Back Future

Evolution of chiropractic care and its acceptance as a viable alternative is evident at hospitals and universities

May 29, 2009
Judy Gerstel
Special to the Star

Some of the things chiropractors are doing behind our backs these days may surprise you.

Talk to a chiropractor and you'll hear less about traditional spinal manipulations and more about academic research and collaborative practice.

Ask Greg Kawchuk about his work – he's a chiropractor with a Ph.D. in bioengineering who holds a prestigious Canada Research Chair at the University of Alberta – and he'll tell you about experimental robotics determining precisely which tissues "experience load" when pressure is applied to the back.

The back, he explains, "is a mechanical structure – like a car."

People with back problems and back pain feel they need an MRI or expensive imaging, he says, "but in most cases that doesn't tell us what's wrong.

"If your lawnmower is having a problem, you wouldn't take a picture of it. You'd turn it over, try the wheels, do things to find out what works. That's what I do for the spine."

His research is geared to finding a way to measure mechanical changes in the back and to see how the spine changes in response to treatment.

One way to measure the changes is a system he's developed that uses vibrations. Kawchuk has just filed a patent for it.

"The vibration passes through the spine, tells us how big the problem area is and where it's located."

He says it's almost like a "seismic chart that indicates where the earthquake started and how big it was."

But adds, "In our case, it's a tiny vibration that's quite pleasant."

Kawchuk, who was a practising chiropractor for 15 years says, "Compared to various liver or heart conditions, there's very little that we know about what causes back pain. Only about 10 per cent is easily identified – caused by trauma, or cancer – while 90 per cent makes us scratch our heads.

"And when you look at back pain as a whole, no one has better science than anyone else. We're all in this together."

Kawchuk says academia, where interdisciplinary research and collaboration is well established, has been more welcoming to chiropractors than clinical settings at hospitals where, historically, turf is often jealously guarded.

Mark Erwin is another chiropractor with a Ph.D. His area of research is the biology of spinal discs. When he was a graduate student at U of T, where he's now an assistant professor in orthopedic surgery, he did spine related research at Toronto Western Hospital.

As Erwin became "good friends and colleagues" with clinicians during his research, the relationship led to his becoming clinically involved with the neuroscience centre spine program.

Now he assists neurosurgeon and clinic director Michael Fehlings with the intake assessment of patients, helping to reduce wait times at the clinic.

"Many patients referred to the clinic do not need surgery," says Erwin. "They're referred there by someone who is not up to speed on who needs surgery and who doesn't. And it's a big waste of the neurosurgeon's time to see patients with mechanical back pain."

Having a chiropractor available in hospitals to "triage" patients is probably a good idea, says Erwin, because of the declining number, "50 or less," and advancing average age, "58," of neurosurgeons in the province.

Another successful model of chiropractors collaborating with clinicians began at Wellesley Central Hospital when patients in the HIV program requested the services of chiropractors. It was adapted by St. Michael's about five years ago after the hospitals merged. Now, there are staff chiropractors at St. Mike's who treat patients, along with conducting research.

Deborah Kopansky-Giles, an associate professor at the Canadian Memorial Chiropractic College, was a leader in setting up the collaborative program. She was one of the first chiropractors in Canada to hold a hospital staff position.

"St. Mike's is an institution that takes risks and wanted to be innovative," she says. "There aren't big hierarchical barriers between different professions. People respect each other's skill sets."

Karen Weyman, a physician in the hospital's family medicine department, says she can't say enough good things about the collaborative program.

"It's been absolutely wonderful. The access is excellent, so patients can be seen quickly and the care is excellent and very knowledgeable. I trust them because I see the results, they've never caused patients harm and most patients come back feeling much better."

One of Kopansky-Giles' patients is Connie Camilleri, who's an RN at St. Mike's and was delighted to have access to a chiropractor on staff.

She'd visited chiropractors before "for general health maintenance" and started seeing Kopansky-Giles when she experienced acute back pain after an injury in 2003.

"She used interferential current therapy and physical manipulation for adjustment," says the 36-year-old nurse. "I still see her occasionally if it flares up. As the body responds and is in better alignment, I don't go as often.

"There's been some bad publicity about chiropractic, particularly around neck adjustments and a slight risk of stroke that happened in isolated cases. But the benefits far outweigh the risks. Absolutely I recommend chiropractic to other people. It's actually a shame that more people don't use it, especially in conjunction with massage therapy."

http://www.thestar.com/article/642057

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