Special to The Washington Post
Tuesday, July 17, 2007; HE01
The sound of cavitation is music to my ears.
That's the popping noise made when a joint is taken past
its normal range of motion and a bubble of gas emerges in
the surrounding synovial fluid. Keep twisting or pulling
and eventually the bubble bursts, relieving pressure on
the joint.
And it feels good.
And here it comes again. I'm facedown on a brown padded
table, my nose positioned in an opening so I can breathe.
My arms hang loosely to the floor and my legs are extended
behind me.
It's comfy here, and I could nap, except Glenn Loebig is
probing a tender spot on my lower right back with one of
his preternaturally muscular thumbs.
"There it is," he announces, making me wince with
a poke. With his open hands, he presses on my lower back,
leans in and with a swift push . . .
Ah, cavitation. And not just one pop but a short, quick
sequence of them, creating a snap, crackle, pop effect.
"That was a good one!" Loebig says enthusiastically,
as if even he's surprised at the intensity. "That's
going to feel better now."
Chiropractic medicine has been derided as a fringe practice
or worse since founder Daniel David Palmer began adjusting
spines just over a century ago. For decades, anyone who
wanted chiropractic treatments for backaches or other ailments
had to find them on his own and pay for them out of pocket.
But times are changing. While the medical profession remains
deeply skeptical of chiropractic as a comprehensive health-care
approach, more doctors are referring patients to chiropractors
to treat lower-back and other musculoskeletal pain.
"I'm an orthopedic spine surgeon, so I treat all sorts
of back problems, and I'm a big believer in chiropractic,"
says William Lauerman, chief of spine surgery and a professor
of orthopedic surgery at Georgetown University Hospital.
"I'm more of a believer for acute problems like short-term
back pain, although I know [chiropractic] can be helpful
for some cases of more-chronic conditions."
Chiropractic treatment for short-term back pain -- "three
or four days, can't get out of bed, that sort of thing"
-- Lauerman says, "is one of the few things that has
been demonstrated to significantly alter the natural history
of acute back pain. . . . People get better quicker if they
go to a chiropractor for a few visits."
An Uneasy Truce
Such referrals come despite the still-thin evidence for
chiropractic's effectiveness. The National Center for Complementary
and Alternative Medicine (NCCAM) describes studies of chiropractic
for back pain as of "uneven quality and insufficient
to allow firm conclusions." A meta-analysis in the
2003 Annals of Internal Medicine found that spinal manipulative
therapy relieved back pain better than sham therapy but
no better than other standard treatments.
Chiropractic students study a minimum of 4,200 hours, according
to the U.S. Department of Labor, with most states requiring
a four-year undergraduate degree and four years of postgraduate
training at an accredited chiropractic college. Chiropractors
also must pass national and state licensing exams before
practicing. But just as in mainstream medicine, sometimes
things go wrong. In 2003, a 43-year-old woman in Mahopac,
N.Y., suffered a stroke after a routine neck adjustment.
The case is headed to court.
"[That stroke] is a rare occurrence, but it is something
we have to be concerned about as a responsible profession,"
says William Morgan, one of two chiropractors at the Bethesda
Naval Medical Center. "We'll study the risk and will
do everything we can to minimize the risk."
Chiropractic patients now number about 22 million, thanks
to medical referrals and the fact that "87 percent
of all American workers who have insurance have plans that
include chiropractic service," says Kevin Corcoran,
executive vice president of the American Chiropractic Association,
based in Arlington. The ACA represents 16,000 of the country's
estimated 60,000 practicing chiropractors.
That doctors refer patients to any of them is a sea change
from 1990, when the U.S. Supreme Court refused to hear an
appeal of a lower court's ruling that the medical establishment
was trying to put the chiropractic industry out of business
through a campaign of denigration. The case, Wilk v. American
Medical Association, prompted the AMA to change its code
of ethics in 1992 regarding chiropractors.
"I think the majority of MDs recognize the value chiropractors
bring," Corcoran says.
The American College of Physicians, which includes about
120,000 internists and medical students, agrees the doctor-chiropractor
relationship is no longer a hot topic. "It just isn't
on our radar," ACP spokeswoman Susan Anderson says.
The AMA declined to comment beyond noting its revised policy,
which says, among other things, "It is ethical for
a physician to associate professionally with chiropractors
provided that the physician believes that such association
is in the best interests of his or her patient."
Chiropractors can't prescribe drugs or perform surgery,
but "we are trained to recognize and diagnose and send
patients to the appropriate care if it's something beyond
our scope," says William Lauretti, an assistant professor
at the New York Chiropractic College in Seneca Falls, N.Y.,
and a former chiropractor in suburban Maryland. Some cancers,
for instance, "can present as low-back pain. We're
trained to tell the difference when there's something more
serious and more urgent than the basic muscle or joint problem."
Morgan, a former Navy petty officer, has been working under
contract alongside staff physicians at the Bethesda Naval
Medical Center for nine years, trying to relieve symptoms
and reduce dependence on medication. In many cases, he's
the first chiropractor his patients have ever seen.
"They trust their physician a great deal, and if they
think I can help make them better, they'll trust me, too,"
he says. "And if I can't make them better, then we'll
find someone who can."
Making Adjustments
When I stand up, I see that Loebig is right. It does feel
better. What had been a nagging bundle of deadline tensions
and bad posture knotted up on the inside of the right hip
is now a pressure-free zone of happiness that gladly accepts
its fair share of weight distribution. I twist from side
to side. My hips glide with newfound ease.
A study conducted over seven years by a physician and a
chiropractor and reported in June's Journal of Manipulative
and Physiological Therapeutics showed that patients who
turned first to chiropractors and other alternative-medicine
professionals for care were hospitalized and had surgery
60 percent less often and spent 85 percent less on pharmaceuticals
than those with medical doctors as primary care providers.
And that's what I'm counting on. After three spinal surgeries
since 2002, two lumbar and 2004's brutally intrusive cervical
fusion, which put a piece of cadaver bone in my neck in
a procedure that was supposed to correct chronic shoulder
and arm pain -- and didn't -- I'm hoping to minimize my
time under the knife.
My neurologist, who is trying to find the right combination
of chemicals to control that pain, prescribed chiropractic
as part of his treatment. Loebig focuses on my shoulder
and arm, finishing each visit with adjustments to the neck
and lower back.
"That should help your golf swing," Loebig says
with a pat on the back as he makes marks on my chart.
I've been adjusted, and not just my back and golf swing
but my outlook as well. I step into the bright sunshine
outside Loebig's Great Falls office a little lighter on
my feet, a little less aware of the chronic pain in my right
shoulder. My head feels looser on my neck, and I feel taller.
The sensation of well-being won't last, I know. It could
be a matter of days, or even hours, before the pressure
builds again and my joints stiffen with stress and tension.
But for now, I'll take it. •
Buzz McClain is a Washington area freelance writer.
Comments: health@washpost.com
