Cracking your Back
Dr. Alan Cappellini, on right, works on Michelle Santella.
Bill Kessler, 58, of McClellandtown, performs a stretch to help strengthen his back at Uniontown Chiropractic.
Bill Kessler, 58, of McClellandtown, performs a stretch to help strengthen his back at Uniontown Chiropractic.
Dr. Alan Cappellini
Dr. Garett Breakiron performs spinal manipulation on patient Linda Frey, 43 at Uniontown Chiropractic.
Dr. Garett Breakiron
Dr. Greg Hogan demonstrates an exercise used to help strengthen the back at Uniontown Chiropractic.
Dr. Alan Cappellini, on right, works on Michelle Santella.
Bill Kessler, 58, of McClellandtown, performs a stretch to help strengthen his back at Uniontown Chiropractic.
Linda Frey could barely stand up straight. With intolerable pain, she moved around gingerly, hunched over, rendered nearly incapacitated by a herniated intervertebral disk in her spine.
A nurse at Uniontown Hospital, Frey hurt her back while on the job last June. She underwent three months of medical therapy, but none of the pills, injections or other treatments brought her sufficient relief from her agony.
“I wasn’t really even able to walk,” the 43-year-old Smithfield woman recalls. “There were times when my husband would have to carry me places. I was in a terrible state. I didn’t sleep at night. I couldn’t walk too long. I couldn’t stand too long. I couldn’t lie too long. It was just excruciatingly miserable.”
In September 2013, Frey sought the help of Dr. Garret Breakiron at Uniontown Chiropractic Center, where she began a series of treatments encompassing spinal manipulation (adjustments), physical therapy and other modalities. The seven to eight months of treatment she’s received since then, coupled with the self-care she’s done at home, have eased the pain and restored much of the function lost to her injury.
Speaking shortly before a therapy session last week at the center, Frey lacks the visible signs of her once-debilitating spinal condition. She appears fit, stands straight, remains on her feet for 15 minutes or more, and talks openly about the benefits she’s gained from chiropractic treatment.
“I can walk a lot better now, and if I have to do certain things, it’s easier for me,” she says. “I know people sometimes don’t believe in chiropractic, but it’s worked for me. Try the treatment plan and stick to it. It’s not just manipulation. It’s a whole plan.”
Helping hands
The term chiropractic literally means “done by hand,” and hands-on spinal manipulation serves as the cornerstone of chiropractic care. By applying varying degrees of force and movements, chiropractors and other practitioners of spinal manipulation work to balance the vertebrae and soft tissues of the back and neck, returning them to a more natural alignment.
Once viewed largely as a complementary or alternative treatment, spinal manipulation is gaining more widespread acceptance among mainstream medicine, as research studies suggest it’s comparable to or more effective than medications and other conservative treatments at relieving back or neck pain. But unlike medications, which provide temporary relief of the pain, spinal manipulation targets the source of the pain.
“The chiropractic adjustment is more specific, meaning that we want to focus on a specific neurological pathway. We either want to stimulate an area that is not functioning optimally or we want to inhibit an area that may be overstimulated,” says Uniontown chiropractor Dr. Alan Cappellini. “We can deliver treatment of a cause as opposed to treatment of symptoms. If you have inflammation or spasm, spasm isn’t the problem. It’s a reaction to a problem. If you take anti-inflammatories and muscle relaxants, you may squelch the symptoms, but they’ll keep recurring because you haven’t addressed the problem.”
If you’re like most people, you’re familiar with the high-velocity, low-amplitude (HVLA) form of spinal manipulation–the hallmark “back cracking” of chiropractic. But spinal manipulation is more than just cracking your back. Rather, it encompasses dozens of subtypes, some more vigorous like HVLA, others more gentle and resembling elements of massage therapy.
Naturally, some types of spinal manipulation are more appropriate for some patients than others. For instance, more aggressive forms may not be suitable for older patients with osteoporosis. Your overall medical condition will help determine which type of spinal manipulation, if any, is right for you.
Today’s chiropractic
Likewise, modern chiropractic care is more than about spinal manipulation. “It also deals with giving specific exercise instruction, whether it be in-house rehabilitation or home therapeutic exercises, so that patients can help themselves at home to increase their flexibility and strength,” Breakiron explains. “This will help decrease the gravitational stress on the spine.”
Although manipulation can return the vertebrae and other spinal structures to a more normal alignment, therapy exercises are necessary to build the muscles required to maintain that alignment and restore flexibility to the back and neck.
Chiropractors not only provide patients with exercises to bolster their spine health, but they also counsel them about proper nutrition and educate them about proper lifting techniques, suitable sleeping positions and other ways to alleviate stress on the back and neck.
“We want to create an optimal environment for healing, so that’s going to include everything from therapy and exercise to rest and nutrition,” Cappellini says. “As far as chiropractic goes, in the purest sense of the word, manipulation is what we do best, but all of these things go hand in hand to create an optimal environment.”
This treatment approach can benefit patients with back pain resulting from an array of conditions, ranging from muscle strains to problems with the spinal disks, the gel-like cushions situated between the vertebrae. For certain conditions, particularly bulging or herniated disks, chiropractors may employ other therapies, such as computerized decompression traction. This treatment works by gently stretching the spine to alleviate pressure on the disks and, eventually, prompt them to retract and no longer press against nerves in the spine.
Chiropractors are also trained to refer patients to other specialists when necessary–both Breakiron and Cappellini note that they work closely with orthopaedic surgeons and other specialists. In some cases, a chiropractor will provide care before and after a patient undergoes spinal surgery.
One of those cases is Dale Kessler. Years of working as a coal miner took their toll on the McClellandtown man’s lower back, forcing him to seek treatment from Breakiron. Eventually, though, Kessler’s spine deteriorated to the point to which he couldn’t even make it out to retrieve the mail from his mailbox, he says. So, this past November, he underwent spinal surgery to remove portions of his vertebrae that were causing his pain and disability.
After the operation, the 58-year-old resumed treatment at Uniontown Chiropractic Center, finishing his sessions last month. “There are many things I can do better, and there are certain things that still aren’t quite right,” Kessler says. “Because of the nerve damage, I still have numbness in my foot, and that could take years, if ever, to heal. But by being in therapy and continuing to exercise, normal, everyday things are much, much better.”
Get the help you need
By some estimates, four out of five people will experience back or neck pain at some point. Back or neck problems may manifest only as localized pain, or referred pain in other parts of the body. For example, a problem in the cervical spine, in the neck, may cause pain, numbness or tingling down the arm, whereas a disorder in the lumbar spine of the lower back may cause shooting pain and functional problems in the buttock and leg.
A sign at Breakiron’s office reads, “Maybe it’ll go away, says the fool.” If you suffer persistent pain from a back or neck injury, don’t wait for the pain to just go away, Breakiron cautions, because the longer you wait to address the problem, the more difficulty you may have correcting it.
“It’s one thing if you’ve had pain for two, three or four days, but I’ve had patients who say they’ve had it for months,” Breakiron says. “When you wait that long, it makes it even harder to take care of.”
“The general rule of thumb is if it’s intermittent pain, you can self-monitor, and if it is going to resolve naturally, it should resolve within three to five weeks,” Cappellini adds. “But if you have continuous pain and disrupted function for four to five consecutive days, I’d like to see you.”
During an initial visit to a chiropractor, expect a detailed discussion about your medical history, including a review of any medications you take and any surgeries you might have had. The specialist will perform a physical exam and various orthopaedic and neurological exams, such as testing your reflexes, muscle and grip strength, and sensation. You also should undergo an X-ray of your spine, Breakiron recommends.
“If you go to a chiropractor and if he didn’t at least have some X-rays of you before or you didn’t bring some in with you and he’s not going to X-ray you, walk out the door,” he adds.
Patients seeking help from Breakiron or Cappellini typically receive a treatment during their first visit. How frequently you need to undergo follow-up sessions varies by practitioner and patient. Both Breakiron and Cappellini advise against agreeing up front to a predetermined number of treatment sessions over an extended period.
“In my opinion, if anyone decides during your initial visit that you need ongoing care for months on end, I say you should run from them,” Cappellini says. “Those are cookbook recipes, and this is not a one-size-fits-all condition.”
Spinal manipulation is generally safe and causes little to no pain, although you may experience some soreness afterward as your body adapts to the repositioning of the vertebrae. Certain high-velocity manipulation techniques in the neck have been associated with stroke and vascular injury, but the risk of these complications is very low and can largely be prevented with the right pre-treatment testing and careful review of a patient’s medical history, Breakiron says.
Given the overall safety and effectiveness of chiropractic care, both Breakiron and Cappellini, as well as a growing number of other experts, recommend it as a first-line treatment for back and neck pain.
“It is a safe and viable alternative to medications and surgery,” Cappellini says. “There is a place in the health-care field for this type of service. That’s why we are busy, and that’s why people seek our services on a daily basis. As time has passed, we have become more involved in multidisciplinary management with medical doctors and have been more accepted in the general community.”
Spines in motion
Frey continues to undergo treatment with Breakiron two to three times a week, and maintains her exercise regimen. She’s hoping to return to work and resume going to the gym, walking around her neighborhood, attending ballgames and enjoying the life she had before her injury.
“I feel much better,” she says. “I’m not 100 percent–I’m probably 75 to 80 percent better–but I’m much farther along. It’s not a quick fix, and it hasn’t been an easy process. It’s not just taking a pain pill, sitting around and doing nothing. You have to keep your body moving. Some of the exercises would hurt, but you didn’t mind doing them because you knew they were bringing you back to a point where your body needed to be fixed.”
Like Frey, Kessler continues to work on his spine health. Now retired, he’s a fixture at Uniontown Chiropractic’s rehabilitation facility, exercising three or four times a week to keep his back strong and mobile.
“Working out and continuing to try to make myself healthier and just better overall is my hobby now,” he says. “If you have a back problem, get it evaluated and see what’s wrong. Don’t let it go. It’s not going to cure itself.
“Get the proper treatment, and learn the exercises that you’re given because they will make you better,” he adds. “If you fail to take care of yourself, whether you had an injury or not, you’re going to fall into a category of weakness and misalignment, whereas if you continue t take care of yourself, your muscles will hold your spine and skeletal system better and you, in turn, will live a much better, pain-free life, believe me.”
Action points
? Consider spinal manipulation as part of a comprehensive treatment plan for back or neck pain that also includes physical therapy, ice, moist heat, pain medications and other conservative treatments.
? Choose a practitioner qualified to offer multiple forms of spinal manipulation and carefully reviews your medical history to determine which form, if any, is right for you. Before starting treatment, tell the doctor about any medical problems you might have.
? Work with your healthcare provider to develop an exercise regimen to strengthen the core muscles of your abdomen, spine, buttocks, and hamstrings.
? If you smoke, talk to your doctor about ways to quit. Smoking can inhibit blood flow to the spinal disks, hastening their decline.
? Practice good whole-body posture, keeping your chest raised, your shoulders back, and maintaining a straight vertical alignment from the top of your head through the center of your body to your feet.
? Work with your doctor to correct any problems with sitting, sleeping or other habits that may contribute to your back or neck pain.
? When lifting something, bend at the knees, not the waist, and hold whatever you’re lifting close to your body.