Answers to Questions about Chiropractic:
Why Would a Walk-In Clinic Refer Me
to a Questionable Chiropractor?

Samuel Homola, D.C.

Question

I recently injured my lower back while working out with weights. The injury was quite painful and I went to a walk-in medical clinic that day for treatment. The doctor diagnosed a lumbar strain, prescribed an NSAID and a muscle relaxer, and said that I would need physical therapy three times a week for eight weeks. He recommended that I get the therapy from a chiropractor whose office is located within the clinic but who operates independently. When I said that I had previously had physical therapy for plantar fasciitis and that I would prefer to return to that office, he rather reluctantly wrote me a prescription.

I was unable to obtain an immediate appointment to be seen by the physical therapist I knew. So I called the chiropractor recommended by the walk-in clinic and scheduled an appointment.

I told the chiropractor that I had low back pain that started while lifting weights and that I had not had back pain before that. He asked me what my insurance was (it is MAMSI) and told me that they would not cover my treatments with him. (In fact, as I later learned, MAMSI does cover chiropractic, as well as physical therapy , for a lumbar strain.) He then offered me a free evaluation, which consisted of him looking at my back and checking my range of motion. As soon as he looked at my back, he claimed to know exactly what the problem was.

When the brief exam was completed, he told me that it was crystal clear that my problem was related to a misalignment in my lower spine, which was causing me to carry more weight on one side than the other. He said that I compensated for this by holding one shoulder higher than the other.( I knew that I have a mild scoliosis in the upper part of my spine, causing one shoulder to appear slightly higher than the other.) He told me that the misalignment was resulting in the joints of my spine wearing out sooner than they should, but he could correct this through use of a technique called Active Release.

He asked me to arch my back and predicted that this would be the most painful position for me. In fact, that position caused me no pain. Instead, I experienced pain when bending forward and bending to the right, which I understand is common in lower back injuries. He told me that the pain I experienced when leaning to the side was not caused by a muscle injury but instead was the result of a problem with the joints of my spine.

In the past, when I had physical therapy for plantar fasciitis, I had the opportunity to observe the treatment of patients with lower back pain. The treatment usually consisted of heat, ultrasound, and exercises to stretch and strengthen the back and abdominal muscles. I expected to hear something similar from the chiropractor, since physical therapy had been prescribed. When I said as much to him, he said that he offered physical therapy, too, but that my plantar fasciitis was caused by an imbalance in my spine and would not heal unless I wore orthotics and corrected my spinal condition. (My plantar fasciitis completely resolved without the use of orthotics or spinal treatment and is no longer bothering me.)

At this point, the chiropractor said he had a special offer for patients who were not covered by insurance. The cost would be $350 for ten sessions over a period of eight weeks. He said the $350 was nonrefundable, even if all the sessions were not used. He offered to make an orthotic for me for $50, which he said was a significant discount. He also said he would give me a discounted rate on any x-rays that needed to be done. If I wanted to receive any treatment that day, I would have to pay the whole $350 in advance, even though neither he nor I had yet checked with my insurance company to see whether the treatment would be covered.

I told the chiropractor I wanted to think about it and discuss it with my regular orthopedist. The chiropractor responded by saying that was fine, but if the orthopedist said he was wrong, that would be because "he needed to get with the times and learn more about Active Release." He added that if I went to physical therapy, it would just make my condition worse because they would be "yanking on my legs."

I was uncomfortable with this chiropractor's approach and decided against seeking treatment from him. I was able to avoid what appears to be a scam, but it bothers me to think that others might be taken in.

Answer

Thank you for your interesting and well-written letter. You were wise to refuse to pay for chiropractic treatment in advance. Your good judgment has undoubtedly protected you from implausible and unnecessary treatment. A lumbar strain will usually resolve on its own with time. There is no reason to believe that your mild scoliosis has anything to do with your plantar fasciitis or that Active Release Technique (ART) will correct scoliosis or plantar fasciitis.

ART was developed by a chiropractor who proposes that manipulation (probing with a thumb) and stretching of muscles and other soft tissues to break down adhesions or fibrous tissue will release entrapped nerves or blood vessels. Such treatment would not correct a scoliosis, as implied by your chiropractor, and may be no more effective than simple massage.

Your letter speaks for itself, and will be useful in helping others evaluate the treatment they receive. Practitioners sometimes have a vested interest in referring patients to each other. When you are uncomfortable with a practitioner's approach, it's always a good idea to seek a second opinion from a disinterested party.

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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 article was posted on May 9, 2003.