Fawn Krosch is in pain. It’s 2 in the afternoon, but she is lying in bed with the shades drawn; all the lights are off and her rural Hawley, Minn., farmhouse is exceedingly quiet. She has a migraine. If she tries to move, the pain radiates through her head and down her neck. Her whole body shudders with nausea and dizziness.
Pain is something the 30-year-old Clay County Sheriff’s Department deputy has lived with since her days as a cross country runner in high school. But now the pain is affecting her health, quality of life, and her job.
“Anything that provides me relief from pain is worth it,” says Krosch. “A pain-free day is a good day for me.”
To try to regulate her pain—and hopefully alleviate it altogether—Krosch visits physical therapists and chiropractors. While neither treatment has eliminated her chronic pain, she believes in their therapeutic and healing abilities. So do thousands of other people around Fargo-Moorhead, and for that matter, millions of folks across the nation.
The Institute of Medicine of the National Academies reports that 100 million Americans suffer from chronic pain. That’s more than diabetes, cancer, and heart disease combined, according to the American Academy of Pain Medicine. An estimated 1.5 billion people around the world deal with pain on a routine basis.
Physical therapy and chiropractic care are two methods people use to treat pain. Their histories, practitioners, and methodologies are different, but each seeks to remedy pain without costly medications or invasive surgeries. Depending on your overall wellness or recovery from an injury (like whiplash from a car accident), you may have wondered which practice is best for you. Here’s what we found out.
History: Physical Therapy
The first school of modern physical therapy opened in 1881 in Boston, and physiotherapeutic (as it was called then) medicine continued to grow in popularity during the polio epidemic and wars of the early 20th century. In 1946, the American Physical Therapy Association (APTA) officially formed, cementing the practice’s place in modern medicine. Today there are more than 184,000 licensed physical therapists in the United States.
Physical therapy is most often used to help patients reduce or eliminate their pain and improve or restore mobility and function. You might seek out physical therapy if you are recovering from surgery, struggling with muscle injury or muscle weakness, or recuperating from a stroke, among other things.
Keith Leikas, Director of Therapy Services for Sanford Health in Fargo, graduated from the University of North Dakota’s physical therapy program in 1978. “I like the idea of patient interaction and working one on one,” he explains. “I enjoy working from beginning to end to do the most that I can to help a person recover to their highest degree.”
The American Chiropractic Association says chiropractic roots can be traced all the way back to early Chinese and Greek civilizations. Some writings hint at spinal manipulation to ease pain. But chiropractic care didn’t gain traction in the United States until the late 1800s when Daniel David Palmer opened the first clinic in Iowa.
Chiropractors initially looked at three primary things: mental health, nutrition, and physical health. Over time, chiropractors began concentrating on disorders of the musculoskeletal and nervous systems. If you have back, neck, or joint pain, or suffer from migraines, you might be a good candidate for chiropractic care. The core belief was, and is, the healthier your spine, the healthier you’ll be.
“The idea of addressing the spine to improve health and function has been around for a long time,” states Jeff Lotzer, a Doctor of Chiropractic at Moorhead Chiropractic Clinic. “The application of how to do it is always evolving in chiropractic.”
Education: Physical Therapy
Like many health professionals, students of physical therapy have an intensive curriculum. They are required to earn a graduate degree—either a master’s or a clinical doctorate—from an accredited program before taking a licensing exam that allows them to practice.
“There is a theory that the expansion of medical information doubles every three years,” states Leikas. “This is certainly true over the course of my career. Specialization has become big in the profession. We tend to have physical therapists whose sole practice is working with neurological disorders or orthopedics or children’s therapies.”
Physical therapists can earn board certification in eight areas through the American Board of Physical Therapy Specialties including Pediatrics, Sports, Geriatrics, Women’s Health, Cardiovascular and Pulmonary, Neurology, Orthopedics, and Clinical Electrophysiology. Because of this diversity, physical therapists can work in a huge range of settings like hospitals, inpatient rehabilitation facilities, clinics, private practices, schools, fitness facilities, home health agencies, and nursing homes. The opportunities for advanced training in mobilization and manipulation are extensive, including year-long residency training.
Chiropractors are educated more like doctors or osteopaths and they are licensed to diagnose. Chiropractic college (candidates are required to have a bachelor’s degree from an accredited institution) runs anywhere from four to five academic years. In most cases, chiropractic candidates spend as much, if not more, time in the classroom and laboratory than medical doctors. Chiropractic students are required to log an incredible number of training hours learning spinal mobilizations and manipulations.
It was for these reasons that Dr. Thomas Solien of Sanford Health in Fargo decided to become a chiropractor after practicing physical therapy for nearly a decade. “My training as a physical therapist was very much limited when it came to spinal mobilization and manipulation in terms of recovery,” he states. “That’s a very important part of managing pain. In chiropractic school you become very adept and skilled at those techniques. When I was a physical therapist, I thought I might be apprehensive in those techniques because I wasn’t trained thoroughly enough.”
Solien breaks down both professions like this: “Generally speaking, physical therapists have been better prepared for rehabilitation and chiropractors are better trained in spinal mobilization and manipulation.”
However, he adds that both professions are closing the gaps in their weaknesses.
Ideal Patient: Physical Therapy
After spending the early part of her career practicing general physical therapy, Kerry Petsinger recently made the switch to specializing in post-acute care, long-term care, and outpatient care at Ecumen, a senior housing provider in Detroit Lakes, Minn. On any given day, she might be evaluating and treating patients who have had strokes, traumatic brain injuries, cardiac surgery, or joint replacements. She enjoys helping patients reduce pain and restore function, and stresses that the ideal physical therapy patient is one who will follow the advice of the therapist and maintain their course of treatment.
“Patients may be asked to do a home exercise program, improve worksite ergonomics, or change their body mechanics,” says Petsinger. “Patients that comply with the therapist’s recommendations and take an active role in their health care tend to have great success with physical therapy.”
Typically, physical therapy patients go through a course of treatment and once they’re healed, they are able to stop the therapy and go back to their normal activities.
Ideal Patient: Chiropractic
Chiropractic patients may find themselves needing several visits to get lasting results. The American Chiropractic Association says this is due to the hands-on, drug-free nature of chiropractic treatment. However, your chiropractor should fully explain his or her recommended treatment and how long you can expect it to last.
In some cases, like when Krosch is suffering from acute pain, instant relief is possible. “I can tell when my neck or my back has something out of place because it sends a sharp pain immediately through my body,” Krosch explains. “If I don’t get that back in place, I won’t get relief, no matter what medications or stretching I do.”
Tools of the Trade: Physical Therapy
Physical therapists use a variety of tools and technologies in their practice. These include, but are not limited to:
Manual Therapy – hands-on techniques to the soft tissue or joints
Ramps – help re-learn the use of lower limbs or re-train patients to walk
Exercise Balls – help strengthen balance and core strength
Resistance Bands – strengthen muscles
Mirror – allows patients to see themselves perform movements
Cardiovascular Equipment – treadmills and bikes aid in strengthening legs and lung function
Traction Units – decrease compression
Ultrasound – generate heat in soft tissues and increase tissue length
Electrotherapy – stimulate muscles to prevent atrophy, decrease pain or swelling
Hydrotherapy – delivers heat and cold
Not all of these tools are used on every physical therapy patient. Therapists are highly trained in evaluating their patients and creating a course of treatment tailored to your specific needs.
Tools of the Trade: Chiropractic
The most common expression you’ll hear from anyone who has visited a chiropractor is that they were “adjusted.” According to the American Chiropractic Association, this means that “the chiropractor used his or her hands—or an instrument—to manipulate the joints of the body, particularly the spine, to restore or enhance joint function.”
Sometimes there is a popping sound when a joint is adjusted. The simplest explanation for this is that a gas bubble is being released by the change in pressure. It should not cause more pain, although mild discomfort is possible. Sometimes you might have lingering soreness—the type of muscle ache you’d get from exercising—but that should vanish within a day.
The types of tools a chiropractor might use include:
Digital X-ray – help identify the location of the joint problem
Activator – small metal tool to aid in spine adjustment
Graston Technique® – stainless steel instruments to detect and treat soft tissue fibrosis or inflammation
Specially designed tables or chairs – aid chiropractor in positioning client for adjustment
Ultrasound – generate heat in soft tissues and increase tissue length
Electrotherapy – stimulate muscles to prevent atrophy, decrease pain or swelling
Fear is the biggest hurdle that chiropractors face when treating patients, particularly new clients. Because of the hands-on approach and movement and positioning required to perform an adjustment, clients may tense up in fear, making the adjustment difficult. Good communication between a chiropractor and his or her patient is key to easing everyone’s emotions.
In most cases, both physical therapy and chiropractic are covered by insurance, although there are often visit limits in place for physical therapy during a specific time period.
Dr. Eunah Fischer, Blue Cross Blue Shield of North Dakota Internal Chief Medical Officer, says the services must be medically appropriate and necessary, and meet BCBSND Medical Policy.
Coverage depends on your benefit plan so you’ll want to read the fine print carefully.
According to public relations specialist Laura Kaslow, Blue Cross Blue Shield of Minnesota offers something similar. If you buy insurance on your own or work for a company that offers small group plans (usually less than 50 employees) the coverage for chiropractic and/or physical therapy will generally mirror the coverage you have for medical office visits, says Kaslow.
“In the cases where people receive coverage though a larger employer or corporation, many of those businesses are ‘self-insured,’ meaning they design their own benefits and pay their own claims, with Blue Cross administering the plan,” Kaslow further explains. “In these cases, benefits will vary from plan to plan depending on the benefits the employer has chosen.”
Regardless of your insurance provider, both therapies are available through direct access but physical therapy still operates mostly through a referral system.
Some trainers and coaches caution that physical therapy and chiropractic should be used in conjunction with an active, healthy lifestyle and not as a quick fix. Most physical therapists and chiropractors agree. Steve Tangen, a certified personal trainer and strength and conditioning coach who has trained a Heisman Trophy (college football’s top athletic honor) winner, says neither therapy is a substitute for disciplined eating and exercise habits. Tangen, who recently relocated to Moorhead from Lincoln, Neb., says physical therapy and chiropractic are tools that should be used to help you maintain your fitness goals and recover from any injuries.
“Being healthy is a lifestyle choice, obviously,” says Tangen. “You need to constantly remind your body that it can still move and be strong and flexible with exercise.”
Too often, Tangen says, people use physical therapy or chiropractic as a Band-Aid, and they don’t follow a fitness plan to keep up the results they achieved with either therapy.
Several factors keep physical therapy and chiropractic care at the forefront of modern medicine.
One reason is our aging population’s search for a longer, healthier life. Petsinger says as baby boomers grow older, more of them are discovering that physical therapy and chiropractic care can help them remain active. “Many older people desire to live in their homes as long as possible, and physical therapy is required to improve balance and strength in order to maximize safety and prevent falls at home.”
People are also more aware of the health benefits of physical therapy and chiropractic and are actively seeking methods that prevent injury or stave off surgery. “This means physical therapists will be called upon more to treat people with early phase injuries instead of acute care, like, say, after a joint replacement surgery,” says Sanford’s Leikas.
Evolution in our everyday behaviors is playing a role, too. Dr. Solien says society’s reliance on computers and its effects on our posturing is assurance that chiropractors and physical therapists will be needed for a long time. “One of the things that I’ve found in my research is the epidemiology in neck pain. The rate of occurrence around the globe is increasing, and it’s likely related to the common use of computers and our seated posturing,” he says.
Moorhead Chiropractic Clinic’s Dr. Lotzer, who is a third generation chiropractor (his grandfather founded the clinic), says word of mouth has certainly played a role in chiropractic’s surging success. “In the last 20 years of my career, chiropractic is becoming more mainstream and accepted. People have come to see that medicine is very good at some things, but other problems may be better addressed by something else.”
Both fields are capitalizing on their increased exposure. The American Physical Therapy Association has gone so far as to create a long-term vision for its members. According to its website: “By 2020, physical therapy will be provided by physical therapists who are doctors of physical therapy, recognized by consumers and other health care professionals as the practitioners of choice to whom consumers have direct access for the diagnosis of, interventions for, and prevention of impairments, functional limitations, and disabilities related to movement, function, and health.”
Just as the practice of medicine is a combination of science and art, so too are the practices of physical therapy and chiropractic. This constant evolution will hopefully continue to help people who suffer from chronic pain, like Krosch, for generations to come.
Patricia Carlson is a freelance writer from Dilworth whose work regularly appears in publications across the country. She also crafts strategic website and marketing content for small businesses. Check out her work at www.patriciacarlsonfreelance.com.
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