Welcome to the fifth of seven installments in the “how to fix your back”, my blog series on complementary (or primary) therapies to manage lower back pain. In case you missed it, I began by bringing you on a journey through the history and benefits of yoga, followed very closely naturally by Pilates. Next, my wife Laura gave her medical input on pharmaceutical management of back pain from the perspective of an MD. Finally, last week I introduced acupuncture as a viable avenue to control the agony associated with lower back pain. Today, I will discuss a combination of two, maybe seemingly unrelated, therapies. Today I will introduce Massage Therapy and Chiropractic Medicine. I will compare and contrast their benefits as well as chronicle their historical claims all the way up to the evidence based claims we hear today.
yep, that’s Jesse from Breaking Bad…Yo,BITCH, give my corn pops!
I can’t even think about chiros without wanting crack my back or neck. And no, it’s not satisfying enough to stretch- I need to hear it! Evidence states that the cavitation (sound) is not necessary to gain the improvement in motion- but damn do I love that sound.
Since I already started on chiropractic medicine, let’s get right down to it, shall we?
Yep, you heard it correctly. Quacks- the whole lot of ‘em.
Obviously this is not true, but many people feel this way. Why though? How are we so divided having a huge population believe that DCs (doctors of chiropractic) are quacks while the other portion absolutely swears by them?!?!
I blame their intentions
DD Palmer “invented” chiropractic medicine in the late 1800s after assisting a hearing impaired janitor improve his ability to hear after a chiropractic adjustment. I put “invented” in quotes because there is absolutely no way to truly determine when adjustments started to be used, but he no doubt brought it to the forefront of modern culture.
So, this dude improved someone’s hearing- maybe not quackery, but something is amiss. There are no Otolaryngologists (ear, nose, and throat doctors) that I’ve heard of that write prescriptions to DCs for hearing loss. In fact, the American Medical Association created a committee on Quackery (what?!?) back in 1966 to “contain and eliminate chiropractic” They had this to say…
Why though? It comes down to the intention behind what is being done. I will discuss the two associations related to the practice of chiropractic with GREAT PREJUDICE. I’m so sure you will see which side I feel is conveying the quackery label.
I recently saw a news story on a couple who are chiros and performed manipulations on infants and young toddlers. A manipulation, or adjustment, if not obvious from the context, it is generally what is associated with chiropractors, “Cracking the spine”. They were doing this because they believed they were decreasing the recidivism of chronic recurring ear infections, behaviors related to ADD/ADHD, and colic. These are beliefs you may expect to come from DCs who subscribe to the original ideas birthed from DD Palmer and the pseudoscience seen connected to the international chiropractic association who believe and treat with the notion that all issues stem from the spine and need adjustment to heal them. Cancer? Needs chiro. Allergies? Needs chiro. Trying to avoid sudden infant death syndrome (SIDS)? Needs chiro. These people promise a lot and have no evidence to substantiate these claims.
Luckily, those who subscribe to the ideology and the (wait for it…) SCIENCE of the American Chiropractic Association would likely treat musculoskeletal issues solely related to the spine. These are practitioners who do not believe that there are bones out of alignment, but rather perform an examination seeking to find motion loss at the spine and manipulating/ adjusting the spine so that the segments of the spine move equally and without compensation likely due to inhibition of the surrounding musculature. This theory is seen with doctors of osteopathic medicine (DOs) and doctors of physical therapy (DPTs) who also perform spinal manipulative therapy and has been verified with high level peer reviewed journal articles seen in prestigious journals such as the New England Journal of Medicine.
Ok, did we legitimize DCs now?
In my rant earlier, I mentioned how cracking your back inhibits (or relaxes) surrounding muscles allowing the spine to move equally and without compensation. This is the main outcome of seeing a chiropractor- Move better, have less pain (pretty sure we can all agree that’s why anyone should go). Massage therapy is based on the same principles.
Forgive me if I skip the history to this modality. I haven’t researched it, but I’m so sure it goes something like this…
In the beginning God created man and all living things, shortly after that, massage.
Seriously, how basic of an understanding do you need of touching and rubbing feels good?
Let’s just say this, massage is great for relaxation (catch all term to not exclude any of the benefits). Relaxation makes just about any problem you can have somewhat better- It alleviates stress allowing the brain to work more efficiently.
Here’s what massage does not do. Many practitioners (not just massage therapists) talk about adhesions in the muscles and other tissue. They tell you massage helps to break up this “scar tissue”. I’ve been guilty of this one. Truth is, in studies done with cadavers, the amount of force required to increase the length of fascia (tissue surrounding muscle and all other tissues) by 1% is 9075 N. Not sure what this means? Me either! However, that means it takes a HUGE amount of force to increase the tissue. So much so, surgeons use scalpels to get the desired effect. Do you think anyone has the power to produce that same amount of force with their hands? Probably not. Thanks cadaver study! Side thought: I wonder when one of the members of ABBA passes away if they will donate their body to science allowing them to be an ABBA Cadaver.
ABBA fans, If you want to write me hate mail, click here
So if not breaking up adhesions and untying those knots, then what? It decreases tone in the muscles (I’m using this to mean inhibits muscle- but in a more prolonged manner). It decreases the natural tone in our bodies, especially at the area that has been working overtime. When we have pain, our pain cycle works thusly
We tighten up the muscles around an injury (or what used to be an injury) and lessen our movement to reduce the risk of injuring ourselves. Unfortunately, you can’t tell those muscles to chill out after the immediate danger has passed. Massage helps to break the pain cycle and move more easily therefore feeling and moving better.
So, chiropractic care and massage- What’s the verdict?
Of all the modalities spoken about in the 5 installments, this one is the closet to hitting home. Yoga was all about mobility and static stability. Pilates was all about dynamic stability with little focus on mobility. Pharmaceutical management was (mostly) about managing symptoms and acupuncture worked in the same vein. Chiro and massage focus on the neuro effects of inhibiting muscles and decreasing tone. These are great things to focus on, but at the end of the day, it’s a more passive form of yoga, as in it provides mobility with minimal stability. Is there any discipline out there that hits both the mobility and stability needed to reduce incidents and pain levels of lower back pain? I have a feeling you may know where I’m going with this (Important personal bias: I AM a physical therapist after all). That being said, I’m saving the best for last. Next week however is my 6th of 7th blog posts about healing your lower back pain and this one is a doozy. I will be tackling the interventional procedures and surgeries most often used for lower back pain. This may be retitled to “How to let a doctor fix your back”.
Anyhow, hope this was helpful. I enjoyed writing it.
As always, be well.
Dr. Daniel Davids PT