Chiropractic and Osteopathy
Chiropractic and Osteopathy
Jules Davidson works as a chef at a large restaurant in New York. After many years of chopping vegetables, kneading bread dough, stirring pots, and working under intense pressure, he began to notice stiffness and pain in his neck and shoulders. His doctor diagnosed arthritis and sent him to an orthopedist. The orthopedist confirmed the diagnosis, further defining the problem as osteoarthritis, or the "wear-and-tear" kind of the disease. The doctor prescribed an anti-inflammatory pain reliever and told him that it was about the only treatment he could suggest. Jules, who hadn't taken a pill in over 60 years, took one look at the prescription then shoved it in his pocket. That afternoon, he made an appointment with a local chiropractor, someone who had treated a waiter at Jules's restaurant for a back problem.
The chiropractor took x-rays of his neck and showed Jules where the vertebrae had become ragged and formed "spurs." She also examined the rest of Jules's back, noting how the spine moved and isolating some areas where Jules felt tenderness in the muscles along the spine. She explained that, over time, the spine had come out of alignment and was thus no longer able to keep the body in balance. This "subluxation," as chiropractors call a misalignment of the spine, led to some irritation of the nerve roots and to the formation of calcium deposits on the vertebrae. She then prescribed a treatment plan that involved Jules coming in twice weekly for six weeks. When told that his Medicare would cover some of the costs, Jules agreed.
During each session, Jules lay face down on an exam table while the chiropractor used a machine that vibrated, loosening the tense, tight muscles in Jules's shoulders and back. After about ten minutes, the chiropractor placed warm packs on his upper shoulders and neck for another ten minutes or so. Finally, she held his upper back, asked him to exhale deeply, then "cracked" his back with a sudden thrust forward. Jules then lay on his back while the chiropractor held his head, rocking it back and forth. When another sudden thrust turned his head, Jules heard a "snapping" noise, after which the chiropractor gave a thrust to the other side. She explained that these were the sounds of once trapped gases escaping from within the joints. Right away, Jules felt that his neck was moving more freely and with less pain.
During subsequent visits, the chiropractor repeated much the same treatments. After a few weeks, she gave Jules a series of exercises to perform every morning and evening to keep his neck more supple and relaxed. He now sees the chiropractor every three weeks and, in between times, feels generally pain-free.
Like Jules, you may have decided that taking nonsteroidal antiinflammatory drugs (NSAIDs) or other medication for your arthritis may do you more harm than good and are searching for a more permanent solution to your problem. Millions of people every year seek help from chiropractors and their cousins in the medical world, osteopaths. Both chiropractors and, to a somewhat lesser extent, osteopaths view spinal manipulation, the adjustment of the vertebrae, as the cornerstone of sound treatment for arthritis and a host of other conditions.
In essence, spinal manipulation therapy is just what it sounds like: treatment of arthritis and other disorders by adjusting the vertebrae of the spine. Twenty-four bones, called vertebrae, make up the spinal column, which surrounds the spinal cord, a sheaf of nerve tissue reaching from the base of the skull to the upper part of the lower back. Between adjoining vertebrae are pairs of spinal nerves, each of which extends to a particular part of the body. Should the vertebrae become misaligned—through trauma, stress, or a chemical imbalance—this places pressure on the nerves or blocks the blood supply to that area. According to those who practice spinal manipulation, the pain of arthritis and its process may be caused or exacerbated by such pressure or blockage. In other words, if the nerves extending from your spine to your knee, for instance, have become blocked, you may feel pain in that joint. Realigning the spine and massaging the soft tissue around the knee will restore proper working order to the joint, or at least release tension and pressure.
Two alternative schools of medicine, chiropractic and osteopathy, consider the spine and the nervous system that springs from it to be the center of all health in the body. Today, more than 94 percent of all manipulative care is delivered by chiropractors, 4 percent by osteopaths, and the remaining 2 percent by general practitioners and orthopedic surgeons. In this chapter, we'll discuss the benefits of chiropractic and osteopathic techniques for arthritis and related problems.
Chiropractic Technique
Chiropractic is a word derived from the Greek cheir, meaning "hand," and praktikis, meaning "practical." Every culture in recorded history has practiced spinal adjustment, but David Palmer, a self-educated American healer, founded the modern school of chiropractic in 1895. Palmer's first patient was a janitor who had been deaf for almost twenty years. By bringing the man's spine back into alignment through massage and pressure, Palmer restored his hearing. Palmer believed that the janitor had lost his hearing because an injury had damaged his spine, preventing the central nervous system from delivering messages to and from his brain and ear. Palmer also believed that the body has an innate ability to heal itself, an ability controlled by the central nervous system. If the spine becomes misaligned, he believed, then the body can no longer restore balance on its own to any part of the body, including its joints and soft tissues.
Chiropractic therapy centers on restoring proper balance and structure to the spinal column and joints and, by doing so, restoring proper working order to the nervous system that radiates from the spinal cord to the organs and tissues of the body. When the vertebrae are properly aligned and the spine remains flexible, nerve impulses from the brain can travel freely along the spinal cord and to all the organs and tissues of the body.
By keeping the spine in alignment through regular visits to the chiropractor, so the theory holds, you will not only help to soothe the inflammation or tenderness in the joints currently affected by disease, but also protect all of your joints from further injury. And by keeping the nervous system in good working order, you'll be allowing your body to function well as a whole and thus be able to heal itself of most ailments. According to theory, then, chiropractic can be seen as both treatment for injury and pain as well as a method of preventing disease.
CHIROPRACTIC DIAGNOSIS AND TREATMENT
Your evaluation with a chiropractor begins the minute you walk through the office door. The chiropractor will pay as much careful attention to the way you walk, stand, and sit as she will to any x-ray or other diagnostic test. After watching the way you move, the chiropractor will ask you questions about your symptoms and past medical history. In fact, because a chiropractor is not a medical doctor, it is extremely important that you rule out any medical problems that could be causing your arthritis as well as to confirm whether you suffer from wear-and-tear arthritis (osteoarthritis) or one of the inflammatory types (gout, rheumatoid arthritis, lupus, etc.) before you visit a chiropractor. She will ask about any recent injuries that may have caused or exacerbated your arthritis, as well as spend time assessing your work, exercise, and nutritional habits to see how they might be contributing to your problem.
Following this discussion, the chiropractor will administer an orthopedic exam, during which she will pay special attention to the range of movement of your spine and limbs. She may ask you to bend forward, backward, and sideways, and to rotate your spine. She'll also perform a neurological examination, including reflex testing, to assess nerve function in all your joints. Then the chiropractor may feel the spine and various other joints with her hands—a technique known as palpation—to further assess mobility and alignment. Under certain circumstances, x-rays may be required to derive more information or to confirm a diagnosis.
Once your chiropractor decides where your particular misalignment—or subluxation, as disturbances in the spine are called in chiropractic—occurs, the chiropractic adjustment begins. Depending on what kind of subluxation the chiropractor finds in your spine, she may choose to perform an active manipulation, in which you'll be asked to stretch your body in a certain way yourself, or a passive manipulation, in which the chiropractor assists your movement, helping to stretch the spine past its range of passive movement using her hands. Another process, known as the high-velocity thrust, involves the chiropractor placing her hands on a particular vertebral area and then thrusting forward with a certain amount of force and speed. (Jules usually received two or more such thrusts during his treatment sessions.)
The chiropractor chooses an adjustment and technique based on your particular needs and physical constitution. Do not be alarmed if your body makes some cracking or hissing noises: These are signs that the bones are moving and gases within the joints are being released. Although chiropractic should never be painful, you may feel a certain pressure and achiness during, and for a few days following, your first few treatments.
Appointments usually last from 30 to 60 minutes. Most chiropractors will suggest one or two visits a week for a couple of weeks, then one every three weeks for maintenance. Generally speaking, the more entrenched and long-standing your arthritis is, the longer it will take to resolve it. On the other hand, if chiropractic is going to work for you, you should see a substantial improvement in symptoms in about a month to six weeks.
FINDING A QUALIFIED CHIROPRACTOR
Chiropractic now ranks as the second largest primary health care field in the world, with more than 18 million Americans visiting a chiropractor every year. A great majority of these people seek relief from stubborn, chronic pain, including the pain associated with arthritis and other musculoskeletal problems. Today, more than 50,000 chiropractors practice in the United States. Although not medical doctors, chiropractors are among the more highly trained alternative caregivers, requiring at least six years of undergraduate and postgraduate training at colleges accredited by an agency officially recognized by the United States Department of Education. Chiropractors become licensed in all 50 states only after passing rigorous state-controlled exams.
To find a qualified chiropractor, your first step might be to ask your own family doctor. In recent years, chiropractors have been able to form a cordial working relationship with much of the mainstream medical community. Also, feel free to ask your friends and acquaintances for referrals—word of mouth is one of the best ways to find a qualified and caring health professional. Or check with the American Chiropractic Association or the International Chiropractors Association. See Natural Resources, page 168 for more information.
Osteopathy: A Holistic Approach
Although this branch of Western medicine remains new to many Americans, osteopathy was founded by a traditional American physician, Andrew Taylor Still, more than 120 years ago. Andrew Still modeled his philosophy of medicine on the theories postulated by the Greek father of medicine, Hippocrates. Hippocrates believed that the body could cure itself and that a doctor should be trained to study aspects of health rather than symptoms of illness in order to understand and treat disease.
In addition, Dr. Still postulated that the body can function properly only if blood and nerve impulses are allowed to flow throughout the body unimpeded. If your spine or another joint comes out of alignment and blocks blood and nerve flow, disease and pain may result. Furthermore, because the musculoskeletal system is the body's largest energy user, tension or restriction in this system can deplete the rest of the body of its energy and thus result in illness.
Of all the mainstream medical specialties, health professionals consider osteopathy to be the most holistic, tending as it does to treat the whole person rather than one set of symptoms or health concerns. Osteopathic treatment centers on restoring balance and order to the musculoskeletal system—and thus to your whole body—through spinal manipulation. Osteopaths also pay particular attention to diet, exercise, and other habits that may be affecting your health. At the same time, it is important to note that osteopathy is far more mainstream than other forms of alternative treatment. Hence, an osteopath may well prescribe drugs and surgery and may not pay quite as much attention to the holistic side of the arthritis equation as, say, a chiropractor, acupuncturist, or herbalist. For this reason, an osteopath may be a wise choice for you if you are nervous about leaving the mainstream medical world behind completely.
YOUR OSTEOPATHIC EXAM AND TREATMENT
Unlike chiropractors, osteopaths are licensed medical doctors who receive extra training in spinal manipulation and the musculoskeletal system in general. Osteopaths are able to perform extensive diagnostic tests, prescribe drugs, and perform surgery. Although most osteopaths are general practitioners, some may have chosen training in a mainstream specialty, such as gynecology, pediatrics, or surgery.
Your first appointment with an osteopath should be quite similar to one with a mainstream physician, with a few notable exceptions. First, he will most likely spend more time discussing your general health, your medical history, your symptoms, and your personal habits. Second, he will pay special attention to the way you sit, stand, and walk, and may ask you to perform special exercises to see how your body moves. Asymmetry, a condition in which one side of your body is being held off-center, thus placing stress on that part of the body, is one condition osteopaths attempt to identify. Osteopaths also look for any abnormal increase or decrease to the normal curve of the spine.
Third, the osteopath will probably spend far more time touching your body, particularly your spine and other joints, than a mainstream physician might. He will feel for temperature and texture changes of the skin, areas of muscular tension, tenderness or swelling, and nerve reflexes. In some cases, x-rays or MRI studies may be suggested, depending on what the osteopath finds during the initial examination.
Once the osteopath locates the source of your problem, he will help you work out a treatment plan. In most cases of arthritis, this will involve the following:
Medication and Surgery. Because osteopathy blends conventional with alternative approaches, osteopaths may be more likely than other holistic practitioners to recommend mainstream medical solutions. On the other hand, they are more apt to suggest trying all other approaches at their disposal before attempting more radical solutions such as joint replacement or heavy dosages of pain/inflammation relievers.
Manipulation. Like chiropractors, osteopaths use their hands—and sometimes gentle currents of electricity or ultrasound technology—to release tension from muscles and restore proper alignment to the spine and other joints.
Relaxation Techniques. By prescribing specially designed exercises and visualization techniques (such as those described in Chapter 6), osteopaths help you to maintain your body's structural integrity by preventing stress and tension from disrupting your musculoskeletal system.
Breathing Exercises. Deep breathing exercises are meant to help bring life-enhancing oxygen and other nutrients to all the tissues of the body, as well as to help keep muscles, tendons, and other supportive tissues supple and lithe, and thus the joints more flexible and lithe.
Posture Correction. Borrowing from a variety of bodywork techniques, including some of those described in Chapter 8, Ayurvedic Medicine, osteopaths attempt to correct postural imbalances that may be contributing to your case of arthritis. By teaching you how to use your body in a more efficient and less stressful way, osteopaths hope to help you reduce the stress and tension that may damage the joints and soft tissue in your back and throughout your body.
Nutritional Guidance. Because osteopathy is essentially a holistic approach to health and healing, your osteopath will assess the state of your diet and help you to develop an eating and nutritional plan that will keep you healthy and your joints as free from disease as possible. The plan may include undergoing allergy testing and eliminating nightshade foods such as tomatoes, peppers, and potatoes from your diet.
FINDING A QUALIFIED OSTEOPATH
Today, more than 35,000 osteopaths practice in the United States. The training they receive in the fifteen osteopathic medical colleges blends conventional medical and surgical techniques with osteopathic manipulative techniques. Medical doctors (M.D.s) who are also osteopaths carry the title doctor of osteopathy, or D.O., and are listed in the telephone book under Physicians and Surgeons. See Natural Resources, page168 for information about locating an osteopath through the American Academy of Osteopathy or the American Osteopathic Association.
To a large extent, Western medical traditions form the basis of both chiropractic and osteopathy. In the next chapter, we explore an approach to health and healing that also focuses on the healing powers of touch.
