By Buzz McClain
Special to The Washington Post Tuesday, July 17, 2007; Page HE01
The sound of cavitation is music to my ears. That's the popping noise made when a joint is taken past its normal range of motion and a bubble of gas emerges in the surrounding synovial fluid. Keep twisting or pulling and eventually the bubble bursts, relieving pressure on the joint.
And it feels good.
And here it comes again. I'm facedown on a brown padded table, my nose positioned in an opening so I can breathe. My arms hang loosely to the floor and my legs are extended behind me.
It's comfy here, and I could nap, except Glenn Loebig is probing a tender spot on my lower right back with one of his preternaturally muscular thumbs.
"There it is," he announces, making me wince with a poke. With his open hands, he presses on my lower back, leans in and with a swift push . . .
Ah, cavitation. And not just one pop but a short, quick sequence of them, creating a snap, crackle, pop effect. "That was a good one!" Loebig says enthusiastically, as if even he's surprised at the intensity. "That's going to feel better now."
Chiropractic medicine has been derided as a fringe practice or worse since founder Daniel David Palmer began adjusting spines just over a century ago. For decades, anyone who wanted chiropractic treatments for backaches or other ailments had to find them on his own and pay for them out of pocket. But times are changing. While the medical profession remains deeply skeptical of chiropractic as a comprehensive health-care approach, more doctors are referring patients to chiropractors to treat lower-back and other musculoskeletal pain.
"I'm an orthopedic spine surgeon, so I treat all sorts of back problems, and I'm a big believer in chiropractic," says William Lauerman, chief of spine surgery and a professor of orthopedic surgery at Georgetown University Hospital. "I'm more of a believer for acute problems like short-term back pain, although I know [chiropractic] can be helpful for some cases of more-chronic conditions."
Chiropractic treatment for short-term back pain -- "three or four days, can't get out of bed, that sort of thing" -- Lauerman says, "is one of the few things that has been demonstrated to significantly alter the natural history of acute back pain. . . . People get better quicker if they go to a chiropractor for a few visits."
An Uneasy Truce
Such referrals come despite the still-thin evidence for chiropractic's effectiveness. The National Center for Complementary and Alternative Medicine (NCCAM) describes studies of chiropractic for back pain as of "uneven quality and insufficient to allow firm conclusions." A meta-analysis in the 2003 Annals of Internal Medicine found that spinal manipulative therapy relieved back pain better than sham therapy but no better than other standard treatments.
Chiropractic students study a minimum of 4,200 hours, according to the U.S. Department of Labor, with most states requiring a four-year undergraduate degree and four years of postgraduate training at an accredited chiropractic college. Chiropractors also must pass national and state licensing exams before practicing. But just as in mainstream medicine, sometimes things go wrong. In 2003, a 43-year-old woman in Mahopac, N.Y., suffered a stroke after a routine neck adjustment. The case is headed to court.
"[That stroke] is a rare occurrence, but it is something we have to be concerned about as a responsible profession," says William Morgan, one of two chiropractors at the Bethesda Naval Medical Center. "We'll study the risk and will do everything we can to minimize the risk."
Chiropractic patients now number about 22 million, thanks to medical referrals and the fact that "87 percent of all American workers who have insurance have plans that include chiropractic service," says Kevin Corcoran, executive vice president of the American Chiropractic Association, based in Arlington. The ACA represents 16,000 of the country's estimated 60,000 practicing chiropractors.
That doctors refer patients to any of them is a sea change from 1990, when the U.S. Supreme Court refused to hear an appeal of a lower court's ruling that the medical establishment was trying to put the chiropractic industry out of business through a campaign of denigration. The case, Wilk v. American Medical Association, prompted the AMA to change its code of ethics in 1992 regarding chiropractors.
"I think the majority of MDs recognize the value chiropractors bring," Corcoran says.
The American College of Physicians, which includes about 120,000 internists and medical students, agrees the doctor-chiropractor relationship is no longer a hot topic. "It just isn't on our radar," ACP spokeswoman Susan Anderson says.
The AMA declined to comment beyond noting its revised policy, which says, among other things, "It is ethical for a physician to associate professionally with chiropractors provided that the physician believes that such association is in the best interests of his or her patient."
Chiropractors can't prescribe drugs or perform surgery, but "we are trained to recognize and diagnose and send patients to the appropriate care if it's something beyond our scope," says William Lauretti, an assistant professor at the New York Chiropractic College in Seneca Falls, N.Y., and a former chiropractor in suburban Maryland. Some cancers, for instance, "can present as low-back pain. We're trained to tell the difference when there's something more serious and more urgent than the basic muscle or joint problem."
Morgan, a former Navy petty officer, has been working under contract alongside staff physicians at the Bethesda Naval Medical Center for nine years, trying to relieve symptoms and reduce dependence on medication. In many cases, he's the first chiropractor his patients have ever seen.
"They trust their physician a great deal, and if they think I can help make them better, they'll trust me, too," he says. "And if I can't make them better, then we'll find someone who can."
Making Adjustments
When I stand up, I see that Loebig is right. It does feel better. What had been a nagging bundle of deadline tensions and bad posture knotted up on the inside of the right hip is now a pressure-free zone of happiness that gladly accepts its fair share of weight distribution. I twist from side to side. My hips glide with newfound ease.
A study conducted over seven years by a physician and a chiropractor and reported in June's Journal of Manipulative and Physiological Therapeutics showed that patients who turned first to chiropractors and other alternative-medicine professionals for care were hospitalized and had surgery 60 percent less often and spent 85 percent less on pharmaceuticals than those with medical doctors as primary care providers.
And that's what I'm counting on. After three spinal surgeries since 2002, two lumbar and 2004's brutally intrusive cervical fusion, which put a piece of cadaver bone in my neck in a procedure that was supposed to correct chronic shoulder and arm pain -- and didn't -- I'm hoping to minimize my time under the knife.
My neurologist, who is trying to find the right combination of chemicals to control that pain, prescribed chiropractic as part of his treatment. Loebig focuses on my shoulder and arm, finishing each visit with adjustments to the neck and lower back.
"That should help your golf swing," Loebig says with a pat on the back as he makes marks on my chart.
I've been adjusted, and not just my back and golf swing but my outlook as well. I step into the bright sunshine outside Loebig's Great Falls office a little lighter on my feet, a little less aware of the chronic pain in my right shoulder. My head feels looser on my neck, and I feel taller. The sensation of well-being won't last, I know. It could be a matter of days, or even hours, before the pressure builds again and my joints stiffen with stress and tension. But for now, I'll take it.
Buzz McClain is a Washington area freelance writer
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