Physicians
The title is not meant to indicate that the information on this page is of interest only to physicians or that it is too complex in nature for a layman to understand. Understanding that it is unlikely that any visitor will read all of the material at this site, I simply want to direct the attention of any visiting physicians to this particular page. It is here that physicians who have not already had referral relationships with chiropractors may find some measure of confidence that having such a relationship is not an unreasonable thing to do.
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1. I feel chiropractic care has its greatest success in treating mechanical pain syndromes. The following characteristics or mechanical pain are common:
| brought on or made worse by certain positions or actions |
| relieved by gentle motion, worse with gross or strenuous motion |
| relieved by rest, aggravated by prolonged rest |
| worse when first rising, better through day, worse again by evening |
| accompanied by spasm, impaired motion, and/or point tenderness at or near the focus of pain. return to top |
2. A chiropractor, like any other clinician, has to be alert for red flags that can indicate that referral is called for or that certain treatment modalities may not be indicated. We too are on the lookout for:
| Fevers |
| Night sweats |
| High blood pressure |
| Angina or angina-like pain which increases with activity |
| History of cancer (with a presumption of recurrence until proven otherwise) |
| Pain without mechanical association - GU, GI, Cardiovascular conditions, etc. |
| Personal or familial history of arthritides, particularly RA, AS |
| Failure to respond to therapy within a reasonable amount of time - progress should be noted within two weeks in the absence of known aggravating circumstances. return to top |
3. Spine-related pain is frequently attributed to DJD (osteoarthritis or OA) of the spine which has been revealed radiographically. DJD probably is part of the story much of the time, but I do not think that it is the whole story. It is obvious that to be visible on a radiograph, DJD must have been present for a significant amount of time before symptoms were present and radiographs obtained. And DJD will still be visible long after the symptoms have passed, so can it be logical identified as the source of a patient's pain? Besides, we have all seen many examples of similar pain in radiographically "perfect" or "normal" spines. return to top
What to call it then? Perhaps strains, sprains, and spasm with their attendant pain distributions are sufficient working diagnoses, particularly where there are no radicular pain patterns. While DJD is certainly part of the picture, it represents permanent change. Focusing undue attention to a permanent phenomenon can serve to rob a patient of the hope that his situation can be improved. return to top
4. Even without radiographs and scans to quantify it, a presumption that osteopoenia or osteoporosis exists in all postmenopausal women and in everyone in their sixties and over is a reasonable starting point. Bone density or mass reduction is a relative red flag, but only a relative one. Chiropractors tailor the amount of force that they use from individual to individual. Reduction in the amount of force used to treat a patient who is likely to have osteoporosis is a given — something we all do without having to give it much thought. Primum non nocere is our watchword too. return to top
5. You may have heard that chiropractors oppose immunization. It is true that some do, but they are not in the mainstream of chiropractic practice. These ultraconservatives are apt to be very vocal and would have their audiences believe that all chiropractors foster this attitude. I acknowledge that there are risks involved in immunizing an individual, but as a public health issue I feel the logic of immunizing populations against diseases is inescapable. The members of my family have all had the routine immunizations that standard medical practice demands. return to top
6. I frequently use an analogy to illustrate for patients the rationale of using chiropractic treatment (essentially a mechanical modality) to treatment mechanical pain.
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Picture a vehicle stuck on a beach at the shore.
Automotive specialists of all stripes converge to help. Transmission, engine,
tire, auto body, electrical, and fuel specialists all agree that the vehicle is
in perfect working order, yet the vehicle remains stranded. At last a tow truck
operator comes by, pulls the vehicle to a firmer surface where it can once
again run normally. Certainly this is an oversimplification that falls a little
flat because all of the automotive specialists would have known the vehicle
needed to be pushed or pulled free. Physicians with an appreciation of
mechanical problems are increasingly discovering that chiropractors offer a
sound conservative alternative. And, if our efforts fail to gain the desired
end, the orthopedist, neurosurgeon, or other appropriate specialist can still
be called in. In other words, let the chiropractor attempt to push the vehicle
out of the sand by hand before calling for the specialist’s tow truck. |
7. I do not think that chiropractic care saves anyone from necessary surgery. return to top
8. Chiropractors frequently use the term "subluxation." In fact for Medicare and Workers' Compensation claims we must include the diagnosis of "subluxation(s)" in order to be compensated. Life would be easier without the term — start with the fact that the medical term means something very different. If it were known as "chiropractic subluxation" (fashioned after "osteopathic lesion") and had a distinctive ICDA code series, there would be less confusion. Instead of an incomplete dislocation, what we are referring to is an abnormal relationship between two bones, usually vertebrae, and the constellation of neurological, muscular, circulatory, and physiological changes that attend that abnormal relationship. return to top
9. How should a physician choose between referral for chiropractic treatment or physical therapy? That is not the easiest question to answer and without sounding hopelessly biased, but frankly it is not always a choice of one or the other - both may be called for. I feel that mechanical lesions heal fastest and best if the primary attention is to mobilization of specific motor units. And I feel that chiropractic is the better approach for effective mobilization. If the patient needs rehabilitation of a serious wound or injury, where a prolonged period of therapy is anticipated, perhaps physical therapy is the better choice. But where mechanical symptoms persist after a reasonable trial of physical therapy, chiropractic care should certainly be considered. return to top
10. On average, routine treatment of a new patient is from four to six times before release, some may respond in one time; others may take longer. The things that militate toward longer treatment periods are no surprise: duration and severity of symptoms, radiations, age, physical conditioning, concomitant conditions, presence of swelling, and so on. In a managed care environment, if referrals were made for six office visits, I would rarely have to request an extension. return to top
11. Medical x-ray use has declined precipitously in recent years. That trend is paralleled in most chiropractic offices. I no longer have an x-ray machine in my office. Instead, I prefer to refer to a radiology center when necessary. In general, though, radiographs have little or no prescriptive value for chiropractic treatment. They hold the most value proscriptively, in that they can demonstrate conditions where chiropractic care could be contraindicated. return to top
12. I hope this list will serve as the seed for growth of a more comprehensive one. If you have any questions that are left unanswered, please feel free to ask me by email at questions@bridgeportchiropractic.com.
Gerard E. Sullivan, DC
4401 Bridgeport Way W
University Place, WA 98466