Beware of unethical chiropractors who sign you up for long-term care plans with no milestones to measure progress.
Over the twelve years that I have been working with CLEAR, there are many stories that I have heard with disturbing regularity. Some of them serve to highlight the current inadequacies with the traditional orthopedic management of scoliosis – but that is a topic for another article. Today I’d like to highlight the most common failings in my own profession when it comes to managing scoliosis cases.
As I share this, please keep in mind that every profession has their share of outstanding members, as well as bad apples. This is in no way a blanket condemnation of the chiropractic treatment of scoliosis, in the same way that the articles I have written about the pitfalls of bracing and surgery should be considered as evidence that I am totally against these procedures. An intelligent decision is made with information and full consideration of all the facts. The purpose of this article is only to warn patients away from common unethical practices often used by those “bad apple” chiropractors, and hopefully (if any of them are reading this), to discourage those same chiropractors from using these tactics in the future.
Our story begins today with a fictional adolescent patient and her mother (let’s call the patient Mary). Mary was diagnosed with scoliosis about a year ago, and her mother has been taking her into the orthopedic office for x-rays every six months. Recently, the last x-ray showed that Mary’s scoliosis had gotten worse, so her orthopedic surgeon fitted her with a brace and told her to start wearing it for sixteen hours every day.
Mary, like many teenagers her age, is concerned with how the brace makes her look, and stand out amongst her peers. She and her mother have many heated discussions and, while Mary does indeed wear the brace as prescribed, she loathes every minute and it becomes a source of constant tension in the household.
Mary’s mother happens to run into a chiropractor, or perhaps is referred to one by a friend. They schedule an appointment at his office. During the initial consultation, the chiropractor explains that bracing can weaken the muscles, reduce spinal flexibility, and might not even prevent the scoliosis from getting worse. He explains the premise of chiropractic, and talks a lot about “unlocking the body’s innate healing potential.” It is an exciting message, and secretly, Mary is thrilled because she is thinking if her mom buys into this, she won’t have to wear the brace.
Well, the chiropractor’s charisma and Mary’s feelings about the brace combine to influence Mary’s mother to sign her up for chiropractic care.
“Scoliosis is a tricky condition to work with,” explains the chiropractor. “We’re going to need to commit to a long-term plan to get the results we want.”
Now, up to this point, there’s nothing wrong with the story. The information is generally factually correct; there are some concerns about bracing, and scoliosis is indeed a tricky condition to work with that requires a long-term commitment. This story could, as a matter of fact, very well have a happy ending at this point – if the chiropractor knows what he’s doing. Unfortunately, the training that chiropractors receive in school in regards to scoliosis is very limited. Most chiropractic techniques mention scoliosis briefly, if at all. Cracking the neck and mobilizing a few spinal segments is not going to cause the spine to re-align into a new, completely straight column, whether it is done once or a hundred times over a year. The foundation of the chiropractic philosophy – remove the interference and let the body heal itself – will be ineffective against the forces of gravity acting upon an already-severe scoliosis. Add as many insoles into your shoes as you would like, undergo electrical muscle stimulation, maybe even do a few posture exercises – at best, these modalities might have a mildly beneficial effect upon a very small scoliosis; at worst, they’re not likely to cause much harm. But once bracing has been recommended, the scoliosis has a documented history of progression, and the goal of treatment is now to avoid spinal fusion surgery, one of the worst things a chiropractor can give to this patient is a false sense of security.
Mary starts coming in to see the chiropractor twice a week, and the first month goes well. She is noticing some benefits of chiropractic care, no doubt; she is sleeping better, getting sick less, having fewer headaches, and missing fewer days of school. There’s no outward sign that anything is wrong.
One month turns into two, and then three. It’s been 25 visits now, and Mary’s long since learned the routine; it’s the same at each visit. There’s no x-ray machine at the chiropractor’s office, and Mary’s mother doesn’t feel the need to go back to the orthopedist since Mary is no longer wearing the brace. Her daughter says she is feeling great, and the chiropractor assures her that Mary’s condition is responding well to chiropractic care.
The first sign of trouble is when Mary’s father sees her in a swimsuit one day, and notices that the asymmetries in her back and shoulder blades look worse than he remembers. When he hears that the chiropractor has not been taking any x-rays to monitor the scoliosis, he insists that Mary re-visit the orthopedic surgeon for a new x-ray, to see what has changed.
When the results of the x-ray come in, Mary and her mother are shocked. The curve has actually gotten worse, not better – to the point where the orthopedic surgeon is now saying it’s too late for bracing, and Mary will need to have the surgery. Otherwise, he explains, curvatures of this magnitude will continue to progress throughout adulthood to the point where Mary’s heart and lungs are affected.
Sometimes the ending is even less happy; sometimes the patient has gone through the entire year of care and spend upwards of $10,000, only to find out at the end that their scoliosis is worse than before. The one recurring theme in the story, though, is that the chiropractor never took any x-rays (or if he did, never shared them with the parents, or never measured Cobb angle, or measured it incorrectly, etc.), nor did he do regular physical examinations using accepted standards of scoliosis care (scoliometers, for example). He applied generally the same treatment to the patients with scoliosis under his care that he did to non-scoliotic patients. There were no physiotherapeutic scoliosis-specific exercises, no home therapy component, and no counseling regarding Mary’s activities of daily living. In essence, the chiropractor used her scoliosis to justify a long-term care plan, without bothering to take short-term re-evaluations along the way to ensure that they were on the right course. Instead, Mary’s mother accepted his direction and continued to march in the same direction, completely unaware they were heading down the wrong road.
Sometimes the story is worse; the chiropractor utilizes fear-based tactics, talking about something called a “killer subluxation,” or focusing purely upon all the worst articles on bracing and surgery, while failing to offer a clear alternative (see what I did there?).
The bottom line is this – whatever treatment you choose, recognize that when scoliosis is diagnosed in a young person who still has growing left to do, you only have one shot. You cannot go back in time and select a different option if the first one doesn’t work. Once the scoliosis has progressed to severe levels, the chance of conservative treatment achieving a successful long-term outcome is greatly reduced. Trust your gut instincts. Make sure that the doctor performs exams and takes x-rays at regular intervals. Learn how to measure Cobb angle (it’s not difficult – we show you how, here) and insist upon tests that will measure what is important to you (is your son or daughter an athlete? Insist that your doctor perform regular spirometer tests to ensure that the treatment is helping their lungs to function at their peak efficiency).
When in doubt, use our List of Questions to Ask Your Doctor – these questions can be good to ask chiropractors and orthopedic surgeons alike. Remember; it’s your spine, and it’s your life! You only get one shot at each, so make the most of both.