If you are in the habit of trying to convince people they need ongoing chiropractic care to achieve wellness, the evidence is lacking. Wellness is not a state that can be achieved via passive measures such as spinal adjustments, massage or physiological therapeutics. Wellness is a state of optimal function that is pursued by active lifestyle measures such as proper exercise, nutrition, sleep and healthy psychological pursuits.1
Pain can be debilitating and has even been described as "the perception of unhappiness."2 For most people, pain, distress and unhappiness are associated with not feeling well and so to be relieved of such symptoms by an adjustment could certainly lead a patient to conclude that state of wellness was derived from the adjustment. However, doctors should know better than to make such a conclusion. This is not to suggest that chiropractic cannot contribute to the wellness/health process. Certainly, if spinal manipulation reduces pain, which allows a patient to exercise regularly and sleep better, then it is reasonable to state that chiropractic care can be helpful for some people who wish to pursue wellness.
In contrast to the above scenario, there is no evidence that a symptom-free individual can acquire wellness via regular chiropractic treatments. In fact, the following case illustrates that indiscriminant spinal adjusting in certain symptom-free individuals can lead to severe neck pain and distress, which is a polar opposite of a state of wellness. A full-text copy of the case can be acquired from The Spine Journal.3
The short story: The patient was a 38-year-old banker who began seeing a chiropractor for treatment that included cervical manipulation. On the sixth visit, he developed pain immediately after a cervical adjustment, which became severe (10/10 at one point) and was accompanied by numbness in his arm. He saw a neurosurgeon who recommended surgery.
Certainly, this sequence of events should lead chiropractic wellness promoters to temper their recommendations. It is of interest that the patient reported he did not have neck pain prior to visiting the first chiropractor for presumed wellness visits, which ultimately lead to the recommendation of neck surgery.
Fortunately, this patient found his way to another chiropractor who used a gentle joint-mobilization technique and nerve-mobilization procedures, as well as cervical- and scapular-stabilization exercises. In a short period of time (only six visits), there was a significant improvement in the patient's pain and function.
The published case report also included an MRI of this patient's cervical spine. Disc herniations were evident at C3-C4, C4-C5 and C5-C6. Murphy reviewed the literature regarding the common asymptomatic nature of disc herniation and the likelihood that spinal manipulation was not a cause of the herniation.3 Rather, it's likely that the patient's asymptomatic disc herniations became symptomatic due to high-velocity manipulations that were unnecessarily delivered to the asymptomatic cervical spine.
Advocates of chiropractic wellness care need to carefully consider this case. It seems to be a much wiser practice choice to treat patients in need of the manual care offered by chiropractors - most of these patients have spinal pain.
References
- Seaman DR. Confusion about wellness and chiropractic. Dynamic Chiropractic, July 2, 2007;25(14).
- Mooney V. Where is the pain coming from? Spine, 1987;12:754-9.
- Murphy DR. Herniated disc with radiculopathy following cervical manipulation: Nonsurgical management. Spine J, 2006;6:459-63.
