Should My Chiropractor Refer
Me to a Physician?

Samuel Homola, D.C.

QuestionI have had four visits to a chiropractor in the last two weeks. My problem is intense pain in the mid back vertebrae and sometimes shooting pain down my neck and arm.

The chiropractor uses electrical massage pads, hot packs, a minute of massage, and then an adjustment. The problem is that the places in my spine where the chiropractor wants to adjust are not adjusting; I tense up my muscles involuntarily so that the adjustment doesn't work. (I hear no "pop.") The only place that works is my neck. After last night's appointment, the chiropractor recommended that I see an acupuncturist to relax my muscles so that I can be adjusted properly.

The other problem is that right after the neck adjustment I felt like my ears were popping more, and the spot he tried to adjust hurt the next day.

At this point, I am ready to call my primary care physician and will probably be referred to physical therapy.

Do you have any advice? I am also uncomfortable that the chiropractor had me buy some kind of herbs for muscle relaxation and a $39 video about posture. When I object, he makes me feel guilty for objecting.

Answer

If two weeks of treatment by your chiropractor has not helped relieve your pain, you should see your primary care physician for another opinion. A trial with physical therapy would be a logical next step.

It is not necessary to make the spine pop to treat a painful back or neck. Failure of your spine to pop during manipulation is not unusual and is not a sign that something is wrong with your vertebrae. There are many cases in which manipulation should not be done, especially when it is ineffective or causes pain. Use of forceful manipulation solely for the purpose of eliciting a pop can be harmful, especially in the neck where vertebral arteries could be damaged. You should not be having your neck adjusted for the pain between your shoulder blades.

There is no logical reason to take herbs for back pain.

You did not state your age or give your history. Has a diagnosis been made? It's important to make sure that you do not have osteoporosis (calcium deficient bones), which commonly weakens the mid-thoracic vertebrae after middle age, causing slumping in the upper back. Did your chiropractor sell you a posture video because you have a hump in your back? Manipulation should be avoided if you have osteoporosis.

Osteoarthritis is a common problem in the mid-thoracic spine. While gentle manipulation can sometimes relieve the pain and stiffness of arthritis, forceful and excessive use of manipulation could irritate and inflame arthritic formations.

You should not hesitate to seek a second opinion and a definitive diagnosis. It's likely that your primary care physician will send you to an orthopedist before sending you to a physical therapist.

Don't feel guilty about questioning your chiropractor's treatment method. A good chiropractor would welcome your questions and would not hesitate to refer you to your primary care physician, along with your records, for a second opinion.

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Dr. Homola is a second-generation chiropractor who has dedicated himself to defining the proper limits on chiropractic and to educating consumers and professionals about the field. His 1963 book Bonesetting, Chiropractic, and Cultism supported the appropriate use of spinal manipulation but renounced chiropractic dogma. His 1999 book Inside Chiropractic: A Patient's Guide provides an incisive look at chiropractic's history, benefits, and shortcomings. Now retired after 43 years of practice, he lives in Panama City, Florida.

This page was posted on April 16, 2002.