Become your own Chiropractor
Chiropractors for years have
explained their technique as one in which the manipulator
"adjusts" the spine. The theory (as explained
to me on numerous occasions when the nearly identical "spiel"
is repeated in offices, at street fairs, etc.) holds to
a belief that the spinal vertebrae can go out of "alignment."
The chiropractor usually demonstrates this condition with
a spinal model whereupon he rotates one of the vertebrae
so that one edge of a facet (the joint type structure that
constitutes a posterior aspect of the vertebral bone and
acts to keep one vertebral body directly above or below
the next) rests on top of another which then stays in that
position until he re-rotates the spine in the opposite direction
and the vertebrae falls into place. This action is to what
they give credit as the source of their ability to relieve
spinal pain, not to mention any other malady to which the
body falls prey. I'm not certain whether even they truly
believe it or not, however some seem pretty convinced and
convincing. Maybe they are just repeating the same rationalization
over and over (despite a knowledge that it cannot really
explain the spine's mechanics) because they have to give
some reason to justify a rapid and violent jerk to the torso
and the wallet. However, it could be that they do have a
knowledge of the true mechanics of the back yet understand
that, if they reveal it to others, the majority of patients
will figure out how to accomplish the same effect on themselves
and eliminate the chiropractor along with
his compensation.
Most physicians with a knowledge of spinal
anatomy and function cannot accept the reasoning many chiropractors
give as an explanation because it is blatantly obvious to
them that the forces necessary to allow a vertebrae to assume
that "misaligned" configuration would have to
tear all the ligaments designed to prevent that action from
occurring. Too, the degree of the misalignment has to be
of such magnitude as to have occurred due to forces far
beyond those reported as precipitating the painful event.
Certainly, trauma on par with an auto accident could create
such stresses; however, it is highly unlikely that 1) the
interarticular ligaments could sustain such injury and still
allow the spine to function at all, 2) that such a mis-alignment
would not be obvious on X-Ray, and 3) once the vertebral
column was re-aligned it would scar down and prevent further
misalignment unless equivalently violent forces were again
to act. This discrepancy between theory and observed reality,
compounded by the seemingly arbitrary assignment of repetitive
future alignments that appear to be more monetarily motivated
than physically beneficial, probably is responsible for
the failure of most medical doctors to accept chiropractors
as legitimate therapists.
On the contrary, I possess the objectivity
to recognize that chiropractors do help some people. Statistically,
about a third of the people they manipulate get relief;
however that only meets the batting average of a good placebo.
Since there are only three possibilities that can result
from any given therapy; the patient 1) gets better, 2) gets
no effect, or 3) gets worse. I assume that the percentages
for each option are about equal. When chiropractors go through
their routine, they simply spin a three sectioned wheel
of probability. The times that I have been "manipulated,"
it didn't seem to matter what my problem was, the treatment
was the same. My back did feel a little better afterwards,
some of the stiffness was relieved as the successive crunching
was accomplished. But the problem was not addressed in any
long-lasting or permanent manner.
This should not be taken to mean that they
do not actually accomplish something that physically helps
other individuals. I am only saying that I think they are
attributing the relief, when it results, to a mechanism
that they admittedly (in the literature) do not understand.
Therefore, they should not take credit for their successes
as a science since it is not the product of consciously
directed action based upon intelligent thought processes.
The possibility also exists that they are leading people
to believe it is a different mechanism for some alternative
reason, acting under the assumption that, if the true mechanics
were explained, the patient could do the equivalent movement
at home to themselves and, thereby, not need to repeatedly
visit a chiropractor).
Their ability to help people then, to my assessment,
becomes a process of simple therapy-mediated (as opposed
to diagnosis-mediated) patient selection, whereby, those
with minor disc herniations that are amenable to the chiropractic
forces generated when the back is literally "wrung"
by force, are helped. Those that do not have such simple
lesions are eliminated with respect to the probability of
future benefit. This causes me to contend that a certain
set of patients actually do get true short-term relief because,
in the twisting action of chiropractic manipulation, the
disc is effectively (albeit violently) shoved back nearer
to a more central position when the ligamentous structures
holding the vertebral bodies together are tightened in a
partially unweighted position. Regardless, it is not because
someone figured out what was mechanically disordered through
a diagnostic process and formulated the ideal therapy. It
is more the product of myopic (in contradistinction to "blind")
luck whether a person is helped or not.
It is technically fraudulent to classify chiropractic
as a "science;" however, this is not to say that
twisting a persons spine in a standard manner will not carry
some level of success. Manipulative therapy is described
by chiropractors as "the art of restoring a full and
pain-free range of motion to joints in order to counteract
the harmful local and distant effects of hyper- or hypo-mobile
joints that have wide-ranging consequences on other parts
of the body." They deliver a "high velocity but
low amplitude thrust" that, usually, if successful,
causes a usually painless, audible noise. In so far as I
am concerned, the audible clunk, or crepitation that is
heard is the fibrocartilaginous material crunching past
other fibrocartilaginous material within the disc space.
I have good reason to believe that it is the same sound
often heard during the performance of The O'Connor Technique
(tm) MANEUVERS.
A 1989 study reported that "the public
seemed to be more satisfied with chiropractors' level of
understanding of the problem of the spinal patient's problems
and more confident with the diagnosis and management when
compared to family practitioners"(36). These data suggest
that the family practitioners were not able to provide as
clear or rational an explanatory model of the problem as
chiropractors. Considering that chiropractors themselves
readily admit that they cannot explain how manipulative
therapy actually functions mechanically, anatomically, or
physiologically, these studies imply only that chiropractors
are more expert at perpetrating misrepresentations than
family practitioners. It demonstrates to me that chiropractors
do not help alleviate back pain better but simply are better
able to "con" patients into believing that they
know what they are doing, and family practitioners are equally
as ineffective but more honest in their responses.
A societal casualty of this study's misinterpretation
is the published conclusion: "The message here is pretty
clear: since most patients are going to get better regardless
of the treatment they receive, how we (physicians) treat
the pain is less important than how we make patients feel
about their care."(37) To hear that sort of conclusion
evidences to me the sorry state of 1990's back pain management
and a more obvious finding. It would appear that physicians
are willing to concede that chiropractors are better at
deceiving the public than they are and that doctors should
learn to engage in similar practices so as to deceive patients
equally well if not better. Such logic makes me lose faith
in the competence of those researchers entrusted with the
duty to adequately interpret scientific data and draw competent
conclusions.
In my opinion, the message should be something
more akin to: physicians are doing a horrible job of helping
people with back pain and rather than learn how to dissemble
better than chiropractors, they should redouble their efforts
to find a method that actually helps people rather than
creating an illusion of expertise while letting the patient
walk out the door with only the law of probabilities on
their side.
The O'Connor Technique (tm) can elegantly
satisfy that need without resorting to hand-holding hocus-pocus.
If you achieve substantial benefit from this website, I
would suggest you inform the health care provider who failed
to adequately alleviate your pain of this website's existence,
so that they can, as rapidly as possible, begin to engage
in meaningful discourse and treatments before they degenerate
into chiropractic coddling. In the long run, true trust
might be developed.
In deference to the field of chiropractic
and to present a balanced picture, there are several controlled
trials that provided evidence that chiropractic manipulation
has a beneficial effect for low back pain, especially for
select subgroups of patients; however in a study of 35 randomized
trials of manipulation, only 5% showed an improved short
term outcome, again though, selection biases and lack of
standardized diagnoses make even that success profile subject
to interpretive bias that evidences one already largely
known marketplace fact: Some people do get relief from chiropractors.
What is problematic about their "theory"
and practice is that they promote the belief that they can
treat any number of unrelated diseases and that a long term
management plan is necessary that causes a person to return
again, and again, and again, for complete treatment success.
In fact, they cannot consistently or scientifically fulfill
those representations. Getting people to believe that a
long-term, repetitive, practitioner mediated process is
necessary accomplishes at least one thing--it insures a
steady income for the chiropractor. Leading the patients
to believe unrelated allergies or ear infections can be
remedied by crunching on a spine, in my opinion, constitutes
fraud and any chiropractor that strays into this realm should
be abandoned in favor of one who sticks to helping the percentages
of patients that they do help with spinal pain.
It is my belief that, in the future, when
the principles of this method are widely studied for confirmatory
validation, the chiropractic beneficial effect will be anatomically
demonstrated to be slightly similar. In those few patients
who have ideally-placed pieces of displaced disc material
in the Lumbar or Cervical regions the herniated disc material
can be serendipitously repositioned centrally by the wringing
action of tightening the ligamentous peripheral lamina of
the annulus fibrosus rapidly and forcefully during the twisting-type
chiropractic manipulation very similar to the means described
in the CHIROTATIONAL TWIST Section of this website. If this
doesn't produce instant relief or if the lesion is in the
less rotatorily mobile thoracic spine, another manipulative
technique is employed in which the spine is put in slight
traction by positioning; then a sharp, forceful push with
the palms is given to the spine which induces an immediate
hyperextension. This, too, is similar to the non-weight-bearing
extension principle described in the EXTENSIONS Section
of this website which physically squeezes the disc material
anteriorly, so long as the disc material isn't positioned
too far peripherally. If so, the pinching can squeeze off
a partially extruded disc segment; and turn it into a fully
extruded or sequestered fragment. Therein lies the harm
they can do.
Their limited success rates can be explained
because there are only certain small percentages of displaced
discs configured ideally to be helped by conventional chiropractic
manipulations and, I would argue, that these are the only
patients who are benefited and, then, only for the short
term. This commits those select patients who "swear
by" instead of "swear at" chiropractors to
a lifetime of repeated remissions requiring costly subsequent
treatments. Until the advances made by The O'Connor Technique
(tm) are put into widespread practice, without chiropractic
treatments, these patients would still suffer; so, chiropractors
do provide a legitimate service.
It is humorous (if not absurd) in this supposedly
scientific era to recognize that chiropractors
themselves admit that they can't (despite years of education)
competently describe or explain adequately the means by
which their method works; however, I do not deny them their
successes in the above described context. The charade begins
to be exposed when, before accomplishing the manipulation,
scarce real efforts are made to truly diagnose those who
definitely will be benefitted by the treatment. Too often,
there is scant effort directed to select out those who most
probably will be further injured by the process because
that would be turning away "business;" however,
in all fairness, I have received a number of chiropractic
referrals because the chiropractor did legitimately recognize
a nerve impingement before initiating treatment.
In order to make the proper assessment, I
can see no other way for them to safely persist in these
practices unless they apply the theory and practice of this
method or resort to routinely using CAT Scans, NMRI's, or
Myelography to determine, in advance, the precise location
of the disc material relative to the spinal nerves prior
to the application of exogenous force. However, it would
be unrealistic for them to attempt to convince patients
to spend hundreds of dollars to insure that their manipulations
are safe; so, they must just keep "cranking" on
backs to see what happens. In an almost Darwinian selection
process, only the "fittest" survive their culling
and the rest are left to Nature's sometimes cruel alternatives.
You see, in order to achieve their limited
success rates and therapeutic results, it is necessary for
chiropractors to generate a certain high level of torque
force to be effective on that percentage of backs that they
do help. It is the act of applying that equivalent level
of force injudiciously that gets them into trouble. Most
apparently don't disseminate statistics upon how many patients
leave the office in greater pain than when they entered.
Instead, most patients are given basically
the same gibberish about a nebulous "subluxation"
causing an aggravation of nerves having effects on any number
of distant, anatomically unrelated organs or tissues, lain
on a table, and given the same hand-on-shoulder and hip-twisting
of the spine procedure given to everyone else who walks
in the door. This may be accompanied by some different hocus-pocus
with measurements of the legs, levels of the shoulders,
or expensive (largely useless) X-rays. This practice wouldn't
be so bad if they didn't usually buy-up old X-Ray machines
with higher radiation outputs than are allowed to be sold
today and unnecessarily expose their patient's sexual organs
which are particularly sensitive to radiation damage. One
needn't accept my word on this score, according to a recognized
authority on the spine, Dr. Richard A. Deyo: "Spine
films are of little use in making a diagnosis, and they
are costly and expose patients to significant radiation
directed right at the genitals." One would do well
to consider the risk/benefit ratio of spinal X-rays before
consenting to them.
My knowledge of the spine gives me reason
to believe that a wrenching maneuver of the spine could
quite reasonably result in a worsening of the patient's
condition. If the herniation has progressed to the point
where the disc material is on the verge of or has actually
escaped the joint capsule, then the action of twisting can
squeeze the fragment further into the canal resulting in
a sequestered fragment or, worse, can shove the fragment
into a nerve root. This can change a condition from not
necessarily a surgical condition to a surgical necessity.
No statistics of which I am aware have documented
the number of people who have had borderline discs turned
into surgical cases due to forceful manipulation. In fact,
it would be very difficult to do so because it would require
an NMRI or CT scan in advance of going to a chiropractor.
Then, after the damaging event, the patient would have to
have a repeat NMRI or CT to document the disc material's
movement. Such a study would also have to demonstrate that
the disc did not get worse on its own. Such a study would
require the coordination of a chiropractor and a neurosurgeon
such that the chiropractor anticipated that he could make
a particular patient worse and, immediately after he does,
sends him to a neurosurgeon. Alternatively, thousands of
patients going to chiropractors would have to have a CT
or NMRI immediately prior to and after such an event. The
former would never occur because no reasonable chiropractor
will expose himself to the potential lawsuit resulting from
a condition he knew he made worse in the presence of an
anticipation to do so and the latter would be so expensive
as to be prohibitive. So, the requisite science to provide
this information does not appear to be forthcoming in the
immediate future.
The O'Connor Technique (tm) doesn't fall into
this trap because, largely, through self-manipulation, the
patient is able to control the direction and level of force
at all times, which they can automatically stop before it
becomes too painful to cause damage. No rapid torque is
required to achieve the same results in nearly all the people
who would otherwise be actually helped by chiropractors.
In that sense, the reader of this material can, more safely,
become their own chiropractor and more.
Personally, with those patients I manipulate
in the office, I could not bring myself to do such a forceful
manipulation without knowing the anatomy of the problem
for fear that I could possibly make the patient worse. A
simple X-Ray would not accomplish this necessity because
it doesn't image soft tissues and the non-bony disc material
does not show up on an X-Ray. The CT and the NMRI do so,
but they cost around $1000. No other imaging study short
of a myelogram (a painfully invasive X-Ray that places dye
into the spinal canal) would show the proximity of the disc
material to the nerve root and thereby ascertain manipulation's
safety.
So, chiropractors largely approach the condition
blindly or at best with such poor acuity that, to me, constitutes
a potentially dangerous form of individualized human experimentation.
If they perform the same manipulation on everyone, the ones
that get better will come back, and those that are hurt
worse presumably won't. When the people who do get worse
don't come back, the chiropractor assumes they are better
if he is an optimist, but rarely will concede that they
may have gotten markedly worse unless he is taken to court.
Luckily, the low back is relatively forgiving
when it comes to the damage a chiropractor can potentially
do; but, when chiropractors attempt to manipulate the neck,
especially in the elderly, the vertebral artery's actual
passage through a hole in the transverse processes of the
cervical vertebrae and/or the tension put on the carotid
artery can lead to a stroke.
A recent report presented at a stroke conference
sponsored by the American Heart Association, at which several
specialists said they had treated patients' arteries torn
during sessions with chiropractors, described "probably
the best documented cause of rips--what doctors call dissections--is
chiropractic manipulation of the neck." At the conference,
Dr. William Powers of Washington University in St. Louis
said "every neurologist in this room has seen two or
three people who have suffered this after chiropractic manipulation."
It was also stated that 85% of cases result in at least
mild impairment according to a Stanford survey.(38)
The O'Connor Technique (tm)
differs substantially from chiropractic in that no forceful
movements or manipulations are necessary or advocated. Success
in alleviating pain does not rely simply upon the actual
movement or forcefulness of the effort with The O'Connor
Technique (tm) but with the proper sequential combinations
of movements that are revealed herein. Forcefulness is not
necessary to open a lock if one knows the combination.
The patient performing the MANEUVERS controls
the amount of force and can stop the maneuver at anytime
pain occurs. The time taken to relax necessary muscle groups
and allow the components of the annulus fibrosus to accept
traction is an individualized process that the individual
determines. In those cases where this technique would be
equivalently as successful as chiropractic, the same end
is achieved; but the cost is almost non-existent with The
O'Connor Technique (tm).
With The O'Connor Technique (tm), most persons
who do routinely get relief from chiropractors are taught
to do their own "manipulation" and given the power
and means to prevent future pain themselves. Even if chiropractors
knew what they were doing they would be unlikely to share
their "secret" because that would reduce the number
of people coming back for treatment, after treatment, after
treatment. For this reason, it will probably be a long time
before chiropractors embrace the theory and practice of
this technique and may be reluctant to teach it since to
do so might put the majority of them out of business. In
fact, it would not surprise me to see a rather boisterous
reaction to any large-scale promotion of The O'Connor Technique
(tm) from some components of the chiropractic
establishment.
Article Contents:
You are not alone
The Pain
Contemporary
Perspective on Back Pain
Historical
Perspective of Back Pain
Science and Art
Alternative
Therapeutic Modalities
Back Surgery
Comparative Programs
Not an Excercise
Program
Dismissing
the "Psychological" Contribution To Spinal Pain
Getting Better
as a Process
Become your own
Chiropractor
Hope
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