Not long ago a friend of mine threw his back out playing racquetball and asked me for advise. I suggested that he use ice to relieve the pain, take an anti-inflammatory painkiller like Advil-and call a chiropractor. He willingly went along with the ice pack and the medicine, but he wouldn’t even consider seeing a chiropractor. “They’re all quacks” he declared with absolute authority-although he’d never been to one.

There are a lot of people who insist there’s something weird, even dangerous, about the doctors who crack backs. (Chiropractors hate that expression, by the way. The noise that occurs during manipulation is the sound made when the Doctor snaps the vertebrae back into normal alignment) But for every one of the detractors who adamantly swear about chiropractors, more and more people just as adamantly swear by them. The loyalists frequently have bounced from one physician to another, unsuccessfully seeking relief from neck or back pain. They finally tried a chiropractor as a last resort, and, to their amazement, the condition began to improve.

Which brings me to another friend I’ll call Clair. She works in the health care field; she wouldn’t let me use her real name because her brother–in-law is a prominent physician and she’s sure he’d be very upset if he found out she prefers a chiropractor to the big shot orthopedist and neurologist he’d recommended when she first hurt her back playing golf ten years ago. She remembers that attack as if it were yesterday-a week flat on her back and six more moving about gingerly until she felt normal. For the next decade her life was ruled by intermittent back pain or fear of an immobilizing spasm that would again confine her to bed. “Finally I decided what the hell, I’ll give chiropractic a try” she says. “I got almost immediate relief. It was so liberating. Instead of going to bed, all I needed was manipulation, ice and some exercise.”

That was three years ago; now she returns whenever she feels a spasm coming on. “I do still get these little doubts” she admits. “ How can the chiropractor be so sure what’s wrong when the MD doesn’t know? But whatever they’re doing, it sure works.”

What they’re doing is correcting a disorder called vertebrae subluxation-the chiropractor’s broad definition for any structural or functional misalignment of the spinal column. Besides being the bony structure that connects the head and the trunk to the legs, the spine also serves as a conduit for the nervous system. Nerves radiate from openings between the 24 vertebrae to every part of the body. Chiropractors believe that any stress or pressure on these nerves causes not only pain at the site of the irritation, but also a variety of maladies in the organs the nerves feed. That is why chiropractors claim they can treat problems as diverse as a herniated disc and constipation by adjusting the spine to remove tension on the nerves.

Chiropractic practitioners do not perform surgery or prescribe drugs, but they often suggest vitamins and give nutritional counseling as part of their holistic approach to wellness. An office visit lasts less than a half an hour and consists of the chiropractor using his hands to apply mild pressure to a specific part of the spine.The cost averages $20 to $30; it is covered by most insurance plans but not many HMOs.

Today it’s fairly well accepted that correcting the spine may effectively relieve the musculoskeletal problems. So why the tainted reputation? Dr. Dennis Rehrig, former chairman of the Board of the Pennsylvania Chiropractic Society, thinks one reason is that chiropractors don’t follow the medical model. “In the Western world, where pills are the solution to the problem, we look like the oddballs out in left field.” He says. “ I’d prefer to see us as structural engineers. We do conservative surgery with our hands instead of a scalpel. Is there a risk? Yes. How much? Well, consider that our malpractice premiums average $3000. a year. Compare that to orthopedic surgeons, who pay about ten times as much.”

There are two legitimate areas of concern in chiropractic. One involves the question of safety; Can something awful happen as a result of manipulation? The remote possibility exists that a stroke could occur from a condition called vertebral artery syndrome, which is caused by manipulation of the neck. The risk is two to three cases per million treatments, compared to 150,000 cases of paralysis per million neurosurgical neck operations. The other danger is misdiagnosis of a serious medical condition. A New Jersey physician told me about a patient of his who had a spinal cord tumor that was aggravated by a chiropractor. The tumor bled into the spinal cord and caused paralysis that was able to be partially reversed by surgery. However, such accidents are quite rare. Dr. Steven Mandel, chief of neurology at Mt.Sinai Hospital in South Philadelphia, has no qualms about referring patients with soft tissue injuries to chiropractors. “There are isolated reports where people went to chiropractors and got worse,” he says. But in general that doesn’t happen, and those stories are more myth than reality.

Far more common than horror stories are success stories about people who’ve gone to a chiropractor with a backache and found that after several sessions some other disorder, like a chronic headache or PMS, also improved. Dr. Mario Spoto, president of the Pennsylvania Chiropractic Society, says he’s had half a dozen female patients with lower back pains who were having difficulty conceiving, and within a year of treatment, all got pregnant. “This is not to say we are treating infertility,” he notes, “ but is does show that there is a relationship between spinal alignment and other problems”.

Chirporactors have been struggling for acceptance since the turn of the century, when B.J.Palmer, son of the movement’s founder began preaching his radical theory of the spine as the source of all disease. He was denounced in the Illinois Medical Journal as “the most dangerous man in Iowa outside a prison cell.” Physicans have been the most vocal-and vicious- critics of chiropractors and the chief disseminators of their negative image. For decades they waged a bloody turf battle against chiropractors, culminating in a protracted lawsuit that ended just a few years ago. A federal judge found the AMA guilty of conspiring in an illegal boycott to eliminate chiropractors as competitors in the health care system. Since that ruling several medical organizations have begun to cooperate with chiropractors, and the AMA has declared it ethical to refer patients to them.

Despite the court victory, chiropractors still feel besieged by widespread misunderstanding of their profession. In fact, a well known neurologist interviewed for this article wondered openly whether chiropractors can still get their diplomas from mail order colleges!

To set him straight: there are 17 major chiropractic colleges in the United States, accredited through an organization approved by the US Office of Education. More than half of this country’s 36,000 chiropractors have graduated since 1977. They undergo strenuous preparation requiring two years of undergraduate study plus four or five years of chiropractic instruction in a science curriculum, similar to that of physicians, which include anatomy, physiology, chemistry, neurology, etc. Unlike M.D.s, chiropractors do not study surgery, pharmacology or immunology. Instead they spend hundreds of hours learning how to adjust the spine. All Pennsylvania chiropractors must pass national and state licensing exams before they can become doctors of their profession.

Doctors of chiropractic (D.C.s) are often confused with doctors of osteopathy (D.O.s) because both perform manipulation. But in training and philosophy the two are quite different. Chiropractors eschew drugs, do nothing but manipulate and concentrate on musculoskeletal dysfunction. By contrast, osteopaths are doctors trained in a medical setting who function like M.D.s They use manipulation chiefly as a tool to improve circulation. Many years ago, in their zeal to have osteopaths acknowledged as equals in the medical profession, osteopathic colleges cut down on the number of hours devoted to teaching manipulative therapy. But lately it’s coming back into vogue. A spokesman for the Philadelphia College of Osteopathic Medicine says, “We’ve learned that people like to be touched by their doctors, and those physicians who don’t use a hands on approach were losing patients.”

Physical therapists are also quite different from chiropractors. They attend colleges that offer a bachelor’s in physical therapy, denoting special training in the use of machines and exercise to relieve pain and repair soft tissue injuries.They do not use manipulation. In Pennsylvania they can only work with patients who are referred by a physician, usually an orthopedist, who might prescribe a treatment program. That may explain why doctors are more likely to send someone for physical therapy than to a chiropractor.

When should you visit a chiropractor? Probably before you consent to back surgery, since adjustments may help the problem and probably won’t hurt it. Based on research, chiropractors tend to be especially effective in treating acute back pain as well as chronic lower back and neck pain and headaches. An Australian study showed that 30 patients chosen randomly for chiropractic adjustment from a group of 85 with long term history of migraine headaches improved radically within seven visits. Dr. Basil Snyman, a popular Center City chiropractor, finds that pregnant women respond particularly well to spinal manipulation. “Their ligaments get loose, the pelvis gets out of place and they often get sciatia” he says. “We can easily relieve the pressure that causes their pain”.

How many treatments will you need? Dr. Elliot Rosenberg, a South Jersey cardiologist, visited a chiropractor for a problem with hip and leg pain that the Mayo Clinic had been unable to diagnose. “I went about six times,” he says. “I always felt better afterwards. There was a reduction in pain and increased mobility. But the relief only lasted a day or so, and I eventually stopped because it didn’t last.” His is a common complaint. If you aren’t getting relief after four to six visits to a chiropractor, then you should seek another therapy.

On the other hand, if you’ve got a long-time problem don’t expect chiropractic to be a miraculous quick fix that will undo what has taken years to develop. Dr. Snyman says: “It’s not always possible to cure structural and mechanical conditions, but they can be maintained. Chiropractors have great success with patients who are other doctors’ failures. That’s why we often joke that D.C. stands for doctor of chronics.”

IF YOU NEED HELP: The best way to choose a chiropractor is through the referral of a satisfied patient or a physician. The Pennsylvania Chiropractic Society (to whici about half the 2,000 chiropractors in the state belong) will give you the name of a member in your area if you call their hotline at 1-800-321-4727. For information or questions about chiropractic, contact the American Chiropractic Association, 1701 Clarendon Boulevard, Arlington, Virginia 22209, 703-276-8800.