CLINICAL REPORT

척추 부정렬에 인한 관련질환

의학적 관점으로서의 카이로프락틱

 

의학적관점에서의 카이로프락틱 


Consider This Therapy for

How Treatment are Done

When Should Treatment Stop

 


ConsiderThis Therapy for

 

The "hand-on" joint manipulation known as chiropractic is considered particularly valuable for relief of acute (temporary) pain in the lower back. This type of pain usually subsides on its own within 3 months, but chiropractic treatment can often bring it to an end immediately. (See also the entry on osteophathic medicine.)

In many cases, chiropractic can also ease pain--due to either a temporary condition or aggravation of a chronic problem--in areas such as the mid-back, neck, or joint. Additionally, it is sometimes used to relieve the pain of headaches, mustle spasms, and nerve inflammation. Its effectiveness for relief of sciatica (pain or numbness along the sciatic nerve, generally in the back, buttocks, hips, or adjacent parts) remains controversial.

After the common cold, low back pain is the most common reason for doctor visits, it's an especially frustrating problem because there's frequently no simple medical explanation for it--and therefore no easy cure. However, there's now mounting evidence that spinal manipulation can be a genuine source of relief. In 1994 the Agency for Health Care Policy and Research (AHCPR) released its Guidelines on Acute Low Back Pain Problems in Adults. This report identified manipulation (defined as certain specific techniques used to re-align or re-adjust a joint) as the preferred method of treatment for relief of acute back pain. Traction, bed rest, corsets, or drug therapics were not recommended.

Similary, a report from the RAND Corporation published in the prestigious Annals of Internal Medicine found manipulation effective for the relief of acute low back pain. (It was not, however, deemed as successful in the treatment of chronic or recurrent low back pain, sciatica, asthma, high blood pressure, or pain caused by neurological conditions.)

Chiropractors, RAND pointed out, perform 94 percent of spinal manipulations (though not necessary with the same techniques emploved in the study.)

To date, there's no scienific confirmation of chiropractic's effectiveness for anything other than low back pain. However, in a few years we should know more. In early 1998, the National Institutes of Health's Office of Alternative Medicine, and the National Institute of Arthritis and Musculoskeletal and skin Disease awarded a research grant to support the first federally funded Center for Chiropractic Research.

 


How Treatment are Done

 

Although the back is the primary focus of chiropractic, the manipulations can be applied to any muscle or joint in the body. Techniques vary among practitioners. Typically, after preparation and proper positioning, the chiropractor creates tension aro

und the offending joint, then applies pressure to return it to its proper position. A popping sound is often heard--and sometimes felt--following this maneuver. The noise is similar to the one you hear when cracking your knuckles. It results from the sudden release of built-up pressure in the joint, and is generally painless. As the joint snaps into place, pain is relieved and proper function is restored. Other techniques you may encounter include soft tissue manipulation, trigger-point manipulation, or deep tissue massage.

On your first visit to a chiropractor, you'll probably be asked to complete a questionnaire about your personal and family medical history. Be sure to discuss any illnesses that run in the family. Although chiropractors are not prepared to diagnose the full gamut of disease, they are trained to perform physical examinations in much the same way as a general medical practitioner. For example, you may be given a blood test to rule out infection and a reflex test to rule out neurological problems. Your blood pressure, Pulse, and respiration will also be measured.

Once these general reading have been taken, the examination will begin to zero in on your musculoskeletal system--the muscles and bones in your body--with particular attention to your spine. The chiropractor will also analyze your posture, and will probably perform some orthopedic tests as he examines your articulations (a chiropractic term for joints). These tests usually involve moving a particular limb in search of joints that are "fixated" (not moving) or moving with impaired range.

If the chiropractor identifies a fixated joint, he will then attempt to determine whether there is any risk involved to restoring normal movement to the joint and what other parts of the musculoskeletal system have been affected by the joint's dysfunction. It is common for a "healthy" joint to overcompensate by moving excessively when another joint is not working correctly. The healthy, hyperactive joint might be near the fixated joint or in an entirely different part of the musculoskeletal system.

Overcompensation can result in new, incorrect structural configurations that cause discomfort or pain.

To rule out any conditions that would preclude treatment, chiropractors usually take an x-ray of the region causing your pain before beginning the manipulations. Some of the region causing your pain before beginning the manipulations. Some chiropractors also take x-rays to locate subluxations (partial dislocations). Most chiropractors have basic x-ray equipment on-site and all chiropractors are trained to read x-ray images. If a specialized view is required, you may be referred to a center that has advanced technology, such as magnetic resonance imaging (MRI) equipment, or other equipment that provides a comprehensive image.

About 90 percent of chiropractors use x-rays. However, full-spinal x-rays in search of subluxation are considered controversial by many practitioners, and constitute less than 17 percent of all x-rays performed by chiropractors, according to the American Chiropractic Association. Many practitioners, chiropractic and otherwise, believe that full-spinal x-rays yield little if any useful information, and thus expose patients to radiation needlessly.

The chiropractor will also examine your muscles to determine if they are balanced. Just as healthy joints compensate for injuries in other structures, muscles may also exhabit "compensated distortion." When one muscle or group of muscles is contracted, for example, those on the other side may be abnormally relaxed.

Once the chiropractor has all the information he needs, treatment will proceed. Therapeutic equipment common to a patient's body. The table has mechanized parts that can be adjusted in accordance with the patient's size and the region of the body that requires treatment. For example, the surfaces where the face, pelvis, and other body structures lie will yield independently as the chiropractor applies controlled force to these areas during treatment.

According to the American Chiropractic Association, more than 90 percent of chiropractor use techniques common to physical therapy, especially in preparation for maniplation. Your practitioner may use a broad, pad-like vibrator to relax your back muscles. He may apply hot or cold compresses to increase circulation and relax painful muscle spasms, or use traction to ease pressure. Ultrasound is often used as a "micro massage" to stimulate circulation and remove fluid from the area around a damaged joint and nearby tissues.

Some chiropractors also recommended and teach relaxation techniques as a way to prevent future strain, and prescribe rehabilitative exercises as part of an extended treatment plan. Some also prescribe and sell dietary supplement and herbs, although such products fall outside the realm of chiropractic.

Treatment Time: The initial visit typically lasts at least 1 hour. Subsequent visit usually take between 10 and 30 minutes.

Treatment Duration: On average, a course of treatment involves 3 to 5 visits per week for 2 weeks. Several studies have noted that consumers using chiropractic care are more satisfied with treatment than patients who receive medical care. Chiropractors are perceived as spending more time face-to-face with the patient, although no studies have been done to verify this.

 


When Should Treatment Stop

 

In many cases, relief is immediate. If pain persisys, allow some time for improvement to appear--2 weeks is generally sufficient in cases of acute low-back pain. If there's still no change, or if the condition becomes worse, stop the treatments and seek alternative therapy. Many chiropractors refer patients to specialists for further evaluation when a condition persists.