The article includes powerful commentary in support of spinal manipulation from Scott Haldeman, DC, MD, PhD, co-author of the Mercy Guidelines2 and several studies on the safety of spinal manipulation;3,4 Jack Zigler, MD, orthopedic spine surgeon with the Texas Back Institute; and Andrew Cole, MD, associate clinical professor of rehabilitation medicine at the University of Washington and recent past president of the American Academy of Physical Medicine and Rehabilitation.
"There are a lot of myths about chiropractic care," says Zigler. "...I decided to look into each of these myths, and what I found is that chiropractic education, side-by-side, is more similar to medical education than it is dissimilar."
The article notes that Drs. Zigler, Haldeman and Cole joined other spine experts in attempting to debunk misconceptions about spinal manipulation5,6 at the North American Spine Society's 17th Annual Meeting, and also references a recent Harvard University study in which low back pain patients who received conventional and "alternative" treatment, including spinal manipulation, were significantly more satisfied with alternative than conventional care.
"About 10 to 12 international guidelines have suggested that there is some benefit to manipulation," says Dr. Haldeman. "If we look at their basic guidelines, manipulation has consistently been accepted by independent government and scientific bodies as being a valid form of treatment."
Dr. Haldeman also mentions that several other studies demonstrate that the potential side-effects of spinal manipulation are short-term and relatively common for "new" patients, and that no direct relationship links spinal manipulation to any increased risk of stroke.
Dr. Cole offers perhaps the most striking endorsement of chiropractic, suggesting instances in which spine surgeons should refer patients to DCs. He emphasizes that manipulation can provide short-term pain relief for acute low back pain and modest relief for chronic low back pain. According to the article, his endorsement goes a step further: "Cole said that, overall, manipulation has the advantage of reducing pain, decreasing medication, rapidly advancing physical therapy and requiring fewer passive modalities."
"Chiropractors work for us as screeners for surgical pathology," Dr. Zigler adds. "They can do the same work-up and send the patient who has already gone through his conservative treatment and had all his diagnostic work done to the surgeon."
The article in Orthopedics Today is significant not only because of its positive depiction of spinal manipulation and chiropractic, but because it comes at a time when several other media sources have portrayed DCs in much less favorable light.7,8 It's encouraging to see good news for a change, particularly in a publication that describes itself as "a monthly medical newspaper for orthopedic surgeons."
- Time to recognize value of chiropractic care? Science and patient satisfaction surveys cite usefulness of spinal manipulation. Orthopedics Today February 2003:23(2), pp14-15.
- Haldeman S, Chapman-Smith D, Petersen DM Jr. Guidelines for Chiropractic Quality Assurance and Practice Parameters. Proceedings of a consensus conference commissioned by the Congress of Chiropractic State Associations, held at the Mercy Conference Center, Jan. 25-30, 1992. Gaithersburg, MD: Aspen, 1993.
- Haldeman S, Carey P, Townsend M, Papadopoulos C. Arterial dissections following cervical manipulation: the chiropractic experience. Canadian Medical Association Journal 2001:165(7), pp905-906.
- Haldeman S, Kohlbeck FJ, McGregor M. Risk factors and precipitating neck movements causing vertebrobasilar artery dissection after cervical trauma and spinal manipulation. Spine 1999:24(8), pp785-794.
- Haldeman S, Cole A, Zigler J, et al. Spinal manipulation in spine care: who? why? when? Presented at the North American Spine Society 17th Annual Meeting, Oct. 29-Nov. 2, 2002, Montreal.
- NASS learns about chiropractic. Over 2,400 surgeons and other specialists learn how to work with DCs. Dynamic Chiropractic, Dec. 16, 2002: www.chiroweb.com/archives/20/26/13.html.
- Plane and Pilot editorial grounds chiropractic. Dynamic Chiropractic, March 24, 2003: www.chiroweb.com/archives/21/07/26.html.
- Penn and Teller take cheap shot at chiropractic, alternative medicine. Dynamic Chiropractic, March 24, 2003: www.chiroweb.com/archives/21/07/17.html.