THE ROLE OF THE CHIROPRACTOR IN THE MANAGEMENT OF SPINAL DISORDERS

 

HISTORY

From its origins in 1895, Chiropractic has been focused on the role of the spine in health. In Davenport, Iowa, Chiropractic’s founder, DD Palmer noted some remarkable changes in patients who received spinal manipulation which he called an ‘adjustment’. From this time on he began use spinal adjustments to treat his patients for a range of problems. One of the tenants of chiropractic philosophy was that non-invasive conservative treatment was preferable to invasive treatment. By using non-invasive treatment the body can be helped to heal itself.

At that time, chiropractic was seen as an alternative to medical treatment. Due to opposing philosophies there was considerable professional animosity between the medical and chiropractic professions especially in the USA. Since then, through an inter-professional interaction and a growing understanding of the differing approaches, the medical and chiropractic profession are increasingly been seen as complementary approaches. Research has shown the effectiveness of the chiropractic approach which has helped to open avenues of interaction for the patient’s benefit. An adherence by chiropractors to evidenced-based treatments will open the way further for chiropractic.

In a recent survey the World Federation of Chiropractic sought to establish a unified identity of chiropractic, so that the public and other health professions can know how chiropractors fit into current healthcare (1). This worldwide survey has implications for the role of chiropractors in the South African context.

The public identity of the chiropractic profession was established as spinal health care experts in the health care system. In this role, chiropractors improve function in the neuromusculoskeletal system while addressing overall health, well being and quality of life in their patients. This is achieved by their specialized approach to examination, diagnosis and treatment which is based on the best available research and clinical evidence. In chiropractic particular emphasis is placed on the relationship of the spine and the central nervous system. Chiropractors are experts in spinal adjustments or manipulation, other manual therapies, exercise instruction and patient education. Chiropractors offer effective treatment without drugs or surgery wherever possible. However, collaboration with other health professionals is essential to provide appropriate treatment for each patient. Chiropractors are known for high patient satisfaction levels due to the patient-centred and biopychosocial approach. This includes the importance of the mind/body relationship in health, the self-healing powers of the body. The chiropractic profession approach encourages the individual to take responsibility for their health.

LOW BACK PAIN

The most common reason people consult a chiropractor is for low back pain (2). As recent research shows, Chiropractors are well equipped to help people suffering form low back pain. In the British Medical Journal Online version, spinal manipulation was shown to be the most cost effective treatment for mechanical low back pain (3). Combined with exercise, spinal manipulation was the most effective treatment option in the study (4). This study follows on the Meade et.al. study which showed that Chiropractic treatment was more effective than out patient treatment by medical personnel in a hospital setting (5). A long term follow up study showed these benefits were still evident after five years (6).

NECK PAIN

This is the second most common area of practice for chiropractors. The Rand report of 1996 concluded that manipulation and mobilisation of the cervical spine (neck) are ‘both more effective than muscle relaxants or usual medical care in producing short-term relief for patients with sub-acute or chronic neck pain.’(7) As experts in spinal health and in specific spinal manipulation, chiropractors are well positioned to offer relief by these proven treatments.

HEADACHES

Some headaches originate form the cervical spine (neck). These headaches which originate from the upper three neck vertebrae are called Cervicogenic headaches. In a review of research by the Cochran collaboration, spinal manipulation and neck exercises were cited as a prophylactic treatment that offers benefits when compared to no treatment at all (7).

WORKING AS PART OF A HEALTH TEAM

The chiropractor is an important player in the health care system. Their strength lies in the ability to diagnose, to offer expert conservative treatment including spinal manipulation and to refer other players in the team. The chiropractic profession is proud to be part of the South African Spine Society and value the inter-professional interaction where ideas and research can be shared and relationships can be fostered and grown.

REFERENCES

1. World Federation of Chiropractic (WFC). Identity Task Report. 15 June 2005. HYPERLINK "http://www.wfc.org" www.wfc.org
2. Hurwitz EL, Coulter, ID, et al. Use of chiropractic services from 1985 through 1991 in the United States and Canada. American Journal of Public Health.
3. UK BEAM Trial Team. United Kingdom back pain exercise and manipulation (UK BEAM) randomised trial: cost-effectiveness of physical treatments for back pain in primary care. BMJ Online First, Nov. 29, 2004.
4. UK BEAM Trial Team. United Kingdom back pain exercise and manipulation (UK BEAM) randomised trial: effectiveness of physical treatments for back pain in primary care. BMJ Online First, Nov. 29, 2004.
5. Meade TW, Dyer S et al.Low back pain of mechanical origin:randomised comparison of chiropractic and hospital outpatient treatment. British Medical Journal 1990;330:1431-37.
6. Meade TW, Dyer S et al. Randomised Comparison of chiropractic and hospital outpatient management for low back pain:results form extended follow up, British Medical Journal 1995 311:349-351.
7. Hurwitz EL, Aker PD t al. Manipulation and mobilisation of the cervical spine, Spine, 1996;21(15):1746-1760.

WHOLE BODY WELLNESS

In the interest of whole body wellness, many chiropractors offer their patients a range of options to help relieve back pain in addition to spinal manipulation, including advice about diet, lifestyle and exercise.

Now, a recent study has found that patients given a combination of spinal manipulation and exercise experienced greater improvements in back function and greater reductions in pain compared to those treated with spinal manipulation or exercise only. Moreover, improvements lasted longer in patients receiving both manipulation and exercise than those who received only one type of intervention. The study included more than 1,300 patients randomised into four groups: a control group that did not receive any intervention, and three groups that each received one of three forms of care - spinal manipulation, exercise, or both.

RESULTS

Compared to the control group who had no treatment, patients in all three intervention groups experienced "small to moderate" benefits in the treatment of back pain, with the greatest improvements in the group that received spinal manipulation followed by exercise. In an accompanying study, researchers examined the cost-effectiveness of adding manipulation, exercise, or both to the usual "best care" practice for back pain. “Best care” practice for back pain includes staying active, avoiding those activities that aggravate the back pain and taking over the counter medication. They found that, depending on the total cost of treating a patient with back pain, spinal manipulation would be "a cost-effective addition to 'best care' for back pain in general practice" and that "manipulation alone probably gives better value for money than manipulation followed by exercise."

Together, these papers provide new evidence that manipulation of the spine, either alone or in conjunction with an exercise program, is an efficacious and cost-effective form of care for people suffering from back pain. If you suffer from back pain, talk to your chiropractor about a treatment plan that includes regular exercise.

REFERENCES

1. UK BEAM Trial Team. United Kingdom back pain exercise and manipulation (UK BEAM) randomised trial: effectiveness of physical treatments for back pain in primary care. BMJ Online First, Nov. 29, 2004.
2.UK BEAM Trial Team. United Kingdom back pain exercise and manipulation (UK BEAM) randomised trial: cost-effectiveness of physical treatments for back pain in primary care. BMJ Online First, Nov. 29, 2004

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