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An Interview with Michael Menke

What are the basic principles of chiropractic care?
Today, most people see chiropractors to reduce pain and to restore movement and improve function. But chiropractors have traditionally maintained a broader perspective on health than pain. Essentially, chiropractors encourage the body to heal itself by removing obstacles to healing. This is a hygienic principle: removing illness causes to improve health. Many chiropractors therefore offer nutritional and dietary advice, taking strain off muscles and joints, managing stress, and coaching patients in exercise, lifestyle and self-care.

Chiropractic was based upon the spine and its role in health and disease. This was not a novel idea when chiropractic was founded in 1895. In fact, the spine has held a role in health and disease in many cultures for thousands of years. Traditions granting the spine a role in health include: acupuncture and traditional Chinese medicine, Ayurvedic medicine, Eastern Hatha yoga and European bone-setters. In the late 19th century, both osteopathy (1874) and chiropractic (1895) emerged to carry on this tradition, each with a different emphasis.

Early chiropractors believed the spine could become "subluxated" - a minor slippage of vertebrae (backbone joints) that would pinch spinal nerves and cause all manner of diseases. The chiropractor's job was to remove subluxations by "adjusting" (manipulating) the spine to bring back normal movement, restore proper nerve flow and regain health.

Though modern chiropractors still keep to the spine as their primary area of approach and many look for subluxations, most do not adhere to the concept that a subluxated spine is the only or the major cause of disease.

What kinds of ailments can chiropractors treat?
Chiropractic spinal manipulation has now had about three decades of very active research. Literally, hundreds of studies have been published in the major medical journals. Spinal manipulation has been found to be effective for some causes of low back pain (chronic pain more than acute), neck pain, muscle tension headaches, and a few other aches and pains.

From my own experience, chiropractic care can help some "slipped" (displaced) or degenerative disks of the spine. Carpal tunnel syndrome, if not too advanced, and other painful joints including knees, shoulders and elbows are sometimes helped with a chiropractic care or by co-management with another medical professional. There are also anecdotes of successful chiropractic treatment for middle ear infections, bed-wetting and asthma through spinal adjusting. To date, these stories are not thoroughly researched. The persistence of these stories among chiropractic clinicians suggests that occasionally these conditions are helped, though each patient must be examined on a case-by-case basis. More research and clinical trials are needed to confirm just which of these cases are treatable by chiropractic management.

How can people find a good chiropractor?
The best way to find a good chiropractor is to ask a friend or relative who goes to a reputable chiropractor. Another way is to ask your medical physician, dentist, optometrist, or other health care professional if he or she knows of any good chiropractors. Obviously the best referral is a satisfied patient who has been helped.

In a doctor of chiropractic, you look first for someone you can trust, as you would any of your health-care providers. I advise people to request an informational interview with a prospective chiropractor. You can then size up the office and the practitioner to see if everything seems plausible, comfortable and professional.

Never sign up for long-term programs, especially with up-front payments or payment plans. Make it clear that you are there to have your problem resolved, then you want to manage it yourself as soon as possible to prevent future problems. Ask for exercises and self-care instructions you can use at home or in the gym. (If your injury is bad or there is some arthritis, you may require more in-office treatment , maybe several times a year, to help you keep functioning.)

Finally, look for results. Chiropractic experts agree that if treated for more than two weeks without a change in your condition or you get worse, then your chiropractic treatment is not sufficient to your problem. You may discuss this with your chiropractor, seek the advice of another chiropractor, or try another health-care professional.

Sometimes it is difficult for you to judge your progress. This is especially true if you had pain for many years. At the beginning, your pain may seem slightly better, the same, or worse. But pain is not the primary indicator of improvement, especially at the beginning. Instead of focusing on pain, note how much more you can do. Improvement in activities of daily living is a more valid measure of progress than pain only. It is also reasonable to ask your medical physician for anti-inflammatory medication to help with discomfort while "rusty" joints regain movement and immobile ligaments are stretched. The chiropractor will also give you home-care instructions including icing, so in most cases you won't need medication.

What do you say to people who are skeptical of chiropractic medicine?
Each health professional has expertise for helping some people with certain problems, but not everyone with every problem. I think we should all be skeptical informed consumers about health-care. Chiropractic is a clinical service with its own limitations and risks like anything else. I personally believe chiropractic saves people from unnecessary surgeries and from taking too many pain medications. Old stories persist about chiropractors treating each and every disease by chiropractic adjustments, and the public knows that is nonsense. On the other hand, when people experience improvement with their headaches and low back pain, other benefits may also occur. With less pain and stress on the body, people can exercise more, work more, and be more sociable. Life is so much better without pain.

I think the bottom line is this: If you have pain that is not improving with your current self-care or treatment strategies, or you have a problem specifically related to your back, neck or spine, see if chiropractic can help. Don't wait until you have surgery to try chiropractic care. Once you have surgery, you are stuck with the results. Try chiropractic first because it offers non-drug, non-surgical approaches to some, but not all, health problems.

How did you become interested in being a chiropractor?
My father was spared a cervical fusion (neck vertebrae) surgery by his chiropractor, Joe Worz, in Greenville, Ohio, in the 1960s. My mother saw the chiropractor for occasional back pain. My first chiropractor in Dayton, Ohio, Harry Alexander, helped my severe neck pain after I fell of a tree at 30 years old; old enough to know better, you would think. At that time, I had degrees in psychology and behavioral sciences and was interested in how mind, body and spirit could work together to create better health. It was evident to me that strategies and models for how to be healthy were missing in most of health care. Chiropractic aspired to a hygienic strategy, instead of treating disease. I also was intrigued with manual medicine to help reduce pain and improve people's lives. This perspective led me to my work with Dr. Weil's Arizona Center for Integrative Medicine here at the University of Arizona.

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