Chiropractic first, medicine second and surgery third is a mantra I have used for almost 30 years as it relates to spinal pain. Not all medical physician’s follow this approach. A recent article in the Wall Street Journal (10/28/13) questions the rate and efficacy of low back surgery in the US. The rate of spinal surgery in the US is 150 per 100,000 people which is three (3x) the rate in Australia. The spinal surgery ratio is even greater compared to Sweden and Britain. The rate of spinal surgery for degenerative disc disease has increased three times (3x) from 1998 to 2008. Several medical experts feel that half (1/2) of these spinal fusions are unnecessary.
Most of these back surgeries are for herniated discs, disc degeneration and stenosis. A contributing factor to these unnecessary surgeries is probably the overuse of MRIs for low back pain. Many studies have demonstrated that when you run a “healthy” pain-free population through an MRI over 60% has spinal pathology including herniated discs, disc degeneration and stenosis.
The need for surgery should be determined by functional exam not by imaging results. If you take a photo of a car on the street you can observe the visual condition of the body and wheels, are there dings or dents, is there uneven wear patterns of the tire tread. If you take a photo under the hood you can see the condition of the hoses, connectors and engine. Until you start the engine and take a test drive you don’t know how the car functions. Patients come to my office on a daily basis with stacks of these MRIs demonstrating herniated discs, disc degeneration and stenosis, but their physical exam do not suggest that these issues are the cause of their pain.
A functional exam of the spine reveals how well the spine is working. Are the 24 vertebrae (spinal bones) and 130+ spinal joints moving properly in the 6 motions the spine needs to moves in? Are the muscles toned and working in harmony, or they imbalanced and in a constant tug-of-war? Are the nerves entrapped as they exit the spine or as they track through the arms or legs? These are a few of the functional components chiropractors observe use when they examine a patient in a functional exam. If any of the above faults or dysfunctions are present, then physical medicine, including manipulation is in order to improve or restore function. A functional pain syndrome deserves functional treatment.
Multiple published studies (most recently in April 2013, see previous Blog) have found the benefits of chiropractic first for treating low back pain. National inquiries around the world from the Canada to Britain have encouraged directed access to chiropractic care for treating back pain, as a first-line approach.
Why is this so important? An article from Lancet (December 2012), found, “Back pain is the condition causing most disability across the globe with osteoarthritis showing the greatest increase in the last 20 years”. So if you know anyone considering back surgery, make sure they have try chiropractic care first, preferably one who is Active Release Certified® (ART) and can also address the muscle and nerve components of spinal dysfunction. For more information, please contact me at Email Dr. Bradley Weiss