Alternative Treatments

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Princeton Spine & Joint Center, Princeton, NJ, USA

There are a wide range of alternative treatments for spinal pathologies. Alternative should be defined here as treatments that lack a generally accepted standard of care by medical doctors based on a lack of rigorous scientific studies supporting their usage. When considering alternative treatments, it is important to always remember that lack of data to prove effectiveness is not the same thing as data proving ineffectiveness. That is to say that in many respects, the jury is still out in terms of evidence-based medicine when it comes to treatments such as acupuncture, chiropractic care, Feldenkrais, and other treatments.

Despite a lack of validation from evidence-based medicine, the usage of alternative treatments by patients with spinal pathologies is enormous. A busy spine specialist may have never seen a patient who has previously gone to a chiropractor or acupuncturist, but those patients have seen the spine specialist. That is to say that sometimes doctors remain unaware of their patients’ usage of alternative medicine because the physician does not ask the question. In turn, many patients are reluctant to bring up their trials of alternative medicine because they may fear their physician will not approve. The disconnectedness between alternative medical practitioners and medical spine specialists has lessened over the decades but it persists, and it need not. Alternative medicine can play a productive role in treating patients, particularly if its usage is integrated into the overall treatment paradigm. When advising about alternative medicine, it is important that a patient understand what treatment is evidence-based medicine and what treatment is not. If that patient is going to pursue a treatment that is not evidence based, then ideally that treatment should first and foremost be unlikely to cause harm to that patient. Ideally, that treatment should not be painful or overly costly.

Chiropractic Care

Perhaps the most common alternative treatment for lumbar spine pathologies is chiropractic care. The tradition of chiropractic medicine follows the tradition of practitioners known as bonesetter who can trace their lineage to ancient Egypt and Greece. Bonesetters were present in the 1800s in North America as well and gave rise in many respects to the field of osteopathy. In the 1890s Daniel David Palmer took those same principles of bonesetters and developed the field known as chiropractic medicine. Chiropractic care originally purported that the problems of the body originated from misalignment of the spine. A chiropractor in this school of thought may not be interested in a patient’s “symptoms” because those symptoms originate from subluxations and misalignments of the spine. Therefore, a practitioner must only examine the spine and address that and the symptoms will essentially resolve on their own. Over the years, this traditional chiropractic school of thought has fallen out of favor, and today the vast majorities of chiropractors integrate use adjustments and manipulations to address musculoskeletal complaints and overall wellness, including in many instances ergonomic, nutritional, and lifestyle issues, but also seek to integrate their care with more traditional allopathic medical care. From an allopathic medical perspective, ideally chiropractic care can be used as a means to help address myofascial pain and adhesions and ultimately be one more tool to help enable a patient to return to therapeutic exercises. If exercises are not incorporated into a treatment program, chiropractic or otherwise, for lower back pain or radicular pain, then the likelihood is that the patient will need to continue to seek the chiropractic adjustments indefinitely as the patient actively strengthening and stretching the muscles surrounding the problem should be viewed as an integral part of most treatment paradigms.

Acupuncture

Apart from praying, acupuncture is one of, if not the¸ oldest known medical treatments. Some texts trace the use of some form of acupuncture back to the Bronze Age. What is certain is that the practice of acupuncture has existed in various forms for thousands of years. Indeed, the longevity of the treatment is often cited as implicit proof of its effectiveness. Of course, longevity of a treatment may make it intriguing, but it is not proof of usage. Over the years, evidence for acupuncture for a variety of pathologies such as postoperative nausea has been found. However, evidence for acupuncture in the use of various spinal pathologies is controversial at best. If acupuncture is to be considered evidence-based medicine for various spinal pathologies, then more research is certainly needed.

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