Monday, June 22, 2009

Chiropractors or Orthopedists?

I pose the question: “If one has back pain should they seek a consult with a chiropractic doctor or an orthopedic surgeon?” In other words, which doctor should be the initial primary care physician?chiropractors or orthopedists

80 % of adults suffer from back pain, so I must assume that this is a concern pondered by many. As a chiropractic physician, my thoughts maybe somewhat biased, however my intention with this article is to present helpful insight for those who wish to make smart decisions about their back care.

I am not anti-medical and have often referred patients to medical doctors or orthopedists (aka: orthopods) when I deemed it in the patient’s best interest. As a matter of fact, I was one of a handful of chiropractors that pioneered hospital privileges for the purpose of chiropractic spinal manipulation under anesthesia. Thus, I worked successfully with and helped educate members of the medical profession on the benefits of chiropractic.

Quality, Competency and Humility of Physicians

To answer the question regarding chiropractor vs. orthopedist, I will begin my answer by saying it really depends on the doctor and his or her willingness to be open-minded about what is in the best interest of the patient(s). I believe either type of doctor could be an excellent primary care physician for the diagnosis of back pain. Doctors in general need to be aware of their limitations and realize they are not the end-all panacea for all types of conditions. As long as they have humility, and they are known to be competent diagnosticians, their patient(s) should be in good hands. One tenant of the health care profession is to “do no harm” and there is much value in this simple phrase.

Practitioners of either profession are trained to utilize a familiar treatment protocol. In other words, orthopedic surgeons often do surgery and chiropractors like to physically manipulate the spine. There is however no guarantee that a patient’s condition warrants either one of those treatments. Sometimes, the necessary treatment is as simple as applying ice and electrical muscle stimulation to a mild strain of the back. The prudent physician offers both a kind listening ear and competency as a diagnostician. Only with a complete history and thorough examination will a physician be in a position to make an accurate assessment, thus suggesting the next step in the doctor’s decision process -- “Do I treat, or do I refer?”

The Doctor Making a Diagnosis is NOT Always the Best Treating Physician

I’ve heard it said: “What’s you’re not up on, you’re down on.”

I believe it is important for a physician of any type to have knowledge of alternative treatments that are beyond the scope of their own practice. Given this knowledge and an open-mind, prudent recommendations are likely to be forthcoming.

Matching Your Back Condition with the Appropriate Doctor

The majority of back pain cases do not require surgical intervention and they are often best handled by a chiropractor. However, it is good for back pain sufferers to know what cases are predominantly amenable to chiropractic care, as well as those that often require the care of an orthopedic surgeon or perhaps a neurosurgeon. The following chart should be helpful.

Condition/Symptoms

Chiropractor

Orthopedist

Neurosurgeon

back strain/spasm

X



back sprain (1 or 2 grade)

X



back sprain (grade 3)


X


pinched nerve (with foot drop or drag)


X

X

pinched nerve (with just numbness or pain)

X



herniated disk (with pain or numbness as low as knee)

X

X


ruptured disk (pain extends below the knee; weakness)


X

X

fracture of vertebrae


X


bony tumor


X


neurological or soft tissue tumor



X

pulled muscles

X



scoliosis

X

X


auto injury

X

X


arthritis or degenerative disk

X

X


sacro-iliac

X



lumbar facet syndrome

X



infection or hot puffy swelling with or w/o fever


X


spinal cord injuries



X

back pain with loss of bowel or bladder function



X

12 comments :

  1. Really appreciable blog. Your blog is very much impressive. I am surely following ur blog.

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  2. Chiropractic treatment is one of the best methods for treating numerous health problems naturally. After years of experience being a chiropractor, I have found that it is a powerful way to solve many pain conditions, like headaches, neck pain and back pain, as well as many non-pain condition as well, such as fatigue, sleep problems, and sinus problems.
    chiropractic conway

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  3. Despite the attempt at impartiality, I'm surprised by several things:
    (1) Why weren't D.O.'s (Doctors of Osteopathy) also known as Osteopaths, mentioned? Perhaps because they're strong competitors? They have nearly the medical training of M.D.s and the chiropractic training of D.C. (Doctors of Chiropractic.)
    (2) Sometimes a good professional Massage Therapist can take care of minor back problems. They're certainly less expensive than multiple visits and x-rays with a D.C.? No mention of them, but then, I understand: they're not medical personnel (and they're inexpensive treatment for minor back problems!)
    (3) The other concern that I have in that in my two limited (I admit) experiences with DCs, I was encouraged in both cases to sign on for long-term treatment regimes ("I recommend that you take 10 treatments, else one day you might step off a curb... ." etc.) Then there are those who push vitamins and other "health supplements" which really is not an area of their expertise -- both of these instances appear to be just ways to generate income (as are the multiple x-rays that some elderly friends have told me they experienced: I'm worried because of costs to them as well as the dangers of excessive amounts of x-rays.
    (4) I'm concerned about the quality of the students, compared to medical students. I know how difficult it is to get into medical school from my friends who tried. Three of my classmates (two high school/1 college) later became "doctors (D.C.)" I was stunned knowing what poor students they were and not particularly academically-minded (at least when I knew them.) Yet all three are now D.C.'s. I realize three does not make it "all."
    (5) My last concern is the theory behind chiropractic. I'll stand corrected, but my understanding is that it was developed by a Dr. Palmer(?) over 100 yrs ago...and much has passed in the anals of medicine since then. Yet, my understanding is that it still is the backbone of what is taught at chiropractic school (and don't use Hippocrates as a comparsion: regular M.D.s don't use that as the medical basis of what they do today!)
    I know you all provide a service, one that I've used myself on occasion (cause it was free from my health provider) -- and I'm willing to stand corrected on any of these issues. I do know that you provide a valuable service, esp. in some cases where some M.D.s have pushed surgery too soon. So, yes, there is def room for your services, but I think it's important to realize that D.C.s, like all of us, have limitations, and I respect anyone, M.D. or D.C., who understands what those are and doesn't try to provide treatment beyond their actual capability or practice intended. Overall, I think it's important that whether one uses a M.D., a D.C., or a D.O, that you ask around, including your primary care physician (they might know of the good DCs and steer you away from the questionnable ones), check the Better Business Bureau, Google the person's name, and just do some checking. And for that matter, that includes M.D.s and any service provider.

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  4. Howard, sorry I didn't post your comment nor respond to you sooner. For some reason, I never got notification of your post and found it in my comments needing moderation. You have several valid points and some that you seem somewhat mis-informed about. Certainly, Osteopaths and massage therapists are very viable choices and I was not trying to exclude them by not writing about them. More importantly, most patients with back complaints are trying to decide between orthopedic practitioners and chiropractors. I simply wanted to address the discussion about the usual confusion and controversy regarding these two professions.

    Regarding long term treatment programs advocated by chiropractors, that is simply the nature of the care. Chiropractors are not generally interested in providing emergency or 911 healthcare. The nature of the science and philosophy of chiropractic care is to treat the whole patient and deal with the cause rather than simply address the symptoms. Most non-traumatic cases of back pain are rooted in a long-term, progressive condition that perhaps had no symptoms until recently and brought the patient to seek care. Fixing such under short-term treatment protocol might be likened to knocking crooked teeth into place, rather than putting braces on and making adjustments over a 2 year period. It is that simple. The body could not tolerate such and if a chiro simply treated the patient until the pain subsided, he or she would be negligent. After all, the pain was the last thing to show up and hence will be the first thing to subside under treatment.

    That being said, there are good and bad docs in every branch of healthcare. Some over utilize this concept and some might take too many X rays. The medical profession is sometimes guilty of over-utilization of expensive and dangerous diagnostic testing as a way of covering themselves against a lawsuit, rather than really being in best interest of the patient. X-rays, although much more subtle than CT scans and invasive testing procedures can be over-utilized as well. On the other hand, asking a chiropractor to treat you without one, would be like asking your mechanic to fix your car w/o looking under the hood.

    Now, related to training of MDs vs. DCs you are only correct about the difficulty about getting admitted to med school vs. chiropractic college. There is definitely a lot more students trying to get into med school, hence the requirements are more competitive. However, you are way off base on the quality and/or difficulty of the course work. The actual course hours taken by DCs are more than those by MDs. They take almost all take the same courses that MDs take, but in addition have to take chiropractic art and science courses. In my experience it is not the best academic performers that make the best doctors. Those that struggle through school, work at the same time yet make it in spite of such usually turn out to be the better docs. The perseverance and perhaps people pleasing personalities make them better at dispensing healthcare.

    Regarding chiropractic theory, Palmer methods are still valid and taught in all chiropractic colleges. However, they are only a miniscule portion of what is taught. The course work, just like in medicine is updated every year according the current scientific findings. Additionally, other than perhaps, Naturopathic physicians, there is no health care provider as knowledgable about, nutrition, vitamins and supplements as the chiropractors. Chiropractic colleges provide many more hours in education for such than medical schools. I hope this info is enlightening.

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  5. Most cases of back pain can be effectively treated by a chiropractor. Chiropractors have been shown to be most effective at treating acute back pain.

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  6. Well, I must add that osteopathic physicians, while taught manipulation during their medical training, they will admit that their training is not enough for confidence in practice, unless they do a post graduate residency on OMT. In contrast, Chiropractic students graduate with already acquired skills in manipulative treatment and physical rehabilitation due to the heavy concentration of the matter during their clinical training. When it comes to nutrition, it depends on the school where the DC attended. All DC schools however, have more requirement in clinical nutrition than allopathic medical schools. Not to be compared with the training of a registered dietitian, which is more in contrast of a DC with a specialty in Chiropractic Nutrition or a part of the counsel of diagnostics and management of internal disorders DABCI.

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  7. I have been looking the World Wide Web for this information article Chiropractor Joondalupand I want to thank you for this post. It’s not easy to find such perfectly written information on this topic. Great Work!

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  8. Thank you for sharing. At what age would you suggest a “healthy” person see a chiropractor? I think its time I visit the chiropractor in Peabody, MA and create habits that support my overall health.

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    Replies
    1. I guess my best answer for this would be two part
      (1) chiropractic can be appropriate at any age, from birth to elderly. Young folks may need it when experiencing various falls or injuries, due to genetic issues like inherited spinal conditions or even with injuries/misalignments resulting from a difficult child birth.
      (2) However, in general, I believe it becomes more imperative around the age of 23-25. This is because of a normal degeneration of the blood vessels that supply nutrition to the spinal discs at about that age. From that point on, normal bio-mechanical movement becomes the only way that the cartilage cells of our spinal discs are supplied with supportive nutrients. Hence, many back problems begin from that age forward. A regular schedule of chiropractic spinal manipulation and a good exercise program to maintain flexibility are smart due diligence for maintaining the ultimate in spinal health.

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  9. Yes chiropractic care is more effective than other type of treatments to reduce body pain and prevent injury. Great article! I appreciate you for the info.

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  10. This is a very interesting article. I would have never thought to match up my injury with the appropriate doctor because I didn't know there were differences. I have had problems with the inside of my knee, the lower left part of my back and the bottom of my neck. What kind of a doctor should I see? http://www.centerforsports.com

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    Replies
    1. Bobby, for your particular set of symptoms that seem to span from bottom to top I would certainly recommend that you start with a well recommended chiropractic physician. In general, they are the best at correlating multiple orthopedic symptoms in different parts of the spine and foundation of such (including the knees). More often than not, there is a relationship. You can always see an orthopedic surgeon after such if the conservative chiropractic care doesn't achieve favorable results.

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