8 Reasons Patients Switch Chiropractors

Guest post by Dr. Adam Tanase

Whenever I meet with a new patient, I ask them about any previous chiropractic experience they’ve had… It’s important to know if they’ve been to a chiropractor in the past, or if this is their very first experience having their spine adjusted.

They usually have very positive things to say about their past experiences. The reason they’re looking for a different doctor is simply because they moved to a new city, the previous doctor retired, or they’ve developed a new problem that would benefit from a different approach.

Occasionally, however, a particular experience motivates them to seek help elsewhere. When this occurs, I like to learn more about what happened, and why they were dissatisfied.

I’m going to outline some of the more common responses that patients have shared with me over the past 15 years. Before I do, however, I want you to know that this not a reflection of the profession as a whole. The majority of patients love visiting their chiropractor and have favorable overall experiences.

If any of these shenanigans sound familiar, don’t get upset. I’m not suggesting that you need to switch chiropractors. But if you’re ever dissatisfied or uncomfortable with your experience in a chiropractic office, changing doctors is much easier than you might expect.

So, let’s begin…

1) “Required” Care Plans

A very common reason patients have told me they switched chiropractic offices is because of care plans that insist upon a specific number of office visits.

It sounds something like this… “He showed me my x-rays, made a few markings on them, and gave me this packet of information. Then he told me it would take a year to fix my problem and I needed 50+ visits. The only choice I was given was how I wanted to pay for it.”

Can you imagine restaurants refusing to serve you until you agree to eat there every week for a year? What if airlines wouldn’t let you board a plane until you signed a contract that binds you to a specific number of roundtrip flights?

Sounds pretty silly, right? These militant offices expect you to be fully committed to the process. If you aren’t, they won’t “accept you” as a patient. What is this, North Korea?

2) Appointments Were Too Frequent

Another common reason patients switch chiropractors is because they have to go too often. This typically unfolds in one of two ways.

First, the patient is told they “need” biweekly visits. For some people, this can be an impossible expectation. Having incompatible work hours, or living impractical distances from the office makes receiving the recommended care stressful or inconvenient. So it’s easy to understand why people search for more suitable options if going to/from the office becomes a hassle.

Second, the benefits of the adjustment are short-lived. The adjustments feel great, but each one seems to only last a few weeks. So they begin searching for different ways to manage their problem, and discover that other chiropractic methods could potentially have a longer lasting effect.

(A footnote I’d like to add is that there are many different ways to adjust the spine, and each has its own recommended treatment interval for optimum results. All of them have merit, but some of these methods require more frequent adjustments than others. It’s up to you to decide what you’re most comfortable receiving.)

3) Didn’t Like the Chiropractor’s Method of Adjusting

Some people find the physical experience of having their spine “popped” quite comfortable, if not pleasurable. Others get weirded out by it, or find it too forceful. One of the most repeated reasons for switching chiropractors that I’ve heard is, “I don’t like having my neck twisted.”

It’s perfectly acceptable to develop a technique preference… Instrument-based methods, for example, are a popular twist-free alternative to conventional chiropractic adjusting. It’s normal to experiment with different methods until you find what works best for you.

4) Not Enough Time With the Doctor

This is a common complaint with doctors in general. No one wants to feel like they’ve been shuffled in and out without having their concerns adequately addressed.

The process of getting adjusted doesn’t take long. You’re not paying for time spent in the office; you’re buying the benefits of an adjustment. But there’s no excuse for taking the “care” out of healthcare. Being treated like cattle doesn’t make a patient feel good.

Allow me to paraphrase a concern I’ve heard a number of times over the years:

“A massage therapist would rub my back for a minute or two, then I’d wait there with my face down on the table. Eventually the doctor would come in, and after barely acknowledging me, adjust me a few different ways, pat me on the back and say I did great, then leave. He didn’t ask if I had any questions, or if anything new was bothering me.”

Similarly, patients want to know the doctor is present and attentive while recognizing their concerns. Here’s one I’ve heard variations of multiple times… “She walked in, called me by the wrong name, and asked me how my ankle was doing… but I was there for help with carpal tunnel syndrome.”

5) Passed Down to an Associate

It’s not uncommon for a chiropractor to get so busy that he needs to hire an associate doctor to assist with patient care. This is normal. Unfortunately, not all associates are as clinically experienced as the doctor you were originally seeing… So after enough sub-par adjustments, patients begin to look elsewhere because they’re tired of not getting the quality treatment they’ve come to expect.

I’ve also heard scenarios where a charming and outgoing doctor handles all the new patients, then passes them along to a different (less personable) doctor to do all the adjusting. This can make people feel like all the focus was placed on getting them in the door, then casting them aside once they were there.

6) Unreasonable Wait Times

A chiropractic office isn’t an ER. There’s really only a handful of treatments we offer, none of which take very long to perform. So when a doctor makes patients wait lengthy periods of time, it’s frustrating. I’ve heard very specific things like “she routinely made me wait while she handled personal issues during my appointment” and “Multiple times I had to wait outside the office for 20-30 minutes because he wasn’t there yet, and didn’t bother to apologize after he arrived, or explain why he was so late.”

I’ve also heard complaints about poor office efficiency. For example, taking several days to return phone calls, neglecting to bill insurance companies in a timely manner, and even being “forgotten” in a therapy room.

Bottom line, when patients feel their time isn’t being respected, they look elsewhere, especially if the quality of care isn’t worth the wait.

7) Heavy Sales Tactics and Scare-Plans

Would you be surprised if I told you that there are coaching programs that chiropractors pay tens of thousands of dollars for that will teach them persuasive sales techniques?

It looks something like this…

Patients sit down with the doctor (as well as the decision-making spouse “for support” when applicable) and hear an artfully crafted presentation on why 12-months of care is so imperative. It can be an emotionally manipulative experience, frightening you about how dreadful life will be with a deteriorating spine. Much like buying a used car, the huckster says whatever it takes to get you to sign on the dotted line.

Fortunately, people are getting wise to this approach. More and more patients have learned to recognize disingenuous tactics. I wish I could tell you this doesn’t happen at all anymore, but sadly, it still does.

8) “Cult-Like” Atmosphere

It pains me to say it, but more than a few patients have used the phrase “cult-like” to describe their experience in a previous chiropractic office.

Visiting such an establishment (which is often a franchise) can feel like you’re participating in a “movement” or involved in a religious sect. They implement monthly community lectures or wellness presentations that are peppered with biblical references and inspirational testimonials designed to invoke like-mindedness.

A passionate and personable doctor with a well-trained staff can attract hordes of impressionable people who gravitate to the “herd” mentality. Stimulating one’s psychological need to belong can have a powerful impact on their decision making.

I’m sure these doctors mean well — deception isn’t their intent. They very much believe what they’re saying… But they expect you to “have faith” in it too, and they make no apologies for pressuring you into making an “investment” and modeling your lifestyle after their own.

You can expect them to offer deep discounts for your family members if they accompany you to the office, because if you’re trying to prevent cancer and live forever (or whatever BS they’re selling), shouldn’t they get on board too?

There’s never an end to chiropractic care in offices like this… it’s unapologetically intended to become part of your weekly routine, as well as your identity.

They cluster 10 or more appointments together to give the (manufactured) impression of “social proof” – others are doing it, so should you! They want everyone to believe they’re really busy “saving lives” in the community. Groupthink is a powerful thing, and they milk it for all it’s worth.

Hundreds of obedient patients willfully adopt the charismatic doctor’s vision. They’ll wear the office logo on t-shirts, attend marketing events to help the doctor spread his/her message, and maybe start working part-time in the office as an assistant.

Barf. Honestly, I felt dirty just writing this description. It’s nauseating to hear about practices like this… If you encounter such an office, use your best judgement before drinking the Kool-Aid.

I’d like to reiterate that these are simply a collection of shared responses from patients I’ve met throughout my career. It’s not a reflection of the entire chiropractic profession.

You don’t need anyone’s blessing or permission to change doctors. So if you’ve been thinking about looking around, go ahead and explore your local options. You might find a great new chiropractor without all the tomfoolery!

(Disclaimer: Remember the objective of upper cervical care is to correct head neck misalignment that is interfering with proper brain to body communication. When this is corrected the body functions at a higher level and can often correct other problems more efficiently on its own. Please do not confuse upper cervical care as a treatment for any condition, disease or symptom.)

8 Reasons People #SwitchChiropractors https://t.co/aC8eZEmKbD

— Travis Robertson (@theuppercblog) November 29, 2016

Do Away With Levels Of Care And Set The Truth Free

By Joe Strauss

Perhaps we are at the point in the development of our model of chiropractic that we should drop the concept of levels of care and just have one level—chiropractic care. At this one and only level, we check the entire spine for vertebral subluxation and adjust if necessary wherever and whenever we find the need, recognizing that different people may need different adjustments and even the same person may need different adjustments from day to day. We could do away with different kinds of care from initial or intensive, or whatever we call it, to wellness or maintenance care. What is it that is different about our care in these situations anyway? Nothing! We always check for subluxations and adjust if necessary each time the practice member comes in. Which is more important, once a day or once a week? They are both equally important.


Perhaps, if we did away with these "levels" of care, we could get people to truly understand what we are doing. Maybe they would view us more like a gym or health club than a doctor treating them for a condition that they hope in time will be eliminated. (In our case the "condition" is vertebral subluxation). Typically, people don't go to their health club on a temporary basis, until a condition (i.e., being out of shape or overweight) is alleviated. They go because they know it is something they should do for their health. They go because they feel healthier, have more energy, and/or are stronger when they go on a regular basis. Some may stop going after they lose the weight or get in shape (and many even before they do), but that is not because they think that they no longer need to go.

I think sometimes we are afraid to be up front with our practice members and tell them from the start what we are about. We are afraid to tell them what they can expect from us and what we expect from them. So, we explain what we are doing in terms they understand or what we think they will understand. People will decide when they no longer want or need chiropractic care. They are free to do that, but we should do everything we can to give them an accurate perception of the kind of care we offer. To do that we need to present chiropractic differently, even different than what every other chiropractor is presenting. They can use chiropractic however they want for as long as they want, but it is in both our and their best interest to know up front that chiropractic is not a treatment for a condition. It is for a better life expression for the duration of an individual's existence.

Why do we still use levels of care? Could we possibly move past this? #Chiropractic #UpperCervical #UCCare... https://t.co/sC4P2PbrUD

— Travis Robertson (@theuppercblog) April 28, 2016

Evidence Based Care Is Medical?

by Matthew McCoy DC, MPH

Because of the kind of work I do I attend a lot of chiropractic seminars, conventions etc. And since I run with the subluxation centered crowd these are usually the types of seminars and conventions I attend. I also grew up around this faction of the profession from an early age and have heard and seen countless presentations by subluxation centered chiropractors.

One thing I have been hearing quite a bit of from the stage and on social media is this notion that "Evidence Based Health Care" is "medical."

This makes no sense.

I understand chiropractors’ concerns in regards to the inappropriate interpretation and use of the concept of evidence based practice – that isn’t the issue. The issue is that requesting or requiring evidence regarding our care or our claims is considered "medical" or that research in and of itself is "medical" and therefore bad.

If a chiropractor tells me or shouts from the stage that they "don’t need no evidence" then I have a couple of questions for them:
1.  How do you determine that the practice member lying on your table is in need of an adjustment?
2.  How do you determine whether or not the subluxation was reduced or corrected?
Because unless you are just walking into your adjusting rooms and pushing haphazardly on the spine in no particular direction and for no particular reason then – you need evidence.

You need evidence that a subluxation is present.

You need evidence of its characteristics.

If you don’t have those then you have nothing.

So, now extrapolate your individual experience with this patient to the population level. We need evidence regarding the population level characteristics of subluxation as it manifests in the masses.

In research this is called epidemiology.

Evidence based practice is simply helping patients make decisions about their health care based upon:
1.  What does the scientific evidence say?
2.  Does the scientific evidence fit the clinical state and circumstance of my practice member?
3.  What does the patient want to do?
All three of these are overseen by the doctor who helps the patient make decisions about their health care.

It’s important to note that the absence of evidence does not mean that chiropractic (or any other care) is not warranted for the practice member. It just means there is no scientific evidence. Absent such evidence the decision to undergo care is based on the remaining factors.

It is also important to point out that there is an evidence hierarchy and that there are higher and lower levels of research. So even in a case where there is not a single case study, never mind a randomized controlled clinical trial, that does not mean there is no evidence. In situations like that one may need to rely on basic science research to bridge the evidence gap in order to make an informed decision.

So next time you hear a chiropractor say "we don’t need no evidence", do us all a favor and educate them on what evidence based practice really means.

As always, I look forward to comments, feedback and suggestions.

Matthew McCoy DC, MPH
Chair – Research Committee
International Federation of Chiropractors & Organizations
matthewmccoy@comcast.net

What do you think? Is Evidence-Based Practice Only Medical? #EBP #Medical #Chiropractic #Research
Posted by Travis Robertson on Thursday, March 31, 2016

What do you think? Is Evidence-Based Practice Only Medical? #EBP #Medical #Chiropractic #Research https://t.co/B3oeDPU1gM

— Travis Robertson (@theuppercblog) March 31, 2016

Infant With Failure to Thrive Thrives After Upper Cervical Chiropractic Care

The December 17, 2015, issue of the Journal of Pediatric, Maternal & Family Health published a study documenting the case of an infant who was medically diagnosed with failure to thrive being helped with chiropractic.

The authors of the study describe failure to thrive (FTT) as infants who cannot maintain growth or have inadequate growth. The condition is fairly common affecting approximately 3-10% of children attending care in a hospital setting and 5-10% of children attended to in a primary care setting.

This may be due to disease, or not enough calories in the infant's diet or even an infant that burns too many calories. The study reports that 80% of all cases have no known underlying medical conditions for the FTT. Because of the lack of clear medical treatment, the study reports that many parents turn to alternatives such as chiropractic, in these situations.

In this case, a 5-month-old infant girl with a medical diagnosis of "failure to thrive" was brought to the chiropractor. The infant girl was also suffering with inconsolable crying, chronic diarrhea, and was dangerously underweight.

The infant's mother reported that her daughter's problems began at the age of two months when she was brought to the pediatrician for a stomach virus, oral thrush, and loose green stools. Medication was prescribed but was ineffective as the infant continued to suffer from green-colored diarrhea and weight loss for the next six weeks.

The problem worsened to the point that the medical recommendation to the infant’s mother was surgical insertion of feeding tubes into her child’s stomach. It was at this point that the mother decided to try chiropractic for her daughter.

A chiropractic examination revealed the presence of subluxations in the infant's upper neck. Subluxations can cause interference to normal nerve function and have an effect on overall physiology. Chiropractic adjustments were begun to correct the subluxations and restore normal nerve function.

After the infant's first chiropractic adjustment, her mother noted that her daughter slept several hours continuously, without waking up and crying. After the third adjustment, the child stopped the daily screaming, and her stools started to return to normal. After one week of care, the child had gained 2 oz. Each successive week, the child's rate of weight gain continued to increase until the child had returned to a normal weight. A five year follow-up showed that the child was normal, in good heath, and properly developed for her age.

In their conclusion, the authors wrote, " This case report provides supporting evidence on the effectiveness of chiropractic care in infants with a failure to thrive. We encourage further research and theoretical development on this approach to patient care vis a vis the detection and removal of spinal subluxation."

(Editor's note: Remember the objective of upper cervical care is to correct head neck misalignment that is interfering with proper brain to body communication. When this is corrected the body functions at a higher level and can often correct other problems more efficiently on its own. Please do not confuse upper cervical care as a treatment for any condition, disease or symptom.)

Infants...even the one with Failure To Thrive, can thrive while under Upper Cervical Chiropractic Care. #FailureToThrive #Infants #Chiropractic #UpperCervicalCare

Posted by Travis Robertson on Thursday, February 25, 2016

Infants...even the one with Failure To Thrive, can thrive while under Upper Cervical Chiropractic Care.... https://t.co/ihXK5Nx5gR

— Travis Robertson (@theuppercblog) February 25, 2016

Chiropractic...About More Than Back Pain?

source:  http://www.metrotownchiropractic.com/en/faq_and_education.html

7 Reasons Why Chiropractic Is About More Than Back Pain
posted by PHS Chiropractic on Friday, October 09, 2015

Do your patients think their care is simply about resolving their back pain? It's time to educate them that while chiropractic is about that, it's also about so much more.
Research has demonstrated that chiropractic can actually help keep your body healthy and active and can be incorporated into anyone's lifestyle as a preventative regimen.

Chiropractic:

1. Boosts immune function, making it easier to ward off infection and illness.

2. Reduces inflammation. Higher levels of inflammatory compounds can lead to diseases like rheumatoid arthritis, inflammatory bowel disease and psoriasis.

3. Reduces blood pressure. In fact, patients who receive adjustments have seen blood pressure decreases that are equal to being given two different anti-hypertensive agents at the same time!

4. Reduces stress, including improving brain activity responsible for stress reactions and reducing cortisol levels.

5. Improves balance by restoring normal healthy spine function.

6. Relieves colic in babies.

7. Relieves asthma symptoms in both adults and children. As chiropractors, we know the benefits of being under chiropractic care extends well beyond just back pain relief. In an article published by ChiroHosting they give 7 reasons why chiropractic is about your overall wellness.

The core concept of chiropractic is to restore the function of your nervous system so that it can do what’s it’s designed to do: keeping your body healthy and active. Chiropractic is truly about prevention. If you keep your nervous system working smoothly and without interference, many health issues become non-issues!

Don’t take our word for it, though. Over the last few years, there’s been a lot of scientific research that shows that chiropractic is good for much more than just aches and pains. Here’s a review of some of this literature.

1 – Chiropractic Boosts Immune Function

A 2010 study found that chiropractic adjustments actually boosted blood serum levels of some important natural antibodies in patients. The authors suggested that chiropractic adjustments might "prime" the immune system, making it easier to ward off infection and illness.

2 – Chiropractic Reduces Inflammation

Researchers in a 2011 study compared back pain patients to people with no pain and gave both groups chiropractic adjustments. The authors found that the back pain patients who received chiropractic care had dramatically lower levels of a key inflammatory cytokine, known as TNF-α. High levels of TNF-α have been linked to inflammatory diseases like rheumatoid arthritis, inflammatory bowel disease, and psoriasis.

3 – Chiropractic Reduces Blood Pressure

Hypertension is a huge public health issue in the US; it’s estimated that about 30% of adults suffer from this serious condition. A 2007 study in the Journal of Human Hypertension looked at a group of patients with high blood pressure. Half received an adjustment of their atlas, and the other half received a sham adjustment.

The decrease in blood pressure was so dramatic in the patients who received real adjustments that the researchers wrote that it "is similar to that seen by giving two different anti-hypertensive agents simultaneously." In fact, 85% of the study patients had improvement after just one adjustment!

4 – Chiropractic Reduces Stress

An interesting study by a team of Japanese researchers in 2011 gave chiropractic adjustments to 12 men and examined PET scan images and blood chemistry to examine the effect that chiropractic has on the autonomic nervous system.

After receiving a chiropractic neck adjustment, patients had altered brain activity in the parts of the brain responsible for pain processing and stress reactions. They also had significantly reduced cortisol levels, indicating decreased stress. Participants also reported lower pain scores and a better quality of life after treatment.

5 – Chiropractic Improves Balance

As we age, sometimes we start to lose some of our balance, strength, and flexibility that we had in our youth. Because of this, older folks are vulnerable to serious injuries from trips and falls. Chiropractic helps keep your body active by restoring the normal, healthy functioning of your spine. One of the important roles of your spine is balance, aided by nerves called proprioceptors. These proprioceptors relay information to your brain on the position of your body.

A small study from 2009 found that people who received chiropractic adjustments had reduced dizziness and improved balance. A 2015 review of the literature suggests that chiropractic care might be an effective, natural way to help prevent falls in elderly patients.

6 – Chiropractic Relieves Colic in Babies

In 2012, researchers studied 104 infants who were suffering from colic. One-third of the infants were treated with chiropractic adjustments and the parents were aware of the treatment; one-third were treated and the parents were unaware of the treatment; and one-third were untreated but the parents were unaware.

The authors found that the parents reported a significant decrease in infant crying in the treated babies, compared to the infants who didn’t receive treatment. The knowledge of the parent had no effect on the improvement.

7 – Chiropractic Relieves Asthma Symptoms

A 2013 study reported that chiropractic adjustments were effective at increasing lung functioning, and some recent research shows that chiropractic care can help reduce the symptoms of asthma in some children.


Reference Studies

1.  Teodorczyk-Injeyan JA, McGregor M, Ruegg R, Injeyan HS. Interleukin 2-regulated in vitro antibody production following a single spinal manipulative treatment in normal subjects. Chiropractic & Osteopathy 2010;(18)26.

2.  Teodorczyk-Injeyan JA, Triano JJ, McGregor M, Woodhouse L, Injeyan HS. Elevated production of inflammatory mediators including nociceptive chemokines in patients with neck pain: a cross-sectional evaluation. Journal of Manipulative and Physiological Therapeutics 2011;34(8):498-505.

3.  Bakris G, Dickholtz M Sr, Meyer PM, Kravitz G, Avery E, Miller M, Brown J, Woodfield C, Bell B. Atlas vertebra realignment and achievement of arterial pressure goal in hypertensive patients: a pilot study. Journal of Human Hypertension 2007;21(5):347-52.

4.  Ogura T, Tashiro M, Masud M, et al. Cerebral metabolic changes in men after chiropractic spinal manipulation for neck pain. Alternative Therapies. 2011;17(6):12-17.

5.  Strunk RG, Hawk C. Effects of chiropractic care on dizziness, neck pain, and balance: a single-group, pre-experimental, feasibility study. Journal of Chiropractic Medicine 2009;8(4):156–164.

6.  Kendall JC, Hartvigsen J, French SD, Azari MF. Is there a role for neck manipulation in elderly falls prevention? – An overview. Journal of the Canadian Chiropractic Association 2015;9(1):53-63.

7.  Miller JE, Newell D, Bolton JE. Efficacy of chiropractic manual therapy on infant colic: a pragmatic single-blind, randomized controlled trial. Journal of Manipulative and Physiological Therapeutics 2012;35(8):600-7.

8.  Engel RM, Vemulpad SR, Beath K. Short-term effects of a course of manual therapy and exercise in people with moderate chronic obstructive pulmonary disease: a preliminary clinical trial. Journal of Manipulative and Physiological Therapeutics 2013;36(8):490-6.

9.  Pepino VC, Ribeiro JD, Ribeiro MA, de Noronha M, Mezzacappa MA, Schivinski CI. Manual therapy for childhood respiratory disease: A systematic review. Journal of Manipulative and Physiological Therapeutics 2013;36(1):57-65.
- See more at: ^{http://www.phschiropractic.com/learn/blog/7-reasons-why-chiropractic-is-about-more-than-back-pain.aspx#sthash.UkgxwprA.dpuf}

Maybe #chiropractic is about more than we thought? https://t.co/XE2ZrOd0ry

— Travis Robertson (@theuppercblog) October 20, 2015

Chiropractic at 120 Years Old Continues to Flourish

From www.nowyouknow.net

In case you missed it, Chiropractic turned 120 this past month on September 18th. Below is a shortened release from the ICA on this event and the impact on healthcare in the world.

Chiropractic’s famous first adjustment is recognized each year as Chiropractic Founder’s Day. This annual observance commemorates September 18th, 1895 as on this day, 120 years ago, Dr. Daniel David Palmer, a pioneering clinician in Davenport, Iowa, administered the first specific chiropractic adjustment.

Dr. D.D. Palmer delivered his historic first chiropractic adjustment with the specific intent of realigning a malpositioned vertebra, found on his patient Harvey Lillard, to its normal healthy orientation. Mr. Lillard, who had lost most of his hearing 17 years earlier, noted his hearing swiftly returned under Dr. Palmer’s care. Dr. Palmer proceeded to evolve his clinical practice with his new methods of repositioning spinal segments that were out of alignment, and experienced positive clinical results in patients with a wide variety of health concerns. His practice grew and the profession of Chiropractic was launched.

The theory and clinical basis of Chiropractic was concisely described as “Founded on Tone” by Dr. Palmer in a book he authored in 1910, The Science, Art and Philosophy of Chiropractic. The growing recognition of relationships between the specific chiropractic adjustment, and the body’s ability to communicate and coordinate its functions for optimizing health, brought new understanding of Chiropractic’s efficacy as a healing art and science. Over subsequent years the science, art and philosophy of this unique and special approach to health care was further described and detailed, with educational institutions established for students to complete an extensive course of study to become Doctors of Chiropractic. Key aspects of the chiropractic approach to health and healing were outlined in a landmark text listing 33 Principles of Chiropractic in 1927, with additional insights and data to follow in an expanding compendium of reference texts and research reports ever since. Over years of research, clinical practice and education, Chiropractic has grown into a widely recognized, distinctive health care profession with an expanding collection of research references, documentation of efficacy and cost-effectiveness, and growing numbers of enthusiastic and grateful patients around the globe.

As an emergent new health science and practice now 120 years old, Chiropractic is predicated on the recognition that the human body is a self-healing, self-regulating organism. And, most constructively, Chiropractic understands how the body, rather than requiring interventions that interrupt or intrude in the healing process, instead needs no interference with its innate capacities for self-coordination, organized communication, and repair -- which is now a concept so accepted and credible that widely-recognized authorities like Drs. Andrew Weil and Deepak Chopra base the core premise of their best-selling books and recordings on this healing model.

The pioneering efforts and key principles of Dr. Palmer that, in his time, were deemed an affront to the orthodox medical industry of the era, set the course for a health revolution in the United States and around the world. From its modest and, unfortunately, often misunderstood and misconstrued beginnings, Chiropractic continues to grow in popularity and acceptance, and is now coming into its own as the largest drugless healthcare profession. It was because of the authenticity and soundness of these principles that Chiropractic has not only survived initial harsh criticism and onslaught by its detractors, but has flourished, and now is increasingly understood and embraced by a wide audience of people in search of health and optimizing their potential in life.

After 120 Years How Are We Choosing To Change The World?

A message to all Chiropractors on the 120th birthday of our profession

Chiropractic embodies a truth and as that is shared through words and actions the more the awareness of that truth will spread. When that awareness reaches critical mass, action, actual system wide change will automatically come forth. I know we all want action now but I feel that the best action right now is to continue to tell the story. Right now there are too many people and groups that will try to squash any real action steps, and they will most likely succeed. It will only be when critical mass has been reached that the core paradigm will shift and those same people and groups will not be able to stop the actions that will spring forth. Perhaps our charge is to continually strengthen the wave of change that is already rising and then ride that wave on to the beach of a brighter future.

P.S. As BJ Palmer once said, "You never know how far reaching something you may think, say or do today, could affect the lives of millions tomorrow!" Who knows how many souls have read or been told something today, right now this very minute, that has changed how they view the world for the better. People that, had others not been willing to tell the story again and again and again and again, might not have heard it. Getting frustrated with the world and people today is normal, but change will happen faster if we are willing to keep telling the story.

"It is not the final chop that brings the tree down but all the ones that came before."

Keep chopping away.

Happy Birthday to a great profession and principle!

Harvard Study: Chiropractic Care Is Safe

Harvard Study Points to Chiropractic Care for Pain Relief

& The Safety of the Chiropractic Adjustment
 

By  Noah Herbert, D.C., CCSP®, William J. Owens DC, DAAMLP,  Mark Studin DC, FASBE(C), DAAMLP, DAAPM
 

A recent article released by Harvard Health Publications at Harvard Medical School points to chiropractic care as a form of pain relief. There are currently many Americans that seek out chiropractors, but many people don’t realize the wide variety of treatments that a chiropractor can provide for pain relief. The article states "while the mainstay of chiropractic is spinal manipulation, chiropractic care now includes a wide variety of other treatments, including manual or manipulative therapies, postural and exercise education, ergonomic training (how to walk, sit, and stand to limit back strain), nutritional consultation, and even ultrasound and laser therapies. In addition, chiropractors today often work in conjunction with primary care doctors, pain experts, and surgeons to treat patients with pain."
 

While this is nothing new for the chiropractic community, it may serve to further educate the public as to the many tools a chiropractor possesses to help patients. While the majority of research on chiropractic has focused on spinal manipulation, or adjustment of the spine, for pain relief, there have been studies done on the effectiveness of chiropractic for treating musculoskeletal pain, headaches, asthma, carpal tunnel syndrome and fibromyalgia (Harvard Health Publications). The author goes on to state "a recent review concluded that chiropractic spinal manipulation may be helpful for back pain, migraine, neck pain and whiplash." It should be pointed out there have been reports of serious complications, including stroke, but this has been shown to be extremely rare and some studies suggest this may not be directly caused by the treatment provided by the chiropractor (Harvard Health Publications).
 

Spinal manipulation, or adjustment of the spine, is a term used to describe providing a high velocity, low amplitude thrust to the vertebra. Chiropractors use this technique to correct the body’s spinal alignment to relieve pain and improve function and to allow the body to heal itself. Treatment usually takes between 10 to 20 minutes and most patients are scheduled 2-3 times per week initially. Patients generally see improvement of their symptoms in the first two to three weeks (Harvard Health Publications).
 

Harvard Medical School is now saying what chiropractors have been saying for over 100 years and although their article was based on pain, it does add more evidence to the false rhetoric of chiropractic patients having a greater risk of stroke. In the future, reports from Harvard and other medical academic institutions will embrace the growing body of scientific evidence of the varied maladies that respond to chiropractic care.
 

References:

Harvard Health Publications. (2015). Chiropractic Care for Pain Relief. Retrieved from http://www.health.harvard.edu/pain/chiropractic-care-for-pain-relief
 

 (Editor's note: Remember the objective of upper cervical chiropractic care is to correct spinal misalignment that is interfering with proper brain to body communication. When this is corrected the body functions at a higher level and can often correct other problems more efficiently on its own. Please do not confuse upper cervical chiropractic care as a treatment for any condition, disease or symptom.)

Profound Yet Simple

by Earl W. Powell, Ph.D.

Many of the most profound ideas in life are really very simple and many of the most simple things in life are really very profound. For instance, the basic ideas of many religions can often be stated simply, but they are ideas that have been profound enough to change the course of millions of lives, and indeed, the course of history.

Simple ideas, or what is afterwards thought of as simple, often come through long study and research -- painstaking trial and error until at last the truth is found. Then upon this truth is built a great and lasting contribution of vital concern, sometimes to all mankind.

Much of the simple truth of chiropractic has come this way. Dedicated men and women searching for answers without closed minds, accumulating knowledge dating back even to the father of health philosophy, Hippocrates.

What is this simple idea that now benefits the health of millions people around the world? It is simply that the nerve system is the "message-carrier" of good health to every part of your body. When there is an interference with the messages to and from the brain, in the nerve system, ill-health will result.

There is no more perfectly ordered mechanism in all of creation than the living body. All that is essential to the maintenance of good health is contained WITHIN us and, so long as the life forces commanded by our innate intelligence are permitted to flow freely through the nerve system good health is the inevitable result. Because of the great wealth of knowledge developed over the years, chiropractors today can find nerve interference with greater ease and adjust the spine with greater accuracy to open "nerve contact" and let the message of good health get through.

The profound wish for good health can most often be fulfilled with the simple truth of chiropractic.

Neck Adjustments and Stroke Risk?

CMT & Stroke Risk: Myth vs. Fact

By Christine Goertz, DC, PhD and Dana Lawrence, DC, M. Med. Ed., MA

By now, most of you have probably heard that the American Heart Association recently published a statement regarding the association between cervical dissection (CD) and cervical manipulative therapy (CMT).

The Aug. 7, 2014 statement, accompanied by a white paper on the topic, was endorsed by both the American Association of Neurological Surgeons and the Congress of Neurological Surgeons. The statement reads as follows:

"CD is an important cause of ischemic stroke in young and middle-aged patients. CD is most prevalent in the upper cervical spine and can involve the internal carotid artery or vertebral artery. Although current biomechanical evidence is insufficient to establish the claim that CMT causes CD, clinical reports suggest that mechanical forces play a role in a considerable number of CDs. Most population controlled studies have found an association between CMT and VAD stroke in young patients. Although the incidence of CMT-associated CD in patients who have previously received CMT is not well established and probably low, practitioners should strongly consider the possibility of CD as a presenting symptom, and patients should be informed of the statistical association between CD and CMT prior to undergoing manipulation of the cervical spine."1

Based upon our own initial strong response to this statement, we want to take a moment to remind everyone about the most recent article we wrote for this column, in which we talked about the need for doctors of chiropractic to be evidence-based in our responses to derogatory comments and/or articles written about the profession.2 Key recommendations that apply to the present conservation included the following:


Take a day or two to calm down before getting out your pen!

Ask yourself, what is the author's claim and is it supported by data?

Consider whether you have data to support a counterclaim.

Assess your response as critically as you have assessed the original article.


The AHA statement presents a perfect opportunity to put this advice into practice. We have already calmed down, so the next step is to review the author's claims and ask if each claim is supported by data (i.e., true or false) and whether there is data to support a counterclaim.


Analyzing the AHA Statement

"CD is an important cause of ischemic stroke in young and middle-aged patients." This statement is supported by the data. Although rare, epidemiological studies estimate the incidence of internal carotid artery dissection at approximately 2.6/100,000 and vertebral artery dissection at approximately .97/100,00.3

"CD is most prevalent in the upper cervical spine and can involve the internal carotid artery or vertebral artery." This statement is well-supported by data. Internal carotid artery dissection is more common than vertebral artery dissection.4

"Although current biomechanical evidence is insufficient to establish the claim that CMT causes CD..." This statement is misleading, at best. It is not that current biomechanical evidence is insufficient to establish the claim, but rather that every study designed to address this issue has shown that it is very unlikely that CMT causes CD.

In the AHA white paper associated with their statement, several studies are referenced that evaluated CMT and cervical biomechanics. A small number of imaging studies have examined arterial blood flow to see if the strain placed on the arteries during a cervical adjustment decreases blood flow at a level that would cause arterial dissection.5-7 Not a single study indicated this is the case. An additional study on cadavers also showed that pressure on the vertebral arteries resulting from CMT is not sufficient to cause a dissection.8

"Clinical reports suggest that mechanical forces play a role in a considerable number of CDs." This statement should not be considered evidence-based for several reasons. First, clinical or case reports are considered to be a relatively low level of evidence,9 and for very good reason. It is not possible to establish a causal relationship from clinical reports. Second, we know from the biomechanical research referenced above that the mechanical forces associated with CMT are unlikely to be the cause of CDs. Finally, the phrase considerable number is disappointingly vague and therefore essentially meaningless.

"Most population-controlled studies have found an association between CMT and VAD stroke in young patients." This statement is supported by the data.10

"Although the incidence of CMT-associated CD in patients who have previously received CMT is not well established..." We do not have really good data on how many people who experience a CD previously received CMT. At the same time, it is misleading to include the phrase CD-associated, as it implies causation. As stated in Wikipedia, "a correlation [or in this case, an association] between two variables does not necessarily imply that one causes the other."

In fact, the most definitive study to date, published in Spine by Cassidy, et al.,10 found that while there is an association between CMT and CD, a similar association exists between a visit to a family-practice medical physician and CD. In other words, a person is as likely to have gone to a medical doctor as a doctor of chiropractic in the week before experiencing a CD. Since MDs are not performing CMT, a logical hypothesis is that people with symptoms of a CD seek treatment from a health care provider.

"...and probably low..." There is no probably about it: The incidence of CMT-associated CD in patients who have previously received CMT is very, very low. Approximately 8 percent of U.S. adults receive spinal manipulation every year.11 We don't know exactly how many of these patients receive cervical manipulation, but it is safe to say it is a "considerable number" (in the millions). The relatively high prevalence of CMT use must be contrasted with the very low incidence of CD. Cassidy, et al., identified 1,818 strokes in 100-million person years.10 A more recent study was able to confirm 388 CDs within a population of 16 million.12

"...practitioners should strongly consider the possibility of CD as a presenting symptom..." This is absolutely true. Two common symptoms are unilateral neck pain and headache.4

"...and patients should be informed of the statistical association between CD and CMT prior to undergoing manipulation of the cervical spine." By virtue of our chiropractic license, we, as is true for all health care providers, have an obligation to inform patients of any known risk associated with any procedure we perform. However, health care practitioners also have an obligation to ensure the information they present to patients in the context of informed consent is based upon the best evidence available.

Currently, the best basic science evidence available indicates that the strains placed on the vertebral artery during CMT are unlikely to cause a stroke, and the best clinical evidence available shows that a person is as likely to have seen a primary care medical physician as a doctor of chiropractic in the seven days prior to experiencing a CD.


A Missed Opportunity

As we critically assess our response, it is our opinion that the AHA statement mixes scientific facts with half-truths and misleading statements, leading people to ultimately arrive at the erroneous conclusion that it has been established CMT causes CD. If you look at the newspaper and blog headlines generated by this statement (e.g., "How Safe Are the Vigorous Neck Manipulations Done by Chiropractors?"13 and "Chiropractic Manipulation of Neck: Stroke Risk?"14), you realize this is precisely what happened when the statement was released.

The AHA white paper lists several events that are associated with CD. These include major and minor cervical trauma, use of oral contraceptives, sporting activities, stretching the neck, some neck movements, violent coughing or vomiting, and visiting a health care provider who administers spinal manipulation. Yet for some reason, the AHA chose to focus its statement on the single association within that list for which there is the strongest evidence against a causal relationship.

By concentrating exclusively on the purported risk of CD following CMT, the AHA has missed an invaluable opportunity to educate both patients and practitioners of the incidence, warning signs, and broad range of factors associated with CD. We challenge the chiropractic profession to step up to the plate and take on this important task.


References

1. Biller J, Sacco R, Albuquerque F, et al. AHA/ASA Scientific Statement. Cervical Arterial Dissections and Association With Cervical Manipulative Therapy: A Statement for Healthcare Professionals From the American Heart Association / American Stroke Association, 2014.

2. Lawrence D, Goertz C. "How to Respond When the Media Criticizes Chiropractic: Do's and Don'ts." Dynamic Chiropractic, July 1, 2014.

3. Lee VH1, Brown RD Jr, Mandrekar JN, Mokri B. Incidence and outcome of cervical artery dissection: a population-based study. Neurology, 2006 Nov 28;67(10):1809-12.

4. Schievink W, Mokri B, O'Fallon W. Recurrent spontaneous cervical-artery dissection. N Engl J Med, 1994;330:393-397.

5. Creighton D, Kondratek M, Krauss J, et al. Ultrasound analysis of the vertebral artery during non-thrust cervical translatoric spinal manipulation. J Man Manip Ther, 2011 May;19(2):84–90.

6. Haynes M, Milne N. Color duplex sonographic findings in human vertebral arteries during cervical rotation. J Clin Ultrasound, 2001 Jan;29(1):14-24.

7. Bowler N, Shamley D, Davies R. The effect of a simulated manipulation position on internal carotid and vertebral artery blood flow in healthy individuals. Man Ther, 2011 Feb;16:87–93.

8. Symons BP1, Leonard T, Herzog W. Internal forces sustained by the vertebral artery during spinal manipulative therapy. J Manip Physiol Ther, 2002 Oct;25(8):504-10.

9. Aslam S, Georgiev H, Mehta K, Kumar A. Matching research design to clinical research questions. Indian J Sex Transm Dis, 2012 Jan-Jun;33(1):49-53.

10. Cassidy JD, Boyle E, Côté P, et al. Risk of vertebrobasilar stroke and chiropractic care: results of a population-based case-control and case-crossover study. Spine, 2009 Feb;32(2 Suppl):S201-8.

11. Barnes PM1, Bloom B, Nahin RL. Complementary and alternative medicine use among adults and children: United States, 2007. Natl Health Stat Report, 2008 Dec 10;(12):1-23.

12. Cai X, Razmara A, Paulus K, et al. Case Misclassification in studies of spinal manipulation and arterial dissection. J Stroke Cerebrovasc Diseases, 2014.

13. Berger S. "How Safe Are the Vigorous Neck Manipulations Done by Chiropractors?" The Washington Post, Jan. 6, 2014.

14. Thompson D. "Chiropractic Manipulation of Neck: Stroke Risk?" WebMD, Aug. 7, 2014.

(Editor's Note:  Based on the above well referenced article it would be logical to conclude that upper cervical care would carry even less risk since most upper cervical chiropractic methods are very gentle and adjust the patient in neutral postures with no rotation of the neck.)