Question
Dear Dr. Anzalone,

It has been suggested to me by numerous concerned friends that I see a chiropractor but I was previously unable to due to financial constraints.  However, starting in 2011, my new insurance plan will cover some chiropractic care and presently I am attempting to ascertain its suitability.  Naturally, I'll consult my current health providers on my specific case before making an appointment but I'd prefer to enter that discussion reasonably informed.

Therefore, what are the general pros and cons to chiropractic care?  I've been diagnosed with herniations and fibromyalgia; are there general concerns I need to be aware of?  Rationally I can see where there could be benefit to spinal manipulation loosening stiffened vertebral joints, aiding in the healing of herniations, and reducing pressure on nerves thereby improving their functioning, however, when I went with my boyfriend to his chiropractor to see what treatment entailed, I must admit that I left with a great deal of distrust in the practice.  The manipulations seemed nearly violent with the doctor pressing on my boyfriend's back sharply; compressing the springs under the table enough that he appeared to be "jumping" (for lack of a better description).  Truthfully, if anyone so aggressively pressed on my back, I would be screaming in agony regardless of my rather substantial pain tolerance.  I was also shocked at the doctor determining which vitamins and how many my boyfriend should take by "aligning the energies".  Is this what can be expected of chiropractic care?  I thought the bulk of the specialty dealt with manual manipulations and exercises.  Am I mistaken?  I understand there is value in alternative therapies but what I saw seemed a little extreme to me.

I appreciate your time and consideration of this rather involved question. Thank you in advance.

Sincerely,

Dawn

Answer
Dawn,

Thanks for your question. Actually, there are several parts to your question: (1) what can a potential patient expect from chiropractic care?; (2) can chiropractic be helpful for fibromyalgia syndrome?; (3) can chiropractic help for disc herniations?

Regarding the first question, my short answer is that a reputable chiropractor who follows evidence-based/evidence-informed treatment approaches should:

a) Determine the reason for the patient visit (which should pertain to a specific musculoskeletal problem (which is what the best evidence shows chiropractic is most helpful for)
b) Conduct a thorough examination, which may include referring the patient for additional testing or imaging, if needed
c) Clearly explain the nature of the patient's musculoskeletal problem, including risks vs. benefits of the proposed treatment
d) Be able to answer any patient questions regarding the nature of the patient's problem and the proposed treatment plan
e) Consider the patient's preferences with regard to the proposed treatment plan

In general, red-flags to watch out for include:

a) A cookie-cutter approach to patient care (i.e., using one technique for patient care)
b) Sales and marketing gimmicks
c) Requests/requirements for payment-up-front for multiple visits
d) Emphasis on metaphysical ideas versus focus of patient care for musculoskeletal problems

Regarding the second point, if you have true fibromyalgia syndrome FMS, you most likely are not a candidate for a high-velocity, low-amplitude thrust-type manipulation (which is probably the most common method of manipulation used by most chiropractors). Most patients with FMS do much better with a soft-tissue, low-force manipulation approach. This can be performed by chiropractors who are skilled in such techniques, or a by a licensed massage therapist who has had experience treating FMS clients. Other options for manual therapy also include acupuncture, and recent evidence has shown that many FMS patients benefit from low-impact and slow-performance physical activities such as Tai Chi.

I must emphasize that if you have true FMS, there is no one sole treatment approach. Most FMS patients do require some physical/physiotherapy approach, as well as appropriate pharmacological therapy. FMS most likely involves a dysfunction of the central nervous system and brain chemistry which manifests as diffuse musculoskeletal pain.

Regarding the third point, chiropractic, like other manual therapy approaches, can be helpful in treating disc herniations, but each patient responds differently, so a certain trial-and-error component often comes into play. Each patient needs to be evaluated individually, and treated accordingly. Sometimes this involves multiple practitioners in different specialities co-treating the same patient.

I hope that this helps to answer your question.