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Is there a vertebra "out", Doc?

Patients frequently come to my office with low back pain and ask me if their vertebra is out of place. They want to know if I can put it back “in” so they will stop hurting. I grew up as the son of a chiropractor and have been practicing since 1980, so I understand what they mean. This subject is a little more complicated than that, and today I want to explore some of the causes and concerns about low back pain.

Chiropractic from Dad's era

My Dad’s generation of chiropractors were still struggling to gain acceptance by the public and by medical doctors. They needed a way to explain chiropractic quickly and simply. The “vertebra out of place” explanation served that purpose. If a vertebra is out of alignment, it can put pressure on a nerve, and that results in pain. Simple reasoning tells us that reversing this process should give relief. Viola! Chiropractic was explained.

There might be some "flaws" in the thinking...

The problem is that low back pain is a far more complicated situation than just a vertebra out of place. The fact that people still remember that explanation is a testament to its simplicity and effectiveness as an introductory explanation. That simplistic defining of chiropractic does not, however explain why some treatments don’t “hold” or why repeat visits to put the vertebra “in” would be necessary.

I understand the patient’s point of view. I understand that relief needs to come quickly. I understand that repeated visits to the doctor seems unnecessary to the patient that feels the immediate pain relief from putting the vertebra “back in”. No other doctor, apart from physical therapists, have patients return to the office so frequently. The idea of repeated visits to put the vertebra “back in” seems unnecessary. This concept is reinforced by the fact that the patient had no pain prior to the event that caused the vertebra to go “out” in the first place.

The need to spend time with multiple visits, cost, and being expected to perform exercises and dietary changes at home makes the treatment plan given by the chiropractor seem to be at odds with the simplistic 1950’s explanation of chiropractic. Let’s look at low back pain from a different point of view.

Understanding chiropractic today

Each vertebra in the spine is surrounded by muscles, ligaments, tendons, arteries, veins, nerves, spinal cord, fat tissue, discs, and well….you get it. Each of these tissues are pain sensitive. Each of these tissues, simply because they exist right up against each other, have a cause-and-effect relationship with each other. If a vertebra moves “out of place”, it will compress other tissues that will cause pain. Muscles will spasm due to the pain and will stay spastic so as not to move and cause more pain. These muscle imbalances cause postural changes. These postural changes cause more muscle imbalances.

Just putting the vertebra back “in” simply is not enough. Look at it this way. If putting the bones back in alignment was all it took to be pain free and cured, a sprained ankle would never hurt! The sprain occurs when the ankle bones are moved further in a direction than they were designed to move. The ankle bones are back “in” when the pain and swelling start. It takes time for that sprain to heal, and this is what is happening to the low back when low back pain arises.

My goal, as a chiropractor, is to get you out of pain as fast as possible. I also want to “fix” all the damaged tissues in your back. I want to help you strengthen those newly repaired tissues so they can stand up to the rigors of your day-to-day living. So, yes, I will put the vertebra back “in” and your pain will lessen. It will likely take more visits than just once because as a doctor I have an ethical obligation to help take you to the best level of health I can. This means I must do my best to repair the damage and strengthen you to keep you from having this problem rise again in the near future.

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