Back to Back: How Chiropractic Stands Today

spineAfter competing with the men’s Ultimate Frisbee team in the regional finals last year, I started to notice a twinge in my lower back. As a person who prides himself on staying healthy, I convinced myself that the pain was temporary; after all, I could only recall one instance when I dove awkwardly for the disc. However, no matter how hard I tried to ignore it, the prickly sensation that traveled down my spine began to hinder my ability to walk or run for extended periods of time. Eventually, one of my friends suggested that I take action. He told me that he had been going to a chiropractor regularly for three years and expected that they would make quick work of my problem.

It is clear that many people, myself included, are not exactly familiar with chiropractic medicine. What is the difference between a physician and a chiropractor? Do they attack the same problem in different ways, or do they focus on different issues entirely? And ultimately, do patients view chiropractic treatment as effective? Surprisingly enough, the answers to these questions are multifaceted, underscoring tensions within the medical field and shedding light on optimal treatment methods.

Although Hippocrates published texts around 400 B.C declaring that it was important to “get knowledge of the spine…[as] it is the requisite for many diseases,” it was only until the nineteenth century that the practice of spinal manipulation started to gain traction. Today, physicians and other health practitioners coexist within a larger system of hospitals, insurance companies, and related institutions. However, as Princeton University professor Paul Starr argues in his Pulitzer Prize-winning book The Social Transformation of American Medicine, the nineteenth century marked an era in which “lay, or popular medicine was an active rival of … professional medicine, with a coherent structure of its own.” Through this turmoil emerged David Palmer, a magnetic healer/ Spiritualist well read in the medical journals of his time. After performing his first chiropractic adjustment in 1895, he went on to establish the first school of chiropractic medicine in 1897.

While medicine is concerned with the general realm of human health, chiropractic tends to focus on disorders of the musculoskeletal system—the bones and muscles that allow us to sit, stand, walk, or run]. However, this means that chiropractic treatment tends to overlap with that of acupuncturists and physical therapists. Although chiropractors may have considered their profession to be separate from medical practice in the past, Richard Cooper of the Medical College of Wisconsin argues that their recent foray “into the reimbursed world of healthcare means that … they must now prove their quality, effectiveness, and value.”

Unfortunately, it appears that support for chiropractic is mixed. Spinal manipulation therapy, the hallmark of chiropractic medicine, appears to offer short-term benefit in some patients with acute or uncomplicated lower back pain, but the evidence is inconclusive for patients with more chronic symptoms. Review articles seem to lean toward one conclusion: chiropractic can sometimes be effective in decreasing musculoskeletal pain, but not to a greater extent than placebos or existing treatments.

At the same time, however, it appears that chiropractors excel in one crucial factor: patient satisfaction. Across the board, patients who go to chiropractors report their visits as more positive in comparison to their visits with physicians or other health professionals. In addition, patients tend to return more often to chiropractors when their symptoms reappear.

What could be causing this phenomenon? In stark contrast to the doctor-patient relationship, where reported trends indicate that visits are increasingly brief and impersonal, chiropractors have been lauded for their alternative approach to medicine. Prominent review articles have noted that the entire chiropractic encounter includes “sensitivity to patients as individuals, effective communication, and a holistic approach to health and disease”. An empathetic touch can therefore go a long way in assisting individuals dealing with chronic pain; while these mannerisms may not be curative, they are certainly comforting.

These findings have interesting implications for health policy. Given that complementary and alternative medicine continues to report greater proportions of health expenditures, it appears that chiropractic medicine serves an important purpose for the patient population. But since chiropractic treatment for lower back pain costs more than any other treatment besides care provided by orthopedic surgeons, Americans will have to determine whether this heightened patient satisfaction is worth the extra expense.

 



Ashkay Shanker can be reached at akshay.shanker@gmail.com


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