Dr. Richard Bruno is Chairperson of the International Post-Polio Task Force and director of The Post-Polio Institute and International Centre for Post-Polio Education and Research at Englewood (NJ) Hospital and Medical Center. His new book, How to STOP Being Vampire Bait: Your Personal Stress Annihilation Program, will be published in 2004. E-mail him at ppsforum@newmobility.com.
Note: This column is for information purposes only and is not intended as a substitute for professional medical advice.
February's column about muscle spasm pain--and not using narcotics to treat it--generated letters asking if chiropractors can treat back and neck pain in polio survivors.
The answer is a very cautious "sometimes." Before you see a chiropractor, you need to know what chiropractic is. Chiropractic is an American creation that was developed in 1895. Chiropractic treatment is based on the theory that there is a "strain or sprain" between spinal vertebrae that causes a misalignment, called a "subluxation." Subluxation is thought to trigger muscle spasm and back or neck pain by reducing the movement of the vertebrae. Chiropractors "adjust" or "manipulate" the spine with their hands, or with a device called an "activator," which "pops" the vertebra back into proper position, restores spinal movement and decreases pain. However, chiropractor Howard Vernon, writing in Chiropractic in the United States: Training, Practice, and Research says that this theory remains "largely speculative" and that "all of the theories of the effects and mechanisms of action of spinal manipulation still lack adequate research."
There isn't just a lack of research documenting how chiropractic treatment for back pain works. It is more than a little disturbing that, in spite of admitting there is no research to support its claims, the American Chiropractic Association says that chiropractors treat not only back pain, but also allergies, asthma, digestive disorders, childhood ear infections, and even attention deficit disorder in children. There are some studies showing that manipulation can be effective in treating back pain. But with such broad claims about chiropractic and so little research documenting its mechanism of action and effectiveness, should polio survivors ever see a chiropractor?
There are situations where spinal manipulation could help: when back pain is caused either by the sacroiliac joints in the pelvis; middle and lower back spinal vertebrae going out of alignment after a fall; an auto accident; or just by turning, bending or lifting improperly. After the initial muscle spasm is calmed down [see February 2005 "PPS Forum"], the sacroiliac joints or vertebrae can often be moved back into place and pain reduced.
Although some chiropractors recommend adjusting the entire spine to treat back pain, there is no evidence that this is more helpful than adjusting only the low back or sacroiliac joints. What's more, spine adjustments that include neck vertebrae are risky. Neck manipulation has been reported to cause spinal cord injury, damage to blood vessels supplying the brain, and stroke. Even low back spinal adjustment is not recommended if you have a history of spinal surgery or a spinal fusion, osteoporosis, or have neurological symptoms--numbness, tingling or recent loss of muscle strength in an arm or leg--that may indicate a pinched nerve or a severely herniated disc.
As with all symptoms in polio survivors, the cause of pain must be identified, or potential causes ruled out, before spinal manipulation is attempted. And you should also know that it's not just chiropractors who can adjust the spine. Medical doctors of osteopathy and specially trained physical therapists can also perform spinal manipulation. But regardless of who's doing the "back cracking," polio survivors should talk to their physicians before being adjusted by anyone.
Unfortunately, even when spinal manipulation does help to relieve back pain, chiropractors don't usually teach proper posture, which is vital to maintain the alignment of the spine and sacroiliac joints. This leads some people with chronically poor posture to depend on frequent adjustments to realign their spines.
The Mayo Clinic concluded that four to eight chiropractic sessions are reasonable to treat new back pain, but that there is no evidence additional treatments are helpful. Repeated adjustment can cause irritation, inflammation and continued or additional pain. So, once the sacroiliac joints or low back vertebrae have been moved into proper position, people should see a physical therapist with experience treating both PPS and chronic pain for help in learning proper posture in sitting, standing and walking. Physical therapists can also suggest braces, forearm crutches and lumbar and seat cushions to help keep your pelvis and spine straight.
