Q&A Written Answers
Intro to Q&A
Dr. Dean: “It is common that people will pose questions for us that really help them understand if and how chiropractic care might be applicable for them. We want to take a moment right now and address some common questions going on.”
Can I see a chiropractor if I am pregnant?
Dr. Dean: “If someone’s pregnant and they ask, ‘Can I see a chiropractor while I am pregnant?” Well, my first response would be, ‘I would hope that you were receiving chiropractic evaluations prior to your pregnancy.’ But if you show up and have never been to a chiropractor and you want to get assessed for chiropractic care when you’re pregnant, then I would say, ‘Yes. You can get checked.’ The first step in any journey like that, though, is to get checked and evaluated. Once you’re evaluated, if you have subluxations and you are pregnant, then of course the type of chiropractic care we would render is that which is the appropriate and gentle means to care for pregnant moms. We see moms through all their entire nine months of gestational periods. Some doctors of chiropractic assist moms in relieving pain during the pregnancy process. We do provide chiropractic care for pregnant moms here on premises.
They typically respond very quickly. They are easy to adjust because they’re very relaxed. They get to lie down on their belly because the middle of the table drops down. So it’s very comfortable.
There is special equipment, tables and pillows used to help that happen. From a physiological standpoint, in the third trimester (when the body begins releasing oxytocin, which begins to soften many of the collagen points for mobilization of the pelvis), if someone has previously had spinal complications, they can become exaggerated, especially in the third trimester. We see a lot of our pregnant moms that weren’t here before show up in the third trimester.”
Are chiropractors doctors?
Dr. Dean: “Are chiropractors doctors?” “I love to give very legitimate and literal answers. If you go to Dorland’s Medical Dictionary, a fairly reasonable authority on looking up what the definition of the word “doctor” is, you’ll find that the definition of the word “doctor” is one who has achieved the credibility and credentialing in their specialty in order to teach that which it is that they do. In other words, doctors should be educators. Science is catching up again and understanding that people with chronic illnesses, which is three quarters of the trillions of dollars that is spent in the world on health care, that chronic illnesses, which are the majority of all the illnesses that are dealt with, are dealt with better when people are better informed. People are collaboratively brought along in their understanding. So, yes, doctors of chiropractic are doctors, but they’re doctors of chiropractic. They’re not doctors in pharmacology or other specialties. So what can we add to that?”
Dr. Brett: “Well, you know, when I was in school, what came up was if you take the list of hours of chiropractors doing classes as compared to the list that medical doctors do in classes. It’s the same number of hours. Yet it’s criss cross where we’re doing anatomy and physiology. They’re doing pharmacology and surgical procedures. Which is why our philosophy has us based on structure and physiology. So, yes, we’re doctors.
Regardless, though, you really want to shop for the terror practice, who fits you best? Just because there’s a doctor in front of anybody’s name doesn’t automatically credentialize them. It has to be the right people to be with. You want to do your shopping for that?”
Why do adjustments sometimes make a popping sound?
Dr. Brett: “The sound is just gas escaping from the joint coming out of fluid, the same as you would hear when you pull your finger. The difference is that we change our line of adjustment to go with the joints, not against the joints. I show patients that when you do this with your fingers (“crack” them), that’s bad. That creates arthritis. When you pull your finger, it doesn’t create arthritis. That’s when patients turn in different directions. So there we’re going with the joints, not against joints.
You can have had a great adjustment and have no pops, and you could have had a terrible adjustment and heard all kinds of sounds. The misconception is that the pops mean you had an adjustment and you moved a bone. As we answered earlier, it’s not about moving bones as much as moving your neurology in terms of interpretation.”
Will a chiropractic adjustment completely remove back pain?
Dr. Brett: “It’s a double edged sword. Chiropractic does help a lot of people with back pain. The problem is that it has nothing to do with treating people with back pain. It just so happens that your nervous system sits inside your spinal column, protected by the spinal vertebra, which, when they’re misaligned and subluxated, can create or give the symptom of back pain. Now everybody thinks we’re back pain doctors. So will a chiropractic adjustment completely remove back pain? Maybe. Will it make the back pain go away? Nobody knows because everybody’s different. Ideally, ‘get checked.’ If there are subluxations that are contributing to your condition then adjusting them will help your body work better. And, over time, certainly our hope and prayer is that you will feel better. If we don’t address the activities and things that you’re doing that are causing subluxations, well then we’re really missing half the battle. We need to modify daily activities so that we’re not creating these patterns that lead to subluxation. So it’s caring for the body and hopefully before there’s back pain.
Dr. Dean: “In terms of patient satisfaction indexes, across all healthcare industries…patient satisfaction indexes really speak widely about the public’s experience with chiropractic. And the satisfaction indexes for chiropractic…This isn’t just me talking about my own child here. The indexes of satisfaction are like from 87 to 92 percent, which is unheard of in the healthcare industry. So, yes, chiropractic tends to help people with low back pain. (Source: National Center for Biotechnology Information)”
Do adjustments hurt?
Dr. Dean: “No. Very, very, very rarely does anybody say, you know, ‘Oh, that adjustment hurt.’ First of all, we adjust newborn babies, literally moments out of the womb. We adjust geriatric patients whose bones are brittle and whose osteoporotic complications are very alarming and we adjust our tonality for each of those situations.”
Dr. Brett: “Nothing that we do is cookie-cutter. Every patient is an individual. While it may appear that we’re doing the same thing to everyone, the intent is the same, but the technique that we use is going to be different. So somebody might see us, for instance, contact a segment of the spine and thrust. And if the person is lying down, if we move our elbow 20 degrees this way or 20 degrees that way, we’ve completely changed what the adjustment is doing and its impact. But to the bystander innocently looking at it might think, “Oh, looks like he did the same thing.” It’s never the same. One of the myths that comes up is, you know, “Don’t go to a chiropractor because they’ll cause arthritis because popping your joints creates arthritis.” The sound is just gas escaping from the joint coming out of fluid, the same as you would hear when you pull your finger. The difference is, is that we change our line of adjustment to go with the joints, not against the joints. I show patients that when you do this with your fingers (“crack” them), that’s bad. That creates arthritis. When you pull your finger, it doesn’t create arthritis. And that’s when patients turn in different directions. So there we’re going with the joints, not against joints. Adjustments do not create arthritis.”
Dr. Dean: “We always do our best to make sure that people aren’t going to hurt. Will there be people who say in the midst of my care, ‘That hurt’ or ‘I’m in pain’? Of course, you know that’s going to happen. But no, that’s not really the standard for anything. ‘Are adjustments safe?’ Well, let the law of insurance malpractice coverage be your guide. You know, if you’re a GP, I forget the standards these days. You know, malpractice could be 10, 20, 30 thousand dollars a year if you’re an internist. It’s more if you’re a pediatrician, it could be hundreds of thousands of dollars. Plastic surgeons pay hundreds of thousands of dollars. Pediatric plastic surgeons, you don’t even want to think about what the malpractice is. And those costs, those premiums, go up. The likelihood of injury for a doctor of chiropractic to have $3 million dollars of coverage, is unheard of. We barely have $1,000-2000/year. So if chiropractic was so alarming, that wouldn’t be the case. The black and white answer is no. There’s assumed risks in anything and we’ll go over any of those with you. But now that’s a part of your process.
Dr. Dean: “Do adjustments hurt? My first response is no. Now, anytime you go to the gym to work out, you go there to work and say, ‘Gee, I hope I’m not uncomfortable today at the gym.’ You know, you go there to press beyond your boundaries, to make changes. Then hopefully with elasticizing recovery, you then rebound and find higher ground and function. You can’t move to higher function without working through boundaries and barriers. So are there times patients will say, ‘Oh, this X or that X?’ Of course that happens. What we are very mindful of is we are not tolerant of there being radiating findings, electric shock sensations or any of that. We’re very comprehensive and attentive to what’s going on with our patients. So no, chiropractic adjustments do not have to hurt at all. In some cases, in working through things, that may occur.”
Dr. Brett: “I like the analogy that you have with the gym when you start the gym for the very first time, that first week is going to be uncomfortable as your body tries to figure out the rhythm of what it is that you’re doing. What typically happens for most patients is that if there is discomfort when they come in, that discomfort gets less over time. There may be some rebounds where there is some exacerbation or soreness, but that intensity becomes less. It has a shorter duration and patients tend to see a progression from discomfort to less discomfort. Again, knowing that our main intent is not so much how you feel, it’s about how your body’s healing and adapting and functioning. That’s what our goal is and what our intent is when we do the adjustments.”
Dr. Dean: “If you want to add-on to that, just this morning, I was in the gym. There was a patient I’ve encouraged to start going to the gym and he’s going out and I see him there at 5 am. I hopped over just to check in on him. He was describing, ‘I’m noticing this or that changing in my body and I’m getting an aching in here.’ I went through the same questions. Now, ‘Are we dealing with radiating findings, electric shock sensations, this or that?’ Had we assessed him right on the spot, it would have been clear that his body’s adapting. He’s changing the biomechanics of his body. He’s shedding some pounds. He’s gaining some strength. And now he has to work on more core stabilization in a manner that doesn’t jeopardize the stability. So the add-on/lengthy answer there gives you a real personal testimony of something that literally just happened this morning.”
What types of pain do chiropractors treat?
Dr. Dean: “Simple answer, none. Doctors of chiropractic don’t treat pain. Doctors of chiropractic care for function. Now, the clumsy or confusing part of that is when we care for the function of the spine, many times people’s pain, such as headaches and backaches, go away. How would you engage that?”
Dr. Brett: “It’s an unfortunate side effect of what we do. Yeah, because we’re equated with, well, people come in with pain and they leave most of the time without pain. But it’s really about function. And when we have that discussion about how you feel isn’t really our most important thing that we’re concerned about. Yes, as human beings, we care how the people feel. But it’s more about how you’re functioning, because we all know someone who unfortunately felt great yesterday and he’s not here today. So it’s important for us that we educate our patients, rather, let’s say, to not put that emphasis upon how you feel.
It’s about how we want to do that. You know, and our culture, particularly in the United States, is really in a sad, sad, sad place. You know, they just released another report now on that out of the top 11 most industrialized nations in the world, “America spends more than any other nation per citizen on health care.” We don’t have a healthcare system. We have a tragedy system. The numbers are over $10,000 per citizen. The second place, most industrialized, competitive nation in the listing is spending about $3,000 or $4,000 per person. And that’s the U.K. The more tragic part of this is while we spend the most out of the 11 countries, guess where we ranked…dead last! We spend more than any other, and we have the least significant results in terms of being a healthy country. The U.K. spends $3,000 or $4,000 and they were in the number two spot, I believe it was. So we have a lot to learn in our country. Maybe we’d be wise to stop focusing on just reducing pain and start focusing on enhancing function. But to circle back to the question, yes, our patients are coming with low back pain and headaches and those things have phenomenal results. Just before filming this, I walked out of a room with an R.N. who was having carpal tunnel syndrome, and we adjusted her cervical spine as well as her carpal joints; she had immediate relief. She was away for an extended period of time and all of her symptomatology exacerbated again. She came back in and she can already notice the difference. So, yes, we help people with headaches and back pain and carpal tunnel syndrome. In many things, TMJ syndromes feel better by the care we render. Right. I mean, we can’t dispute the facts.”
Dr. Dean: “So, Doctor Brett, why don’t we kind of go back and forth and just start thinking of all the specific simple names of symptoms that we see come through the front door? So headaches, neck pain, low back pain, arm pain, carpal tunnel syndrome, chest pain, difficulty breathing, TMJ, sciatic pain, and ankle pain. You know, I’m kind of cringing saying the last thing I ever want to do is be a doctor known for treating pain. Right. I want to help you function better. And yes, in that we want you to feel better. There’s almost never rheumatoid arthritis patients who are going to get rid of their rheumatoid arthritis. But by getting adjusted, they reduce the dosages of the drugs they’re taking for their inflammatory complications. It works.”
Are all patients adjusted the same way?
Dr. Dean: “The answer is no. To the innocent bystander who observes an individual, a doctor of chiropractic touching his spine and sees them in the same area as they may innocently say, ‘Oh, well, they’re rendering the same adjustment to all these people.’ Please understand, in terms of the human spine, you have dozens of segments and each segment by itself moves in six directions: flexion, extension, rotation: left, right, lateral bending: left, right. In the application of an adjustment, there are virtually an infinite number of lines of drive. We can be superior to inferior, inferior to superior, lateral to medial, all terminologies that you don’t need to be trained in how to assess. But literally simply moving the line of drive several inches one way or another makes one adjustment completely different than the other.
They look the same, but they’re not the same.”
Will I be required to remove my clothing at my appointment?
Dr. Dean: “No. First of all, we begin with an assessment to evaluate if you’re even in the right place. Some people who believe they have a chiropractic issue and show up at a chiropractic office, we may discover that the first thing they need to address might not be their chiropractic complications and they need to be referred to other facilities. So there is an assessment process that goes on and there’s certainly no need to disrobe for that part of a screening, in terms of the physical assessment and functions and whatnot, there’s no need to disrobe for that. If it ends up that we assess that you need to have x-rays, then you would be appropriately gowned in order to take those x-rays.”
Can I learn to adjust myself?
Dr. Brett: “No, please, we’re begging you. Do not try to adjust yourself.”
Dr. Dean: “Don’t people snap their necks and crack their necks and their fingers? They’re making the same click that the chiropractors make.”
Dr. Brett: “It’s frightening. It’s not specific. You can actually cause subluxations, those misalignments in the spine that are going to absolutely affect how the nervous system works. You can cause strains and sprains. They can create muscle spasms. Please don’t do them. Please don’t go to websites and say, ‘can I adjust myself?’ Don’t watch YouTube videos and think, ‘Oh, my gosh, I could do that.’”
Dr. Dean: “My challenge is that people will find validation for almost any answer they’re already seeking, regardless of what the truth is. So if you’re an individual who loves snapping and cracking your joints, you’re gonna find someplace that validates you for that. I mean, that’s the conundrum of the world and media and everything else. So the fact is, people will tell me, ‘But Doc, when I crack my joints, it feels good’. Well, one of the positions that certain physiologists and endocrinologists talk about in terms of that is you are tearing tissue when you randomly thrust into joints. And some people are like, ‘It didn’t crack yet.’ They’re randomly abusing their joints. Sooner or later, you will traumatize tissue enough to get a release of what are called endorphins. These are natural, internal opiate-based drugs essentially that have a shock sensation of feeling really good. I can’t contend with a patient who’s in the midst of having opium in their bodies emitted every time they’re snapping their joints. ‘Don’t do it.’ When a doctor of chiropractic applying a chiropractic adjustment specifically for the correction of subluxation does what they’re doing because of a thorough analysis and X-rays and assessments and measurements, the precision with which an adjustment is supposed to be applied has profound preparation to it. Could you compare that as being the same to someone randomly snapping their spine? No, but if you’re of that disposition, I will not labor to disprove you or move you from the position you’re standing on.”
Dr. Brett: “So, yes, we will encourage you not to adjust yourself.”
Dr. Dean: “He’s right.”
How do I find a good chiropractor?
Dr. Dean: “I think the question would be, ‘How do you find a good doctor of any specialty?’ And it’s getting harder and harder with the nature of our culture, particularly in the United States, to find good doctors who really just want to live for good work with the nature of how the systems work. Right now, a lot of doctors are leaving many different specialties, and they’re just drawn away from it. So you have to shop and you really have to seek an individual. Forget about chiropractors, just doctors, period. You have to shop. You have to be a wise consumer and you have to ask questions and not just agree to someone’s care of you just because they’re on your provider list, you know? So how do you find a good doctor of chiropractic? Where would you go with that?”
Dr. Brett: “Well, I mean, these days everybody’s looking online. They look at reviews and customer satisfaction and patient satisfaction is something that’s always important. However, because everyone’s different, just because you like someone and I like you doesn’t mean that I’m going to like who you like. So there’s the ‘like’ aspect. More importantly, though, there needs to be the competency aspect, meaning that there needs to be an office. They need to have procedures in place to fully assess the condition, make a decision about the patient and how to care for them.”
Dr. Dean: “I’m very leery of situations where someone will call up and say, ‘Can I come and get adjusted?’ ‘Have you been here before?’ ‘No.’ ‘Have you seen a chiropractor before?’ ‘No.’ And then they come in and they’re anticipating, ‘I’ve seen this on TV. I’ll just lie down and get adjusted.’ We don’t work that way. Your care is more important to us that we need to assess you to determine if we think we can help.
Well, some people don’t want doctors that are clinically deliberate about those steps. They want to hear a crack. They want to get thrown on a table. And, you know, for those people, I wouldn’t try to shift your opinion.”
Dr. Brett: “Coming in our door should not be stressful for you. The way we do things is of the highest clinical competency to make sure: number one, that we think we can help you. And number two, that you want us to help you. If this isn’t the right place for you, and we are not the good chiropractors for you, then we’ll help you find somewhere else that will basically do what you want them to do.”
Dr. Dean: “Now, in terms of being a wise and educated consumer, you’re looking for clinical relevance, that they’re clinically competent at what they do. They have specific techniques they’re trained in. And they have a very competent means of assessing you. They’re not rushing to thrust on your spine and do things. And then you want a disposition. You know, you’ve got to feel like that person connects with what your needs are for communication. Communication is key. Broken communication is what we’re dealing with from brain to body. Broken communication is our challenge in all relationships and broken marriages. Communication is the key element. So whatever your physician’s specialty is, whether it’s a heart surgeon, a chiropractor, a neurologist, you really have to make sure that both clinical relevance and personal competency of communication are high.”
How long does a chiropractic adjustment last?
Dr. Dean: “I’m going to answer this from the opposite direction – once someone receives an impulse to their shoulder or something, the body tissues have a memory that lasts forever. The body never forgets a single trauma it’s been through emotional or physical. So on the good side of things, the body never forgets an adjustment. So once an adjustment is specifically and gently applied, it is exercising a resonant presence in your body for the rest of your life. So an adjustment lasts forever. Now, if you’re asking how long will I be out of pain? Only God knows that answer.
There are some people who are vomiting and in the middle of vomiting, they’re like, wow, I feel terrible. But yet, vomiting is among the most brilliant and healthy activities the body could innately turn on. The need to expel something bad from the gizzard is healthy. But it doesn’t feel very good. So if you’re asking how long does the ‘feel-good’ experience work for some people, they get adjusted once in their life and they feel better forever. And for some people, that’s not how it works. So you might have chosen a different approach to ‘how long does an adjustment last?’”
Dr. Brett: “I was thinking of ‘how long does it take to do an adjustment?’ Well, we always say in our office that ‘A good adjustment takes less than 30 seconds after you’ve done the assessments, come up with a care plan, figure out what you’re going to do, why you’re going to do it, and you’ve trained the patient on what they need to do.”
Dr. Dean: “We need to qualify that because people will go down the road of, ‘Well, my chiropractor takes a half hour to adjust me.’ And then I do an analysis because I actually rate and write up practices all over North America. Their adjustment isn’t taking a half hour. They’re talking about the ballgame. They’re doing five to seven minutes of documentation rather than having a scribe do the notes for them. Sometimes you’re taking phone calls in the middle of an appointment. I’m on the college campuses where chiropractic is taught. There are very, very, very few techniques in chiropractic where the adjustment takes more than minutes. So there may be other things which you pointed out accurately: the assessment, asking questions and all that. If we qualify the answer here, the chiropractic adjustment is when the hands are on the body to apply the needed correction to your subluxation. That takes anywhere from 30 seconds to a couple of minutes. If it’s taking longer than that, it’s probably that there’s other things going on. None of them are necessarily bad. They’re just not the adjustment. We should understand that in the world of science and research, we know that when we adjust a person and we do less adjustments and less peripheral activities, the body gains more neurological impact and gain from that. Then when a doctor’s doing this and doing that and rubbing muscles over here and doing it, we actually dilute the specificity of the neurological correction.”