November 2008

Our dirty little secret

by Dr. Mark Payne

Chiropractic long defined itself as a profession concerned with the relationship between spinal structure and function. Using a simplistic model of misaligned bones interfering with impulses along nerve roots, for years we educated patients that normal spinal alignment is critical.

Today, most doctors understand things aren't nearly as simple as that. For nearly three decades the profession has tried to replace the old "bone out of place" model with a more sophisticated paradigm built around altered joint motion.

Yet, more recent research indicates neither model is complete by itself. Normal function and structure are actually intimately related. Unfortunately, many health care consumers don't truly understand subluxation on a more sophisticated level and patients still view chiropractors as doctors who "pop things back in place."

Every day, in offices around the world, patients consult DCs for help with various complaints. While some offices are concerned solely with symptomatic relief, others recommend extensive care plans to "correct the cause."

Since patients are already predisposed to think in terms of bones "out of place," doctors typically find the concept of spinal misalignment an easy way to communicate with them. To one degree or another, most doctors who recommend extensive corrective care programs will use structural concepts to illustrate the nature and severity of the patient's problems.

Most "corrective care" programs require a considerable commitment by the patient and rely heavily on lengthy series of adjustments to "correct" the spine back to normal alignment.

The "dirty little secret" is that most such programs are doomed to failure.

It's a secret not because doctors are hiding it from the general public, but because many doctors themselves don't understand how ineffective spinal adjustments alone are at actually changing spinal structure.

This is an issue that has been studied numerous times and confirms what most experienced doctors already know: it's very difficult to produce substantial change on the post-care x-rays.

Let's take a common postural problem, loss of the cervical lordosis, as an example. Most corrective care practitioners x-ray their patient, detect loss of cervical lordosis, and prescribe a series of adjustments. All of which would be fine as long as a positive outcome can be reasonably expected.

Fig.1 -- This patient presented after nearly two years of very frequent "corrective care" adjustments during which time there was no improvement in the cervical lordosis.

Fig. 2 -- Same patient after approximately 12 weeks of postural rehabilitation consisting of cervical extension traction and exercise, most of which was done at home.
 

Unfortunately, most techniques studied to date appear to yield only about four or five degrees of correction on average. The cold, hard truth is we have no good evidence to demonstrate any technique is particularly effective at restoring cervical lordosis.

Despite this, many well-meaning doctors continue to recommend long, protracted programs of adjustments with little chance of success simply because they aren't aware of other treatment options.

There are, however, better ways to get the job done. A 1994 study shed new light on what might actually work in terms of correcting cervical curves. The authors looked at three treatment groups.

Group one consisted of 35 patients treated using diversified manipulation and drop table adjusting in combination with cervical extension traction methods. Group two received identical adjustments without extension traction and finally a third control group received no treatment. At the end of the study, treatment group one (the traction and adjustment group) had an average improvement in lordosis of 13.2 degrees.

That's roughly 300% better than the four or five degrees typically obtained with adjustments only! Since then, two additional studies of extension traction have produced similar results.

Caution: Extension traction procedures involve backward bending of the head and neck and may be contraindicated in certain patients. Careful screening is advised before using any form of cervical extension traction. Interested doctors may contact our office for my free report, "Patient Safety-Screening Procedures" and suggested treatment protocols for extension traction.

Next time, I'll discuss some of the underlying reasons why real spinal correction is so difficult to achieve with adjustments alone. In the meanwhile, please consider that for more than a century, chiropractors have struggled to deliver real spinal correction. Now we finally understand more about what it takes to effectively deliver corrective care.

(Mark Payne, DC, is the president of Matlin Mfg., a manufacturer and distributor of postural rehabilitation products since 1988. For more information regarding postural chiropractic call 334-448-1210 for a free report, "The Best Corrections of Your Career." For more articles and information, visit www.matlinmfg.com.)