Answers to Questions about Chiropractic:
How Can a Medical Doctor Locate a Good Chiropractor?

Samuel Homola, D.C.

Question

As an MD, I have had to deal with patients who treated either on occasion or regularly with chiropractors. When I had my own family practice, I decided it was best to search out and develop a relationship with a "reasonable" chiropractor. I met one whose approach to treatment was similar to mine. He educated me about different philosophies of chiropractic care. As I recall, he said chiropractors were divided philosophically into "straights" and "mixers." I can't recall which is which, but one group wanted to be a part of the medical community, treated only musculoskeletal ailments, and didn't go in for all the supplements, etc. The other school thought they could treat everything.

We had a great relationship. I sent him a number of patients. If the patient didn't make any improvement after two or three visits, he felt that the treatment wasn't worthwhile and discontinued it.

Although a skeptic in both life and in medical practice, I can also accept that some things work without us knowing why. I don't buy into the misalignment philosophy of many chiropractors. Yet, I can't argue with some of the successes with patients suffering from muscular back pain.

Currently, my work is solely in the area of occupational medicine. Many claims adjusters and case managers, who wield a lot of power when it comes to referrals, recoil in horror when there is any mention of a chiropractor. I suspect their experience is that once a chiropractor gets hold of a patient, he or she never lets go.

I recently started working in a new clinic and have yet to establish a relationship with a chiropractor. That's one of the items on my agenda for this summer. My plan is to meet at the chiropractor's office so I can see how the office is set up, what sort of information is available in the waiting room, etc. Naturally, I will ask about what types of problems they treat (musculoskeletal vs. heart disease, etc.), whether they sell nutritional supplements and vitamins, and their philosophy on maintenance therapy. I wonder if you have any other suggestions for questions.

Answer

"Straight" chiropractors use only spinal adjustments to treat the gamut of human illness. They are dedicated to locating and correcting (imaginary) vertebral "subluxations," which they find in everyone's spine. "Mixer" chiropractors offer manipulation with other methods, including such bogus methods as homeopathy, megavitamins, colon irrigation, and acupuncture. Both types might attempt to treat organic ailments—one using only spinal adjustments and the other using spinal manipulation along with vitamins, etc. Both might recommend "maintenance therapy" to prevent the development of "subluxations."

There is a third group of chiropractors who limit their practice to treatment of musculoskeletal problems, using a variety of physical treatment methods, such as physiotherapy, ergonomics, and so on, along with spinal manipulation. This group might also offer advice in the use of exercise, nutrition, life-style changes, and other useful self-help measures. These chiropractors might be considered "mixers," who (a) use appropriate physical treatment methods, (b) limit their practice to care of mechanical-type musculoskeletal problems, and (c) treat only when patients have symptoms (no maintenance therapy). Since manipulation is not always indicated, a physical therapy modality might be used, alone or together with massage, manipulation, stretching, etc.

Your best bet is to look for a chiropractor who rejects subluxation theory and whose practice is limited to treatment of musculoskeletal problems, using a variety of physical treatment methods along with manipulation. Such chiropractors usually realize that if a patient worsens after a week or two of treatment, or has not improved after a month of treatment, the treatment should be discontinued.

I would avoid "straight" or "subluxation-based" chiropractors who think that most ailments are caused or precipitated by vertebral misalignment and that the only treatment needed is a spinal adjustment. These chiropractors manipulate everyone's spine, and some manipulate the neck of every patient they see—a dangerous and unnecessary practice.

It's not easy to find a good, properly-limited chiropractor, but many can be eliminated from consideration simply by looking at their yellow page ads. For additional information, see:

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Dr. Homola is a second-generation chiropractor who has dedicated himself to defining the proper limits on chiropractic and to educating consumers and professionals about the field. His 1963 book Bonesetting, Chiropractic, and Cultism supported the appropriate use of spinal manipulation but renounced chiropractic dogma. His 1999 book Inside Chiropractic: A Patient's Guide provides an incisive look at chiropractic's history, benefits, and shortcomings. Now retired after 43 years of practice, he lives in Panama City, Florida.

This article was posted on January 22, 2004.