Doctors are increasingly using the principles of evidence-based medicine in their work and abandoning outdated methods and treatment regimens. But many hospitals and clinics still make non-existent diagnoses and prescribe useless pills and tests.
In this series of articles, evidence-based doctors and I discuss medical practices that are used in clinics, but have no scientific basis.
We talked with a neurologist about who realigns cervical vertebrae and whether this practice can cure some diseases or, conversely, add problems.
Who and why proposes to realign the vertebrae in the cervical spine?
Such services are offered by osteopaths and chiropractors. They can work in private clinics or open their own offices, because they essentially only need their own hands to practice.
Such a specialist may have a diploma, because there is a residency in osteopathy, and neurologists often retrain as chiropractors.
But if manual therapy is even more or less clear – the doctor can remove muscle spasm and thus improve the condition, then osteopathy for me is akin to esotericism. People click on some specific points and begin to treat a huge list of diseases, from autism to infertility. One patient told me that the osteopath put his fingers in her ears to press on some points there. I do not understand this.
When it comes to cervical alignment, osteopaths and chiropractors offer such services to treat headaches and dizziness and improve blood circulation in the brain.
They also often talk about the treatment of osteochondrosis, meaning simply some kind of discomfort in the neck, headaches or numbness of the limbs. In fact, osteochondrosis is a pathological condition in which various degenerative changes occur in the structures of the spine, affecting ligaments, joints, intervertebral discs and bones. This disease develops before adulthood, starting at about 10 years of age and later, and is treated by pediatric orthopedists.
So neither discomfort in the neck after a working day, nor even some degenerative changes in the vertebrae, which in principle many adults have, are osteochondrosis. And they certainly don’t affect headaches.
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Is it even possible to realign the vertebrae?
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It happens that patients come to me and say: “My vertebra has fallen out.” At first I get scared: “How did you fly out? What’s happened?” And then it turns out that they were simply told that the vertebra had fallen out and needed to be put back in place.
People simply don’t understand how the spine works. They think that since the shoulder joint can be dislocated and realigned, then so can the vertebrae. But the shoulder is a large ball-and-socket joint; it is designed completely differently.
The vertebra can actually move, for example, if a person gets injured. In addition, this can happen in older people with degenerative changes and at any age with congenital pathology of the spine, as well as malignant neoplasms. Such displacement is called spondylolisthesis.
If we open the anatomical atlas, we will see that in the spine there is a canal through which the spinal cord passes. If it is damaged, very serious symptoms occur. A person may find himself in a wheelchair and unable to feel his arms or legs. A headache in such a situation would be the least of his problems.
The vertebrae are interconnected by a large number of small joints and ligaments. This is a rather complex structure, and without serious injuries no “vertebral prolapse” can happen.
A slight misalignment may occur in the lower back, but this usually occurs over time due to prolonged use and does not particularly affect anything.
But you definitely shouldn’t move the vertebrae yourself – it’s simply dangerous to your health.
Moreover, no manipulation of the neck will affect headaches and migraines. If we are talking about quite severe discomfort, for which people usually go to the doctor, neither degenerative changes in the vertebrae nor spasm of the neck muscles are its cause. If the osteopath can relax the neck muscles, the neck will go away, not the head.
As for blood circulation, the vessels supplying the brain pass through the vertebrae, and it is not possible to squeeze them with muscles. If the body were designed in such a way that a muscle spasm could block the blood flow to the brain, it is unlikely that people would live long.
Can realignment of vertebrae lead to complications?
Yes it is possible. Manipulation of the cervical spine may damage the vertebral arteries and cause dissection. This is when the wall of the vessel delaminates, blood penetrates into it and forms a hematoma. Small blood clots can then escape into the bloodstream and cause an ischemic stroke.
Of course, this will not happen with a regular massage, because the artery runs quite deep in the spine. But aggressive influence can damage it. For example, when they turn their head sharply until it crunches or use a hammer on the spine.
Such manipulations can also lead to displacement of the vertebra. I know a story when a woman, after an appointment with an osteopath, ended up at the Sklifosovsky Emergency Medical Institute with a cervical collar.
What should you say to a doctor who talks about realigning vertebrae?
If you have pain and dizziness, go to a neurologist, if you have problems with your neck, go to an orthopedist. The specialist will find out what the problem is and prescribe treatment.
If a doctor, without conducting an MRI or X-ray, claims that your vertebra has fallen out, but you move normally and feel your arms and legs, you should doubt his qualifications.
We can influence muscles and ligaments – for example, improve posture or remove some kind of spasm. But to do this, you don’t need to move the bones, but through training, you need to restore the correct movement pattern. This is a slow process, but the result will be that you maintain correct posture without conscious effort.
People hope for a quick solution to the problem: the osteopath will crunch once, everything will “fall into place,” and the problem will disappear. Unfortunately, this doesn’t work.
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