Dr. Doug Pooley
Do Adjustments over time make my spine weak?
As a seasoned practitioner moving into my 40th year of practice this misconception about the impact of multiple adjustments to the spine seems to crop up periodically. I have never before seen the need to address this old wives tale, as to me it just logically didn’t add up for the following reasons: Firstly, how could someone believe that leaving an improperly functioning spine and pelvis would be better than getting it fixed… it made no sense. Secondly, how could you possibly believe that a damaged joint or joints would not require a period of care and treatment to correct? Thirdly, why would anyone assume that a chiropractor would ever adjust an area that either did not need to be corrected or no longer required adjustment?
One of my own assistants approached me and asked that I consider addressing this because she personally was having trouble convincing her significant other to get much needed care for his back. Apparently he understood that he needed treatment, but refused to do so out of fear that adjustments might further weaken his spine and thereby contribute to the development of arthritis, or the more absurd notion that once you go to a chiropractor it becomes a life sentence. I appreciated her concerns so decided to explore the question in order to provide the information needed to make a choice based upon fact not hearsay.
To do this, let’s look first at how and why joints work. The sole purpose of a joint is to facilitate movement. Nature gave us joints for multiple purposes, from locomotion to the simplest of activities such as pushing a key in the operation of a computer. Joints are among the most complex of the body’s structures and contain by far the greatest concentrations of nerves which constantly communicate with the brain our position in space. These joints have evolved in such a way as to perform specific tasks with ease and efficiency. They are all structured to last a lifetime and possess the same inherent capacity for repair as any other tissue in the body. Over the course of time they are constantly engaged, being broken down and rebuilding. This is especially true of the weight-bearing joints such as the hips, knees, ankles and spine. One of the most ridiculous things I hear in practice is: “My doctor says I am getting old so I just have to understand that my joints are going to ache”. Age, to the upper limits of life expectancy has little or nothing to do with joint pain. With the exception of certain rare disease states such as Rheumatoid Arthritis, joints break-down due to wear and tear associated with deviations in functional mechanics over time, trauma which can be incident related or developmental, nutritional deficiencies or medications….full stop! As mentioned, joints have evolved over time, and have been designed to last as long as you do. If age were the major contributor to joint pain, then why does one hip deteriorate and not the other? Why on x-ray does one section of the spine show arthritic change and not others? The reason has nothing to do with age and everything to do with a breakdown in function (the way the joint moves). It is insult to the joint complex via trauma or wear and tear that causes it to become injured.
This is just logical. So let’s extrapolate further to the real impact of a chiropractic adjustment. A chiropractic adjustment serves to introduce movement to a joint or joints that for whatever reason have lost their functional integrity. The only way this can happen is by working the joint in the plane that it was designed to move. By freeing up the joint and conditioning the surrounding supportive tissues, this re-establishes homeostasis (functional balance and working integrity). This automatically initiates a cascade of healing processes from decreasing the wear and tear component of joint friction, to improving circulation by decreasing muscle tension, to reducing the strain in supportive ligaments and tendons to normalizing neurological communication with the brain. In short, an adjustment does exactly the opposite of what injury and insult create. It starts the process of normalizing functional mechanics. The amount of treatment required to maximize the clinical benefit of care varies for the following most common reasons:
Area of injury…when injured, weight bearing joints are structured to tolerate more stress and insult than non weight bearing articulation, but when compromised, due to the additional loading associated with gravity can take longer to normalize.
Acute vs. Chronic…under normal circumstances, treating a new injury as opposed to a long standing one is a much quicker process. For the most part, the greater the length of time that an area has suffered insult, the more ingrained the damage becomes with increased likelihood of collateral complications to surrounding tissues.
Pre-existing evidence of degenerative changes. Injury to an already compromised joint complex will often serve to intensify both levels of discomfort as well as time/effort required to re-establish structural integrity.
Pre-existing weakness such as scoliosis, congenital hip problems, bowed legs/knock-knees or flat feet
Obesity and/or nutritional deficiency
Postural alteration such as forward head carriage or rounded shoulders
Repetitive strain either occupational, habitual or activity related
Sleeping on your stomach
Stress either emotional, physical or chemical
Existing disease states
Medication use….some common medications have been proven to contribute to the development of arthritic changes in joints and some drugs used in the treatment of inflammatory joint strain and arthritis actually serve to inhibit the healing process. (reference-- previous post:”The Myth of Medication’s Value in the Treatment of Chronic Functional Injury--Pooley”).
Any of the above alone or in combination can impact the length of treatment required, but according to a publication in the Journal of Manipulative and Physiological Therapeutics titled “Economic and Resource Status of the Chiropractic Profession in Ontario, Canada: A Challenge or an Opportunity”, the average number of services for patients seeing a chiropractor is 9 so the ruse that when you go to a chiropractor you have to go forever is totally fabricated and completely misleading.
Let’s take a minute to examine the flip side: What happens when you fail to correct a problem? This is fairly predictable based upon interaction with thousands of patients and let me give you an example: Mr. Jones develops a strain in his right knee which starts off periodic in accordance with activity but over several months becomes more persistent and severe. When the pain gets bad enough he takes some medication, but eventually those meds don’t work and he now requires stronger drugs. This seems to get rid of the pain, but the condition is still there and his wife tells him that he limps when he starts walking. Now Mr. Jones just doesn’t feel like doing many of the things he used to enjoy so he sits around a lot more. He starts to put on weight which of course compounds his knee problem. The limp gets worse which now seems to be affecting his hip and lower back. He is taking more meds for the pain and additional meds to help with the stomach upset and bowel changes. Now, 18 months in he is finding it difficult to work, he is overweight and has been diagnosed with Type2 diabetes. This requires more drugs as well as a pill for his depression. He is scheduled to see an orthopedic specialist, but that does not happen for another 6 months. Six months after that he undergoes a knee replacement which is deemed successful but his hip and back are now so bad that he re-enters the queue for more surgery. If you think for a moment that this is fiction, it is not. This is taken from a recent patient intake and is a regular occurrence. Could much if not all of this been avoided if the knee had been expeditiously treated, the answer is a resounding yes. Most minor injuries resolve without treatment, but if a condition persists beyond 30 days without improvement the likelihood of successful resolution is significantly diminished with an inevitability of collateral damage. You don’t need science to justify this, it is just logical.
The take away
Chiropractic is one of the original 4 health disciplines licensed in the province of Ontario. Training is a four year specialized post-graduate program offered at only 2 certified institutions in Canada. Chiropractors by virtue of training and experience are the most qualified professionals to functionally evaluate joint health and biomechanics. If you leave a long standing joint injury without treatment it will eventually get worse and lead to other potentially disabling concerns. Chiropractic care is by far the safest and most efficient treatment for stabilizing injury and normalizing function. By normalizing function and alignment chiropractic care is anti-arthritic by nature. The average number of visits per incident to a chiropractor is 9, making it exceptionally cost effective and efficient care. There are no scientific studies that indicate chiropractic to be unsafe. In fact, studies show far less statistical evidence of injury than many of the other treatment choices for musculo-skeletal injury.