Non-Operative Treatment: Chiropractic Care

Chiropractic Overview

Chiropractic care is non-surgical, drug-free therapy that includes spinal manipulation and non-manipulative therapies such as electrical stimulation, massage and ultrasound. While the physicians at the San Diego Center for Spinal Disorders (SDCSD) do not fully agree with all of the practices and theories of chiropractic philosophy, we understand that some of our patients find chiropractic care to be helpful. Therefore, we occasionally recommend it as part of the overall treatment plan for spinal disorders.

If a patient's spine is stable without nerve root impingement, chiropractic care may be an option. Chiropractic care is not recommended to treat spondylolisthesis, abnormal spinal curvature or disc herniation.

Chiropractic Philosophy

Doctors of Chiropractic (DC) believe that good health is dependent on a normal, well-functioning central nervous system. The central nervous system includes the spinal column, spinal cord and nerve roots. Chiropractic philosophy includes:

• The central nervous system (CNS) is critical to the body's overall health
• It is essential to treat the cause of illness, not just the symptoms
• Prevention and early intervention (e.g. diagnosis) is key

Further, chiropractic philosophy emphasizes the importance of proper nutrition, daily exercise, and lifestyle modification to promote good physical and mental health.

Examination

Chiropractors follow diagnostic procedures that are similar to those practiced by medical doctors. The consultation includes a thorough review of the patient's history and current symptoms, physical examination, and x-ray or other imaging studies. In addition, mobility and positioning of spinal joints, muscle function, posture, and overall range of motion are evaluated.

Manipulative Therapies

Manipulation

In chiropractic terms, the word subluxation is used to mean joint dysfunction. Chiropractors believe that subluxations can cause pain, numbness, dizziness, a feeling of pins and needles, and other neurologic symptoms. Manipulation adjusts the spinal joints to correct subluxation(s).

Using his or her hands, the chiropractor applies specifically controlled pressure directly to a joint or muscle. Successful manipulation may release a joint back into correct position and/or alleviate muscle spasms causing spinal nerve irritation.

Flexion Distraction

Flexion distraction combines chiropractic manipulation with gentle adjustments made while the patient lies on a specialized treatment table. The features of the table allow it to slowly move up and down, side to side, and to rotate. The table movements mimic flexion/extension, lateral flexion, and circumduction. Distraction manipulation does not cause pain.

Non-Manipulative Therapies

Electrical Stimulation

Electrical stimulation is also known as Transcutaneous Electrical Nerve Stimulation (TENS). TENS delivers a painless electrical current through the patient's skin to specific nerves. The current produces mild heat that works to relieve stiffness and pain and helps to improve range of motion (mobility). This treatment is non-invasive with no known side effects. It may be used to control acute pain and chronic pain.

Massage

There are many types of massage including acupressure ("Shiatsu"), deep tissue ("Swedish Massage") and myofascial release. Massage may benefit patients with acute sprains or strains and other soft tissue conditions.

• Acupressure
  The practitioner uses his hands and fingers to apply steady pressure to specific body points (meridians, acupressure points). Acupressure theory claims that it opens blockages allowing energy (Qi, "chee") to freely flow. This type of massage also reportedly stimulates circulation to help remove toxins and promote healing.
• Deep Tissue Massage
  Deep tissue massage claims to work by increasing the flow of lymphatic fluid. Overuse and injury can cause pain, stiffness, and numbness. The practitioner uses his fingers, thumbs and elbows to massage the muscles and connective tissue. The lymphatic fluid helps to maintain the body's fluid balance and protect against infection.
• Myofascial Release
  Fascia is a sheath of connective tissue that supports muscles, bone, and organs. Stress from injury or poor posture causes the fascia to tighten. As the fascia constricts, pain may be caused by muscles and bones pulled out of place. The practitioner uses his fingers, palms, elbows and forearms to firmly and gently stretch the fascia.

Ultrasound

Ultrasound is a common non-invasive therapy used to treat back and neck pain, tendon and ligament injury, muscle spasms, joint problems and other spine related conditions. Besides chiropractors, ultrasound is also used by physical therapists in rehabilitation facilities.

The practitioner applies gel to the patient's skin to help transmit the ultrasound waves into the tissues. The ultrasound probe is gently swirled over this area. Ultrasound uses high-frequency sound waves to deliver heat deep into tissues (e.g. muscles). This therapy promotes circulation and healing, relaxes muscle spasm, decreases inflammation and helps to alleviate pain.

Conclusion

The medical staff at SDCSD may recommend chiropractic care for some conditions, especially those that involve acute soft tissue strains and sprains. However, we do not recommend chiropractic manipulation for disorders that involve significant nerve impingement or spinal instability.