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Dynamic Chiropractic – July 29, 2012, Vol. 30, Issue 16
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dynamicchiropractic.com >> Back Pain

Chiropractic and Surgery: Separate, But Not Divided

By Brian Capaldi, DC

Is there ancient wisdom that can be applied to modern problems? I believe so. I also believe in yin and yang, or the union of opposites. Polarities are a good example of this concept.

People generally think of hot and cold temperatures in terms of opposites. But in actuality, cold is the absence of heat, not the opposite of it. These polarities, like many things in life, are distinguishable from one another, but never separate. They exist exclusively in relation to each other.

Now, what if we applied that same sort of thinking to our practice and the health care world around us? What if we engaged, as providers, in optimizing patients' health instead of treating our specialties as separate and divided entities? What if we realized that we too exist in relation to each other? As a chiropractic physician, I have unique insight into these medical dualities. I understand the delicate and somewhat complex relationships between chiropractors and physicians, and chiropractors and surgeons. But much to the pleasure of any good holistic management teacher, I refuse to be a stakeholder on either side of the debate. I choose to recognize the benefits that can be obtained when MDs, DOs and DCs work together, both for their patients and for their practices.

In both surgical and chiropractic capacities, there's a certain percentage of patients who will always have less than ideal outcomes with the treatments offered. But that's the onerous, yet realistic aspect of medicine as a whole. There's an implicit level of humanity that exists invariably, and not all patients will find improvement 100 percent of the time. If we can embrace this as truth and move past our differences to a state of multidisciplinary thinking, we can all benefit from integrated health care and grow others' appreciation for our expertise.

The way I see it, if patients are willing to explore surgery as viable option to relieve their pain in between chiropractic care, why can't we? That's not to say patients should always see all specialists available. We know chiropractic care is the first choice for patients experiencing neck and back pain; we also know surgery is inevitable on occasion, and that in such cases, having chiropractic intervention pre- and post-operatively is the ideal route.

A good surgery center has an understanding of this order of treatment and of assessing patients. It can determine who is a candidate for surgery in between chiropractic treatment, and who will be able to benefit from chiropractic care alone. In fact, surgery should rarely be scheduled for patients who haven't exhausted all conservative treatment options first.

Quite simply, good surgeons respect the role played by chiropractors in the community, and the preventive and restorative functions that are unique to chiropractic techniques. After all, it's the chiropractic practices that allow surgeons to better gauge who is a candidate for surgery and who is not. Likewise, good chiropractors understand that the conditions they treat are not always amenable to chiropractic care exclusively. The key in those circumstances is building a partnership with surgeons.

We could spend days discussing the benefits of an integrated approach from the medical side of the table, but let's take a moment to consider what patients think. When we consider the substantial amount of pain many of them endure on a daily basis, we can all probably agree that they weigh all possibilities when it comes to pain relief. Pain is intimately tied to brain functions that govern behavior and decision-making, including expectation, attention and learning. That means even the most discerning patients might consider new options for treatment when their physical symptoms are so extreme that they can no longer limit their choices.

In short, it's not likely that such patients will exclude chiropractic care or surgery from their list of possibilities, and may even devote a generous amount of time to both in order to find their best chance at relief. Now if patients can view our disciplines as a whole greater than the sum of its parts, why can't we?

Chiropractors should be involved at the onset of almost every debilitating spine condition. But in the spirit of reciprocation and relating, chiropractors should establish alliances with other specialists as well, recognizing the significance of working in cooperation with others when in the best interest of the patient.

In this modern world of medicine, we have become so specialized and our knowledge so compartmentalized that we often fail to see how we exist in relation to one another. In this instance it's you, the chiropractor, who is the critical starting point and ending point, and the primary center for conservative care for patients with back pain. And by referring patients to physiatrists, surgeons, psychical therapists or orthopedic specialists for evaluation and treatment, when appropriate, you'll foster wisdom and wellness in the workplace as it relates to the whole. Two thousand years of ancient wisdom can't be wrong, even when applied to the business of health care.


Dr. Brian Capaldi, a graduate of Palmer College of Chiropractic who originally maintained a private chiropractic practice in Malvern, Pa., now practices at the Philadelphia location of the Laser Spine Institute. He is also a certified strength and conditioning coach and a certified personal trainer, and has experience as team chiropractor for amateur sports athletes, including the men's and women's basketball teams at Villanova University in suburban Philadelphia. Contact Dr. Capaldi with questions or comments at .

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