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Chiropractors See It Differently: A Surgeon’s Observations

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Handbook of Spine Technology

Abstract

The practice of physical manipulation and manual therapies as treatment options for low back pain and other spinal problems has been prevalent for thousands of years. Manual therapies in the Western world are often offered by chiropractors as part of alternative medicine. Modern and mainstream health care community has greatly benefited from chiropractic practice, especially in alleviating spinal pain and related injuries. Although chiropractic practice has remained consistent over the years, it has gradually transitioned from craft to profession. However, the profession continues to encounter numerous internal and external challenges that have threatened to curtail its aim of becoming a fully-accepted practice in the mainstream health care industry.

This chapter, researched and written by a spine surgeon, is aimed at providing insight into the role of chiropractors in promoting population health by offering interventions for low back pain. The chapter is based on a wide range of literature on the positive contribution of chiropractors in the promotion of patients’ well-being. The author discusses the similarities and differences between chiropractors and other health care professionals in terms of education, training, work philosophy, and treatment mechanisms. Much of the focus on this chapter will be on the extent to which chiropractors view their profession as complementary to rather than contrary to mainstream health care community.

A clear understanding about chiropractic is important because it will see the profession gain full legitimacy in the allied health field. Most importantly, the chapter will help in bridging the conceptual gap that exists between chiropractors and other health care providers. Most importantly, policy makers and the general public will change their skepticism with regards to the crucial profession of chiropractic and begin embracing the concepts of traditional and alternative medicine to improve public health.

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References

  • Abdel Shaheed C, Maher CG, Williams KA, Day R, McLachlan AJ (2016) Efficacy, tolerability, and dose-dependent effects of opioid analgesics for low back pain: a systematic review and meta-analysis. JAMA Intern Med 176(7):958–968. https://doi.org/10.1001/jamainternmed.2016.1251

    Article  CAS  PubMed  Google Scholar 

  • Blanchette MA, Stochkendahl MJ, Borges Da Silva R, Boruff J, Harrison P, Bussiéres A (2016) Effectiveness and Economic Evaluation of Chiropractic Care for the Treatment of Low Back Pain: A Systematic Review of Pragmatic Studies. PLoS One 11(8):e0160037. Published 2016 Aug 3. https://doi.org/10.1371/journal.pone.0160037

  • Bronfort G, Haas M, Evans R, Leininger B, Triano J (2010) Effectiveness of manual therapies: the UK evidence report. Chiropr Osteopat 18(1):3

    Article  Google Scholar 

  • Brouwer PA, Brand R, van den Akker-van ME, Jacobs WC, Schenk B, van den Berg-Huijsmans AA, … Peul WC (2015) Percutaneous laser disc decompression versus conventional microdiscectomy in sciatica: a randomized controlled trial. Spine J 15(5):857–865

    Google Scholar 

  • Brox JI, Sorensen R, Friis A, Nygaard Ø, Indahl A, Keller A et al (2003) Randomized clinical trial of lumbar instrumented fusion and cognitive intervention and exercises in patients with chronic low back pain and disc degeneration. Spine 28:1913–1921

    Article  Google Scholar 

  • Bussières AE, Al Zoubi F, Stuber K, French S, Boruff J, Corrigan J, Thomas A (2016) Evidence-based practice, research utilization, and knowledge translation in chiropractic: a scoping review. BMC Complement Altern Med 16:216

    Article  Google Scholar 

  • Carnes D, Mars TS, Mullinger B, Froud R, Underwood M (2010) Adverse events and manual therapy: a systematic review. Man Ther 15(4):355–363

    Article  Google Scholar 

  • Chapman-Smith D (2010) The chiropractic profession: basic facts, independent evaluations, common questions. Chiropr Rep 24:1–8

    Google Scholar 

  • Cherkin DC, Sherman KJ, Balderson BH, Cook AJ, Anderson ML, Hawkes RJ, … Turner JA (2016) Effect of mindfulness-based stress reduction vs cognitive behavioral therapy or usual care on back pain and functional limitations in adults with chronic low back pain: a randomized clinical trial. JAMA 315(12):1240–1249

    Google Scholar 

  • Chou R, Qaseem A, Snow V, Casey D, Cross JT, Shekelle P, Owens DK (2007) Diagnosis and treatment of low back pain: a joint clinical practice guideline from the American College of Physicians and the American Pain Society. Ann Intern Med 147(7):478–491

    Article  Google Scholar 

  • Chou R, Baisden J, Carragee EJ, Resnick DK, Shaffer WO, Loeser JD (2009) Surgery for low back pain: a review of the evidence for an American Pain Society Clinical Practice Guideline. Spine (Phila Pa 1976) 34:1094–1109

    Article  Google Scholar 

  • Clar C, Tsertsvadze A, Hundt GL, Clarke A, Sutcliffe P (2014) Clinical effectiveness of manual therapy for the management of musculoskeletal and non-musculoskeletal conditions: systematic review and update of UK evidence report. Chiropr Man Ther 22(1):12

    Article  Google Scholar 

  • Coulter ID (1997) What is chiropractic. McNamee KP. The chiropractic college directory, 98

    Google Scholar 

  • Coulter I, Adams A, Coggan P, Wilkes M, Gonyea M (1998) A comparative study of chiropractic and medical education. Altern Ther Health Med 4(5):64–75

    CAS  PubMed  Google Scholar 

  • Davis MA, Yakusheva O, Gottlieb DJ, Bynum JPW (2015) Regional supply of chiropractic care and visits to primary care physicians for back and neck pain. J Am Board Fam Med 28(4):481–490

    Article  Google Scholar 

  • Deyo RA (2015) Fusion surgery for lumbar degenerative disc disease: still more questions than answers. Spine J 15(2):272–274. https://doi.org/10.1016/j.spinee.2014.11.004

  • Deyo RA, Mirza SK, Martin BI (2006) Back pain prevalence and visit rates: estimates from U.S. national surveys, 2002. Spine (Phila Pa 1976). 31(23):2724–2727. https://doi.org/10.1097/01.brs.0000244618.06877.cd

  • Deyo RA, Mirza SK, Martin BI, Kreuter W, Goodman DC, Jarvik JG (2010) Trends, major medical complications, and charges associated with surgery for lumbar spinal stenosis in older adults. JAMA 303(13):1259–1265

    Article  CAS  Google Scholar 

  • Dynamic Chiropractic (2007) Gallup poll: Americans have low opinion of chiropractors. Retrieved August 27, 2019, from https://www.dynamicchiropractic.com/mpacms/dc/article.php?id=52038

  • Edzard E (2016) The evidence shows that chiropractors do more harm than good. Retrieved August 29, 2019, from https://life.spectator.co.uk/articles/the-evidence-shows-that-chiropractors-do-more-harm-than-good/

  • Elton D (2014) The distribution and analysis of annualized claims data for more than 3.7 million commercial health plan members. Data retrieved from the United Healthcare national commercial claims database, July 1, 2013−June 30, 2014. November 10, 2014

    Google Scholar 

  • Fairbank J, Frost H, Wilson-MacDonald J, Yu LM, Barker K, Collins R (2005) Randomized controlled trial to compare surgical stabilization of the lumbar spine with an intensive rehabilitation program for patients with chronic low back pain: the MRC spine stabilization trial. BMJ 330(7502):1233

    Article  Google Scholar 

  • Feldman V (2014) Return on investment analysis of Optum offerings – assumes Network /UM/Claims services; Optum Book of Business Analytics 2013. Analysis as of December 8, 2014

    Google Scholar 

  • Fritzell P, Hagg O, Wessberg P, Nordwall A, Swedish Lumbar Spine Study Group (2002) Chronic low back pain and fusion: a comparison of three surgical techniques: a prospective multicenter randomized study from the Swedish lumbar spine study group. Spine 27:1131–1141

    Article  Google Scholar 

  • Gibson JNA, Waddell G (2005) Surgery for degenerative lumbar spondylosis: updated Cochrane Review. Spine 30(20):2312–2320

    Article  Google Scholar 

  • Globe G, Farabaugh RJ, Hawk C, Morris CE, Baker G, Whalen WM, … Augat T (2016) Clinical practice guideline: chiropractic care for low back pain. J Manip Physiol Ther 39(1):1–22

    Google Scholar 

  • Hartvigsen, JanBuchbinder, Rachelle et al (2018) What low back pain is and why we need to pay attention. The Lancet 391(10137):2356–2367

    Google Scholar 

  • HCUPnet (2014) Agency for Healthcare Research and Quality. http://hcupnet.ahrq.gov/HCUPnet.jsp. Accessed 30 Oct 2014

  • Helm S II, Deer TR, Manchikanti L, Datta S, Chopra P, Singh V et al (2012) Effectiveness of thermal annular procedures in treating discogenic low back pain. Pain Physician 15:E279–E304

    Google Scholar 

  • Hurwitz EL, Carragee EJ, van der Velde G, Carroll LJ, Nordin M, Guzman J, Bone and Joint Decade 2000–2010 Task Force on Neck Pain and Its Associated Disorders (2008) Treatment of neck pain: noninvasive interventions: results of the Bone and Joint Decade 2000–2010 Task Force on Neck Pain and its Associated Disorders. Spine 33(4 Suppl):S123–S152. https://doi.org/10.1097/BRS.0b013e3181644b1d

    Article  PubMed  Google Scholar 

  • Jacobs WC, van Tulder M, Arts M, Rubinstein SM, van Middelkoop M, Ostelo R et al (2011) Surgery versus conservative management of sciatica due to a lumbar herniated disc: a systematic review. Eur Spine J 20:513–522

    Article  Google Scholar 

  • Jacobs W, van der Gaag NA, Tuschel A, de Kleuver M, Peul W, Verbout AJ et al (2012) Total disc replacement for chronic back pain in the presence of disc degeneration. Cochrane Database Syst Rev 9:CD008326

    Google Scholar 

  • Johnson C, Killinger LZ, Christensen MG, Hyland JK, Mrozek JP, Zuker RF, … Oyelowo T (2012) Multiple views to address diversity issues: an initial dialog to advance the chiropractic profession. J Chiropr Humanit 12;19(1):1–11. https://doi.org/10.1016/j.echu.2012.10.003

  • Keeney BJ, Fulton-Kehoe D, Turner JA, Wickizer TM, Chan KCG, Franklin GM (2013) Early predictors of lumbar spine surgery after occupational back injury: results from a prospective study of workers in Washington State. Spine 38(11):953–964

    Article  Google Scholar 

  • Kent C (2018) Chiropractic and mental health: history and review of putative neurobiological mechanisms. J Neuro PsyAn Brain Res: 1–10. JNPB-103

    Google Scholar 

  • Koes BW, Van Tulder M, Thomas S (2006) Diagnosis and treatment of low back pain. BMJ 332(7555):1430–1434

    Article  CAS  Google Scholar 

  • Kovacs FM, Urrútia G, Alarcón JD (2011) Surgery versus conservative treatment for symptomatic lumbar spinal stenosis: a systematic review of randomized controlled trials. Spine (Phila Pa 1976) 36(20):E1335–E1351

    Article  Google Scholar 

  • Krebs EE, Gravely A, Nugent S, Jensen AC, DeRonne B, Goldsmith ES, … Noorbaloochi S (2018) Effect of opioid vs nonopioid medications on pain-related function in patients with chronic back pain or hip or knee osteoarthritis pain: the SPACE randomized clinical trial. JAMA 319(9):872–882

    Google Scholar 

  • LeFebvre R, Peterson D, Haas M (2013) Evidence-based practice and chiropractic care. J Evid-Based Complement Altern Med 18(1):75–79

    Article  Google Scholar 

  • Liliedahl RL, Finch MD, Axene DV, Goertz CM (2010) Cost of care for common back pain conditions initiated with chiropractic doctor vs medical doctor/doctor of osteopathy as first physician: experience of one Tennessee-based general health insurer. J Manip Physiol Ther 33(9):640–643

    Article  Google Scholar 

  • Lisi AJ, Salsbury SA, Twist EJ, Goertz CM (2018) Chiropractic integration into private sector medical facilities: a multisite qualitative case study. J Altern Complement Med 24(8):792–800

    Article  Google Scholar 

  • Mannion AF, Brox JI, Fairbank J (2013) Comparison of spinal fusion and nonoperative treatment in patients with chronic low back pain: long-term follow-up of three randomized controlled trials. Spine 13(2013):1438–1448

    Article  Google Scholar 

  • Martin BI, Mirza SK, Comstock BA, Gray DT, Kreuter W, Deyo RA (2007) Reoperation rates following lumbar spine surgery and the influence of spinal fusion procedures. Spine 32:382–387

    Article  Google Scholar 

  • May S, Comer C (2013) Is surgery more effective than non-surgical treatment for spinal stenosis, and which non-surgical treatment is more effective? A systematic review. Physiotherapy 99:12–20

    Article  Google Scholar 

  • Mirza SK, Deyo RA (2007) Systematic review of randomized trials comparing lumbar fusion surgery to nonoperative care for treatment of chronic back pain. Spine 32:816–823

    Article  Google Scholar 

  • Nelson CF et al (2005) Chiropractic as spine care: a model for the profession. Chiropr Osteopat 9:1–17

    Google Scholar 

  • Nyiendo J, Haas M, Goodwin P (2000) Patient characteristics, practice activities, and one-month outcomes for chronic, recurrent low-back pain treated by chiropractors and family medicine physicians: a practice-based feasibility study. J Manipulative Physiol Ther 23(4):239–245

    Google Scholar 

  • Nyiendo J, Haas M, Goldberg B, Sexton G (2011) Patient characteristics and physicians’ practice activities for patients with chronic low back pain: a practice-based study of primary care and chiropractic physicians. J Manip Physiol Ther 24(2):92–100

    Article  Google Scholar 

  • Oderda GM, Gan TJ, Johnson BH, Robinson SB (2013) Effect of opioid-related adverse events on outcomes in selected surgical patients. J Pain Palliat Care Pharmacother 27(1):62–70

    Article  Google Scholar 

  • Paige NM, Miake-Lye IM, Booth MS, Beroes JM, Mardian AS, Dougherty P et al (2017) Association of spinal manipulative therapy with clinical benefit and harm for acute low back pain: systematic review and meta-analysis. JAMA 317(14):1451–1460. https://doi.org/10.1001/jama.2017.308612

    Article  PubMed  PubMed Central  Google Scholar 

  • Palmer DD (1967) Three generations: a history of chiropractic. Palmer College of Chiropractic. Davenport, Iowa

    Google Scholar 

  • Paulozzi LJ, Jones CM, et al (2011) Vital signs: overdoses of prescription opioid pain relievers – United States, 1999–2008. Division of Unintentional Injury Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention. 60:5

    Google Scholar 

  • Peul WC, Bredenoord AL, Jacobs WC (2014) Avoid surgery as first line treatment for non-specific low back pain. BMJ 349:g4214

    Article  Google Scholar 

  • Qaseem A, Wilt TJ, McLean RM, Forciea MA, Clinical Guidelines Committee of the American College of Physicians (2017) Noninvasive treatments for acute, subacute, and chronic low back pain: a clinical practice guideline from the American College of Physicians. Ann Intern Med 166(7):514–530. https://doi.org/10.7326/M16-23672017;166

    Article  PubMed  Google Scholar 

  • Roland M, van Tulder M (1998) Should radiologists change the way they report plain radiography of the spine?. Lancet 352(9123):229–230. https://doi.org/10.1016/S0140-6736(97)11499-4

  • Savigny P, Kuntze S, Watson P. (2009). Low back pain: early management of persistent non-specific low back pain. National Collaborating Centre for Primary Care and Royal College of General Practitioners

    Google Scholar 

  • Seladi-Schulman J (2017) Laser back surgery: benefits, drawbacks, efficacy, and more. Retrieved August 29, 2019, from https://www.healthline.com/health/back-pain/laser-back-surgery#recovery-time

  • Slaughter AL, Frith K, O’Keefe L, Alexander S, Stoll R (2015) Promoting best practices for managing acute low back pain in an occupational environment. Workplace Health Saf 63(9):408–414

    Article  Google Scholar 

  • Smith KM (2016) The relationship between institutional culture and faculty perceptions of online learning in chiropractic higher education. Doctoral dissertation, Trident University International

    Google Scholar 

  • The Bone and Joint Decade 2000–2010 for prevention and treatment of musculoskeletal disorders (1998) Conference proceedings. Acta Orthop Scand Suppl 218:1–86

    Google Scholar 

  • The Center for Behavioral Health Statistics and Quality (2016) Key substance use and mental health indicators in the United States: results from the 2015 National Survey on Drug Use and Health (HHS publication no. SMA 16-4984, NSDUH series H-51). Retrieved from https://www.samhsa.gov/data/sites/default/files/NSDUH-FFR1-2016/NSDUH-FFR1-2016.htm

  • Todd NV (2017) The surgical treatment of non-specific low back pain. Bone Joint J 99-B:1003–1005

    Article  CAS  Google Scholar 

  • Triano JJ, Goertz C, Weeks J, Murphy DR, Kranz KC, McClelland G, … Nelson CF (2010) Chiropractic in North America: toward a strategic plan for professional renewal – outcomes from the 2006 Chiropractic Strategic Planning Conference. J Manip Physiol Ther 33(5):395–405

    Google Scholar 

  • Turner JA, Shortreed SM, Saunders KW, LeResche L, Von Korff M (2016) Association of levels of opioid use with pain and activity interference among patients initiating chronic opioid therapy: a longitudinal study. Pain 157(4):849

    Article  CAS  Google Scholar 

  • United States Bone and Joint Initiative (2014) The burden of musculoskeletal diseases in the United States (BMUS), 3rd edn. Rosemont, IL. Available at http://www.boneandjointburden.org.

  • Van Tulder MW, Koes B, Seitsalo S, Malmivaara A (2006) Outcome of invasive treatment modalities on back pain and sciatica: an evidence-based review. Eur Spine J 15(1):S82–S92

    Article  Google Scholar 

  • Vowles KE, McEntee ML, Julnes PS, Frohe T, Ney JP, van der Goes DN (2015) Rates of opioid misuse, abuse, and addiction in chronic pain: a systematic review and data synthesis. Pain 156(4):569–576. https://doi.org/10.1097/01.j.pain.0000460357.01998.f1

  • Whedon J (2017) Association between utilization of chiropractic services and use of prescription opioids among patients with low back pain. Presented ahead of print at the National Press Club in Washington D.C., on March 14, 2017. Accessed online from http://c.ymcdn.com/sites/www.cocsa.org/resource/resmgr/docs/NH_Opioids_Whedon.pdf

  • Whedon JM, Mackenzie TA, Phillips RB, Lurie JD (2015) Risk of traumatic injury associated with chiropractic spinal manipulation in medicare part B beneficiaries aged 66–99. Spine 40(4):264–270

    Article  Google Scholar 

  • World Federation of Chiropractic (2005) Summary minutes of the proceedings of the assembly of members; July 14–15, 2005

    Google Scholar 

  • Young KJ (2014) Gimme that old time religion: the influence of the healthcare belief system of chiropractic’s early leaders on the development of x-ray imaging in the profession. Chiropr Man Ther 22(1):36

    Google Scholar 

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Authors and Affiliations

  1. Division of Spine, Department of Orthopedics, University of British Columbia, Vancouver, BC, Canada

    John Street

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  1. John Street
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Correspondence to John Street .

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Editors and Affiliations

  1. Department of Neurosurgery, Allegheny General Hospital Department of Neurosurgery, Mars, PA, USA

    Boyle Cheng

Section Editor information

  1. Department of Surgery, University of Toronto, Toronto, ON, Canada

    Hamilton Hall

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Street, J. (2020). Chiropractors See It Differently: A Surgeon’s Observations. In: Cheng, B. (eds) Handbook of Spine Technology. Springer, Cham. https://doi.org/10.1007/978-3-319-33037-2_134-1

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  • DOI: https://doi.org/10.1007/978-3-319-33037-2_134-1

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