Nearly everyone suffers from back pain at some point. One treatment option is chiropractic care, which includes spinal manipulation (also called manual manipulation). A review of research, published in the Journal of the American Medical Association, found that spinal manipulation can help relieve pain and improve function in people with acute low-back pain, one of the most common types of back pain.
Duke chiropractor Eugene Lewis, DC, MPH, answers questions about how chiropractic care can help.
What kinds of conditions does a chiropractor treat?
I mainly see spine-related conditions. It could be pain in the low back, called the lumbar spine, or in the upper back, called the thoracic spine, or it might be neck (cervical spine) pain. It could be an injury or it could be chronic. It could be related to a disc problem. It could involve leg or arm pain or headaches in addition to back or neck pain. Chiropractors work with other parts of the body, too -- knee injuries, shoulder injuries, things like that -- but my main focus is on the spine.
When can a chiropractor help with back pain?
People often want to try the most conservative approaches first. So before considering treatments like injections or surgery for back pain, they may want to consider things like chiropractic care, physical therapy, or oral pain medications. Much of the time, back pain resolves with those kinds of treatments.
What types of chiropractic treatments do you offer?
I primarily work with patients using manual manipulation. That means I’m using my hands to try to improve mobility. If I can improve joint mobility in a certain area -- the spine, neck, middle back, lower back, pelvis -- then I may be able to reduce muscle tightness or the irritation of nerves that travel down the arm or leg, causing numbness or tingling, pain, or even changes in strength. I sometimes use other therapies as well, but the main mode of care I use is manual manipulation.
What are some other aspects of chiropractic care?
I spend about 20 to 25 percent of my time talking with and listening to my patients. We talk about flexibility; we talk about strength-building; we talk about balance. I look at your ergonomics: What do you do for work? How do you bend, turn, lift? Do you ride in a car all day? Do you sit in front of a computer? I try to understand what may be contributing to the pain or other symptoms you may be experiencing.
Often I’m trying to help patients by encouraging them: “Yes, you can do this,” or “When something like this happens, try to do this instead of that.” That way, they’re not anticipating pain and causing more pain and more muscle spasms. Pain scientists have found that anticipation of pain can lead to more episodes, more muscle spasms, more headaches, and so forth. So teaching patients that there’s another way is important.
Our goals focus largely on returning people to the activities that are necessary in their lives, whether those are job-related, family or socially oriented, or recreational in nature. Active people are more healthy and more happy.
What should I expect at my first visit to a chiropractor?
It won’t be a lot different from what you’re used to with other medical providers. I would gather a lot of information: How your pain began, what is affected when you do this or that, what your level of pain is, and any other symptoms you may have. If your information is in Duke MyChart, I’m going to read it beforehand. If you have images -- MRIs, X-rays -- or blood work, I’m going to look at all that beforehand.
Then I’m going to perform an exam that assesses both the medical and mechanical aspects of your pain. For example, I’ll look at how things are moving, at alignment, at muscle tone, nerve function, how well you can bend, turn, twist, what kind of movements reproduce the symptoms you’re having. If you haven’t had imaging and we need to order it, we can do that.
After the exam, we have a discussion: “This is what I think is happening, this is what I can offer you, and this is how I think it will help you.” Since I’m part of a team, if I think a patient will get additional benefit or more benefit from seeing a physical therapist, physiatrist, spine surgeon, or other provider, I will also suggest that referral.
Are there risks or pain associated with spinal manipulation?
It’s the same as any procedure: It may be a little uncomfortable. But I try to take it as gently as possible; I won’t push beyond your limits. You may get a little sore afterward, but as time passes, you should notice that less and less. Fortunately, complex side effects associated with manual manipulation are rare.
How often do I need to see a chiropractor?
Chiropractic care is a progression. At first, I might see a patient once or twice a week. If the condition is acute, I might see the patient every day in a week at first. As they improve, I’d start backing away; I’d start giving the patient more things to do on their own at home. I want my patients to be as independent as possible. There are patients who have chronic problems and need to come back and see me once in a while. But the great majority of patients have issues that are resolvable, and I may never see them again after their condition has improved.