I’m hoping a medical professional could explain, in unbiased language (since there seems to be some animosity towards them), what exactly a chiropractor does, and how they fit into rehabilitation for patients alongside massage therapists and physical therapists. What can a chiropractor do for a patient that a physical therapist cannot?
Additionally, when a chiropractor says a vertebrae is “out of place” or “subluxated” and they “put it back,” what exactly are they doing? No vertebrae stays completely static as they are meant to flex, especially in the neck. Saying they’re putting it back in place makes no sense when it’s just going to move the second you get up from the table.
Thanks.
In: Biology
Physical therapist that gets asked this question at least once a week here. Here’s my….diplomatic answer:
Chiropractic practice began in the 1800s and considers itself an evolution/variant/extension/permutation/whatever of osteopathic medicine. Essentially, in their view, the body needs to be looked at as a whole rather than individual symptoms to be treated. Chiropractors classic theory then says that the stresses of day to day living, trauma, etc will cause shifts in how your bones are “aligned” which then affects blood circulation and conduction of signals by the nervous system which will ultimately affect your global health. Therefore by “adjusting” the skeleton back to its ideal form, you can restore homeostasis and the body will then naturally heal itself.
Modern research has shown for a while that the force required to truly relocate bones that aren’t legitimately dislocated would either be injurious to the patient or you would have to be superhuman to actually do so (particularly in the case of vertebra given how thick the ligaments that hold each piece together — you don’t often see people spontaneously paralyze themselves because their spine fell apart like a game of Jenga). As such, you see more and more chiropractors start to hock other “natural” remedy treatments that still stick to the original idea of a “holistic body treatment”. Not that there’s anything wrong with considering a patient as a whole person in your treatment options, but when you’re approaching the problem as an endless cycle of pushing joints back into position that will inevitably “fall out” again (as opposed to say, helping them perform their daily tasks without pain and educating them on what they can do to be as independent as possible) is that really keeping the patient’s best interests in mind?
Edit: as for what is “actually” happening when PTs or Chiros perform a joint manipulation/adjustment/thrust technique based on current evidence: All joints are sealed and filled with lubricant fluid. The techniques involve momentarily distracting the pieces from each other, creating a gas bubble from the negative pressure that results in a chemical reaction cascade ultimately resulting in endorphins being released to the surrounding musculature, allowing them to relax and the joint then can move more due to less restrictions from muscular tightness.
I go to a NUCCA chiropractor (they specialize in upper cervical adjustments). It’s very subtle and the appointment lasts about 2 minutes for adjustments. It’s not the crazy popping and twisting you see on a lot of videos.
They do X-rays and I have some pretty cool X-rays that show how my neck/spine has gotten back into the curve it’s supposed to have. The way they phrase it is to get the body in the best alignment possible so that it can heal itself and do its thing. So they measure and do minor adjustments on my neck and back and it’s over in a couple of minutes. I’m not sure if every chiropractor does X-rays and photos but this particular one does (again it’s a NUCCA chiropractor).
I went because of vertigo issues and random research said to look for that particular type of chiropractor. Placebo or not my vertigo attacks have been reduced, my posture is better (with photos and X-rays…so some kind of data) and I generally feel a lot better.
I know a lot of folks hate on chiropractors and I honestly don’t know if it scientifically does anything. But besides feeling better, seeing the photos and X-rays, to me, was some kind of data showing something actually/physically changed besides “just feeling better.”
Chiropractic was *literally made up* by an anti-medicine con artist who said it was a religion given to him in a dream by a magical ghost.
I am not making any part of that up.
Chiropractors do *nothing* in a best case scenario. Unfortunately they also hurt lots of people too.
I doctor friend of mine told me there was a study done with nearly 50,000 patients. A third went to a chiropractor, the second third went to a massage therapist and the final third were given one page document telling what exercises to do. The results for the three groups were similar.
So. Bad things. Bad bad things.
Know how you pop your knuckles? And move the bones around in your fingers? Imagine that but in your shoulders hips and spine.
This is a really bad thing and almost every doctor I know gets angry at the mention of them
99% is nonsense. I found one near me that runs a legit medical facility with PT and doctors on site. He was the first one to openly admit that the adjustment does virtually nothing, and I spent most of my time there doing traction exercises to help restore curvature to my neck, and I was able to see progress through x-rays. That solved the pain issue and I stopped going. With being more mindful about my posture I haven’t had an issue since.
I sit at a computer all day and my lower back feels all smushed by the end. So at night I end up stretching. Much like a cat, even holding something to pull myself to ‘decompress’ my spine”, or at least that’s how it feels.
I know the term ‘*decompression*’ is something Chiros always say. Is this the same? Should I not do this?!
A chiropractor is like a good massage therapist; they don’t heal you, they make you feel better. Pain relief is a good thing. They don’t heal shit; they just make you feel better.
Physically, chiropractic is basically a combination of really halfhearted massage and really lazy physical therapy. The reason it works, to the degree that it works, is that both massage and physical therapy are extraordinarily beneficial. Good physical therapy and good massage can absolutely do freaking wonders for the healing process, and so something that sort of half heartedly combines small bits of both of them is probably going to have some positive therapeutic effect.
I will add that part of the reason massage is so effective is that it releases a lot of endorphins in the muscles, and “adjustments” also release some endorphins, so there’s that.
But of course, all of the claims by chiropractors are absolute woo, and chiropractic adjustments have caused numerous significant injuries and deaths because it is really absolutely unhinged. Yet it has some small therapeutic impact by dint of overlap with massage and PT, so insurance will usually pay for it, so it is accepted.
Chiropractors vary tremendously. Some are “quacks,” while others are essentially physical therapist that focus on the back/neck. If you are considering one… do your homework. If your doctor recommends one, you are probably safe going to that one.
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