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"Do all Chiropractors Provide the Same Quality of Care?" Trophism, Spondylolisthesis, kyphosis

Are all chiropractor’s the same?


            Chiropractic exists in most towns and no doubtedly exists in Pahrump, in limited numbers as well.   However, are they all the same? Clearly not.  There are as many as 200 different techniques out there.  Most of which are variations of spinal manipulation.  Some of the most frequent techniques used include:  Diversified technique, Extremity adjusting, Gonstead, Cox Flexion/Distraction, Activator, and Thompson technique.  Each chiropractor utilizes a different method to move a vertebrae, rib, or extremity joint with one or more of these techniques.  Pay special attention to the technique your chiropractor is using especially if you have trophism, spondylolisthesis, or kyphosis issues.


            However, what sets us apart is the diagnostic methods and equipment we use to find and correct your dysfunction.  Some chiropractors will use more technical methods and fancy computer-based devices and others will simply use their hands to palpate misalignments and inflammatory processes. 


            It may be important for you to do some research prior to booking an appointment to your local chiropractor to determine whether their methods will be amenable to your conditions and circumstances.  What works for one patient may not work for another.  This is why receiving x-rays is an integral part of chiropractic analysis. 


            I recently had a chiropractic patient come to my office who exhibited lower back pain.  My office took digital X-rays and determined that the patient had a condition called trophism in one of the lower facets of her lumbar spine.  When I asked the patient how she was being adjusted in this region, she stated she was laid on her side and twisted abruptly.  I term this type type of diversified adjustment, “pretzel twisting”.  I asked her whether she had x-rays at the previous facility she was treated at and she replied that x-rays were taken.  She questioned me why her back was hurting more after the adjustment then it was before.  She further indicated that the doctor did not review her x-rays with her.  Apparently, the trophism in her lower lumbar spine was not detected and a technique was used that further exacerbated her condition.  When a patient has trophism in the 5th lumbar spine, there is much less mobility with regards to rotational movement and if a technique to mobilize this area is used that involves twisting this region, the facet that is affected with the trophism can break apart. 


            To make it easier to understand how this can affect you, I will define trophism more specifically.  Facet trophism is defined as an asymmetry between the angles of the right and left facet joints that allow the vertebrae to move freely from side to side.  When an adjustment is performed that involves twisting, pain can be increased when attempting to move a region that is seemingly immoveable due to anatomical restriction from the trophism.  Therefore, using the wrong technique can result in increased pain.  This can result in torsion during flexion and extension and trigger spinal instability and pathological changes in the vertebral discs.  See the diagram below to better understand trophism.




            It is important to understand how chiropractic treatment involving supportive blocks can go horribly wrong if the chiropractor does not understand basic physics.  A few months ago, a patient presented to my office from another facility who had a Grade III spondylolisthesis.  This condition occurs when due to trauma or degeneration, the posterior elements of the vertebrae break apart and the body of the vertebrae slips forward.  This can cause great pain and radicular symptoms down one or both legs.   People will often refer to this as “sciatica”.   The problem in this case was that despite the previous chiropractor taking x-rays, the doctor did not understand the proper angle to place the supportive blocks and caused the already affected vertebrae to move further forward causing more and more pain after each visit.  I explained to this patient after taking my own x-rays that the procedure being performed had good intention, but was being applied incorrectly.  Within 2 visits and proper application of force to the patient’s lower back, the patient’s pain symptoms and function rapidly improved.  She stated in her first two visits, her pain and function improved more than the treatment she had at a previous facility for the last year.   The patient is still under my care and her pain is now nearly non-existent and her function has improved to the point where she can now due work around the house without constant pain.  See the picture below to see what spondylolisthesis looks like.



By Lucien Monfils - Own work, CC BY-SA 3.0,

            Another condition which requires extreme care with treatment is called extreme kyphosis of the thoracic spine or midback.  This condition looks like a buffalo hump in appearance and is more often viewed in older female patients.  It is extremely important to research which technique your chiropractor uses prior to receiving treatment if you have this condition.   Without due care, a fracture in this region can occur due both due to the osteopenic/osteoporotic conditions that are sometimes the cause of this condition.  My office has a technique to assist with this condition.  Please call our office to find out more how we can help you.  See the picture below to determine if you have extreme kyphosis.




Today we have discussed a few reasons why knowing what and how your chiropractor diagnoses your conditions can have a significant bearing on whether your experience will be beneficial or not.


Our office uses state of the art digital x-ray which is reviewed with you on your very first visit.  We also use a combination of techniques designed to make your treatment as comfortable as it can possibly be with the assistance of a Nurse Practitioner for more stubborn conditions and medical assistance.  Make an appointment to come visit the office or drop by to see how what we do is different from the treatments you have received in the past.  We are happy to review your case and determine whether conservative chiropractic care will improve your condition. 


            To find out more about your condition(s) and to set up a free consultation, please visit my website at to book online, or call us at 702-530-BACK (2225) for more information. 

David Lewis, DC, QME

Welcome to MedSpine. 

Office hours:  Monday – Thursday from 7:30AM – 5:00PM


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