Question
QUESTION: I'm retired and live in Spain.  I have various herniated discs and severe arthrosis of the knees and hips. I'm being treated by an American chiropractor here for chronic pain.  The results are minimal, and when I ask for recommendations of other things that I might do to alleviate the pain, he says that I should continue with him, that I need indefinite long-term care,that eventaully there will be an improvement.  My funds are limited, and needless to say, I'm concerned about whether I should change my form of treatment to other types of alernative medicine, i.e. acupuncture, massage, etc.  How does one determine the effectiveness of a chiropractor; over what period of time should I judge his effectiveness; and how can one know who might be a better chiropractor beyond trial and error?  Honestly, the amplitude and duration of his "spinal thrusts" seem to be weak.  He says he will only treat my neck and not my lower back for fear of aggravating the subluxions, but my hips and knees are where all the pain is.  He insists that simply treating my neck and upper spine will bring results, but the herniated discs are in the lumbar spine.  Recommendations?  Thanks

ANSWER: Dear Vincent,

It is often difficult to know when it is time to make a change and find a new chiropractor.  I have to assume that the doctor that you are seeing is honorable, and that he is doing all that he feels that he can to help you.  That being said, you, as the consumer, have to make the determination as to whether or not the best care provided by your current doctor is helping you to obtain your desired results.  It is not shameful to finally come to the conclusion that a current path or treatment plan is insufficient or ineffective... and that a change of direction is warranted. I know that in my practice, I am constantly thinking of ways that I can change what I currently do with a patient so that I can maybe help a little bit more.

As a rule of thumb, consider the following guidelines:

1) If a treatment plan makes initial sense to you, give it 2-4 weeks before you evaluate your outcomes. It is very common to overvalue day-to-day symptoms, for better and for worse.
2) If you find that your treatment results are not congruent with your goals, always talk to your doctor.  Ask if there is anything else that can/should be done. Express your concerns. A good physician will listen, consider, and evaluate your comments.  He/she will then discuss all options with you. He/She will likely have an opinion as to a new pathway, or will be able to articulate in a way that makes sense why treatment should continue unchanged.
3) If your are not satisfied, or if the explanations do not make sense, don't be afraid to try somebody new.  I know that I do not help all patients with all conditions.  I personally get frustrated when a patient leaves my care, but it is usually more of a personal frustration over my failure in helping.  I hate to loose!  It is OK... and in fact desirable... to have a physician frustrated when a patient isn't responding to his care.  

Now, regarding your condition in particular.  If you were my patient, I would definitely be directing the majority of my treatment towards your lower back condition.  This would include, potentially, adjustments, traction, stretching, strengthening, passive therapies, such as electrical stimulation therapy, posture training, work training, etc. There are some chiropractors that ONLY treat the neck, believing that it will have benefits throughout the spine.  I personally do not ascribe to this philosophy.  You need to remember that your damaged discs will never be the same again. They will continue to be prone to re-injury and further degeneration over time. There are, therefore, three types of care, all of which are important to you.

1) Initial intensive care.  The goal of this type of care is simply to ease your pain and suffering.  The primary interest of the physician is to reduce pain, swelling, inflammation, and muscle spasm.
2) Rehabilitative care.  Once the symptoms begin to ease off, the emphasis of treatment shifts away from pain control and more towards function, flexibility, and strength.  Exercises specific to your condition should be implemented performed not only in the office but also at home.
3) Wellness.  Once maximum symptom relief is obtained, and full benefit of rehabilitation achieved, the patient must commit himself/herself to continuing the exercises and programs/efforts that were found to be successful.  During this phase, treatment with the doctor is regular, but much less frequent (maybe once every two weeks to once per month). The patient MUST continue with home stretching and strengthening work.  You must guard against the thoughts that since the pain is gone, "all is well". This faulty thinking will lead to a certain relapse.  Liken this phase to that of brushing your teeth.  It is something that you do when you are NOT in pain... not something that you do AFTER you develop tooth decay and pain.

Vincent, I hope that I gave you some thoughts that will be helpful for you.  It is difficult to make changes... yet this is YOUR body.  Your current chiropractor works for YOU. If you are unhappy with the arrangement, then employ somebody else.

Good luck,

Keith Biggs, DC
http://www.eastmesachiropractor.com


---------- FOLLOW-UP ----------

QUESTION: Many thanks for your response.  Could you recommend a chiropractor in Vic, Girona, or Barcelona Spain?  My Spanish postal code is 17500.

Answer
Vincent,

I wish that I could make a recommendation in Spain, but the truth of the matter is that I don't know any doctors in Spain.   I made a quick attempt to google search Spain, Chiropractor, 17500, and I didn't get any hits at all.

Make a search yourself.  Call the offices, and talk with the doctors about your issues.  Ask if they are willing to perform a complimentary consultation or examination.

Good luck

Keith Biggs, DC
http://www.eastmesachiropractor.com