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Rehabilitation and Maintenance Care: An Evidence-Based Critique

The story of the first chiropractic adjustment is one we all know well. Every student to pass through the halls of Life Chiropractic College West has repeatedly heard this same story from an astounding array of sources: professors, classmates, guest speakers, and books to name a few. Today, at the risk of boring or even alienating you, the reader, I would like to repeat this story one more time, perhaps in a different light.

Andrew Verdaguer

Andrew Verdaguer

1895 – Davenport, Iowa. Daniel David Palmer hunched over a hearing-impaired man by the name of Harvey Lillard. D.D. Palmer located in the man’s back a lump which he believed to be a displaced vertebrae. Palmer subsequently pressed on this lump and, by doing so, somehow managed to restore the man’s hearing. Due to a lack of proper documentation, the complete circumstances around this first adjustment remain shrouded in mystery. However, one thing is clear: Harvey Lillard was not well. His body and nervous system needed rehabilitation and D.D. Palmer surely obliged, if not by accident.

Fast-forward over 100 years and the number of people that see a chiropractor for their ailments in the United States has grown from just one man to an estimated 35 million every year [1]. It is estimated that nearly 100% of the population in the U.S. is affected by disorders relating to the spine at some point in time. One-third of the adult population is currently experiencing low back pain, two-thirds of the adult population will go through at least one episode of neck pain, and over three-quarters of these people will seek health care for such reasons [2]. Yet despite the effectiveness of chiropractic for these ailments, less than 12% of the general population is currently seeking chiropractic care.

Spinal manipulation therapy, an umbrella term under which the chiropractic adjustment falls, has been shown time and time again to be a safe and effective treatment for a vast number of spine-related disorders. In fact, chiropractic care has been rated more effective than any other branch of health care for treating low back pain [3] and routinely outperforms all other forms of care for back and neck pain, including prescription drugs and over-the-counter medications [4]. Patients that choose chiropractic care are also 64% less likely to use opioid drugs for the management of their pain [5].

Rehabilitation and maintenanceOne area in which chiropractic care seems to generate much speculation is what is known as “maintenance” or “wellness” care, in which an asymptomatic patient receives chiropractic adjustments in order to maintain their current level of health and avoid future illness. But how do we reconcile treating people that seem to need no treatment, when so much of the population in need has no chiropractic care? If the purpose of the chiropractic adjustment, categorized as a “destructive force” by the 33 Chiropractic Principles, is to remove interference in the nervous system, then how do we justify adjusting a patient that seemingly has no nervous interference? Reason dictates that introducing a destructive force into a body devoid of subluxations would be counter-productive.

A significant body of evidence shows that populations receiving maintenance care have no different rates of mortality, disease, or disability when compared to populations not receiving maintenance care [6,7]. There is some evidence to suggest that upper cervical chiropractic adjustments have the capability to normalize blood pressure [8], but is this finding truly enough to merit maintenance care that could potentially cost patients thousands of dollars?

Since 1895, the chiropractic profession has made leaps and bounds in quality of patient care but it has also lost sight of its original achievement: rehabilitating a body in distress. Instead, many practices are filled with wellness patients who have already successfully healed from their acute subluxations. Are we overprescribing chiropractic care without reason, the way medical doctors have overprescribed opioids and antibiotics in the past? With such an outstanding list of benefits for the chiropractic profession to boast and so many opportunities for chiropractors to help people in need, should practices cater to maintenance care that may offer minimal benefit, or focus on providing care that could drastically increase the quality of life for those in need?

With the recent explosion in technological advancements and fewer reasons for people to stay healthy and active, the number of people that could really benefit from proper chiropractic care is almost guaranteed to rise. In order to honor D.D. Palmer and the origin of chiropractic and continue pushing it forward, I suggest we first take a step backward to adjust our trajectory and ensure our Doctors of Chiropractic are focused on taking care of the people in a true state of dis-ease.

This article first appeared in the February 2020 issue of Lifelines, the Life West student magazine.

 

Resources

  1.  “One in Four Americans Sought Care for Neck and Back Pain Last Year,” Gallup.com, accessed November 2018: https://www.gallup.com/poll/194984/one-four-adults-sought-care-neck-back-pain-last-year.aspx?g_source=Well-Being&g_medium=newsfeed&g_campaign=tiles
  2. Murphy DR, Justice BD, Paskowski IC, Perle SM, Schneider MJ. The establishment of a primary spine care practitioner and its benefits to health care reform in the United States. Chiropr Man Therap. 2011;19(1):17. Published 2011 Jul 21. doi:10.1186/2045-709X-19-17
  3. Consumer Reports Health Ratings Center. Relief for your aching back: What worked for our readers. ConsumerReports.org; March 2013
  4. Consumer Reports Health Ratings Center. Back-Pain Treatments. ConsumerReports.org; July 2011.
  5. Kelsey L Corcoran, Lori A Bastian, Craig G Gunderson, Catherine Steffens, Alexandria Brackett, Anthony J Lisi, Association Between Chiropractic Use and Opioid Receipt Among Patients with Spinal Pain: A Systematic Review and Meta-analysis, Pain Medicine, , pnz219, https://doi.org/10.1093/pm/pnz219
  6. Goncalves, G., Le Scanff, C. & Leboeuf-Yde, C. Effect of chiropractic treatment on primary or early secondary prevention: a systematic review with a pedagogic approach. Chiropr Man Therap 26, 10 (2018). https://doi.org/10.1186/s12998-018-0179-x
  7. Maiers M, Hartvigsen J, Evans R, Westrom K, Wang Q, Schulz C, et al. Short or long-term treatment of spinal disability in older adults with manipulation and exercise. Arthritis Care Res. 2018. https://doi.org/10.1002/acr.23798. Epub ahead of print.
  8. Bakris G, Dickholtz M, Sr, Meyer PM, Kravitz G, Avery E, Miller M, Brown J, Woldfield C, Bell B. Atlas vertebra realignment and achievement of arterial pressure goal in hypertensive patients: a pilot study. J Human Hypertens. 2007;21:347–352.
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