Question
Hi Dr. Gillman,
I am a health conscious, athletic, middle aged mom trying to decide whether or not I should "sign-up" for a chiropractic treatment program. I actually took my husband to this chiropractor(recommended to me by a friend who has had great success in treatment of her sciatica) to evaluate my husband (who was asymptomatic) but visibly "crooked". Well, to make a long story short, I ended up seeing him as well for a complimentary evaluation, x-rays, etc. I mean, I don't have any symptoms, I feel really good, except for some occasional neck and shoulder pain when I get stressed or sometimes I can move wrong and pull something out of place. Sometimes if I'm on my feet too long, my lower back will get sore (in my opinion, the usual stuff). But I haven't had any major traumas and I basically feel quite good. I play a  tennis several times a week and I work with a personal trainer 2 times a week (who by the way has noticed the tightness in my thoracic spine area and has commented on my posture.) Anyway, the chiro said I was a phase II in degeneration. My neck did not have that nice curve and I guess he saw some other "problems" with my spinal x-rays. So, this proposed treatment program which I am told will most likely last for over a year with several adjustments being required each week then tapering off as needed will no doubt be a huge commitment (financially and time-wise). And then there is the "maintenance" after the "treatment program" which I understand could be an adjustment every week or as little as 2x per month depending on how I hold on. That still seems like a lot, but of course this is all new to me. I'm already married, if you know what I mean!! Does this seem "normal" to you? Is this how chiropractic care works basically? It seems like a life long commitment...

Certainly, I want to be as healthy as I can be and I feel that I more or less am, so I don't know how much healthier this treatment program is going to make my spine. Can the configuration of my spine actually be changed through adjustments and manipulations?

I need some help deciding. Can you give me some advice?

Thanks!

Answer
Hi Elaine,

Your concerns are quite justified.   I've responded in several previous posts on this topic.  It is a personal choice to see a chiropractor when you are feeling okay and only have minor aches and pains, just like it would be if you chose to get a massage when you're feeling okay.   There is no evidence that routine joint manipulation is going to straighten out anything that appears "misaligned."  It just doesn't happen.  How do you compare the patient that is getting 2x/week treatment for several months and feels and functions no different than the patient that sees the chiropractor six times and then only periodically?   If the outcome is the same, e.g. pain relief, ability to perform exercise, ability to perform daily activities or job duties, then what is the reason for getting a ton of treatment sessions?   Creating better alignment?  No. Sorry, but that is not a valid parameter. Is it to prevent "degeneration?"   Again, NO, the degeneration most likely is inherited/genetic, and there is not always correlation between degeneration and pain.  Also, there is no evidence that gobs of treatment sessions will slow down, stop, or repair degenerative joints.  So that's not a valid parameter either.   This is a notable problem in the chiropractic profession (and with PT's, too):   overtreating.   In the old days it was preached that DC's had to "locate and correct subluxations" of the spine since they were thought to "create nerve interference" and lead one down a destructive path to "disease."  Sadly, there remains a very dogmatic camp of chiropractors that still cling to this.  The "subluxation" theory is terribly flawed.  Correcting misalignments is not exactly what spinal adjustments do. It doesn't work that way.   The concept of misalignment of bones as seen on x-ray is a misnomer, especially when a doctor starts measuring with hand-drawn lines that are a degree off in one direction or another.  This is not to say that x-rays can't detect a gross misalignment, e.g. spondylolisthesis (google this), but misalignment does not correlate with pain or dysfunction.   So why should a chiropractor treat a patient?  Pain reduction.  Improved ability to perform activity as part of your rehabilitation or during active treatment of a condition.  These two nearly sum it up.  Treatment to change your spine curve? Not valid.   X-ray to see what's aligned? Not valid.  X-ray just because the doctor wants to see what your spine looks like?  Not valid.   With this in mind, the paradigm of extended durations of treatment in people that feel okay makes no sense.  It is not how modern chiropractic care is being conducted.   And more and more chiropractors are moving towards a multimodal style of care, employing various forms of soft tissue therapy (e.g. Graston Technique) and exercise therapy.

I hope this was helpful.  Let me know if you need more information.  I would suggest peeking at previous posts on this topic.

'Regards,

Dr. G