Chiropractic Care: Is this too much?

I recently saw a deal on Groupon for 4 chiropractic appointments for £40. This included xrays and 3 adjustments. I was kind of hoping that this would be it and then everything would be all tickity boo. Now they want me to spend another £300 on a ‘discounted care package’ of 12 appointments to ensure a full recovery and that’s the concession rate cos I said I was broke.

I don’t doubt that I need more appointments because my back was all over the shop and I’ve not been looking after it. My back has bent sideways due to compensating from injury and worn disc in the lower back but luckily it’s only the first stage of degeneration and I should make a full recovery. Are there any docs out there that can put my mind at rest as I don’t want to spend too much. Thanks.

Go and see your GP and get referred to the NHS physio. Chiropracty is very often snake oil. The xray serves the same purpose as a beauticians white lab coat…

Didn’t Cochrane report say that chiropractic was a waste of time and/or money?

They helped my back out after my daughter was born, but once they have their claws in you they like to keep them in.

What do the physio’s do with your back? Do they do the adjustments like the chiropractor does because they’ve been working a treat?

I recently saw a deal on Groupon

ALARM ALARM ALARM

Group on is used by companies trying to break into a market or get rid of excess stuff. (It’s also used by people thinking there is a freebie to be had but they are the minority/target)

Of course they want you to come back it’s like the free car health check at KwikFit make a loss on one thing but find 10 things to charge for.

Seek medical advice first then find treatment from someone not trying a special intro offer.

Physios tend to dish out a damn good prodding / massage / shove things back into place. And give you an exercise sheet to do. The exercise sheet is probably the more important part if you ask me.

Yea well I didn’t go to them just because I saw a groupon deal I’m not that gullible. I’ve heard bad things about groupon too but they do some good stuff cheap. Do the NHS give you an xray and tell you exactly what’s wrong with your back? I know a few people who have been to this chiropractor and it’s worked wonders for them and so far it has for me as well and I didn’t realise how much discomfort I’d been in. But now the £300 doesn’t sound so wonderful. I’ll go and ask my GP what he thinks.

Yea well I didn’t go to them just because I saw a groupon deal I’m not that gullible.

Not saying that you are, you have suspected that something may be going on…

If there is something obvious wrong then you can probably see it, if there isn’t then it will take work.

See what the NHS will cover first

OK I’ve done a bit of reading about this now. It seems that chiropractors are more into doing the xrays and realigning the spine through ‘adjustments’ so that the nerves are healthy whereas physios are more into increasing blood flow and encouraging certain exercises to improve the situation. I suppose the chiropractic treatment has worked well for me so far because i’m out of alignment and have had a slightly trapped nerve. Hopefully the doc can give me some good advice on the way forward from here.

Giantjaunt.

To most people trained in traditional western medicine chiropractic is nonsense and possibly dangerous. Any company doing that sort of a sell would make me very dubious indeed.

Osteopathy is a different spinal manipulation technique that often is much subtler. Phyisotherapy is a different model again – more concerned with soft tissue – but one recognised by the western medics

I have had back manipulation from various folk over the years – the best IMO / IME spend a decent amount of time working on the soft tissues and any manipulations are subtle

Chiropractic = quackery. Sorry.

The whole thing is based on nonsense; I’m sure it works sometimes, either by fluke or by placebo effect, but generally they’re best avoided.

I’ve just healed you through the Internet.
£50 please…….

DrP

Typical, I read this after I booked an appointment yesterday…! Had a local place recommended by a few friends. My lower back has been giving me grief on and off for a few years, and often when riding making it hard to pull up or back on the bike.
I’ll give it a few weeks and see if I notice any difference, then try the GP again although I have been fobbed off with pills the last 2 or 3 times so wouldn’t expect a different response next time..!

My sports physio “cracks” my back a la chiropractor-style.

I’m always a bit dubious of the alignment chat if I’m honest. Backs move and hold all sorts of different lines. Injuries and bad posture can make them hold bad lines more of the time and these can become the “new normal posture,” but as i see it this is what they are correcting.

Chiropractors “crack them back into place”, but the way the physio explained it -he was releasing muscular tension so that with looser soft tissue my back is now more flexible. The exercises he’s given me are designed to maintain or improve this flexibility / muscle tone.

4 chiropractic appointments for £40. This included xrays and 3 adjustments

I’m just amazed these people are allowed to just dose somebody with radiation.

I’m just amazed these people are allowed to just dose somebody with radiation

Ditto.
The need for XRing a lumbar/lower spine (which is a whopper dose of radiation in comparison to, say, a chest XR) are few and far between.

Back pain is a big issue TBH – lots of time off work/lost money simply through lower back pain and injuries.

Think about how you’re (and I’m) sitting RIGHT NOW – if you’re slouching, STOP IT! Sit upright – really work those back muscles to get some strength back in them!

DrP

They aren’t supposed to xray without proper clinical need, I’m astonished at that group on offer. Surprised the gcc allow it, as an osteopath I would advise anyone to walk away from any practice that tries to sign you up for this type of course of treatment.

If you dissolved all the soft tissue off someone, would what would happen to their spine? It would fall to pieces all over the floor. A spine is the shape it is because of the muscles and ligaments holding it up.

So if someone pushes your vertebrae into a new position, the “adjustment” is gone by the time you reach the carpark.

Chiro is pure woo. Yes, some money is too much. See a physio. Warning: physios usually prescribe exercise. (That’s why people prefer chiro.)

From the Cochrane Library:

Spinal manipulative therapy = cracking backs.

“Spinal manipulative therapy (SMT) is an intervention that is widely practiced by a variety of health care professionals worldwide. The effectiveness of this form of therapy for the management of chronic low-back pain has come under dispute.

Low-back pain is a common and disabling disorder, which represents a great burden to the individual and society. It often results in reduced quality of life, time lost from work and substantial medical expense. In this review, chronic low-back pain is defined as low-back pain lasting longer than 12 weeks. For this review, we only included cases of low-back pain that were not caused by known underlying conditions, for example, infection, tumour, or fracture. We also included patients whose pain was predominantly in the lower back, but may also have radiated (spread) into the buttocks and legs.

SMT is known as a “hands-on” treatment of the spine, which includes both manipulation and mobilisation. In manual mobilisations, the therapist moves the patient’s spine within their range of motion. They use slow, passive movements, starting with a small range and gradually increasing to a larger range of motion. Manipulation is a passive technique where the therapist applies a specifically directed manual impulse, or thrust, to a joint, at or near the end of the passive (or physiological) range of motion. This is often accompanied by an audible ‘crack’.

In this updated review, we identified 26 randomised controlled trials (represented by 6070 participants) that assessed the effects of SMT in patients with chronic low-back pain. Treatment was delivered by a variety of practitioners, including chiropractors, manual therapists and osteopaths. Only nine trials were considered to have a low risk of bias. In other words, results in which we could put some confidence.

The results of this review demonstrate that SMT appears to be as effective as other common therapies prescribed for chronic low-back pain, such as, exercise therapy, standard medical care or physiotherapy. However, it is less clear how it compares to inert interventions or sham (placebo) treatment because there are only a few studies, typically with a high risk of bias, which investigated these factors. Approximately two-thirds of the studies had a high risk of bias, which means we cannot be completely confident with their results. Furthermore, no serious complications were observed with SMT.

In summary, SMT appears to be no better or worse than other existing therapies for patients with chronic low-back pain.”

Cracking joints is nothing more than a party trick. Go to your GP and get referred to a physio and save yourself some cash.

Ditto.
The need for XRing a lumbar/lower spine (which is a whopper dose of radiation in comparison to, say, a chest XR) are few and far between.

Which unit of radiation measurement is Whopper from…. still very low in the grand scheme of things

Every dose is potentially fatal – right?

http://imgs.xkcd.com/blag/radiation.png

I’ve seen a chiropractor and a physio at different times. There wasn’t a huge amount of difference between the treatments, both included massage, manipulation and exercises to take away.

Also the use of X rays can be a smidge misleading…. If we x rayed a large amount of the population over 40 a larger proportion than those experiencing back pain have degeneration. So why do only some of them report pain?

There is a lot more to back pain than simple mechanics. True in the short term muscle imbalance, acute nerve compressions etc can cause these problems (and in some instances especially herniations and compressions) can lead to severe and long term pain.

However, there are many incidences of long term (chronic) non specific low back pain (NSBP)where we aren’t sure of what is going on, and the original injury has cleared up (most acute back pain should clear up in 8-12 weeks). There is evidence for changes in the structure and function of the nervous system, central processing of pain signals and changes in hormonal responses to stimuli that may be involved. It is a very interesting but complex condition to treat as there are so many factors involved, not all of which are purely mechanical, so stretching / mobs / manips can get you so far for the majority of folk.

I would say if its bothering you, go to the GP, get referred on to someone in the NHS (it’s free) and see what they have to say. However, depending on their point of view, bias to treatment approach and your expectations of them (both in outcome and the type of intervention they provide) plus how well you get on with them may affect the outcome of rehab.

I went to a chiropracter, it was good but he wanted me to keep coming everyweek at £40 a go and I felt i was getting less and less attention each week.

Went to a physio who I explained all this to. He saw me once a month for three months and gave me loads of exercises to do at home, explained what the problems were and how I could recover best at home.

I prefer physios!

The chiropractor doing x-rays thing really scares me.

Years ago my wife had one done and the chiropractor came out afterwards with a very grave face and said I think you need to go to see your GP *now* because there’s a huge shadow on one of your lungs.

She gave my wife the x-ray to do a ‘show and tell’ with. GP basically said it’s not worth the film it’s printed on because of it’s provenance and referred her.

After 2 weeks of stress and worry a proper x-ray gave an all clear. Verdict was that the chiropractor was crap at doing x-rays.

Plus as above – relatively untrained people giving radiation doeses prior to quack treatment is a waste of time, money and potentially your healtf.

Just spent £40 a time for two placebo (?) sessions lasting about one hour. Must be lucky because they sorted me out!

OP – sounds like you are being taken for a ride though.

Snake oil or not, I was impressed that he focused on the exact spots where pain was sourced without me saying or indicating anything. I was a little sceptical and still am, but the slight re-alignment of various vertebrae (if that is what happened) has had some clear effects on the pain I WAS suffering.

This seems to be the way with chiropractors – trap you into a needless course of ‘treatment’. Some even use this pen type thing that gives a little shock rather than a manipulation – £35 for 5 minutes at the local one.

None of the osteopaths I have been to do this, if anything they estimate fewer sessions than are needed.

Plus if it is an osteopath that gives you a deep-tissue massage before any manipulation, then one session is generally all that is needed (unless you have had a mtb accident which leaves a distinct kink in your spine).

Isn’t the cracking just the release of nitrogen gas?

http://www.osteopathcheshire.co.uk/how_does_it_work.html

Mike:
“Typical Effective Radiation Dose from Diagnostic X Ray—Single Exposure
Exam Effective Dose
mSv (mrem)1
Chest (LAT) 0.04 (4)
Chest (AP) 0.02 (2)
Skull (AP) 0.03 (3)
Skull (Lat) 0.01 (1)
Pelvis (AP) 0.7 (70)
Thoracic Spine (AP) 0.4 (40)
Lumbar Spine (AP) 0.7 (70)“

In comparison to a chest XR (which also needs to be justified), an almost 20 times higher dose is needed.
Granted, in isolation it’s not a big dose, but (and I admit I’m not fully aware of the ‘policing’ involved in a chiropractors compared to the NHS) if a chiropractor ‘feels’ a patient needs lots of XRs, that can add up to a worrying amount of unnecessary radiation.

DrP

IME chiros tend to do one x ray for diagnosis.

Again IMO / IME the key thing is the skill of the practitioner and the diligence with which they work.

I have had practitioners do the best part of an hour of soft tissue work then a few gentle manipulations. I have also been hustled in and out in 10 mins with almost no soft tissue work.

Traditional western medicine is rubbish at treating chronic back pain. manipulation would appear to help in some cases

So if someone pushes your vertebrae into a new position, the “adjustment” is gone by the time you reach the carpark.

that is just not true.

They are not ‘pushing’ anything into an unnatural position, they are putting it back into the correct position after you have managed to get it out of position after some event, like a prolonged period of sitting badly at work.

Often your muscles have tightened up as well, meaning that any manipulation ‘undoes’ itself with time, which is why an osteopath or physio that does deep massage first to loosen these muscles up first is much more effective – and anybody that is any good will then prescribe posture changes and exercises to avoid the problem in the future.

I use one of these to keep my upper back in shape:

http://www.backstretcher.com/en/exercises/

which is a good and effective alternative if your problems are upper back.

I’ve seen a chiropractor and a physio at different times. There wasn’t a huge amount of difference between the treatments,

To be clear, there wasn’t a huge amount of perceived difference between the treatments. If I went to two doctors and one gave me medicine and the other gave me Ribena, I wouldn’t perceive much difference between the treatments. Doesn’t mean they’re the same.

Chiropractic is based on nonsense (google ‘vitalism’ if you want a giggle). The guy who invented it considered trying to establish it as a religion. Many modern chiropractors employ a mix of “straight” chiropractic and established actual medical practices (heat / cold treatments, physio etc), which might go a long way towards accounting for any sort of efficacy beyond placebo.

From my experience chiropractors treat your symptoms and a physio will treat your symptoms and the causes. Whilst a chiropractor will usually provide initial relief they don’t seem to address and remedy the cause of injury or pain.

TJ.

I would say there are appropriate western ways to treat acute NSLBP that appear to work reasonably well (there is still room for improvement). There isn’t really an appreciable difference in outcome if you use manips or exercise, however the evidence base is pretty ropey on both sides. Combining the two appears the most sensible approach and is common in osteo / physio.

The problems (in my opinion) behind using manips is that they provide a quick fix, and a lot of the time folk don’t bother with their ex’s as they feel better. However over the coming week (s) they stiffen up and want another bash of manips. This can foster dependence on the practitioner which is a seriously bad thing (for the person not the practitioner £££) and can have an effect on the likely long term outcome for getting long term reductions in pain.

Pain is an incredibly complex phenomenon that is way beyond simple stimulus level nociception, and is something that we still don’t understand at the moment. The reasons for why some people develop chronic pain are still largely unknown, and until we know that then treating it is not an easy thing, and i feel doesn’t solely involve traditional medication / manip / ex interventions.

marp – Member

TJ.

I would say there are appropriate western ways to treat acute NSLBP that appear to work reasonably well (there is still room for improvement). There isn’t really an appreciable difference in outcome if you use manips or exercise, however the evidence base is pretty ropey on both sides. Combining the two appears the most sensible approach and is common in osteo / physio.

fair enough

To chip in again – I actually went to see a chiropractor several years ago, for a low back injury (fell off bike in the ice!). Thought I’d see what it was all about.
The take home messages I got were:
-do lower back exercises
-that’ll be £37 please…
-come back and see me next week

I acknowledge that deep massage and therapy can be useful, and I’m not completely dismissing any ‘hands on approach’ to physical healing, but his ‘explanation’ of what was wrong with my spine was basically the definition of a dislocated spine.
As I walked in there, I didn’t have a dislocated spine….

I only went for a few sessions, then stopped, but I did continue the back exercises for a while. I’d say it was strengthening the lower back that helped in the longer run, not the “2 clicks” that cost me £18.50 a go….

DrP

Try an osteo next time DrP. Less fake science more hippy dippy 🙂 IME generally more effective / credible.

If I see any such details on groupon I think ‘why are they soo quiet to discount their professional services’?

I once went for an initial consultation with a Chiropractor and he detailed the service, it felt like a big sell. It ended up with him detailing upto a total of £1,000 and a ‘commitment’.

I walked there and then.

Turns out that some places really are like that. Others (like the one I trust) say ‘now we’d love to see you back, but if you need us – please do’ etc

Thanks for all the feedback everyone this has turned into a good discussion. While the chiro appointments have worked for me so far I certainly have my reservations. Although the chiro has talked about exercises to help my back he hasn’t actually given me any yet. Surely if he’s ‘adjusting’ my back it would be wise for me to be doing exercises to strengthen the back with it in it’s proper position and like others have said surley it’s not just all about the spine but the bits round about it too? So although I’m feeling a benefit I think he is certainly trying to string it out with these 10 minute appointments. I suspect I’ll only be told about the secret exercises if I commit to the ‘care package’ (£300).

I’ll be seeing my doc about it this week to see what he has to say. Apparently one of my neighbours does some kind of Ju Ju magic with backs so I could consider that as well.