What is chiropractic?
Musings on my ever-evolving understanding of what I do for a living.
By Dr. Joshua Kiely, DC
This blog is about a topic that I am constantly coming back to and re-evaluating. I think I’ll look back on this in a few year’s time and probably have a laugh, but I wanted to put some thoughts down to remember where my head’s at and explore what chiropractic care really can be.
I hope this can be a bit of a fresh look at chiropractic for those that have had poor experiences, and for those that have had great experiences, I’d love to hear your thoughts as well.
The definition of a chiropractor
A chiropractor is a doctor who helps with issues pertaining to muscles, joints, bones, and nerves, primarily with the use of their hands. Typically the primary tool is spinal manipulation therapy (also called an adjustment, or back cracking).
This definition is broad and I believe the breadth of it has led to many different interpretations and interventions being used as chiropractors. I can’t speak to what most chiropractors do, but I can outline what this means to me. If I were to rewrite this definition to try and hone in on how I practice it would go a bit more like this:
A chiropractor is an expert in diagnosing and treating issues related to movement and pain. Chiropractors use a conservative treatment approach (i.e. no injection, surgery, or medication) to calm pain down and build people back up, with the goal that the patient can enjoy the activities that matter most to them. Chiropractors recognize when further intervention is necessary and refer to other experts in order to help their patients. The toolbox is endless, but the principles are as follows:
Listen to the patient first and always.
No dogmatic insistence on any particular tool for treatment (I’m looking at you back-cracking).
Goals are based on the patient’s needs and values.
Empower patients to effectively manage their own health instead of trying to “fix” their problems (see recent blog on posture for example)
No contracts, sales gimmicks, or focusing on random x-rays of their back or neck.
Be optimistic about the healing ability of the human body and encourage patients to go about their normal lives once they are feeling better.
My definition clearly is a bit more verbose, but I think that just about covers everything.
What about back-crackin’ then?
This had been a bit of a struggle for me when I first started practicing. In school, chiropractors are taught that spinal manipulation therapy (SMT) - the technical term for crackin’ - could be applied to a great many conditions with excellent results. Turns out this is only half true.
SMT is a wonderful tool when used effectively in a well-rounded approach to injury care and prevention. For the vast majority of painful conditions, SMT does not perform very well on its own, which is why it’s only a part of how I practice as an Ottawa chiropractor.
Since it’s obvious that exclusively crackin’ backs just won’t cut it for most people, I’ve begun to categorize treatment of most injuries into three phases, with a bit of overlap between each. For most people the phases are as follows:
Phase 1: Calm stuff down.
At this phase most people are struggling with movement and normal activities, so sometimes we have to limit certain activities and work on simple movements until we are able to tolerate more. Pain levels may also be very high due to how recent the injury occurred or perhaps there are other factors that increase fear, anxiety, and stress, causing a spike in pain.
Phase 1 is when hands-on chiropractic care (including SMT and many other manual therapies) can really shine. Hands-on care can be a phenomenal pain mediator and improve a patient's comfort in the short term to relieve suffering while the body heals.
I often rely heavily on education (for example, this blog on taking care of yourself during COVID with simple tools), manual therapy, and simple activities (walking, biking, stretching etc) to help people through the most painful of days with the understanding that the pain will run its course and we will be able to return to more activity soon.
Phase 2: Build people up.
As the pain becomes more tolerable, we gradually return to normal activities. During this phase it can be helpful to follow a plan to build our capacity slowly to avoid reaggravation or injury. I think it’s important that this stage proceeds even if we’re not completely pain free - often times getting moving and doing activities we like actually reduces pain even further.
During this phase we may also introduce new movements or even consider special exercises to target particular muscle groups or abilities (think jumping, lifting, or working on certain skills). While building back up, the role of manual therapy and SMT is diminished because we’re not dealing with as much pain that needs to be calmed down.
For example, we often introduce specific strengthening or endurance exercises such as the ones covered in this blog post on simple back exercises.
Phase 3: Better than we started (with the occasional hiccup).
Pain is in the rearview mirror, we’ve taken steps to improve any areas that may have needed some help and life is good.
It’s inevitable in life that we’ll hit a bump or two along the way, and this is when SMT and manual therapy can come in handy again. Combined with an appropriate plan for activity and good lifestyle habits, we can use the occasional treatment and reap some benefits mentally and physically.
Conclusion
The loudest complaint I’ve heard in the clinic, and I think the reason chiropractors get a bad rap is that some patients simply don’t ever make it to Phase 3 or even Phase 2. I’ve even heard that many chiropractors will try and lock a patient into a contract for months of regular care using SMT several times a week.
This runs completely counter to what the research tells us - if we don’t see improvement within a few visits, it’s time to have a tough conversation and consider further intervention or a change of plan (i.e. not just rely on SMT to work “eventually”).
If I fixate on SMT and manual therapy as the only way of dealing with an injury, I won’t be empowering anyone to take control of their own health and I’ll never actually address the fact that the human body is meant to move, adapt, hurt, and grow.
Hopefully this sheds some light on what I actually do with patients. Research and science are always advancing, and I’m sure my practice will change in tune, but for the meantime I’ll be offering up hefty doses of education, reassurance, listening, problem-solving, and manual therapy as needed and desired.
If this blog resonated with you, get in touch. I’m happy to talk things through with you and see if chiropractic care might work well for you.
