Don's Home Health Spine Treatment Chiropractic
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Only in recent years have medical doctors started to work with chiropractors instead of having a confrontational relationship with them. They will refer patients to chiropractors for back pain and other musculoskeletal problems.

For many years, chiropractors were labeled as quacks by the established medical community. Part of this may have come from it's founder Daniel David Palmer (1845 - 1913), who was interested in various health philosophies of his day, such as magnetic healing, and Spiritualism. His chiropractic theories revolved around the concept that altered nerve flow was the cause of all disease. His first two claims of success with spinal adjustment were curing a deaf man and a man with heart trouble.
Traditional chiropractic is based on subluxation theory, which says that misalignments in the spine or other skeletal structures may cause blocked and impaired nerve functions. In addition to back pain the impaired nerves can lead to a variety of conditions such as allergies, asthma, digestive problems, etc.

The idea is that if a chiropractor realigns the spine then normal nerve pathways will be restored and good health will be the result for the patient. However, there is no scientific evidence that supports these theories and this is why medical doctors were opposed to chiropractic. All the studies made in support of chiropractic are basically testimonials from patients.
Source: Chiropractic Versus The AMA EZineArticles.com

Chiropractic is now licensed in every state (with the possible exception of Louisiana and Mississippi), and there are mature professional bodies for education, accreditation, and credentialing, So the profession of chiropractic, circa 2005, is here to stay.
In a 2009 Consumer Reports reader survey chiropractic had the best patient satisfaction (59% highly satisfied) for back pain.

(Note: Some people for whom I have a great deal of respect, including my father, have had good results from chiropractors; The two I tried were not helpful to me personally.)

If Hans Selye (1955) and Dr. Sarno ("The Mind-Body Connection", 1990) are correct and much of the problem is stress related, help from a chiropractic adjustment may be a placebo effect. But if you pain goes away without taking drugs, who cares!

My gut feeling is if you go to a clinic with a variety of special apparatus and professions, you would be better off than to an individual chiropractor who has a limited arsenal. Some offices have a combination of Physical Therapists, Chirporactors and Osteopaths (D.O.); That would be my choice since I had better luck with physical therapy than Chiropractic. That's assuming these things really do result in psylological changes to musculoskeletal and neurological components and are not just a placebo effect.
Note: Just because a machine is expensive or has a computer attached to it doesn't mean it's better. See discussion of Spinal decompression therapy below.

Treatment:
There is a wide variation of techniques used by different chiropractors.

The principal procedure used by many chiropractors is a form of manipulation known as adjustment that refers to a variety of manual mechanical interventions. There are over 50 adjustments in a chiropractor's repertoire.

Chiropractors also use a number of soft-tissue techniques (such as massage, heat, ice, and kneading) to relax a patient's muscles before a manipulation, to release trigger points (painful knots of muscle fibers), and to lengthen tendons and muscles.

  • Manipulation is movement of short amplitude and high velocity that moves the joint beyond where patient's muscles could move the joint by themselves but short of ligament rupture.
  • Mobilization is movements administered by the clinician within physiologic joint space in order to increase overall range of motion.
In general, an adjustment consists of a sudden, short, controlled thrust against a joint. The chiropractor will move the affected joint to the limit of its range of movement and then make a rapid thrust beyond this point to stretch the joint capsule and surrounding tissues.
The popping or cracking you sometimes hear with manipulation is not caused by vertebrae slipping back into place but from bubbles bursting in the synovial fluid in the connective tissue capsule that surrounds the joint. Gases dissolved form bubbles as the fluid become less soluble from reduced pressure as the joints are pulled apart.

The following are some of the more common techniques taken from several chiropractic web sites listed under links below; I have no information about their claims for success.

  • Diversified Chiropractic Manipulation: Diversified Technique uses a variety of adjustive techniques to detect "subluxations" and to create motion in a vertebral joint. Chiropractors who use diversified technique are more likely to offer appropriate hands-on spinal manipulation than those who use a "special technique.". They deliver a high-velocity, low-amplitude thrust or "impulse." to a joint which restores motion to the joint segment. It usually results in a cavitation of a joint (quick, shallow thrusts that cause the popping noise often associated with a chiropractic manipulation/adjustment).

  • Drop table: A special table lifts the patient and as the doctor applies adjustment(s) to the patient, the table is designed to drop a few inches simultaneously. This technique is beneficial to patients that cannot tolerate adjustments while lying on their side.
    	
    	
  • Flexion-distraction technique: The technique involves hands-on treatment and the use of a specialized table which allows for passive distraction, flexion, lateral bending, and rotation. This is a gentle, non-thrusting type of manipulation used to treat bulging or herniated discs. Spinal stenosis is also treated using this approach.
    	
    	
  • Activator: The Activator Technique incorporates the use of a unique hand-held spring-loaded instrument called the Activator that delivers a lighter, but quicker, thrust than can be delivered by hand.

  • Spinal decompression therapy: - also called Intervertebral Differential Dynamics (IDD) Therapy ® and Mechanical Decompression Distraction System (DRS)
    You are seeing more and more chiropractors with these Spinal Decompression tables.
    The two major decompression machines used by Chiropractors are the DRX9000 and the Accu-SPINA™. VAX-D (Vertebral axial decompression therapy), IDD, and DRS are similar systems.
    These are basically fancy traction machines.
    The table rotates up so you can get fitted while standing and it then lowers you down. You are fitted with a harness that allows traction to be localized to a specific area of the back. The "computer controlled" machine cycles between brief moments of pulling and relaxing (oscillation) using the "patented logarithmic decompression curve." This reduces protective muscle spasm that contributed to the poor success rate of conventional "traction" techniques. It also includes heating pads and some include electrical stimulus pads.
    It was developed by Dr. Allan E. Dyer, MD, PhD, a cardiologist and former Deputy Minister of Health in Ontario, Canada.
    Chapter 35 "Nertebral Axial Decompression" in "The Practice of Minimally Invasive Spinal Technique", 2005, talks about Dyer's system.
    Many insurers will not pay for spinal decompression treatments. Medicare will pay $20 per session for traction while chiropractors using these machines typically charge $150 to $300 per session.
    Some of the literature (distributed by chiropractors not the manufacturer) refer to the 1994 Ramos Martin article "Effects of vertebral axial decompression on intradiscal pressure" in the Journal of Neurosurgery. That study only showed that intradiscal pressure was reduced by decompression (traction). It didn't make any claims about restoring the structure or function of the disk or have any logarithmic curves.

    Many chiropractor's web sites claim spinal decompression facilitates the flow of oxygen and nutrients inside the disc as well as drawing herniated materials back into the disc and refer to unnamed MRI studies. The only study I could find was a paper "Simple Pelvic Traction Gives Inconsistent Relief To Herniated Lumbar Disc Sufferers" by Edward Eyerman MD presented to the American Society of Neuroimaging 2/26/98. It did show a 30-90% reduction in disk herniation size in 6 of 14 patients tested.

    It seems to me that drawing the herniated material back in doesn't do any good unless tear in the wall (anulus fibrosus) is repaired. Radial Anular Tears @ chirogeek.com says that healing never extends deeper than the outer 1/3 of the anulus, because of lack of blood supply inside.

    Regence Health reports that "Two small randomized studies (n=27 and 64) reported little to no difference between patients treated with or without mechanical traction."
      It seems to me a home inversion table would be almost as good for a lot less money.
    See:
    In 2010 VAX-D was not covered by Medicare.
    See 2010 Coverage Issues and Centers for Medicare & Medicaid Services (CMS) - Medicare Coverage for current coverage.
    Optimum Health Reimbursement Policy for Spinal Decompression, October, 2007
    Non-surgical spinal decompression therapy: does the scientific literature support efficacy claims made in the advertising media?
    Be Wary of Spinal Decompression with VAX-D or Similar Devices
    Decompression Therapy: Rehability Multi-Specialty Spine & Sports Medicine/Chicago, IL
    Operation of a vertebral axial decompression table - Patent 6039737
    Chapter 35 "Vertebral Axial Decompression" in "The Practice of Minimally Invasive Spinal Technique"
    "Simple Pelvic Traction Gives Inconsistent Relief To Herniated Lumbar Disc Sufferers" by Edward Eyerman MD paper for the American Society of Neuroimaging 2/26/98. Be Wary of Spinal Decompression with VAX-D or Similar Devices, 2007

  • Sacral Occipital Technique (SOT): Stretching a joint by placing a roll or wedge in the correct position beneath the spine when the patient is lying down. However, doing this takes time, and the results are not achieved as quickly as those brought about by manipulation.
  • Kinesiology facilitates a triad of health (chemical, mental and structural factors) to properly describe the balance of major health categories.
    Commonly based on the notion is that every organ dysfunction is accompanied by a specific muscle weakness, which enables diseases to be diagnosed through muscle-testing procedures.
  • Active Release Techniques® (ART) - Treats soft tissue problems.
    An aggressive massage technique that treats problems with muscles, tendons, ligaments, fascia (thin sheath of fibrous tissue muscles, bones, organs, nerves, blood vessels and other structures) and nerves. Headaches, back pain, carpal tunnel syndrome, shin splints, shoulder pain, sciatica, plantar fasciitis (irritation and swelling of the thick tissue on the bottom of the foot), knee problems, rotator cuff tendinitis and tennis elbow are just a few of the many conditions that can be treated with ART.

    Damaged tissues muscle, tendon, or ligaments) heal with adhesions or scar tissue formation rather than the formation of brand new tissue.

    ART uses hand (thumb or fingers of doctor's hand) pressure and tension applied on the muscle involved while moving the muscle underneath the contact (thumb or fingers of doctor's hand). The affected tissue is trapped while the body part is moved, taking the tissue from its shortened to elongated position.
    See:
    Active Release Technique, Dr. Steven M. Horwitz Chiropractor
    Active Release Techniques® main page
    Active release therapy, a new treatment, appears promising. (J Musculoskel Med. 1998;15(8):11-18)

DC - Doctor of Chiropractic - 2-4 years of college plus 4 years of a chiropractic college course. Chiropractic colleges are accredited by the Council on Chiropractic Education, recognized by the U.S. Department Education.

Books:
Low Back Pain: Mechanism, Diagnosis, and Treatment By James M. Cox
Links:
Back Problems Symptoms - Cause - Remedy here
Chiropractic at nccam.nih.gov
Glossary of Chiropractic Terms
Tips on Choosing a Chiropractor
Whacking, Cracking, and Chiropracting
National Chiropractic Associations, Licensing Boards, etc.
Chiropractic Treatment Techniques, Chiropractic Medicine, HolisticOnLine.com
Treatments - Chiropractic Wellness Center or Northen NY -
Chiropractic Health Care - Traditional and advanced treatmen, by Dr. Dale Porter, Watertown, NY
Journal of Manipulative and Physiological Therapeutics
Flexion Distraction Treatment (pdf)
Frequently Asked Questions at Schofield Chiropractic
Chiropractic Versus The AMA EZineArticles.com
Chiropractor testimony
Chiropractic Management of Chronic Lower Back Pain in Older Adults

last updated 14 Dec 2010