, muscle sprains,
or even segmental joint discomfort that is caused by degenerative disc disease, repetitive use,
poor posture, musculoskeletal injury, or general deconditioning. Put simply,
your muscles are too tight, too weak, too strained to appropriately stabilize your
spine at rest or when moving. Pain is the language that your body, and in particular,
these muscles use to communicate to you that they are tight, weak, or working outside of their
performance envelope when called upon to stabilize your spine. Chiropractic manipulation is like ear
plugs that don’t allow you to hear the painful message that your body is trying to communicate.
But without addressing the underlying problem that caused the pain, the message is still there loud
and clear, the moment you take away the ear plugs. That’s why they give you homework, or exercises,
to do at home in between sessions. That’s what really treats your problems.
Which leads me to reason number 2. Chiropractic manipulation is a passive
modality. A passive modality is a technique that is used by someone else, on you while you do
nothing other than receive the treatment. As mentioned before, the mechanical back pain
that you experience is not the problem itself, but rather the message your body uses to alert you to
some other problem. Your task is to acknowledge the message, decipher what it is telling you,
and then treat the underlying problem that is causing the symptoms you are experiencing.
If your muscles are too tight this means that you will stretch the affected areas over time
and develop more flexibility. If they are too weak it means that you will strengthen them over time,
and develop better ability for them to deal with the tasks that you impose. If they are
poorly balanced with their opposing muscle groups, you will develop your proprioception,
to allow you to improve your body mechanics and mobility. In each case, there is an underlying
problem that you, and only you must correct to eliminate the driver of the pain symptoms.
Chiropractic manipulation cannot do this. Chiropractic manipulation cannot
restore strength or flexibility. Nor can it restore proprioceptive function or mobility.
Only the affected individual can do that through hard work over an extended period of time.
If you have a hole in your roof and you simply paint over the water stains on the wall where
it was leaking, your wall might look pretty, but the next time it rains, guess what’s happening?
Chiropractic manipulation does not engage the patient to be actively involved in their cure,
and it does nothing to empower the patient to care for themselves.
Chiropractic manipulation is no better than physical therapy. That’s right,
you heard what i said. Chiropractic therapy when compared to physical therapy,
head to head, is not more effective. While small studies have shown that chiropractic therapy is
better than doing absolutely nothing, it is not better than doing conventional therapy,
despite what your chiropractor may tell you. This means that chiropractic manipulation is not
required for the resolution of mechanical back pain symptoms. Period. No study has shown this
to be true. So if it is not required, why do it? And why charge you for it? If you want to do it
because it feels nice like a massage, then so be it. But you should not be left with the impression
that it is actually doing something to your spine, or that it is in any way a necessary part of your
treatment. Cracking your back is like painting the wall in your living room while the roof is leaking
on your head. You can do it, but does it make any sense? Isn’t it more straightforward to
just to fix the roof, or just address the problem causing the pain directly? You are just as equally
served by going to a physical therapist to undergo a regimen of active, progressive
exercise therapy because that is really what you need. In fact, if you had the requisite knowledge,
you could skip the therapist altogether and treat the problem yourself. Any therapist, whether they
be a physical therapist or chiropractor, if they are treating you with an evidence-based practice,
or one that is based on the results of peer-reviewed study, should use exercise
as the foundation of their treatment of your back pain symptoms. Your treatment should be
almost entirely based on exercise, and it should be indistinguishable from a work out at the gym.
Cracks don’t make you stronger, more flexible, more resilient, or less prone to injury.
But neither do TENS, ultrasound, cupping, massage, or acupuncture. Only exercise can
do that. All the rest is window dressing. If your therapist, chiropractic or physical,
does not have you doing exercise for the duration of your session with them,
then you need to find yourself another therapist. Mechanical back pain, which includes the vast
majority of back pain that people present with, has a natural history of self-resolution within
4-6 weeks. This means that if you did nothing at all to treat that back pain, nothing at all,
for almost every person it would get better on its own within a month to a month and a half.
Doing nothing. So really the only reason to seek medical intervention of any kind
is to expedite the resolution of the symptoms, for which chiropractic manipulation offers no
advantage over conventional therapy. And arguably, when you look at the long term, chiropractic
manipulation is less advantageous, since as discussed above, it treats only the symptoms
and not the pathology, thereby leaving the patient just as tight, or just as weak, or just
as proprioceptively naive after treatment as they were prior to treatment. Which may be the point.
If you have only treated the pain and you haven’t eliminated the pain generator,
you have a situation where the pain is likely to return…and then you have to return to the
chiropractor for more treatment….because your symptoms came back. And on and on and on.
Now I am not saying that all chiropractors knowingly take advantage of this fact,
but you can see how it isn’t bad for their business no? Which leads me to another point.
Remember that the majority of cases of mechanical back pain get better by themselves in less than
6 weeks? This means that if you are receiving chiropractic manipulation for more than 6 weeks
and your symptoms don’t get better, your treatment is almost worse than you doing nothing. Yeah,
I can hear you saying, “told you, something is wrong with me. I knew it all along.” But, that
would be wrong. Studies still indicate that even then The natural history of back pain is still
quite favorable overall. While ⅓ to ⅔ of patients recover within one week, almost 90 percent recover
in six weeks, and 95 percent within 12 weeks. Relapse occurs in up to 40% so this speaks to
the importance of active, progressive, exercise therapy in the treatment of mechanical back pain.
You actively have to do something to yourself to make your back pain disappear for good.
And that doesn’t mean getting up and walking into the chiropractors office to get cracked.
As I mentioned above, subluxation in the manner in which chiropractors does not exist.
It is an outdated concept. The International Chiropractic Education Collaboration, comprised of
10 chiropractic programs outside of North America, has stated they will only teach subluxation in a
historical context. Vitalism, and the proposed vertebral subluxations that are believed to cause
most disease are the reason for which spinal manipulation was invented. The theory suggests
that slightly displaced vertebrae interfere with nerve vibrations, a supernatural, vital force,
thereby causing disease. Adjusting, or repositioning the vertebrae is believed
to remove the interference with the body’s innate ability to heal itself. But of course,
this ridiculous word salad has not been demonstrated in any study.
It is untestable. How convenient. After all, there are so many questions to answer here.
What is slightly displaced? How is displacement measured? What nerve vibrations are interfered
with? How much interference with these vibrations is sufficient to cause disease?
Does less interference cause less disease or a milder form of disease? Does more interference
cause more disease, or a worse form of disease? Have these nerve vibrations been demonstrated or
measured before? How are the vertebrae adjusted? How much vertebral adjustment is required to cure
disease? Does less adjustment cure less disease or only mild disease? Does more adjustment cure more
disease or worse disease? What particular innate healing ability are they talking about? Which
biological pathways do these healing abilities correspond with? There are so many questions
here that there are a bazillion opportunities for research studies to demonstrate the “truth”
of these concepts and to provide the answers we are waiting for. However, oddly there are not
any studies to provide this information so I think that it is safe to say that there is no evidence
to support these ideas. But if these ideas are the basis for the spinal manipulation technique,
doesn’t that mean that there is really no scientific basis for cracking your back? Snap!
Well isn’t that awkward. Let me assure you, that for the vast majority of people, there is nothing
wrong with your back even despite the back pain that you have transiently have, and you
do not need a chiropractor to crack your back to realign you or to put anything back into place.
That is complete and utter BS. You are normal, and intermittent back pain is
a normal part of life that does not have a serious cause in most of you.
So now that I have established that you don’t need a chiropractor to manipulate your back
to treat your back pain, let me tell you why you don’t need a surgeon to fix your back
pain either. Let me assure you that drugs or surgery are not generally required for
almost everyone watching this video to treat their mechanical back or neck pain symptoms.
Most cases of mechanical back pain are self-limited and don’t require surgery
since the cause of the pain is minor. 95% resolve within 3 months, and only 5%
are a result of more serious problems that require additional medical treatment.
Back pain is generally not an indication for surgery. As surgeons we primarily care about
leg pain, leg weakness, or loss of sensation or function in the lower extremities. These findings
tell us that nerves or the spinal cord have been compressed by bone, disc materials, tumors,
or something else higher in the back. Surgery can be used to decompress the squished structures and
stabilize the spine around the site of injury. Pain, on the other hand, is a nebulous idea.
Everyone experiences pain differently and the causes of back pain vary, so there is no single
procedure that can be done to stop back pain. Surgery is an invasive procedure that requires
us to cut into the body. It is associated with higher risk and more complications than
non-operative treatment, such as chiropractic therapy. It should be considered only AFTER
you have exhausted all other non-operative treatments such as activity modification,
medication, therapy (physical or chiropractic), massage, or bracing. If you haven’t attempted
these treatments first and failed, then we usually won’t consider you a surgical candidate. Surgery
is inherently risky and we want you to rule out less risky options before surgery is considered.
Because 95% of back pain is self-limited and caused by minor issues, usually only reassurance,
education, and active progressive exercise therapy are required to treat the majority of back and
neck pain problems. Basically, 19 out of every 20 back pain patients require only exercise.
Findings that are present on MRI often do not correlate with symptoms that patients complain of.
Many of the findings are also present on “normal” people who do not have back pain. Just because a
finding was present on an MRI does not mean that it is the cause of the patient’s pain,
nor does it mean that surgery is required to address that finding. Surgeons don’t treat
imaging findings. We treat loss of function that is caused by structural problems.
So if you don’t need chiropractic manipulation or surgery to treat your back pain,
then how do you do it? Generally, back pain can be effectively treated with a staged approach
geared toward the phases of the pain. Acutely, when the pain is most severe, patients can start
a gentle movement program such as the Mckenzie method to address initial muscle spasm and to
facilitate more active modalities. The McKenzie method has been shown to improve short term
outcomes for back pain. Subacutely, once pain has begun to subside and the patient is more mobile,
an active, progressive, exercise program that focuses on movement and flexibility of the spine,
and strength of the core, back, and lower extremities is utilized to restore baseline
function. After recovery, a similar exercise program can be used for maintenance to prevent
back pain from recurring again in the future. I will leave a link to exercises that you can use
to maintain your own back health and prevent back pain, in the description down below.
So that is why, for most people you don’t need a chiropractor or a surgeon
to treat your back pain. Thanks for watching and subscribing.
As always, that’s been a word from dr chris, not your everyday ortho.