We always encourage prospective clients to do their research before committing to a recovery option. This is in-part why we choose to post so much content on our website.
Despite our emphasis on education, not everything is relevant and meaningful to your recovery. As a chiropractor, I do often see individuals accumulating head knowledge without actually getting anywhere with their own recovery journey.
This is a problem.
Research supports that advice and education is not good enough
We always revert back to the Lancet’s low back pain series because it is still the most authoritative clinical guideline to date. According to their recommendations, exercise + education is the most effective approach to managing low back pain.
Interestingly enough, when we spilt education and exercise apart, we see that exercise alone is not a superstar impressive treatment intervention. This will explain why you cannot YouTube or Instagram exercise to a successful recovery
Even more interestingly, we see that education alone is actually ineffective. A recent study by Jones and friends affirms this. Based on their data, they concluded that advice does give a small short-term improvement. However, the change is so small that it’s unlikely enough to be meaningful (i.e., no real change for you).
For today’s blog post, we will share the one big question that you should not be asking to maximise your recovery success. Yes, education is important. However, not all head knowledge is useful.
Do not ask why!
If you are in the startup scene or big on TED talks, you’d probably heard of Simon Sinek’s Start with Why. Despite his compelling arguments, starting with why may not actually give you the best outcomes you are looking for. I am not going to go into details but you can click through to read more about why why isn’t enough.
When it comes to recovery, there are two major whys that people are interested in, that are also unhelpful.
All of us with chronic pain would have at some point asked why me. I don’t think it’s an unfair or unreasonable question. The problem is more of that there is no answer that would satisfactorily provide an answer in a way that would actually help with your recovery outcomes.
The truth is we don’t really know why some people are more susceptible to chronic pain than others. So, there’s really no good answers to that question.
More importantly, having an answer to the why me question is not a prerequisite to a good recovery outcome. In that sense, the question is actually more of a distraction.
Focusing too much on “why me” could also need to unnecessary rumination. And that we do know is no good for your mental health, which does actually have an effect on your symptom experience.
Why does xxx hurt?
The second question, which arguably is more common, surfaces when chronic pain sufferers seek a singular cause to their symptom experience.
They want to know why their neck/knee/hip/back/shoulder (delete as appropriate) hurts.
Well, we also don’t know!
It’s true that we often have a mechanism for an initial pain response. For example, you may get back ache after training too hard, too fast at the gym.
What we don’t understand at this point is why some pain persists even after the physical tissue has healed! The Lancet has strongly asserted on multiple occasions that there is often no physical tissue damage in chronic pain!
I know this is not intuitive and perhaps mind boggling. It would help to first understand why pain doesn’t equal damage. Once you have a better understanding of pain science (i.e., how pain actually works), it will be a lot easier to get onboard with the evidence-based recovery solutions.
This is why you don’t need an x-ray or MRI
When people experience pain, they often turn to x-rays or MRIs first. You probably think that you need to see what’s going on in order to help yourself get better.
Well, you don’t.
What’s more bewildering is that we see patients doing worse with x-rays and MRIs! You probably think that’s obviously the case because only people with serious condition will end up going for imaging scans.
No lah. Researchers are smart enough to match similar cases together to compare how recovery looks for a person who choose to go for imaging versus one who doesn’t.
The results are startling!
Patients who opt for x-rays and MRIs are more likely to experience worse disability, poorer sense of well-being, higher medical spending, increased healthcare utilisation, more absence from work. In short, you take longer to get better and you experience poorer recovery outcomes!
THERE IS NO MEASURABLE VALUE IN GOING FOR A MRI FOR YOUR CHRONIC PAIN.
Also, you are 8x more likely to consider surgery! Intense right?
Again, severity of the condition is not a factor. Researchers control for covariates in their experiments to account for that.
How can chiropractors adjust spines without x-ray! How can they know where to adjust?
Totally legitimate question. But the fact that you are asking it shows how powerful social media is at influencing our thoughts and beliefs.
Before even asking that question, we should go back to first principles. Does chiropractic adjustment even work?
The short answer seems to be no. There are tons of research comparing spinal adjustments to sham treatments, a lot of which are done by chiropractors, to show that they don’t really work.
The next question is … does being more “specific” in adjustments actually improve client outcomes?
Well, the answer is also no. Which kinda makes sense since the treatment doesn’t even work better than placebo to begin with?
For this, we will cite the work of Nim and friends that was published just earlier this month. In their study, they found that selecting the “correct” site to apply spinal manipulation did not make any difference to a patient’s recovery.
So, it really doesn’t matter!
The study is amazing and the coauthors are superstar researchers. Charlotte Leboeuf-Yde is known for her ridiculously big sample studies (almost 30,000 participants) and eight year study of 9600 twins. Stephen Perle is super heavily invested in chiropractic research, and super vocal about evidence-based practice.
Elephant in the room: x-ray is just a sham to sell chiropractic packages
It’s quite a common sales tactic right? If you want to sell someone something, you either make them super afraid or you give them a problem so you can sell them a solution for.
In my opinion, that’s exactly why chiropractors insist on x-rays. Again, there is more than enough research to suggest chiropractic adjustment is a pretty mediocre treatment. And also research to show that you don’t really need to know where to adjust. And chiropractic organisations such as American Chiropractic Association has openly recommend against x-rays in the absence of red flags (e.g., loss of bowel control, fever, night sweats).
There’s really no good clinical reasons for you to be having an x-ray. With that in mind, the only benefit there can be is that it helps with sales.
You can check out my earlier post on why x-ray is a sham for all the relevant citations.
What do I do then?
We always circle back to the same point. Work with an evidence-based practitioner.
The reason why a lot of what we are writing is not intuitive to you is because of our attitudes and beliefs. Our attitudes and beliefs are often shaped by our past experiences, family and friends, culture, mainstream practices, social media narratives, etc.
They are not based on data. They are not based on what works.
If you are sick and tired of your pain coming back over and over again, and you’d like to learn how you can manage your recovery, reach out to us via the contact form below.
Let us help you help yourself find true freedom from pain.
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Frustrated by the lack of results-driven and ethical chiropractic clinics in Singapore, Chiropractor Jesse Cai found Square One Active Recovery to deliver meaningful and sustainable pain solutions.
Our goal? To make our own services redundant to you.