Billings Montana Chirpractor , Billings Chiropractic Care

What is chiropractic?
What kind of education is required to become a Chiropractor?
What is an adjustment and what does it do?
What's that cracking sound?
Does it hurt?
Is it Safe?
Why does my problem keep coming back?
How long will it take and what is it going to cost?
I've heard that once you see a chiropractor you have to continue forever. Is that true?
I can crack my own back. Is that bad?
Will I get arthritis if I crack my knuckles?
What are the stages of chiropractic care?

What is chiropractic?
Chiropractic is a branch of healthcare that focuses on the nerves, muscles and bones and how they function together. Many aches, pains and illnesses have their origin in the neuromusculoskeletal system. Chiropractors are able to treat the neuromusculoskeletal system by manual manipulation and adjustment of the spine, extremities and the associated soft tissues.

What kind of education is required to become a Chiropractor?
To become a Chiropractor takes many years. You must first have a bachelors degree which encompasses several of the sciences including but not limited to: Physics, chemistry, biochemistry, anatomy, physiology, neurology. The chiropractic course of education is a 5 year program which leads to the granting of the title DC, Doctor of Chiropractic. Most students choose to study full time through the Summers and so complete the program in approximately 3.5 years. The chiropractic education is in many ways equivalent to the medical school education. However, since Chiropractors do not prescribe drugs the education does not place much focus on pharmacology. Instead chiropractic education places a heavier emphasis on anatomy and neurology than medical school.

In addition to graduating from an accredited chiropractic school there are a series of four national board exams which must be satisfactorily completed. Further, each state has its own requirements which must be met prior to issuing a license.

What is an adjustment and what does it do?
A chiropractic adjustment is the application of a specific force to a specific joint of the body. The result of this is the brief opening of the joint space and realignment of the bones comprising the joint space. Adjustments are applied to virtually any joint found in the body.

In the case of the spine, proper alignment of the vertebrae allows for the free transmission of nerve impulses from the brain through the spinal cord and out to the periphery and vice versa. Proper alignment also allows for adequate blood flow and exchange of nutrients and waste products into and out of the spine.

What's that cracking sound?
On occasion I am asked about the sound of chiropractic adjustment. Usually the person asking is concerned about their bones “crunching” together.

The sound is called a cavitation and is commonly heard with adjusting. The cavitation is produced when a joint is quickly and briefly widened. A vacuum is created in the joint space which is quickly filled with synovial fluid and results in an audible sound. This same phenomenon occurs when pulling a suction cup off of a hard surface; the space between the suction cup and the surface is widened which creates a vacuum that is quickly filled and produces a popping sound.

The sound you hear is a result of the joint space opening, not the bones moving together or “crunching”.

Does it hurt?
Generally there is no pain from an adjustment. The adjustive force is typically delivered as a smooth, quick impulse. Sometimes we may have to be a little more assertive in applying this force in the case of longstanding stiffness and the patient might experience momentary discomfort followed by some degree of immediate relief. This discomfort is nothing like what one would experience from receiving an injection or undergoing surgery.

If you have never been adjusted before you may feel slightly sore the next day, much like the type of soreness you experience when you workout after a long time away from working out.

Is it Safe?
Yes. In fact chiropractic care is the safest, most conservative health care around. The following information is provided by the American Chiropractic Association.

'To properly assess the risks of chiropractic treatment, it must be compared against the risks of other treatments for similar conditions. Some of the most common treatments for musculoskeletal pain ' including prescription and over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) ' carry risks significantly greater than those of chiropractic manipulation.'

A study from the New England Journal of Medicine estimated that at least 16,500 NSAID-related deaths occur among patients each year.

Wolfe MM, Lichtenstein DR, Singh G: Gastrointestinal toxicity of nonsteroidal anti-inflammatory drugs. NEJM. 1999; 340:1888.

According to a study from the American Journal of Gastroenterology, approximately one-third of all hospitalizations and deaths related to gastrointestinal bleeding can be attributed to the use of aspirin or NSAID painkillers like ibuprofen.

Lanas A, et al. A nationwide study of mortality associated with hospital admission due to severe gastrointestinal events and those associated with nonsteroidal anti-inflammatory drug use. Am J Gastroenterol. 2005;100:1685'1693.

According to the Institute of Medicine, at least 1.5 million Americans are sickened, injured or killed each year by errors in prescribing, dispensing and taking medications.

Institute of Medicine (IOM). (2007). Preventing medication errors: Quality chasm series. P. Aspden, J. Wolcott, J. L. Bootman, & L. R. Cronenwett (Eds.). Washington, DC: The National Academies Press.

Mistakes in giving drugs are so prevalent in hospitals that, on average, a patient will be subjected to a medication error each day he or she occupies a hospital bed. (Institute of Medicine)

The risks associated with Chiropractic treatment include: mild soreness, bruising and rib fractures. Rib fractures usually occur in cases where the patient didn’t inform the doctor of their severe osteoporosis. Further, the risk of stroke has been associated with Chiropractic cervical manipulation. However, research has shown that Chiropractors do not cause strokes. In fact a recent study in Canada compared the rate of stroke occurring after chiropractic treatment with the rate occurring after a visit to a Medical Doctor. The researchers found that the two were not significantly different. Which means that just as many people had a stroke after a visit to a Medical Doctor.

A more accurate interpretation is that neither Chiropractors nor MDs cause strokes in their patients. Rather, patients who are in the beginning stages of a stroke tend to seek out health care. The stroke symptoms that brought them to seek care then fully manifest sometime after their encounter with a healthcare provider regardless of who they saw and what treatment they received.

'Risk of Vertebrobasilar Stroke and Chiropractic Care,' Spine (Vol. 33, No. 48).

To put it in numbers: the risk of a stroke occurring in conjunction with cervical manipulation is 1 in 2,000,000. The risk of death from gastrointestinal bleeding due to the use of over the counter Non-Steroidal Anti Inflammatory medication (or NSAID) is 800 in 2,000,000. You are 800x more likely to be injured by an over the counter medication than by chiropractic treatment.

Terrett AGJ: Current Concepts in Vertebrobasilar Complications following Spinal Manipulation. West Des Moines, IA: NCMIC Group, Inc., 2001

Klougart N, Leboeuf-Yde C, Rasmussen LR: Safety in chiropractic practice part I: The occurrence of cerebrovascular accidents after manipulation to the neck in Denmark from 1978-1988. J Manipulative Physiol Ther 1996; 19;371.

Haldeman S, Carey P, Townsend M, Papadopoulos C: Arterial dissections following cervical manipulation: the chiropractic experience. CMAJ 2001;165:905.

Fries JF: Assessing and understanding patient risk. Scan J Rheumatol 1992; suppl. 92:21.

Why does my problem keep coming back?
The two most common reasons are: 1)Habitual patterns of holding. 2)The source of the problem was never addressed.

What do I mean by 'habitual patterns of holding'?
All of us have developed ways of sitting, standing, walking, etc… We have performed these patterns so many times that they have become unconscious habits that build upon each other. Lets take the case of knee pain, for example. Because of your knee pain you have altered the way you walk. Because of the alteration of your walk, your hip and foot begin to hurt. Because of the pain in your hip and foot, your alter the way you stand. Because you altered your stance, your back begins to hurt. Because your back hurts you alter the way you push, pull or lift. And so on.

Over time these alterations come to feel familiar. When we start to put your body back into it’s natural and healthy alignment this will feel unfamiliar to you. Because it feels unfamiliar your tendency will be to move back toward what feels familiar and continue the chain of events that is keeping you injured. It takes time to develop new habits.

In the second case the source of the problem was not adequately addressed. Sometimes patients discontinue care once they are no longer in pain. However, relief of pain does not necessarily mean that the underlying problem has been healed. If it did then an MD could simply give you one pain pill, one time and you would be cured. Given that many people on pain meds are given a prescription for a month’s worth of pills this is clearly not true; the absence of pain does not mean that the underlying problem has been healed.

In the case where a patient discontinues treatment when the pain is relieved they are likely to relapse and re-experience the same issues over and over.

I am happy to treat you in my office for pain relief but I would much rather see you move forward into rehabilitative care and experience lasting results than continually relapse and require multiple rounds of relief care. After your initial relief care, moving into rehabilitative care requires less treatments than if you were to discontinue care once relief is achieved and relapse occurs. That also means that addressing the source of the problem rather than the symptoms costs you less.

Let me explain why it costs you less. Relief care is also high frequency care. That is, during relief care you can expect 2-5 appointments per week for 1-8 weeks (depending on the nature and severity of your symptoms). As your symptoms are relieved the frequency of appointments decreases.

If you move into a rehabilitative phase of care your appointment frequency continues to decrease. As we work through the rehabilitative phase of care the frequency begins to drop to 1 appointment per week and even as low as 1 appointment per month (again depending on the nature and severity of your symptoms).

If you discontinue treatment once you are out of pain and then relapse several weeks later the relief care phase starts all over again. And again it will take a higher frequency of appointments to relieve your pain.

How long will it take and what is it going to cost?
That depends on the problem and each person is different. In most cases people experience some degree of relief right away. However, the severity and nature of the problem are the major influences on frequency and duration of treatment. It is important to note that the aches and pains that bring you into my office didn’t start overnight and fixing them will likely not happen overnight either. Also, the ones that did start overnight are usually due to some traumatic event and require an adequate amount of attention for proper healing to take place.

If you were to go to your MD and be prescribed an antibiotic you would be advised to finish taking the medicine even if you are feeling better half way through the prescription. Chiropractic can be seen in a similar way; just because you are initially out of pain it doesn’t mean that your treatment is complete.

I can’t give you a blanket statement about how long it will take, again every person is different and the care is tailored to the person. However, I will say that the cost is very likely to be much less than that of surgery or continually refilling a prescription.

I've heard that once you see a chiropractor you have to continue forever. Is that true?
This is a concept that needs clarification. There are different scenarios in which the answer is demonstrated.

The first scenario is that some people don’t realize the extent of their pain until it is removed. These people choose to keep coming back to a Chiropractor in order to stay pain free. In cases where pain and stiffness have been endured for years chiropractic care may only be palliative. That is, we can decrease the pain and stiffness but the damage done is irreversible and healing the source of the problem is unlikely to occur. This is a scenario where a person may need to see a Chiropractor as a long term health care plan. In this situation the patient usually comes in just before the symptoms manifest. For example, if the patient predictably begins to experience the pain and stiffness about six weeks after being treated then the patient calls us around that time for another adjustment. If they feel that they can go longer then the interval between appointments is longer. If they exacerbate their symptoms before six weeks then we see them sooner. Essentially this patient is treated as needed.

Another way to clarify this issue is to compare Chiropractic treatment to Dental treatment. If you go to a dentist once and have a cavity filled no one would reasonably believe that you will never have to go back to the dentist again. Even if you only return for checkups and cleanings these are considered reasonable means of monitoring and maintaining your dental health. This is similar to the scenario in Chiropractic where a person decides to come in for regular checks in order to monitor and maintain their health.

Another scenario involves patients seeking wellness care. Typically these patients initially come in for treatment of a specific issue such as back pain, neck pain, headaches, etc… They experience very satisfying results from care and begin to experience some of the larger benefits, also; beyond pain relief many people have experienced increased energy, a stronger immune system and decreased illness with regular chiropractic treatment. These people are life long patients because the feel noticeably better overall with regular care.

Finally, lots of people also come in for a specific problem that can be resolved within a certain time frame and then are discharged from care until they decide to come back for another ailment or a re-injury of their original problem.

A Chiropractor is no different from any other healthcare provider. Just because you see them once that doesn’t mean that you will never need to see them again. Conversely, just because you see them once that doesn’t mean that you must continue forever. The choice is entirely yours. What ends up happening, though, is that many people choose to make it a regular part of their health care because it works and it is cost effective.

I can crack my own back. Is that bad?
There isn’t a yes or no answer to this question so let me try and explain the larger context in which the answer falls.

The reason you are experiencing pain and/or stiffness is that some of your spine is not moving as it should. The body’s response to this is to allow the segments above and below the hypomobile ones to move easily in an attempt to maintain your range of motion. When you crack your own back what you are doing is moving the easily moved segments. However, the ones that need to be moved are the hypomobile segments. This is a way in which we truly need other people in our lives. Chiropractors are highly trained at locating and restoring motion to the hypomobile segments.

Self adjusting can be bad if you do it excessively or with too much force. Also, when you crack your own back you can never address the segments that are the source of your pain and stiffness. Even a chiropractor cannot adjust themselves.

Will I get arthritis if I crack my knuckles?
No. In fact a recent study showed that knuckle cracking was actually healthy for the joints and helped to prevent arthritis. The same is true of adjusting all of the joints in the body.

First lets talk about two types of arthritis: Rheumatoid and Degenerative. Often times people have been told not to crack there knuckles for fear of developing Rheumatoid arthritis. The truth is that no one knows what causes this type of arthritis. The prevailing theory is that is a systemic disease that targets the hands.

Degenerative arthritis is a condition due to repetitive injury. For example, a carpenter who hammers for several hours a day for many years will likely develop some pains in their wrist and elbow. If we x-ray the wrist and elbow we will likely see changes in the quality and shape of the bones in those areas due to repetitive motion and stress.

So, to answer the age old question “will I get arthritis if I crack my knuckles?” the answer is no. The only way this can happen is if you crack your knuckles excessively, to the point of causing repetitive motion stress and damage.

What are the stages of chiropractic care?

Relief Care:
Most people start seeing a Chiropractor because of a specific ache or pain. In the Relief Care phase of treatment the goal is to get you out of pain. Many people experience some degree of relief right away while for others it may take several days for the beginning of pain reduction to occur. Every case is different but we can expect that the relief care phase will last from 1- 8 weeks. If it becomes evident that we are seeing no change in your symptoms then you will be referred to another healthcare provider in order to better address your needs.

Rehabilitative Care:
The goal of treatment during this phase of care is to correct the underlying causes. This phase of care typically lasts 1-3 months. The frequency of treatment is reduced and the patient becomes more proactive in their health and wellness. Treatment is often supplemented by stretching/strengthening exercise, nutrition and lifestyle change.

It is important to realize that the symptoms that brought you in for treatment most likely did not happen overnight; they are the expression of countless micro and/or macro traumas you have experienced throughout your life. Likewise, healing your injury will also not happen overnight.

As an example: If you were to go to your MD and be prescribed an antibiotic you would be advised to finish taking the medicine even if you are feeling better half way through the prescription. Chiropractic can be seen in a similar way; just because you are initially out of pain it doesn’t mean that we have addressed the source of your pain yet.

Further, it actually costs less to move into the phase of rehabilitative care than to relapse and return for multiple rounds of relief care.

Wellness care:
Now that we have relieved your pain and addressed the source of your symptoms we look to the maintenance of your improved health. Receiving regular chiropractic care has benefits beyond pain relief. Often times people have experienced increased energy, a stronger immune system and decreased illness with regular chiropractic treatment. People feel noticeably better overall with regular chiropractic care. During this stage our goal is promote vitality and optimal health.

This is also the preventative stage of treatment. Regular check ups help to prevent small problems from becoming large problems.