Q&A with Chiropractor Steven Piper

In our 3rd segment of the Evolve Q&A, we are chatting with Chiropractor Steven Piper on many concepts and questions individuals have regarding the profession of chiropractic treatment. 

1.      What can I expect at my first appointment?

Your initial visit will typically last 45 minutes to an hour. It’s a comprehensive one-on-one assessment where we focus on movement and assessment of faulty movement patterns. I can appreciate the fact each patient and diagnosis is unique and I tend to use thorough history and physical to develop a tailored approach to each treatment. In most cases I prefer to watch you lift, move, etc. and observe the kinetic chain in action. I like to use academic evidence, clinical experience and your goals as the cornerstones of the assessment. Once the initial visit is complete, I provide a report of findings and may suggest follow-up visits that last approximately 30 minutes. Follow-up sessions a pre versus post treatment design and include but are not limited to exercise prescription, joint manipulations, mobilizations, kinesiotaping, soft tissue therapy such as Active Release Technique®, Graston Technique® and movement assessments.

2.      I have heard some controversy that getting your neck adjusted can be dangerous. Is this true?

This controversy refers to spinal manipulation therapy (a.k.a. adjustment) of the neck associated with the risk of stroke. There is no medical or scientific evidence that suggests neck adjusting can cause a stroke. The association of neck adjusting and stroke is extremely rare. In the rare cases that have been reported, stroke patients are asked what happened prior to the symptoms beginning. A landmark study showed that people who suffered from a stroke were likely to attend to a healthcare provider (family g.p., chiropractor etc.) due to the start of symptoms. (Cote et al. 2011) When you look at the very early symptoms of stroke they include neck pain and headache. Many chiropractic patients are treated for neck pain and headaches on a daily basis. Stroke is unpredictable and you need to pay close attention to the additional signs such as facial paralysis (unable to smile), trouble speaking, your tongue suddenly moves to the side when you stick it out. Chiropractors who ask a brief history of your symptoms every time they see you can actually help you recognize when it’s not your usual headache or neck pain.     

Reference

Choi, S., Boyle, E., Côté, P., & Cassidy, J. D. (2011). A population-based case-series of Ontario patients who develop a vertebrobasilar artery stroke after seeing a chiropractor. Journal of manipulative and physiological therapeutics, 34(1), 15-22.

3.      Once I'm feeling better do I still need to see a chiro?

I like to pride myself on most of my patients feeling better within 3-4 visits which include improving joint mobility, improving strength of tendons and muscles, releasing soft tissue and correcting faulty movements. At that point I am happy to book a follow up appointment 4-6 weeks later that involves supportive care. In my opinion getting patients better is ultimate goal. That being said progression is the key. This is why I recommend follow up supportive care visits so we can continue to make you stronger and continue to improve a healthy lifestyle. It really is human nature that once you feel better you fall off the daily dose of improving your lifestyle bandwagon. A follow up visit can always get you back on track.   

4.      How easy is it to break your SI joint?

Im not sure. If you mean how easy is it to fracture your sacrum or your ilium (the two bones that make up the joint in between known as the SI joint) then I would say not easy. Direct significant trauma (like a bad car accident) could cause a fracture to either of these bones in which case there is severe pain associated with it and in all cases of suspected fracture you should attend to emergency medical services. As for breaking the SI joint, I’ve never read any academic literature that describes this. Mechanical SI joint irritation can be very painful and may even feel broken but without significant trauma it would be hard to imagine truly breaking the SI joint. The SI joint has minimal amount of movement capabilities (3-4 degrees) so there are highly sensitive joint receptors that detect changes in pressure within the joint that often can cause significant pain with only minimal movement of the hips and low back. I suggest seeking out your healthcare provider or contact me for a proper assessment.

5.      How do I know if my spine is out of alignment? What does it take to mis-align my spine?

Great questions. Once we reach skeletal maturity (age 25 in most people) our bony spine alignment becomes our alignment for life and is stabilized by the muscles, ligaments and other tissues surrounding the bony spine. Over the long period of your life, degenerative changes and or trauma can alter your bony alignment but in most cases these changes can be offset with daily physical activity and a goal to keep moving throughout your lifespan. That being said there are times where muscle, ligament, joint and, or disc injuries in your back can cause you to alter your functional alignment. Take for example those times when you hurt your back and you are unable to stand up straight. We could say your spine is out of alignment but it’s really the tight, protective muscles that won’t let you stand up straight. I also hear people say their spine feels out of alignment and this is similar to saying I have stiffness, tenderness, and, pain in back that is causing me to feel out of alignment.

6.      Why is it when I turn my head my shoulder hurts?

In most cases it’s because the muscles in your neck attach to the upper and middle parts between or on your shoulders. The neck and shoulders are intimately linked through muscles such as scalenes, upper trapezius, levator scapulae, semispinales, splenius capitus to name a few. Often times shoulder pain or neck are chicken and egg type questions. Do you have shoulder pain because your neck has joint stiffness or is neck sore because you strained a muscle in your shoulder? In my opinion, when your hurt this is a great time to seek out help from your health care provider. The pain may go away on its own but advice and treatment from a healthcare provider can often help you recover much quicker.   

7.      I'm fearful that getting my neck adjusted will cause more damage than anything else. The risk of breaking my neck seems high, is this true?

I think this question is similar to question 2. In my opinion fear of something typically comes from assumptions or misunderstanding. Injury to your neck is dependent on each patient’s condition and the type of treatment being delivered. Spinal manipulation or adjusting is an effective tool for alleviating neck pain in many people. That being said it needs to be applied to the right patient at the right time in the right condition. As we age our bone density decreases and the risk of fracture increases. In a recent study of patients aged 66-99 years of age, chiropractic patients reporting an injury to the head neck within 7 days of visit was 76% lower than visits to a primary care physician. When you look deeper at the study, specifically at osteoporosis and risk of injury with chiropractic treatment you see there is an increase in risk of fracture. (Whedon et al. 2015) That supports the idea of providing the right treatment for the right person. To my knowledge and experience there is no literature that suggests chiropractic treatments to healthy individuals (no known comorbidities such as osteoporosis) have a risk of fracture. There is an ever growing amount of support however that chiropractic treatments are safe and effective.    

Reference

Whedon, J. M., Mackenzie, T. A., Phillips, R. B., & Lurie, J. D. (2015). Risk of Traumatic Injury Associated With Chiropractic Spinal Manipulation in Medicare Part B Beneficiaries Aged 66 to 99 Years. Spine, 40(4), 264-270.

8.      Why are chiropractors referred to as whack and cracks?

It’s a slang phrase that refers to a chiropractor providing an adjustment (high velocity low amplitude thrust) to joints that result in a cavitation (popping or cracking sound) releasing joint pressure. If you have ever cracked your knuckles then consider yourself an honorary whack and crack. Synovial joints of the body are under pressure (a lot like a pop can that is unopened) and with an increase in pressure there is lack of joint mobility and increased stiffness. With an adjustment (not really a whack but more of a thrust) there is an audible pop (just like when you open the can of pop) that releases the pressure and allows for better joint mobility. Some chiropractors are unfortunately labelled this way as this may be the only form of treatment they provide. A chiropractor should always have your overall health as the primary outcome and have many forms of treatment not simply the whack and crack in their treatment arsenal. I can remember a great phrase that applies to just providing a whack and crack: “If all you have is a hammer then everything you see will be a nail.”